There is no deductible during a year for persons who are under age 18 on
January 1 of that year. Persons who are at least 18 years of age on January 1 of a
year must pay a deductible of $300 during that year, but the deductible amount is
limited to $600 per year for families with two or more persons who are at least 18
years of age on January 1 of that year. The maximum out-of-pocket amount for
copayments, coinsurance, and deductibles is $2,000 a year for a person who is at least
18 years of age on January 1 of that year, but not more than $3,000 a year for a family
consisting of two or more persons.
The bill contains certain requirements for providers with respect to charging
interest on deductible amounts not paid, providing services to persons who have not
paid a deductible amount, and charging for services to which a deductible applies.
Choice of health care network or fee-for-service option
Under the bill, the board may establish areas in the state for the purpose of
receiving bids from health care networks. In each area designated by the board, the
plan must offer participants two options for the delivery of their health care services:
a fee-for-service option and a health care network (network) option. Annually, the
board must solicit bids from networks, which are defined in the bill as a
provider-driven, coordinated group of health care providers and facilities. Only
qualifying networks may be selected to provide services in an area. The bill specifies
various criteria related to a network's organization and provision of services that a
network must satisfy to be qualifying. On the basis of the bids and other information
submitted by the networks, the board must certify which networks are qualifying,
and then classify the certified networks according to price and quality measures as
the lowest-cost network, low-cost networks, and higher-cost networks.
During annual open enrollment periods, plan participants may select a
fee-for-service option or a certified network for the delivery of their health care.
Participants who do not make a selection are assigned randomly to the lowest-cost
network or a low-cost network, or to a fee-for-service option that is the lowest-cost
option. In addition, a participant who selects a higher-cost network or a
fee-for-service option and who fails to pay any required additional premium amount
will be assigned randomly to the lowest-cost network or a low-cost network, or to a
fee-for-service option that is the lowest-cost option. Each participant must select
a primary care provider who is responsible for overseeing all of the participant's care.
On behalf of a participant who selects a network classified as the lowest-cost
network or a low-cost network, the board pays to the network on a monthly basis the
amount that the network bid, and the participant pays no additional amount as
premium. On behalf of a participant who chooses a network classified as a
higher-cost network, the board pays to the network on a monthly basis the amount
that was bid by the lowest-cost network, and the participant must pay the difference
between what the network bid and the amount that the board pays.
The board establishes provider payment rates for services provided under a
fee-for-service option. A provider that provides services to a participant who has
selected a fee-for-service option must accept the rate established by the board as the
full payment and may not charge the participant any amount by which the provider's
charge has been reduced. In addition to establishing provider payment rates, the
board, with the assistance of actuarial consultants, establishes the monthly
risk-adjusted cost of the fee-for-service option and classifies the fee-for-service
option in the same manner as networks are classified. A participant who selects a
fee-for-service option that is classified as a higher-cost choice must pay an
additional amount, which is capped in the bill, that is based on the classification of
the fee-for-service option chosen by the participant and the number of certified
low-cost networks available to the participant. There is no additional cost to a
participant who chooses a fee-for-service option if the board determines that there
are no low-cost networks available to the participant.
Assessments on individuals and employers
Under the bill, the Department of Revenue (DOR) must impose and collect
assessments that are calculated by the board, based on the board's anticipated
revenue needs. The assessments may be collected from individuals and employers
through the income tax system, or through another system devised by DOR.
Generally, the assessment for an individual who is the employee of another
person is between 2 percent and 4 percent of the individual's social security wages.
If the individual's social security wages are 150 percent or less of the federal poverty
line, however, the assessment is zero. If such wages are between 150 percent and 300
percent of the poverty line, the assessment is on a sliding scale between zero and 4
percent, depending on the amount of the individual's social security wages and on the
number his or her dependents.
The assessment on a self-employed individual is between 9 percent and 10
percent. The assessment on someone who is eligible to participate in the plan but
who is neither self-employed nor the employee of another person is 10 percent of the
individual's federal adjusted gross income, up to the maximum amount of the income
subject to social security tax.
