SB562: Bill Text

SB562, s. 81 Section 81. 609.20 (1m) (d) of the statutes is repealed.

SB562, s. 82 Section 82. 628.36 (4) (a) (intro.) of the statutes is amended to read:

SB562,65,11 628.36 (4) (a) (intro.) The commissioner shall provide information and assistance to the department of employee trust funds, employers and their employees, providers of health care services, and members of the public, as provided in par. (b), for the following purposes:

SB562, s. 83 Section 83. 628.36 (4) (b) 1. of the statutes is repealed.

SB562, s. 84 Section 84. 628.36 (4) (b) 2. of the statutes is repealed.

SB562, s. 85 Section 85. 628.36 (4) (b) 3. of the statutes is repealed.

SB562, s. 86 Section 86. 632.87 (5) of the statutes is amended to read:

SB562,65,23 632.87 (5) No insurer or self-insured school district, city or village may, under a policy, plan, or contract covering gynecological services or procedures, exclude or refuse to provide coverage for Papanicolaou tests, pelvic examinations , or associated laboratory fees when the test or examination is performed by a licensed nurse practitioner, as defined in s. 632.895 (8) (a) 3., within the scope of the nurse practitioner's professional license, if the policy, plan, or contract includes coverage for Papanicolaou tests, pelvic examinations, or associated laboratory fees when the test or examination is performed by a physician.

SB562, s. 87 Section 87. 632.895 (8) (f) 4. of the statutes is created to read:

SB562,66,2 632.895 (8) (f) 4. A disability insurance policy providing only health care benefits not provided under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 88 Section 88. 632.895 (9) (d) 4. of the statutes is created to read:

SB562,66,5 632.895 (9) (d) 4. A disability insurance policy providing only health care benefits not provided under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 89 Section 89. 632.895 (10) (a) of the statutes is amended to read:

SB562,66,14 632.895 (10) (a) Except as provided in par. (b), every disability insurance policy and every health care benefits plan provided on a self-insured basis by a county board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district under s. 120.13 (2) shall provide coverage for blood lead tests for children under 6 years of age, which shall be conducted in accordance with any recommended lead screening methods and intervals contained in any rules promulgated by the department of health and family services under s. 254.158.

SB562, s. 90 Section 90. 632.895 (10) (b) 6. of the statutes is created to read:

SB562,66,17 632.895 (10) (b) 6. A disability insurance policy providing only health care benefits not provided under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 91 Section 91. 632.895 (11) (a) (intro.) of the statutes is amended to read:

SB562,66,24 632.895 (11) (a) (intro.) Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle, or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

SB562, s. 92 Section 92. 632.895 (11) (c) 1. of the statutes is amended to read:

SB562,67,3 632.895 (11) (c) 1. The coverage required under this subsection may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB562, s. 93 Section 93. 632.895 (11) (d) of the statutes is amended to read:

SB562,67,8 632.895 (11) (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

SB562, s. 94 Section 94. 632.895 (11) (e) 3. of the statutes is created to read:

SB562,67,11 632.895 (11) (e) 3. A disability insurance policy providing only health care benefits not provided under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 95 Section 95. 632.895 (12) (b) (intro.) of the statutes is amended to read:

SB562,67,18 632.895 (12) (b) (intro.) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital or ambulatory surgery center charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies:

SB562, s. 96 Section 96. 632.895 (12) (c) of the statutes is amended to read:

SB562,67,22 632.895 (12) (c) The coverage required under this subsection may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured plan.

SB562, s. 97 Section 97. 632.895 (13) (a) of the statutes is amended to read:

SB562,68,2 632.895 (13) (a) Every disability insurance policy , and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.

SB562, s. 98 Section 98. 632.895 (13) (b) of the statutes is amended to read:

SB562,68,6 632.895 (13) (b) The coverage required under par. (a) may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB562, s. 99 Section 99. 632.895 (14) (b) of the statutes is amended to read:

SB562,68,12 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for a dependent who is a child of the insured.

SB562, s. 100 Section 100. 632.895 (14) (c) of the statutes is amended to read:

SB562,68,18 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

SB562, s. 101 Section 101. 632.895 (14) (d) 7. of the statutes is created to read:

SB562,68,21 632.895 (14) (d) 7. A disability insurance policy providing only health care benefits not provided under the Healthy Wisconsin Plan under ch. 260.

SB562, s. 102 Section 102. Nonstatutory provisions.

SB562,68,23 (1) Healthy Wisconsin Plan.

