SB562, s. 63
14Section
63. 66.0137 (5) of the statutes is amended to read:
SB562,30,2415
66.0137
(5) Hospital, accident, and life insurance. The Subject to s. 260.37,
16the state or a local governmental unit may provide for the payment of premiums for
17hospital, surgical and other health and accident insurance and life insurance for
18employees and officers and their spouses and dependent children. A local
19governmental unit may also provide for the payment of premiums for hospital and
20surgical care for its retired employees. In addition, a local governmental unit may,
21by ordinance or resolution, elect to offer to all of its employees a health care coverage
22plan through a program offered by the group insurance board under ch. 40. A local
23governmental unit that elects to participate under s. 40.51 (7) is subject to the
24applicable sections of ch. 40 instead of this subsection.
SB562, s. 64
25Section
64. 70.11 (41p) of the statutes is created to read:
SB562,31,3
170.11
(41p) Healthy Wisconsin Authority. All property owned by the Healthy
2Wisconsin Authority, provided that use of the property is primarily related to the
3purposes of the authority.
SB562, s. 65
4Section
65. 71.26 (1) (be) of the statutes is amended to read:
SB562,31,85
71.26
(1) (be)
Certain authorities. Income of the University of Wisconsin
6Hospitals and Clinics Authority, of the Health Insurance Risk-Sharing Plan
7Authority,
and of the Healthy Wisconsin Authority, of the Fox River Navigational
8System Authority, and of the Wisconsin Aerospace Authority.
SB562, s. 66
9Section
66. 77.54 (9a) (a) of the statutes is amended to read:
SB562,31,1310
77.54
(9a) (a) This state or any agency thereof, the University of Wisconsin
11Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Health
12Insurance Risk-Sharing Plan Authority,
the Healthy Wisconsin Authority, and the
13Fox River Navigational System Authority.
SB562, s. 67
14Section
67. 100.45 (1) (dm) of the statutes is amended to read:
SB562,31,2315
100.45
(1) (dm) "State agency" means any office, department, agency,
16institution of higher education, association, society or other body in state
17government created or authorized to be created by the constitution or any law which
18is entitled to expend moneys appropriated by law, including the legislature and the
19courts, the Wisconsin Housing and Economic Development Authority, the Bradley
20Center Sports and Entertainment Corporation, the University of Wisconsin
21Hospitals and Clinics Authority, the Wisconsin Health and Educational Facilities
22Authority, the Wisconsin Aerospace Authority,
and the Fox River Navigational
23System Authority
, and the Healthy Wisconsin Authority.
SB562, s. 68
24Section
68. 109.075 (9) of the statutes is created to read:
SB562,32,3
1109.075
(9) This section does not apply to an employer that ceases providing
2health care benefits to its employees because the employees are covered under the
3Healthy Wisconsin Plan under ch. 260.
SB562, s. 69
4Section
69. 111.70 (1) (dm) of the statutes is amended to read:
SB562,32,185
111.70
(1) (dm) "Economic issue" means salaries, overtime pay, sick leave,
6payments in lieu of sick leave usage, vacations, clothing allowances in excess of the
7actual cost of clothing, length-of-service credit, continuing education credit, shift
8premium pay, longevity pay, extra duty pay, performance bonuses, health insurance
9coverage of benefits not provided under the Healthy Wisconsin Plan under ch. 260,
10life insurance, dental insurance, disability insurance, vision insurance, long-term
11care insurance, worker's compensation and unemployment insurance, social
12security benefits, vacation pay, holiday pay, lead worker pay, temporary assignment
13pay, retirement contributions, supplemental retirement benefits, severance or other
14separation pay, hazardous duty pay, certification or license payment, limitations on
15layoffs that create a new or increased financial liability on the employer and
16contracting or subcontracting of work that would otherwise be performed by
17municipal employees in the collective bargaining unit with which there is a labor
18dispute.
SB562, s. 70
19Section
70. 111.70 (4) (cm) 8s. of the statutes is amended to read:
SB562,34,220
111.70
(4) (cm) 8s. `Forms for determining costs.' The commission shall
21prescribe forms for calculating the total increased cost to the municipal employer of
22compensation and fringe benefits provided to school district professional employees.
23The cost shall be determined based upon the total cost of compensation and fringe
24benefits provided to school district professional employees who are represented by
25a labor organization on the 90th day before expiration of any previous collective
1bargaining agreement between the parties, or who were so represented if the
2effective date is retroactive, or the 90th day prior to commencement of negotiations
3if there is no previous collective bargaining agreement between the parties, without
4regard to any change in the number, rank or qualifications of the school district
5professional employees. For purposes of such determinations, any cost increase that
6is incurred on any day other than the beginning of the 12-month period commencing
7with the effective date of the agreement or any succeeding 12-month period
8commencing on the anniversary of that effective date shall be calculated as if the cost
9increase were incurred as of the beginning of the 12-month period beginning on the
10effective date or anniversary of the effective date in which the cost increase is
11incurred.
