Analysis by the Legislative Reference Bureau
On March 23, 2010, the federal government enacted the Patient Protection and
Affordable Care Act (PPACA), which, among other things, imposes requirements and
limitations on health insurance policies and health plans, requires the creation of
state-based health insurance exchanges through which individuals and small
employers can purchase insurance, changes the income eligibility criteria for
Medicaid (known as Medical Assistance in this state), and creates incentives for
improving access to health care. The insurance reforms, insurance exchange
requirements, and changes to Medicaid are located in Titles I and II and Subtitles
A and B of Title X of PPACA. This substitute amendment requires that, before a state
agency takes any action to implement Title I or II or Subtitle A or B of Title X of
PPACA for which the agency would typically promulgate a rule, the agency must
request the Legislative Reference Bureau to prepare legislation that allows the

agency to take the action. The agency must then submit the proposed legislation to
each standing committee of each house of the legislature that has jurisdiction over
health or insurance matters. The substitute amendment prohibits the agency from
taking the action to implement Title I or II or Subtitle A or B of Title X of PPACA until
the legislation allowing the agency to take the action takes effect. The substitute
amendment also prohibits an agency from requesting a grant or other moneys from
the federal government to implement Title I or II or Subtitle A or B of Title X of
PPACA and from expending any state moneys, or federal moneys passing through
the state treasury, to assist the federal government in implementing Title I or II or
Subtitle A or B of Title X of PPACA. The substitute amendment specifies that an
agency is not prohibited from exchanging or providing information about,
communicating or advising about, or discussing PPACA with any person or agency;
reviewing, analyzing, or researching PPACA, or addressing consumer complaints
about PPACA. A secretary or commissioner of an agency is not prohibited from
serving on a board that discusses and considers the effects of PPACA. The substitute
amendment also specifies that if the Office of the Commissioner of Insurance (OCI)
receives a report of an insurer's medical loss ratio, OCI may review that medical loss
ratio to determine if the insurer is experiencing financial problems and may work
with the insurer to resolve those financial problems. As an exception to the
requirements under the substitute amendment, the substitute amendment allows
an agency to request any grant or other moneys for certain purposes specified under
Title I or II or Subtitle A or B of Title X of PPACA and to implement the project or
program for which the grant or other moneys are received and expend the grant or
other moneys.
The substitute amendment requires agencies of the state to submit annually
to the legislature a report that describes the cost, since March 23, 2010, to that
agency of implementing PPACA and any federal moneys received after March 23,
2010, related to implementing PPACA, with the first report due by September 1,
2012. In addition, certain agencies must include certain information in their annual
reports for that year and in an analysis of any change in the information after March
23, 2010. DHS must include the average spending per recipient for Medical
Assistance programs and the spending for Medical Assistance programs as a
percentage of the state budget. The Department of Safety and Professional Services
shall include the number of physicians practicing in the state. OCI must include the
number of insurance companies that offer health care plans in the state. The
substitute amendment also requires the commissioner of insurance to include in his
or her annual report to the legislature a review of the effect the implementation of
PPACA has on rates of health care plans that are not issued through a governmental
body. That review must include the average rate for each health care plan.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB531-ASA1, s. 1 1Section 1. 20.9265 of the statutes is created to read:
AB531-ASA1,3,2
120.9265 Federal health reform cost reports. (1) Definitions. In this
2section:
AB531-ASA1,3,83 (a) "Agency" means an office, department, agency, institution of higher
4education, association, society, or other body in state government created or
5authorized to be created by the constitution or any law, which is entitled to expend
6moneys appropriated by law, including the legislature, the courts, and any authority
7created in subch. II of ch. 114 or subch. III of ch. 149 or in ch. 231, 233, 234, 238, or
8279.
AB531-ASA1,3,129 (b) "Medical Assistance program" includes any program operated under subch.
10IV of ch. 49, demonstration program operated under 42 USC 1315, and program
11operated under a waiver of federal law relating to medical assistance that is granted
12by the federal department of health and human services.
AB531-ASA1,3,1513 (c) "Patient Protection and Affordable Care Act" means the federal Patient
14Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health
15Care and Education Reconciliation Act of 2010, P.L. 111-152.
AB531-ASA1,3,21 16(2) Report required. By September 1, 2012, and annually thereafter, subject
17to sub. (3), each agency shall submit to the legislature in the manner provided under
18s. 13.172 (2) a report that describes the cost, since March 23, 2010, to that agency of
19implementing the Patient Protection and Affordable Care Act and any moneys
20received from the federal government after March 23, 2010, that are related to
21implementing the Patient Protection and Affordable Care Act.
AB531-ASA1,4,2 22(3) Specific agency requirements. (a) In the report under sub. (2), the
23department of health services shall include the average spending per recipient for
24Medical Assistance programs, and the spending for Medical Assistance programs as