The maximum amount of an assessment that DOR may impose on a household,
defined as an individual, his or her spouse, and his or her immediate family, as that
term is defined by the board, is 4 percent of the annual limit on the contribution and
benefit base of the Old-Age, Survivors, and Disability Insurance program, as
calculated annually by the U.S. Social Security Administration. For 2008, this base
is $102,000.
For an employer, the assessment calculated by the board must be between 9
percent and 12 percent of an employer's aggregate social security wages, except that
for taxable year 2010 the assessment imposed on a small employer (an employer who
has no more than ten employees) is 33 percent of the amount calculated that would
otherwise be collected. For taxable year 2011, the assessment on a small employer
is 67 percent of the amount calculated that would otherwise be collected.
The assessments that are collected by DOR must be deposited into the Healthy
Wisconsin trust fund. The board may annually increase or decrease the assessment
percentages for individuals and employers, but an annual increase may not exceed
the percentage increase in medical inflation, unless otherwise provided by law.
Miscellaneous matters
Under current law, DHFS provides financial assistance to eligible persons who
have chronic kidney disease, cystic fibrosis, or hemophilia for the cost of medical
treatment for those diseases. This assistance is collectively referred to as the
Chronic Disease Aids Program. Generally, a person with one of these chronic
diseases who has other health care coverage is not eligible for assistance under the
Chronic Disease Aids Program. Under the bill, a person with coverage under the
plan is still eligible for assistance under the Chronic Disease Aids Program.
Under current law, the state is required to, and counties, cities, villages, and
towns (political subdivisions) may, provide health care coverage through insurance
or on a self-insured basis for their employees. The bill provides that the state and
political subdivisions may provide for their employees health care benefits that are
not provided under the plan, since state and political subdivision employees, if they
satisfy the eligibility criteria, will have coverage under the plan.
Under the bill, if a entity that levies a property tax reduces the costs of
providing health care benefits to its employees as a result of providing benefits under
the plan, the entity must distribute at least 50 percent of the reduction amount as
reduction in property taxes levied for 2010. The reduction amount for each taxpayer
is based on the equalized value of the taxpayer's property.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB562,7,83
13.172
(1) In this section, "agency" means an office, department, agency,
4institution of higher education, association, society, or other body in state
5government created or authorized to be created by the constitution or any law, that
6is entitled to expend moneys appropriated by law, including the legislature and the
7courts, and any authority created in subch. II of ch. 114 or subch. III of ch. 149 or in
8ch. 231, 233, 234
, 260, or 279.
SB562, s. 2
9Section
2. 13.48 (13) (a) of the statutes is amended to read:
SB562,7,2110
13.48
(13) (a) Except as provided in par. (b) or (c), every building, structure or
11facility that is constructed for the benefit of or use of the state, any state agency,
12board, commission or department, the University of Wisconsin Hospitals and Clinics
13Authority, the Fox River Navigational System Authority,
the Healthy Wisconsin
14Authority, or any local professional baseball park district created under subch. III
15of ch. 229 if the construction is undertaken by the department of administration on
16behalf of the district, shall be in compliance with all applicable state laws, rules,
17codes and regulations but the construction is not subject to the ordinances or
18regulations of the municipality in which the construction takes place except zoning,
19including without limitation because of enumeration ordinances or regulations
20relating to materials used, permits, supervision of construction or installation,
21payment of permit fees, or other restrictions.
SB562,8,324
13.62
(2) "Agency" means any board, commission, department, office, society,
25institution of higher education, council, or committee in the state government, or any
1authority created in subch. II of ch. 114 or subch. III of ch. 149 or in ch. 231, 232, 233,
2234, 237,
260, or 279, except that the term does not include a council or committee
3of the legislature.