SB562,69,3 (a) Legislative findings. In establishing the Healthy Wisconsin Plan under chapter 260 of the statutes, as created by this act, the legislature finds all of the following:

SB562,69,9 1. `Costs.' Health care costs in Wisconsin are rising at an unsustainable rate making the need for comprehensive reform urgent. Rising costs are seriously threatening the ability of Wisconsin businesses to globally compete; farms to thrive; government to provide needed services; schools to educate; and local citizens to form new and successful business ventures. Some indicators of rising costs are the following:

SB562,69,11 a. Total health care spending in Wisconsin in 2007 is projected to be $42.3 billion, and is projected to grow 82 percent, to $76.9 billion, in the next decade.

SB562,69,14 b. The cost of employer-provided health care in Wisconsin increased by 9.3 percent in 2006, averaging $9,516 per employee. This figure is 26 percent more than the national average.

SB562,69,16 c. Employee premium contributions and out-of-pocket costs are rising faster than wages.

SB562,69,19 d. Rising costs have led to a decline in employer-provided health benefits. In 1979, 73 percent of private-sector Wisconsin workers had employer-based health insurance coverage; however, only 57 percent received health benefits in 2004.

SB562,69,23 e. At least one-half of all personal bankruptcies in the United States are the result of medical expenses. Over 75.7 percent of this group had insurance at the onset of illness. In 2004, there were 13,454 medical bankruptcies in Wisconsin affecting 37,360 people.

SB562,70,2 f. The costs of health services provided to individuals who are unable to pay are shifted to others. Of the $22 billion charged by hospitals in 2005, $736,000,000 was not collected. Those who bear the burden of this cost shift have an increasingly difficult time paying their own health care costs.

SB562,70,6 2. `Access.' There is a large and increasing number of people who have no health insurance or who are underinsured. For this growing population, health care is unaffordable and, most often, not received in the most timely and effective manner. Some indicators of lack of access to health care are as follows:

SB562,70,8 a. Over one 500,000 Wisconsin residents were uninsured at any given point during 2007.

SB562,70,9 b. Over 65 percent of the uninsured in Wisconsin are employed.

SB562,70,11 c. The uninsured are less likely to seek care and, thus, have poorer health outcomes compared to the insured population.

SB562,70,15 d. In 2007, total spending on the uninsured in Wisconsin is projected to reach over $1,000,000,000. About 23.2 percent of this amount will be in the form of uncompensated care; 21.7 percent will be provided through public programs; and 37.5 percent will be paid by the uninsured individuals.

SB562,70,17 3. `Inequity.' The health care system contains inequities. Some indicators of inequity are as follows:

SB562,70,20 a. Wisconsin businesses are competing on an uneven playing field. The majority of Wisconsin businesses that do insure their workers are subsidizing those businesses that are not paying their fair share for health care.

SB562,70,23 b. Our current system forces the sick and the aging to pay far higher premiums than the healthy and those covered under group plans, rather than spreading the risk across the broadest pool possible.

SB562,70,25 c. The uninsured face medical charges by hospitals, doctors, and other health care providers that are 2.5 times what public and private health insurers pay.

SB562,71,5 4. `Inefficiency.' Wisconsin does not have a clearly defined, integrated health care system. Our health care system is complex, fragmented, and disease-focused rather than health-focused, resulting in massive inefficiencies and placing inordinate administrative burdens on health care professionals. Some indicators of inefficiency are as follows:

SB562,71,10 a. Health care financing is accomplished through a patchwork of public programs, private sector employer-sponsored self-insurance, commercial insurance, and individual payers. The most recent study for Wisconsin estimates that about 27 cents of every health care dollar is spent on marketing, overhead, and administration, leaving only 73 cents left to deliver medical care.

SB562,71,13 b. This fragmentation and misaligned financial incentives lead, in some instances, to excessive or inadequate care and create barriers to coordination and accountability among health care professionals, payers, and patients.

SB562,71,19 c. The Institute of Medicine estimates that between 30 cents and 40 cents of every health care dollar is spent on costs of poor quality — overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency. Included in this inefficiency are an unacceptable number of adverse events attributable to medical errors. Patients receive appropriate care based on known "best practices" only about one-half of the time.

SB562,71,22 d. The best care results from the conscientious, explicit, and judicious use of current best evidence and knowledge of patient values by well-trained, experienced clinicians.

SB562,71,25 5. `Limitations on reform.' Federal laws and programs, such as Medicaid, Medicare, Tri-Care, and Champus, constrain Wisconsin's ability to establish immediately a fully integrated health care system.

SB562,72,8 6. `Wisconsin as a laboratory for the nation.' Wisconsin is in a unique position to successfully implement major health care reform. Many providers are already organized into comprehensive delivery systems and have launched innovative pilot programs to improve both the quality and efficiency of their care. Wisconsin is at the forefront in developing systems for health information transparency. Organizations such as the Wisconsin Collaborative for Healthcare Quality, Wisconsin Health Information Organization, and the Wisconsin Hospital Association have launched ambitious projects to provide data on quality, safety, and pricing.

