Wisconsin collects healthcare claims data and other information from providers in order to disseminate consumer guides and legislative reports. The Wisconsin Health Information Organization also operates an APCD, one of the largest in the country, along with a consumer website for comparing cost and quality information. Wisconsin received a $2.4 million dollar grant from CMS in 2014 in order to develop a state innovation plan to reduce Medicare and Medicaid costs.
In the current legislative session, Wisconsin passed a bill that would set up a state-based reinsurance program, the Wisconsin Health Care Stability Plan, to expand access to care and lower costs for consumers. The reinsurance program will pay insurers up to 80 percent of that part of claims totaling more than $50,000 but less than $250,000 using public money. The program’s stated aims are to reduce premium increases, keep more individuals insured, and entice insurers to offer insurance plans in the state. The plan would be implemented upon CMS’ approval for a 1332 State Innovation Waiver. If approved, Wisconsin would join Alaska, Hawaii, Minnesota, and Oregon as states that have received a 1332 waiver from the federal government.
Wisconsin’s current regular legislative session runs 1/16/2018 – 1/7/2019.
Recent Legislative Developments
|SB669||This bill prohibits a health insurance policy, referred to in the statutes as a disability insurance policy, or a governmental self-insured health plan from including in a contract for pharmacy services, or allowing a pharmacy benefit manager or another entity to include in a contract for pharmacy services, a provision that prohibits or penalizes a pharmacist’s disclosure to an individual purchasing a prescribed drug or device of the cost of a prescribed drug or device, a less expensive therapeutically equivalent drug or device, or a less expensive method of purchasing the drug or device.||Inactive – Failed to pass on 3/28/18.|
|2018||AB885||This bill creates the Wisconsin Healthcare Stability Plan (WIHSP), which is a state-based reinsurance program for health carriers, subject to the approval of a waiver of the federal Patient Protection and Affordable Care Act. The bill allows the commissioner to submit one or more requests for a state innovation waiver under the federal Affordable Care Act, known as a “1332 waiver,” to implement WIHSP. The bill specifies the 2019 benefit year payment parameters to be used for submitting the waiver but allows the commissioner to adjust the payment parameters to secure federal approval of the waiver request. If the federal government does not approve WIHSP as submitted or a substantially similar plan, the commissioner may not implement WIHSP. Current federal law allows a state to apply for a waiver of certain provisions of the Affordable Care Act, and the state is then eligible to receive moneys from the federal government, known as pass-through funding, that the federal government would have paid in premium tax credits, cost-sharing reductions, or small business credits if the waiver had not been approved.||Active – Referred to Rules Committee on 2/14/18.|
|AB 1046 / SB 874||This bills requires that no manufacturer or wholesale distributor may sell or offer to sell an essential off-patent or generic drug at a price that results in price gouging.||Inactive – Both bills failed to pass on 3/28/18.|
|SB267||This bill requires health insurance policies, known in the bill as disability insurance policies, and governmental self-insured health plans to cover certain preventive services and to provide coverage without subjecting that coverage to deductibles, copayments, or coinsurance. The preventive services for which coverage is required are specified in the bill. The bill also specifies certain instances when cost-sharing amounts may be charged for an office visit associated with a preventive service.||Inactive – Failed to pass on 3/28/18.|
|AB 365||This bill would prohibit insurance policies and plans, known in the bill as disability insurance policies, and self-insured governmental health plans from imposing a lifetime limit or an annual limit of the dollar value of benefits.||Active – Re-referred to Committee on Insurance, Financial Services, and Constitution and Federalism 1/26/18.|
|SB 8||This bill requires the Dept. of Health Services to obtain any waiver of federal Medicaid laws necessary to continue administration of SeniorCare and to implement any waiver received for the administration of SeniorCare. The bill also requires that any general purpose revenue monies remaining after paying pharmacies and pharmacists and paying for the program administration, and any federal monies remaining be used by DHS for the following purposes: to reduce enrollment costs for seniors participating in SeniorCare to reduces the prices paid by SeniorCare enrollees for prescription drugs, and to enlarge the number of prescription drugs available through SeniorCare program.||Inactive – Died.|
|SB 50||This bill would exempt prescription drugs from the Unfair Sales Act, an act that prohibits “loss leaders” or wholesale and retail sales of merchandise to be sold at a price below the cost of merchandise for the seller. Under the bill, that prohibition would not apply to prescription drugs.||Inactive – Died.|
|SB267||This bill would require health insurance policies, known in the bill as disability insurance policies, and governmental self-insured health plans to cover certain preventative services and to provide coverage without subjecting that coverage to deductibles, copayments, or coinsurance.||Inactive – Died.|
|2018||SB 770||This bill would trigger a Section 1332 State Innovation Waiver application to CMS. It would add a reinsurance program, the Wisconsin Healthcare Stability Plan, which, if approved, will pay insurers up to 80% of that part of claims totaling more than $50,000 but less than $250,000 using public money. Insurers get no aid for claim portions exceeding $250,000. The state will pay about $50 million of the $200 million annual cost of the program, with the rest (roughly 75%) coming from the federal government in pass-through funds.||Passed – signed by governor on 2/27/18.|