1a percentage of the state budget, for that year and in an analysis of any change in
2spending after March 23, 2010.
AB531-ASA1,4,63 (b) In the report under sub. (2), the department of safety and professional
4services shall include the number of physicians practicing in the state in that year
5and in an analysis of any change in the number of physicians practicing after March
623, 2010.
AB531-ASA1,4,107 (c) In the report under sub. (2), the office of the commissioner of insurance shall
8include the number of insurance companies that offer health care plans, as defined
9in s. 628.36 (2) (a) 1., in the state for that year and in an analysis of any change in
10the number of insurers after March 23, 2010.
AB531-ASA1, s. 2 11Section 2. 49.45 (2m) (c) (intro.) of the statutes, as affected by 2011 Wisconsin
12Act 32
, section 1423k, is amended to read:
AB531-ASA1,4,1713 49.45 (2m) (c) (intro.) Subject to par. pars. (d) and (dm), if the department
14determines, as a result of the study under par. (b), that revision of existing statutes
15or rules would be necessary to advance a purpose described in par. (b) 1. to 7., the
16department may propose a policy that makes any of the following changes related to
17Medical Assistance programs:
AB531-ASA1, s. 3 18Section 3. 49.45 (2m) (dm) of the statutes is created to read:
AB531-ASA1,4,2419 49.45 (2m) (dm) The department may not follow the procedures under this
20section to implement a policy that involves an action to implement the Patient
21Protection and Affordable Care Act, as defined in s. 146.965 (1) (b). If the department
22proposes a policy under par. (c) that involves an action to implement the Patient
23Protection and Affordable Care Act, the department shall comply with the procedure
24under s. 146.965 (2) before taking the action.
AB531-ASA1, s. 4 25Section 4. 146.965 of the statutes is created to read:
AB531-ASA1,5,2
1146.965 Implementation of federal health reform. (1) Definitions. In
2this section:
AB531-ASA1,5,53 (a) "Agency" means a board, commission, committee, department, or officer in
4the state government, except the governor, a district attorney, or a military or judicial
5officer.
AB531-ASA1,5,86 (b) "Patient Protection and Affordable Care Act" means the federal Patient
7Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health
8Care and Education Reconciliation Act of 2010, P.L. 111-152.
AB531-ASA1,5,17 9(2) Legislation required; exceptions. (a) Notwithstanding s. 227.11 (2), before
10an agency takes any action to implement any portion of title I or II or subtitle A or
11B of title X of the Patient Protection and Affordable Care Act for which the agency
12would typically promulgate a rule, the agency shall request that the legislative
13reference bureau prepare legislation that allows the agency to take the action. The
14agency shall submit the proposed legislation to each standing committee of each
15house of the legislature that has jurisdiction over health or insurance matters under
16s. 13.172 (3). The agency may not take the action until the legislation allowing the
17agency to take the action takes effect.
AB531-ASA1,5,2218 (b) No agency may request a grant or other moneys from the federal
19government to implement title I or II or subtitle A or B of title X of the Patient
20Protection and Affordable Care Act, unless the state legislature has enacted
21legislation to allow the request for the grant or other moneys and the legislation is
22in effect.
AB531-ASA1,6,323 (c) No agency may expend any moneys of this state, or of any subdivision or
24agency of this state, or any federal moneys passing through the state treasury to
25assist the federal government in implementing any portion of title I or II or subtitle

1A or B of title X of the Patient Protection and Affordable Care Act unless the state
2legislature has enacted legislation to allow the agency to expend those moneys and
3the legislation is in effect.
AB531-ASA1,6,54 (d) 1. This subsection does not prohibit an agency from taking any of the
5following actions in the absence of legislation allowing the agency to take the action:
AB531-ASA1,6,86 a. Exchanging or providing information about, communicating or advising
7about, or discussing the Patient Protection and Affordable Care Act with any person
8or agency.
AB531-ASA1,6,109 b. Reviewing, analyzing, or researching the Patient Protection and Affordable
10Care Act.
AB531-ASA1,6,1211 c. Addressing consumer complaints regarding the Patient Protection and
12Affordable Care Act.
AB531-ASA1,6,1613 2. If the office of the commissioner of insurance receives a report of a medical
14loss ratio from an insurer, the office of the commissioner of insurance may review the
15medical loss ratio to determine if the insurer is experiencing financial problems and
16may work with the insurer to resolve those financial problems.
AB531-ASA1,6,1917 3. This subsection does not prohibit a secretary or commissioner of an agency
18from serving on any board that discusses and considers the effects of the Patient
19Protection and Affordable Care Act.
AB531-ASA1,7,620 (e) Notwithstanding pars. (a) to (c), an agency may request any grant or other
21moneys from the federal government under the Patient and Protection and
22Affordable Care Act for the purposes under section 1003, 2403, 2405, 2703, 2704,
232706, or 2954 of the Patient Protection and Affordable Care Act; for aging and
24disability options counseling and assistance programs; for smoking cessation
25programs for Medical Assistance program recipients; for the Family Care program

1as described in ss. 46.2805 to 46.2895 or any other long-term care program operated
2under the Medical Assistance program; and for any purpose for which the grant or
3other moneys were available from the federal government before March 24, 2010. If
4the agency receives the grant or other moneys under this paragraph, the agency may
5implement the project or program for which the grant or other moneys are received
6and may expend the grant or other moneys.
AB531-ASA1, s. 5 7Section 5. 601.46 (3) (k) of the statutes is created to read:
AB531-ASA1,7,128 601.46 (3) (k) A review of the effect the implementation of the Patient
9Protection and Affordable Care Act, as defined in s. 20.9265 (1) (c), has on rates of
10health care plans, as defined in s. 628.36 (2) (a) 1., whether offered inside or outside
11of any health insurance exchange, that are not issued through a governmental body.
12The review shall include the average rate for each health care plan.
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