SB562, s. 4
4Section
4. 13.94 (1) (dj) of the statutes is created to read:
SB562,8,75
13.94
(1) (dj) Annually, conduct a financial audit of the Healthy Wisconsin Plan
6under ch. 260 and file copies of each audit report under this paragraph with the
7distributees specified in par. (b).
SB562, s. 5
8Section
5. 13.94 (1s) (c) 5. of the statutes is created to read:
SB562,8,109
13.94
(1s) (c) 5. The Healthy Wisconsin Authority for the cost of the audit under
10sub. (1) (dj).
SB562,8,25
1313.95 Legislative fiscal bureau. (intro.) There is created a bureau to be
14known as the "Legislative Fiscal Bureau" headed by a director. The fiscal bureau
15shall be strictly nonpartisan and shall at all times observe the confidential nature
16of the research requests received by it; however, with the prior approval of the
17requester in each instance, the bureau may duplicate the results of its research for
18distribution. Subject to s. 230.35 (4) (a) and (f), the director or the director's
19designated employees shall at all times, with or without notice, have access to all
20state agencies, the University of Wisconsin Hospitals and Clinics Authority, the
21Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
22the Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, and
23the Fox River Navigational System Authority, and to any books, records, or other
24documents maintained by such agencies or authorities and relating to their
25expenditures, revenues, operations, and structure.
SB562,9,73
16.002
(2) "Departments" means constitutional offices, departments, and
4independent agencies and includes all societies, associations, and other agencies of
5state government for which appropriations are made by law, but not including
6authorities created in subch. II of ch. 114 or subch. III of ch. 149 and in chs. 231, 232,
7233, 234, 235, 237
, 260, and 279.
SB562,9,1510
16.004
(4) Freedom of access. The secretary and such employees of the
11department as the secretary designates may enter into the offices of state agencies
12and authorities created under subch. II of ch. 114 or subch. III of ch. 149 and under
13chs. 231, 233, 234, 237,
260, and 279, and may examine their books and accounts and
14any other matter that in the secretary's judgment should be examined and may
15interrogate the agency's employees publicly or privately relative thereto.
SB562,9,2218
16.004
(5) Agencies and employees to cooperate. All state agencies and
19authorities created under subch. II of ch. 114 or subch. III of ch. 149 and under chs.
20231, 233, 234, 237,
260, and 279, and their officers and employees, shall cooperate
21with the secretary and shall comply with every request of the secretary relating to
22his or her functions.
SB562, s. 10
23Section
10. 16.004 (7d) of the statutes is created to read:
SB562,9,2524
16.004
(7d) Containment of health care costs. In consultation with the board
25of the Healthy Wisconsin Authority, the secretary shall establish, by rule, a program
1to contain health care costs in this state during any year in which the board
2determines that health care costs increase at a rate exceeding the national average
3of medical inflation, as defined in s. 260.01 (4).
SB562, s. 11
4Section
11. 16.004 (7h) of the statutes is created to read:
SB562,10,105
16.004
(7h) Employer assessments to the Healthy Wisconsin trust fund. 6The secretary shall establish a methodology for allocating employer assessments
7among state agencies to pay the Healthy Wisconsin trust fund for the operation and
8funding of the Healthy Wisconsin Plan under ch. 260. State agencies shall pay, from
9appropriations used to fund fringe benefit costs of state employees, to the Healthy
10Wisconsin trust fund amounts determined by the secretary.
SB562,10,2013
16.004
(12) (a) In this subsection, "state agency" means an association,
14authority, board, department, commission, independent agency, institution, office,
15society, or other body in state government created or authorized to be created by the
16constitution or any law, including the legislature, the office of the governor, and the
17courts, but excluding the University of Wisconsin Hospitals and Clinics Authority,
18the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan
19Authority,
the Healthy Wisconsin Authority, the Lower Fox River Remediation
20Authority, and the Fox River Navigational System Authority.