|SB806||This bill allows the establishment of employer groups to jointly provide health care benefits on a self-funded basis to the employers’ eligible employees and their dependents under a health care benefit arrangement. Two or more employers that are members of the same chamber of commerce or industry-based association may form an employer group. Employer groups that provide evidence to the commissioner of insurance that they have formed and are able to comply with the requirements in the bill qualify to participate in the self-funded health benefits project.||Active – Referred to Committee on Insurance, Financial Services, and Constitution and Federalism on 2/14/18.|
|AB445||This bill would create the “Badger Health Benefit Authority” which would establish and operate a Wisconsin Health Benefit Exchange and make qualified health plans available to qualified individuals and employers. It would seek federal grants and other funding for the purpose of the exchange. A qualified health plan in the exchange is a plan that covers the costs of health care services and meets the certification criteria described in the federal Patient Protection and Affordable Care Act. After the exchange begins operation, no insurer would be able to offer or issue health benefit coverage in the state to an individual or small employer except through the exchange.||Inactive – Died.|
Transparency in Healthcare
- Wisconsin Statutes § 153.05 directs the Department of Health Services to collect health data and claims information from hospitals, ambulatory surgical centers, and other healthcare providers for the purposes of conducting analyses and disseminating healthcare information in language that is understandable to lay persons. The Department is to enter into a contract with a data organization which is responsible for analyzing and reporting on “health care claims information with respect to the cost, quality, and effectiveness of health care.” The contracting entity shall also maintain a centralized data repository which the Department may access without additional charge.
- The data organization is also to provide an internet site than offers health care provider cost and quality data and reports to consumers and conduct statewide campaigns to improve health literacy.
- Wisconsin Statutes § 153.08 mandates that hospitals may not increase or charge rates in excess of rates currently in effect unless the hospital publishes a legal notice in a newspaper likely to give notice in the area where the hospital is located between 45 and 30 days before the proposed rate change is to take effect. The hospital may otherwise increase its rates during the course of the hospital’s fiscal year by any amount that in the aggregate do not exceed the percentage amount that is the percentage difference between the consumer price index reported for the 12-month period ending Dec-31 of the preceding year and the consumer price index reported for the 120month period ending on Dec-31 of the year prior to the preceding year.
- Wisconsin Statutes § 153.10 requires that the Department of Health Services prepare and submit a standard report concerning health care providers other than hospitals and ambulatory surgical centers respecting health care claims information to the Governor and both houses of the legislature
- Wisconsin Statutes § 153.20 requires that the Department of Health Services prepare and submit an annual reporting concerning “the number of patients to whom uncompensated health care services were provided by each hospital and the total charges for the uncompensated health care services provided to the patients for the preceding year, together with the number of patients and the total charges that were projected by the hospital for that year.” Hospitals are required to file with the data collection entity under § 153.08 an annual plan setting forth the number of projected patients to whom uncompensated health care services will be provided and the projected total charges for uncompensated care.
- Wisconsin Statutes § 153.21 directs the Department and contracting entity under § 153.05 to prepare guides to assist consumers in selecting health care providers, health care plans, and in selecting hospitals and ambulatory surgical centers.
- Wisconsin Statutes § 153.22 directs the contracting entity under § 153.05 to prepare and submit an annual report to the Governor and both houses of the legislature that “summarizes utilization, charge, and quality data on patients treated by hospitals and ambulatory surgery centers during the most recent calendar year.”
- Wisconsin Statutes § 153.45 states that the Department shall release data in standard forms, public use data files, and in custom-design reports so long as the department ensures that the identification of patients, employers, and health care provider are properly masked.
- Wisconsin Statutes § 146.903 delineates the required disclosures respecting cost and quality of a health care provider. Upon the request of a consumer, a health care provider must disclose at no cost to the consumer the median billed charge for a health care service, diagnostic test, or procedure. Additionally, a provider that submits data to a health care information organization must also make comparative quality information available to the consumer concurrently with the median billed charge information. Providers must post a notice that consumers have the right to request charge information at no cost. Providers must also maintain a document that list charge information for the 25 presenting conditions identified for the health care provider’s provider type.
- Similarly, a hospital must maintain a single document that lists charge information for each of the 75 diagnosis related groups for inpatient care and outpatient surgical care identified in the code, including the median billed charge, the average allowable payment under Medicare, and the average allowable payment from private third-party payers. Consumers shall be provided a copy of the document at no charge upon request.
- Wisconsin Statutes § 150.85 permits the state attorney general to authorize cooperative agreements between healthcare providers, purchasers, and provider networks by issuing a Certificate of Public Advantage (COPA) if the likely benefits resulting from the agreements outweigh the disadvantages attributable to a reduction in competition that may result from such agreements. Providers issued a COPA are immune from civil or criminal antitrust action under the state action doctrine for actions within the scope of the Certificate.
- Wisconsin Statutes § 150.93 imposes a moratorium on the construction of hospital beds.
- None identified.