For the purpose of determining if a municipal employer has maintained
12current fringe benefits under sub. (1) (nc) 1. a., the commission shall consider the
13municipal employer to have maintained its health care coverage benefit if the
14municipal employer provides health care coverage to its school district professional
15employees through the Healthy Wisconsin Plan under ch. 260 and supplements that
16coverage, if necessary, to produce a health care coverage benefit that is actuarially
17equivalent to the health care coverage benefit in place before the school district
18professional employees become covered under the Healthy Wisconsin Plan under ch.
19260. If a dispute arises concerning the municipal employer's determination of
20actuarial equivalence or what supplemental benefits are sufficient to achieve
21actuarial equivalence, the dispute shall be resolved by a neutral person who is
22designated by the commission. In each collective bargaining unit to which subd. 5s.
23applies, the municipal employer shall transmit to the commission and the labor
24organization a completed form for calculating the total increased cost to the
25municipal employer of compensation and fringe benefits provided to the school
1district professional employees covered by the agreement as soon as possible after
2the effective date of the agreement.
SB562, s. 71
3Section
71. 111.91 (2) (pt) of the statutes is created to read:
SB562,34,54
111.91
(2) (pt) Health care coverage of employees under the Healthy Wisconsin
5Plan under ch. 260.
SB562, s. 72
6Section
72. 120.13 (2) (b) of the statutes is amended to read:
SB562,34,127
120.13
(2) (b) Provide health care benefits
not provided under the Healthy
8Wisconsin Plan under ch. 260 on a self-insured basis to the employees of the school
9district if the school district has at least 100 employees. In addition, any 2 or more
10school districts which together have at least 100 employees may jointly provide
11health care benefits
not provided under the Healthy Wisconsin Plan under ch. 260 12on a self-insured basis to employees of the school districts.
SB562,34,1815
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
17632.85, 632.853, 632.855, 632.87 (4)
and (5), 632.895
(9) to (15), 632.896, and
767.25
18(4m) (d) 767.513 (4).
SB562, s. 74
19Section
74. 149.12 (2) (em) of the statutes is created to read:
SB562,34,2220
149.12
(2) (em) No person who is eligible for coverage under the Healthy
21Wisconsin Plan under ch. 260 is eligible for coverage under the plan under this
22chapter.
SB562,35,10
1230.03
(3) "Agency" means any board, commission, committee, council, or
2department in state government or a unit thereof created by the constitution or
3statutes if such board, commission, committee, council, department, unit, or the
4head thereof, is authorized to appoint subordinate staff by the constitution or
5statute, except a legislative or judicial board, commission, committee, council,
6department, or unit thereof or an authority created under subch. II of ch. 114 or
7subch. III of ch. 149 or under ch. 231, 232, 233, 234, 235, 237
, 260, or 279. "Agency"
8does not mean any local unit of government or body within one or more local units
9of government that is created by law or by action of one or more local units of
10government.
SB562, s. 76
11Section
76. Chapter 260 of the statutes is created to read:
SB562,35,1212
Chapter 260
SB562,35,13
13Healthy Wisconsin Plan
SB562,35,14
14260.01 Definitions. In this chapter, except as otherwise provided:
SB562,35,15
15(1) "Authority" means the Healthy Wisconsin Authority.
SB562,35,16
16(2) "Board" means the board of trustees of the authority.
SB562,35,21
17(3) "Health care network" means a provider-driven, coordinated group of
18health care providers comprised of primary care physicians, medical specialists,
19physician assistants, nurses, clinics, one or more hospitals, and other health care
20providers and facilities, including providers and facilities that specialize in mental
21health services and alcohol or other drug abuse treatment.
SB562,35,25
22(4) "Medical inflation" means changes in the consumer price index for all
23consumers, U.S. city average, for the medical care group, including medical care
24commodities and medical care services, as determined by the U.S. department of
25labor.
SB562,36,1
1(5) "Plan" means the Healthy Wisconsin Plan.
SB562,36,10
2(6) "Primary care provider" means a health care provider who is identified as
3the key professional responsible for coordinating all medical care for a given
4participant, including referral to a specialist. "Primary care provider" includes
5general practice physicians, family practitioners, internists, pediatricians,
6obstetricians and gynecologists, advanced practice nurses, certified nurse midwives,
7and physician assistants. "Primary care provider" may also include a specialist who
8is treating a person with a chronic medical condition or special health care needs for
9which regular treatment by a specialist is medically necessary or a specialist who is
10treating a disabled person.