SB562,11,323
16.045
(1) (a) "Agency" means an office, department, independent agency,
24institution of higher education, association, society, or other body in state
25government created or authorized to be created by the constitution or any law, that
1is entitled to expend moneys appropriated by law, including the legislature and the
2courts, but not including an authority created in subch. II of ch. 114 or subch. III of
3ch. 149 or in ch. 231, 232, 233, 234, 235, 237
, 260, or 279.
SB562,11,76
16.41
(4) In this section, "authority" means a body created under subch. II of
7ch. 114 or subch. III of ch. 149 or under ch. 231, 233, 234, 237
, 260, or 279.
SB562, s. 15
8Section
15. 16.417 (1) (a) of the statutes is amended to read:
SB562,11,149
16.417
(1) (a) "Agency" means an office, department, independent agency,
10institution of higher education, association, society, or other body in state
11government created or authorized to be created by the constitution or any law, that
12is entitled to expend moneys appropriated by law, including the legislature and the
13courts, but not including an authority or the body created under subch. III of ch. 149
14or under ch. 260.
SB562,12,217
16.52
(7) Petty cash account. With the approval of the secretary, each agency
18that is authorized to maintain a contingent fund under s. 20.920 may establish a
19petty cash account from its contingent fund. The procedure for operation and
20maintenance of petty cash accounts and the character of expenditures therefrom
21shall be prescribed by the secretary. In this subsection, "agency" means an office,
22department, independent agency, institution of higher education, association,
23society, or other body in state government created or authorized to be created by the
24constitution or any law, that is entitled to expend moneys appropriated by law,
1including the legislature and the courts, but not including an authority created in
2subch. II of ch. 114 or subch. III of ch. 149 or in ch. 231, 233, 234, 237
, 260, or 279.
SB562,12,105
16.528
(1) (a) "Agency" means an office, department, independent agency,
6institution of higher education, association, society, or other body in state
7government created or authorized to be created by the constitution or any law, that
8is entitled to expend moneys appropriated by law, including the legislature and the
9courts, but not including an authority created in subch. II of ch. 114 or subch. III of
10ch. 149 or in ch. 231, 233, 234, 237
, 260, or 279.
SB562,12,2113
16.53
(2) Improper invoices. If an agency receives an improperly completed
14invoice, the agency shall notify the sender of the invoice within 10 working days after
15it receives the invoice of the reason it is improperly completed. In this subsection,
16"agency" means an office, department, independent agency, institution of higher
17education, association, society, or other body in state government created or
18authorized to be created by the constitution or any law, that is entitled to expend
19moneys appropriated by law, including the legislature and the courts, but not
20including an authority created in subch. II of ch. 114 or subch. III of ch. 149 or in ch.
21231, 233, 234, 237
, 260, or 279.
SB562,13,424
16.54
(9) (a) 1. "Agency" means an office, department, independent agency,
25institution of higher education, association, society or other body in state
1government created or authorized to be created by the constitution or any law, which
2is entitled to expend moneys appropriated by law, including the legislature and the
3courts, but not including an authority created in subch. II of ch. 114 or subch. III of
4ch. 149 or in ch. 231, 233, 234, 237
, 260, or 279.
SB562,13,87
16.70
(2) "Authority" means a body created under subch. II of ch. 114 or subch.
8III of ch. 149 or under ch. 231, 232, 233, 234, 235, 237
, 260, or 279.
SB562,13,2111
16.765
(1) Contracting agencies, the University of Wisconsin Hospitals and
12Clinics Authority, the Fox River Navigational System Authority, the Wisconsin
13Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
the
14Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, and the
15Bradley Center Sports and Entertainment Corporation shall include in all contracts
16executed by them a provision obligating the contractor not to discriminate against
17any employee or applicant for employment because of age, race, religion, color,
18handicap, sex, physical condition, developmental disability as defined in s. 51.01 (5),
19sexual orientation as defined in s. 111.32 (13m), or national origin and, except with
20respect to sexual orientation, obligating the contractor to take affirmative action to
21ensure equal employment opportunities.