SB562,72,12 (b) Initial terms of Healthy Wisconsin Authority board. Notwithstanding the lengths of terms of the members of the board of the Healthy Wisconsin Authority specified in section 260.05 (1) of the statutes, as created by this act, the initial members shall be appointed for the following terms:

SB562,72,14 1. One member each from section 260.05 (1) (a), (b), and (g) of the statutes, as created by this act, for terms that expire on July 1, 2010.

SB562,72,16 2. One member each from section 260.05 (1) (a), (b), and (e) of the statutes, as created by this act, for terms that expire on July 1, 2011.

SB562,72,18 3. One member each from section 260.05 (1) (c), (e), and (g) of the statutes, as created by this act, for terms that expire on July 1, 2012.

SB562,72,20 4. One member each from section 260.05 (1) (d), (f), and (g) of the statutes, as created by this act, for terms that expire on July 1, 2013.

SB562,72,22 5. One member each from section 260.05 (1) (a) and (b) of the statutes, as created by this act, for terms that expire on July 1, 2014.

SB562,72,24 6. One member each from section 260.05 (1) (a) and (b) of the statutes, as created by this act, for terms that expire on July 1, 2015.

SB562,73,14 (c) Provisional appointments. Notwithstanding the requirement for senate confirmation of the appointment of the members of the board of the Healthy Wisconsin Authority under section 260.05 (1) of the statutes, as created by this act, the initial members may be provisionally appointed by the governor, subject to confirmation by the senate. Any such appointment shall be in full force until acted upon by the senate, and when confirmed by the senate shall continue for the remainder of the term, or until a successor is chosen and qualifies. A provisional appointee may exercise all of the powers and duties of the office to which such person is appointed during the time in which the appointee qualifies. Any appointment made under this subsection that is withdrawn or rejected by the senate shall lapse. When a provisional appointment lapses, a vacancy occurs. Whenever a new legislature is organized, any appointments then pending before the senate shall be referred by the president to the appropriate standing committee of the newly organized senate.

SB562,74,2 (d) Property tax credit. If with respect to levies imposed for 2010, any taxing jurisdiction, as defined in section 74.01 (7) of the statutes, reduces the costs of providing health care coverage to its employees as a result of providing that coverage under the Healthy Wisconsin Plan under chapter 260 of the statutes, as created by this act, together with any supplemental coverage needed to ensure that the health care coverage provided to employees of the taxing jurisdiction is actuarially equivalent to the coverage they received in 2009, the taxing jurisdiction shall distribute at least 50 percent of the savings to the property taxpayers in the taxing jurisdiction as a reduction in the property tax assessments as of January 1, 2010. The reduction shall be calculated based on the equalized value of the property, as determined under section 70.57 of the statutes, and shall reduce the property taxes otherwise payable in that year.

SB562, s. 103 Section 103. Effective dates. This act takes effect on the day after publication, except as follows:

SB562,74,16 (1) Healthy Wisconsin Plan. The treatment of sections 13.94 (1) (dj) and (1s) (c) 5., 16.004 (7d) and (7h), 40.05 (4) (a) 4., (ag) (intro.), (ar), (b), and (be) and (4g) (d), 40.51 (1), (2), (7), (8), and (8m), 40.52 (1) (intro.), (1m), and (2), 40.98 (2) (a) 1., 49.45 (54), 49.473 (2) (c), 49.665 (5) (ag), 49.68 (3) (d) 1., 49.683 (3), 49.685 (6) (b), 49.687 (1m) (d), 59.52 (11) (c), 60.23 (25), 66.0137 (4), (4m) (b), and (5), 109.075 (9), 111.70 (1) (dm) and (4) (cm) 8s., 111.91 (2) (pt), 120.13 (2) (b) and (g), 149.12 (2) (em), 609.01 (7), 609.10, 609.20 (1m) (c) and (d), 628.36 (4) (a) (intro.) and (b) 1., 2., and 3., 632.87 (5), and 632.895 (8) (f) 4., (9) (d) 4., (10) (a) and (b) 6., (11) (a) (intro.), (c) 1., (d), and (e) 3., (12) (b) (intro.) and (c), (13) (a) and (b), and (14) (b), (c), and (d) 7. of the statutes, the renumbering and amendment of sections 40.51 (6) and 62.61 of the statutes, and the creation of sections 40.51 (6) (b) and 62.61 (1) (b) of the statutes take effect on January 1, 2010.

SB562,74,17 (End)