SB562,36,20
11260.05 Creation and organization of authority. (1) Creation and
12membership of board. There is created a public body corporate and politic to be
13known as the "Healthy Wisconsin Authority." The nonvoting members of the board
14shall consist of the secretary of employee trust funds and 4 representatives from the
15advisory committee under s. 260.49 who are health care personnel and
16administrators, selected by the advisory committee. The secretary of employee trust
17funds shall serve as the initial chairperson of the board until such time as the board
18elects a chairperson from its voting membership. The board shall also consist of the
19following voting members, nominated by the governor and with the advice and
20consent of the senate appointed, for staggered 6-year terms:
SB562,36,2221
(a) Four members selected from a list of names submitted by statewide labor
22or union coalitions. One of these members shall be a public employee.
SB562,36,2523
(b) Four members selected from a list of names submitted by statewide
24business and employer organizations. One of these members shall be a public
25employer.
SB562,37,2
1(c) One member selected from a list of names submitted by statewide public
2school teacher labor organizations.
SB562,37,43
(d) One member selected from a list of names submitted by statewide small
4business organizations.
SB562,37,65
(e) Two members who are farmers, selected from a list of names submitted by
6statewide general farm organizations.
SB562,37,77
(f) One member who is a self-employed person.
SB562,37,98
(g) Three members selected from a list of names submitted by statewide health
9care consumer organizations.
SB562,37,11
10(2) Terms of office; vacancies; quorum; business. (a) The terms of all members
11of the board shall expire on July 1.
SB562,37,1812
(b) Each member of the board shall hold office until a successor is appointed
13and qualified unless the member vacates or is removed from his or her office. A
14member who serves as a result of holding another office or position vacates his or her
15office as a member when he or she vacates the other office or position. A member who
16ceases to qualify for office vacates his or her office. A vacancy on the board shall be
17filled in the same manner as the original appointment to the board for the remainder
18of the unexpired term, if any.
SB562,37,2319
(c) A majority of the members of the board constitutes a quorum for the purpose
20of conducting its business and exercising its powers and for all other purposes,
21notwithstanding the existence of any vacancies. Action may be taken by the board
22upon a vote of a majority of the members present. Meetings of the members of the
23board may be held anywhere within or without the state.
SB562,38,2
24(3) Board member responsibility as trustee. Each member of the board shall
25be responsible for taking care that the highest level of independence and judgment
1is exercised at all times in administering the plan and overseeing the individuals and
2organizations selected to implement the plan.
SB562,38,3
3(4) Duties. The board shall:
SB562,38,74
(a) Establish and administer a health care system in this state that ensures
5that all eligible persons have access to high quality, timely, and affordable health
6care. In establishing and administering the health care system, except as otherwise
7provided by law, the board shall seek to attain all of the following goals:
SB562,38,98
1. Every resident of this state shall have access to affordable, comprehensive
9health care services.
SB562,38,1110
2. Health care reform shall maintain and improve choice of health care
11providers and high quality health care services in this state.
SB562,38,1312
3. Health care reform shall implement cost containment strategies that retain
13and assure affordable coverage for all residents of this state.
SB562,38,1414
(b) Establish, fund, and manage the plan as provided in this chapter.
SB562,38,1815
(c) Appoint an executive director, who shall serve at the pleasure of the board.
16The board may delegate to one or more of its members or its executive director any
17powers and duties the board considers proper. The executive director shall receive
18such compensation as may be determined by the board.
SB562,38,2219
(d) Provide for mechanisms to enroll every eligible resident in this state under
20the plan. Contracts entered into by the board with providers shall include provisions
21to enroll all eligible persons at the point of service, and outreach programs to assure
22every eligible person becomes enrolled in the plan.
SB562,38,2423
(e) Create a program for consumer protection and a process to resolve disputes
24with providers.
SB562,39,4
1(f) Establish an independent and binding appeals process for resolving
2disputes over eligibility and other determinations made by the board. Any person
3who is adversely affected by a board eligibility determination or any other
4determination is entitled to judicial review of the determination.
SB562,39,65
(g) Submit an annual report on its activities to the governor and chief clerk of
6each house of the legislature, for distribution under s. 13.172 (2).
SB562,39,107
(h) Contract for annual, independent, program evaluations and financial
8audits that measure the extent to which the plan is achieving the goals under par.
9(a) 1. to 3. The board may not enter into a contract with the same auditor for more
10than 6 years.
SB562,39,1411
(i) Accept bids from health care networks in accordance with the criteria set out
12in s. 260.30, or make payments to fee-for-service providers in accordance with s.
13260.30. The board shall consult with the department of employee trust funds in
14determining the most effective and efficient way of purchasing health care benefits.
SB562,39,1615
(j) Audit health care networks and providers to determine if their services meet
16the plan objectives and criteria under this chapter.
SB562,39,19
17(5) Powers. The board shall have all the powers necessary or convenient to
18carry out the purposes and provisions of this chapter. In addition to all other powers
19granted the board under this chapter, the board may:
SB562,39,2120
(a) Adopt, amend, and repeal bylaws and policies and procedures for the
21regulation of its affairs and the conduct of its business.
SB562,39,2222
(b) Have a seal and alter the seal at pleasure.
SB562,39,2323
(c) Maintain an office.
SB562,39,2424
(d) Sue and be sued.
SB562,40,2
1(e) Accept gifts, grants, loans, or other contributions from private or public
2sources.
SB562,40,43
(f) Establish the authority's annual budget and monitor the fiscal management
4of the authority.
SB562,40,65
(g) Execute contracts and other instruments, including contracts for any
6professional services required for the authority.
SB562,40,87
(h) Employ any officers, agents, and employees that it may require and
8determine their qualifications and compensation.
SB562,40,99
(i) Procure liability insurance.
SB562,40,1110
(j) Contract for studies on issues, as identified by the board or by the advisory
11committee under s. 260.49, that relate to the plan.
SB562,40,1312
(k) Borrow money, as necessary on a short-term basis, to address cash flow
13issues.
SB562,40,1514
(L) Compel witnesses to attend meetings and to testify upon any necessary
15matter concerning the plan.
SB562,40,18
16260.10 Eligibility. (1) Covered persons. Except as provided in subs. (2) to
17(5) and subject to sub. (6), a person is eligible to participate in the plan if the person
18satisfies all of the following criteria:
SB562,40,2019
(a) The person has maintained his or her place of permanent abode, as defined
20by the board, in this state for at least 12 months.
SB562,40,2221
(b) The person maintains a substantial presence in this state, as defined by the
22board.
SB562,40,2323
(c) The person is under 65 years of age.
SB562,41,224
(d) The person is not eligible for health care coverage from the federal
25government or a foreign government, is not an inmate of a penal facility, as defined
1in s. 19.32 (1e), and is not placed or confined in, or committed to, an institution for
2the mentally ill or developmentally disabled.
SB562,41,53
(e) Subject to s. 49.45 (54), unless a waiver requested under sub. (6) (b) has been
4granted and is in effect, the person is not eligible for Medical Assistance under subch.
5IV of ch. 49, including for health care coverage under BadgerCare Plus.
SB562,41,10
6(2) Gainfully employed. If a person and the members of the person's
7immediate family do not meet the criteria under sub. (1) (a) and (b), but do meet the
8criteria under sub. (1) (c) to (e) and the person is gainfully employed in this state, as
9defined by the board, the person and the members of the person's immediate family
10are eligible to participate in the plan.
SB562,41,15
11(3) Dependent children. If a child under age 18 resides with his or her parent
12in this state but the parent does not yet meet the residency requirement under sub.
13(1) (a), the child is eligible to participate in the plan regardless of the length of time
14the child has resided in this state, if the child meets the criteria under sub. (1) (b) to
15(e).
SB562,41,19
16(4) Pregnant women. A pregnant woman who resides in this state who does
17not yet meet the residency requirement under sub. (1) (a) is eligible to participate in
18the plan regardless of the length of time the pregnant woman has resided in this
19state, if she meets the criteria under sub. (1) (b) to (e).
SB562,41,25
20(5) Collective bargaining agreement. A person who is eligible to participate
21in the plan under sub. (1), (2), (3), or (4) and who receives health care coverage under
22a collective bargaining agreement that is in effect on January 1, 2010, is not eligible
23to participate in the plan until the day on which the collective bargaining agreement
24expires or the day on which the collective bargaining agreement is extended,
25modified, or renewed.
SB562,42,2
1(6) Waiver request. (a) In this subsection, "department" means the
2department of health and family services.
SB562,42,103
(b) 1. The department shall develop a request for a waiver from the secretary
4of the federal department of health and human services to provide coverage under
5the plan to individuals who are eligible for Medical Assistance under subch. IV of ch.
649 in the low-income families category, as determined by the department, including
7individuals who are eligible for health care coverage under BadgerCare Plus. The
8waiver request shall be written so as to allow the use of federal financial
9participation to fund, to the maximum extent possible, health care coverage under
10the plan for the individuals specified in this subdivision.
SB562,42,1611
2. The department shall, not later than July 1, 2009, submit the waiver request
12developed under subd. 1. to a special legislative committee that shall be comprised
13of the members of the joint committee on finance and the members of the standing
14committees of the senate and the assembly with subject matter jurisdiction over
15health issues. The special legislative committee shall have 60 days to review and
16comment to the department on the waiver request.
SB562,42,1917
(c) Except as required under par. (b), the department may develop waiver
18requests to the appropriate federal agencies to permit funds from federal health care
19services programs to be used for health care coverage for persons under the plan.