SB562,14,1524
16.765
(2) Contracting agencies, the University of Wisconsin Hospitals and
25Clinics Authority, the Fox River Navigational System Authority, the Wisconsin
1Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
the
2Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, and the
3Bradley Center Sports and Entertainment Corporation shall include the following
4provision in every contract executed by them: "In connection with the performance
5of work under this contract, the contractor agrees not to discriminate against any
6employee or applicant for employment because of age, race, religion, color, handicap,
7sex, physical condition, developmental disability as defined in s. 51.01 (5), sexual
8orientation or national origin. This provision shall include, but not be limited to, the
9following: employment, upgrading, demotion or transfer; recruitment or recruitment
10advertising; layoff or termination; rates of pay or other forms of compensation; and
11selection for training, including apprenticeship. Except with respect to sexual
12orientation, the contractor further agrees to take affirmative action to ensure equal
13employment opportunities. The contractor agrees to post in conspicuous places,
14available for employees and applicants for employment, notices to be provided by the
15contracting officer setting forth the provisions of the nondiscrimination clause".
SB562,14,2318
16.765
(4) Contracting agencies, the University of Wisconsin Hospitals and
19Clinics Authority, the Fox River Navigational System Authority, the Wisconsin
20Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
the
21Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, and the
22Bradley Center Sports and Entertainment Corporation shall take appropriate action
23to revise the standard government contract forms under this section.
SB562,15,17
116.765
(5) The head of each contracting agency and the boards of directors of
2the University of Wisconsin Hospitals and Clinics Authority, the Fox River
3Navigational System Authority, the Wisconsin Aerospace Authority, the Health
4Insurance Risk-Sharing Plan Authority,
the Healthy Wisconsin Authority, the
5Lower Fox River Remediation Authority, and the Bradley Center Sports and
6Entertainment Corporation shall be primarily responsible for obtaining compliance
7by any contractor with the nondiscrimination and affirmative action provisions
8prescribed by this section, according to procedures recommended by the department.
9The department shall make recommendations to the contracting agencies and the
10boards of directors of the University of Wisconsin Hospitals and Clinics Authority,
11the Fox River Navigational System Authority, the Wisconsin Aerospace Authority,
12the Health Insurance Risk-Sharing Plan Authority,
the Healthy Wisconsin
13Authority, the Lower Fox River Remediation Authority, and the Bradley Center
14Sports and Entertainment Corporation for improving and making more effective the
15nondiscrimination and affirmative action provisions of contracts. The department
16shall promulgate such rules as may be necessary for the performance of its functions
17under this section.
SB562,16,320
16.765
(6) The department may receive complaints of alleged violations of the
21nondiscrimination provisions of such contracts. The department shall investigate
22and determine whether a violation of this section has occurred. The department may
23delegate this authority to the contracting agency, the University of Wisconsin
24Hospitals and Clinics Authority, the Fox River Navigational System Authority, the
25Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
1the Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, or the
2Bradley Center Sports and Entertainment Corporation for processing in accordance
3with the department's procedures.
SB562,16,166
16.765
(7) (intro.) When a violation of this section has been determined by the
7department, the contracting agency, the University of Wisconsin Hospitals and
8Clinics Authority, the Fox River Navigational System Authority, the Wisconsin
9Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
the
10Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, or the
11Bradley Center Sports and Entertainment Corporation, the contracting agency, the
12University of Wisconsin Hospitals and Clinics Authority, the Fox River Navigational
13System Authority, the Wisconsin Aerospace Authority, the Health Insurance
14Risk-Sharing Plan Authority,
the Healthy Wisconsin Authority, the Lower Fox River
15Remediation Authority, or the Bradley Center Sports and Entertainment
16Corporation shall:
SB562,16,2519
16.765
(7) (d) Direct the violating party to take immediate steps to prevent
20further violations of this section and to report its corrective action to the contracting
21agency, the University of Wisconsin Hospitals and Clinics Authority, the Fox River
22Navigational System Authority, the Wisconsin Aerospace Authority, the Health
23Insurance Risk-Sharing Plan Authority,
the Healthy Wisconsin Authority, the
24Lower Fox River Remediation Authority, or the Bradley Center Sports and
25Entertainment Corporation.
SB562,17,193
16.765
(8) If further violations of this section are committed during the term
4of the contract, the contracting agency, the Fox River Navigational System Authority,
5the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan
6Authority,
the Healthy Wisconsin Authority, the Lower Fox River Remediation
7Authority, or the Bradley Center Sports and Entertainment Corporation may permit
8the violating party to complete the contract, after complying with this section, but
9thereafter the contracting agency, the Fox River Navigational System Authority, the
10Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
11the Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, or the
12Bradley Center Sports and Entertainment Corporation shall request the
13department to place the name of the party on the ineligible list for state contracts,
14or the contracting agency, the Fox River Navigational System Authority, the
15Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority,
16the Healthy Wisconsin Authority, the Lower Fox River Remediation Authority, or the
17Bradley Center Sports and Entertainment Corporation may terminate the contract
18without liability for the uncompleted portion or any materials or services purchased
19or paid for by the contracting party for use in completing the contract.
SB562,18,622
16.85
(2) To furnish engineering, architectural, project management, and other
23building construction services whenever requisitions therefor are presented to the
24department by any agency. The department may deposit moneys received from the
25provision of these services in the account under s. 20.505 (1) (kc) or in the general
1fund as general purpose revenue — earned. In this subsection, "agency" means an
2office, department, independent agency, institution of higher education, association,
3society, or other body in state government created or authorized to be created by the
4constitution or any law, which is entitled to expend moneys appropriated by law,
5including the legislature and the courts, but not including an authority created in
6subch. II of ch. 114 or subch. III of ch. 149 or in ch. 231, 233, 234, 237
, 260, or 279.
SB562,18,239
16.865
(8) Annually in each fiscal year, allocate as a charge to each agency a
10proportionate share of the estimated costs attributable to programs administered by
11the agency to be paid from the appropriation under s. 20.505 (2) (k). The department
12may charge premiums to agencies to finance costs under this subsection and pay the
13costs from the appropriation on an actual basis. The department shall deposit all
14collections under this subsection in the appropriation account under s. 20.505 (2) (k).
15Costs assessed under this subsection may include judgments, investigative and
16adjustment fees, data processing and staff support costs, program administration
17costs, litigation costs, and the cost of insurance contracts under sub. (5). In this
18subsection, "agency" means an office, department, independent agency, institution
19of higher education, association, society, or other body in state government created
20or authorized to be created by the constitution or any law, that is entitled to expend
21moneys appropriated by law, including the legislature and the courts, but not
22including an authority created in subch. II of ch. 114 or subch. III of ch. 149 or in ch.
23231, 232, 233, 234, 235, 237
, 260, or 279.
SB562, s. 31
24Section
31. 20.855 (4m) of the statutes is created to read:
SB562,19,5
120.855
(4m) Healthy Wisconsin Plan. (s)
Healthy Wisconsin Authority. From
2the Healthy Wisconsin trust fund, a sum sufficient to pay the Healthy Wisconsin
3Authority for the operation and funding of the Healthy Wisconsin Plan under ch. 260.
4Estimated disbursements under this paragraph shall not be included in the schedule
5under s. 20.005.
SB562, s. 32
6Section
32. 25.17 (1) (gd) of the statutes is created to read:
SB562,19,77
25.17
(1) (gd) Healthy Wisconsin trust fund (s. 25.775).
SB562, s. 33
8Section
33. 25.775 of the statutes is created to read:
SB562,19,11
925.775 Healthy Wisconsin trust fund.
(1) There is established a separate,
10nonlapsible trust fund designated as the Healthy Wisconsin trust fund, consisting
11of all moneys appropriated or transferred to or deposited in the fund.
SB562, s. 34
12Section
34. 40.05 (4) (a) 4. of the statutes is created to read:
