AB64-ASA1-AA8,6,20 2013. Page 531, line 15: after that line insert:
AB64-ASA1-AA8,6,21 21 Section 933t. 49.471 (4m) of the statutes is created to read:
AB64-ASA1-AA8,7,1122 49.471 (4m) Purchase options for BadgerCare Plus and the assistance for
23childless adults demonstration project.
(a) 1. The department shall, if required,
24request a waiver from or submit amendments to the state Medical Assistance plan

1to the secretary of the federal department of health and human services to establish
2a program that allows individuals with income above the maximum income
3eligibility limit applicable under this section or the assistance for childless adults
4demonstration project under s. 49.45 (23), and who otherwise meet the eligibility
5requirements under this section or under s. 49.45 (23), the option of purchasing
6coverage through this section or through the demonstration project under s. 49.45
7(23) instead of purchasing an individual health plan through private insurance. The
8department shall also include a request for any federal waiver or state Medical
9Assistance plan amendments necessary to allow an option for small businesses to
10purchase coverage for their employees under this section as part of the small
11business health options program through an exchange under 42 USC 18031.
AB64-ASA1-AA8,7,1512 2. The department shall seek any federal waiver and state Medical Assistance
13plan amendments necessary to allow individuals who qualify under subd. 1. to use
14advanced tax credits and cost-sharing credits, if eligible, to purchase one of the
15options described under subd. 1.
AB64-ASA1-AA8,7,2416 (b) 1. The department shall coordinate the administration of the purchase
17options under this subsection with the programs under this section and s. 49.45 (23)
18to maximize efficiency and improve the continuity of care, consistent with the
19requirements of this section and s. 49.45 (23). The department shall seek to
20implement mechanisms to ensure the long-term financial sustainability of the
21programs under this section and s. 49.45 (23). These mechanisms must address
22issues related to minimizing adverse selection, the state financial risk and
23contribution, and negative impacts to premiums in the individual and group
24insurance markets.
AB64-ASA1-AA8,8,2
12. The purchase option program shall include, at a minimum, all of the
2following attributes:
AB64-ASA1-AA8,8,43 a. Establishment of an annual per enrollee premium rate similar to the average
4rate paid by the state to managed care plan contractors.
AB64-ASA1-AA8,8,65 b. Establishment of a benefit set equal to the benefits covered under this section
6and s. 49.45 (23).
AB64-ASA1-AA8,8,87 c. Annual enrollment that is limited to the same annual open enrollment
8periods established for the programs under this section and s. 49.45 (23).
AB64-ASA1-AA8,8,109 d. The ability for the department to adjust the purchase option's actuarial value
10to a value no lower than 87 percent.
AB64-ASA1-AA8,8,1211 e. Reimbursement mechanisms for addressing potential increased costs to the
12programs under this section and s. 49.45 (23).
AB64-ASA1-AA8,8,1713 (c) By March 1, 2018, the department of health services shall submit a report
14to the appropriate standing committee in each house of the legislature under s.
1513.172 (3) that provides information on the status of the request for a federal waiver
16and the results from actuarial and economic analyses that are necessary for a waiver
17proposal.
AB64-ASA1-AA8,8,2318 (d) If any necessary waiver or amendments to the state plan described under
19par. (a) 1. are approved, the department shall implement the program. If the
20department is authorized to implement the program, and if any waiver or state plan
21amendment described under par. (a) 2. is necessary and is approved, or if the
22department determines neither a waiver nor state plan amendment is necessary, the
23department shall allow the purchase options described under par. (a) 2.”.
AB64-ASA1-AA8,8,24 2414. Page 563, line 2: after that line insert:
AB64-ASA1-AA8,9,2
1 Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act
230
, is amended to read:
AB64-ASA1-AA8,9,93 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
4a village provides health care benefits under its home rule power, or if a town
5provides health care benefits, to its officers and employees on a self-insured basis,
6the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
7632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,
8632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17),
9632.896, and 767.513 (4).”.
AB64-ASA1-AA8,9,10 1015. Page 563, line 2: after that line insert:
AB64-ASA1-AA8,9,12 11 Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act
1230
, is amended to read:
AB64-ASA1-AA8,9,1813 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
14a village provides health care benefits under its home rule power, or if a town
15provides health care benefits, to its officers and employees on a self-insured basis,
16the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
17632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867,
18632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).”.
AB64-ASA1-AA8,9,19 1916. Page 563, line 2: after that line insert:
AB64-ASA1-AA8,9,21 20 Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act
2130
, is amended to read:
AB64-ASA1-AA8,9,24 2266.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
23a village provides health care benefits under its home rule power, or if a town
24provides health care benefits, to its officers and employees on a self-insured basis,

1the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
2632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867,
3632.87 (4) to (6), 632.883, 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513
4(4).”.
AB64-ASA1-AA8,10,5 517. Page 831, line 3: after that line insert:
AB64-ASA1-AA8,10,7 6 Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin
7Act 30
, is amended to read:
AB64-ASA1-AA8,10,118 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and
10(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6),
11632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.
AB64-ASA1-AA8,10,12 1218. Page 831, line 3: after that line insert:
AB64-ASA1-AA8,10,14 13 Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin
14Act 30
, is amended to read:
AB64-ASA1-AA8,10,1815 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),
17632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89,
18632.895 (9) (8) to (17), 632.896, and 767.513 (4).”.
AB64-ASA1-AA8,10,19 1919. Page 831, line 3: after that line insert:
AB64-ASA1-AA8,10,21 20 Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin
21Act 30
, is amended to read:
AB64-ASA1-AA8,11,222 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
2349.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),

1632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.883, 632.885,
2632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.
AB64-ASA1-AA8,11,3 320. Page 857, line 18: after that line insert:
AB64-ASA1-AA8,11,5 4 Section 1691am. 185.983 (1) (intro.) of the statutes, as affected by 2017
5Wisconsin Act 30
, is amended to read:
AB64-ASA1-AA8,11,136 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
7cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
8646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
9601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
10631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
11632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and
12(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
13the sponsoring association shall:”.
AB64-ASA1-AA8,11,14 1421. Page 857, line 18: after that line insert:
AB64-ASA1-AA8,11,15 15 Section 1691am. 185.983 (1) (intro.) of the statutes is amended to read:
AB64-ASA1-AA8,11,2316 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
17cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
18646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
19601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
20631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
21632.853, 632.855, 632.867, 632.87 (2) to (6), 632.883, 632.885, 632.89, 632.895 (5) and
22(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
23the sponsoring association shall:”.
AB64-ASA1-AA8,11,24 2422. Page 876, line 22: after that line insert:
AB64-ASA1-AA8,12,1
1 Section 1791df. 253.07 (title) of the statutes is amended to read:
AB64-ASA1-AA8,12,2 2253.07 (title) Women's health block grant; state family planning funds.
AB64-ASA1-AA8,1791dh 3Section 1791dh. 253.07 (6) of the statutes is created to read:
AB64-ASA1-AA8,12,44 253.07 (6) State-funded family planning program. (a) In this subsection:
AB64-ASA1-AA8,12,95 1. “Federal funding prohibition” means an enacted federal law, a regulation,
6or an executive order or action that prohibits federal moneys from being paid by the
7state to or directly to a provider under Title X of the federal Public Health Service
8Act, 42 USC 300 to 300a-6, because of the scope of services offered by the provider
9or the scope of services for which the provider offers referrals.
AB64-ASA1-AA8,12,1310 2. “Nonpublic family planning provider” means an entity other than a public
11entity or governmental unit that is a provider of services for family planning and that
12is eligible to apply for grant funding under Title X of the federal Public Health Service
13Act, 42 USC 300 to 300a-6, on December 31, 2016.
AB64-ASA1-AA8,12,1914 (b) Notwithstanding sub. (5), if a nonpublic family planning provider becomes
15subject to a federal funding prohibition, the department shall establish a
16state-funded family planning program to ensure continuity of family planning
17services in the state and distribute state funds to any nonpublic family planning
18providers that are subject to a federal funding prohibition to be used to provide family
19planning services.”.
AB64-ASA1-AA8,12,20 2023. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,12,21 21 Section 2218s. 625.02 (1) of the statutes is renumbered 625.02 (1m).
AB64-ASA1-AA8,2218t 22Section 2218t. 625.02 (1j) of the statutes is created to read:
AB64-ASA1-AA8,12,2323 625.02 (1j) “Health insurance" has the meaning given in s. 632.745 (12).
AB64-ASA1-AA8,2218u 24Section 2218u. 625.03 (1m) (intro.) of the statutes is amended to read:
AB64-ASA1-AA8,13,4
1625.03 (1m) (intro.) This Except as specifically provided otherwise in this
2chapter, this
chapter applies to all kinds and lines of direct insurance written on risks
3or operations in this state by any insurer authorized to do business in this state,
4except:
AB64-ASA1-AA8,2218v 5Section 2218v. 625.13 (1) of the statutes is amended to read:
AB64-ASA1-AA8,13,116 625.13 (1) Filing procedure. Except as provided in sub. (2) and s. 625.25 (2)
7(a)
, every authorized insurer and every rate service organization licensed under s.
8625.31 which has been designated by any insurer for the filing of rates under s.
9625.15 (2) shall file with the commissioner all rates and supplementary rate
10information and all changes and amendments thereof made by it for use in this state
11within 30 days after they become effective.
AB64-ASA1-AA8,2218w 12Section 2218w. 625.15 (2) of the statutes is amended to read:
AB64-ASA1-AA8,13,2013 625.15 (2) Rate filing. An insurer may discharge its obligation under s. 625.13
14(1) or 625.25 (2) (a) by giving notice to the commissioner that it uses rates and
15supplementary rate information prepared by a designated rate service organization,
16with such information about modifications thereof as is necessary fully to inform the
17commissioner. The insurer's rates or proposed rates and supplementary rate
18information shall be those filed from time to time by the rate service organization,
19including any amendments or proposed amendments thereto as filed, subject,
20however, to the modifications filed by the insurer.
AB64-ASA1-AA8,2218x 21Section 2218x. 625.21 (1) of the statutes is amended to read:
AB64-ASA1-AA8,14,822 625.21 (1) Rule instituting delayed effect. If the commissioner finds that
23competition is not an effective regulator of the rates charged or that a substantial
24number of companies are competing irresponsibly through the rates charged, or that
25there are widespread violations of this chapter, in any kind or line of insurance or

1subdivision thereof or in any rating class or rating territory, he or she may
2promulgate a rule requiring that in the kind or line of insurance or subdivision
3thereof or rating class or rating territory comprehended by the finding any
4subsequent changes in the rates or supplementary rate information be filed with the
5commissioner at least 15 days before they become effective. The commissioner may
6extend the waiting period for not to exceed 15 additional days by written notice to
7the filer before the first 15-day period expires. This subsection does not apply to
8health insurance, which is subject to s. 625.25 (2) (a).
AB64-ASA1-AA8,2218y 9Section 2218y. 625.22 (1) of the statutes is amended to read:
AB64-ASA1-AA8,14,1310 625.22 (1) Order in event of violation. If the commissioner finds after a
11hearing that a rate or proposed rate is not in compliance with s. 625.11, the
12commissioner shall order that its use be discontinued, or that it may not be used, for
13any policy issued or renewed after a date specified in the order.
AB64-ASA1-AA8,2218z 14Section 2218z. 625.22 (3) of the statutes is amended to read:
AB64-ASA1-AA8,14,1915 625.22 (3) Approval of substituted rate. Within Except for rates for health
16insurance, which is subject to s. 625.25 (2) (a), within
one year after the effective date
17of an order under sub. (1), no rate promulgated to replace a disapproved one may be
18used until it has been filed with the commissioner and not disapproved within 30
19days thereafter.
AB64-ASA1-AA8,2219b 20Section 2219b. 625.23 of the statutes is amended to read:
AB64-ASA1-AA8,15,7 21625.23 Special restrictions on individual insurers. The commissioner
22may by order require that a particular insurer file any or all of its rates and
23supplementary rate information 15 days prior to their effective date, if and to the
24extent that he or she finds, after a hearing, that the protection of the interests of its
25insureds and the public in this state requires closer supervision of its rates because

1of the insurer's financial condition or rating practices. The commissioner may extend
2the waiting period for any filing for not to exceed 15 additional days by written notice
3to the insurer before the first 15-day period expires. A filing not disapproved before
4the expiration of the waiting period shall be deemed to meet the requirements of this
5chapter, subject to the possibility of subsequent disapproval under s. 625.22. This
6section does not apply to an insurer with respect to rates for health insurance, which
7is subject to s. 625.25 (2) (a).
AB64-ASA1-AA8,2219c 8Section 2219c. 625.25 of the statutes is created to read:
AB64-ASA1-AA8,15,9 9625.25 Rates for health insurance. (1) Definitions. In this section:
AB64-ASA1-AA8,15,1010 (a) “Group health benefit plan" has the meaning given in s. 632.745 (9).
AB64-ASA1-AA8,15,1111 (b) “Health benefit plan" has the meaning given in s. 632.745 (11).
AB64-ASA1-AA8,15,1212 (c) “Insurer" has the meaning given in s. 632.745 (15).
AB64-ASA1-AA8,15,1313 (d) “Large group market" has the meaning given in s. 632.745 (17).
AB64-ASA1-AA8,15,1414 (e) “Small group market" has the meaning given in s. 632.745 (26).
AB64-ASA1-AA8,16,6 15(2) Filing of rates; hearing. (a) Every insurer, and every rate service
16organization licensed under s. 625.31 that has been designated by any insurer for the
17filing of rates under s. 625.15 (2), shall file with the commissioner all proposed rates
18and supplementary rate information, and all proposed changes and amendments to
19rates and supplementary rate information, for use in this state for any health benefit
20plan offered by the insurer before the proposed rates or changes to rates become
21effective. An insurer may not use a proposed rate or change to a rate until it has been
22filed with and approved by the commissioner. Unless the commissioner holds a
23hearing on the proposed rate or change to a rate, a proposed rate or change to a rate
24is approved if the commissioner does not disapprove the proposed rate or change
25within 30 days after filing, or within a 30-day extension of that period ordered by the

1commissioner prior to the expiration of the first 30 days. The requirement under this
2paragraph applies with respect to rates and changes to rates for all health benefit
3plans, including individual health benefit plans, group health benefit plans offered
4in the small group market, and group health benefit plans offered in the large group
5market, that have not gone into effect by the effective date of this paragraph .... [LRB
6inserts date].
AB64-ASA1-AA8,16,97 (b) If any proposed change to a rate filed under par. (a) increases the existing
8rate by more than 10 percent of that rate, the commissioner shall hold a public
9hearing before approving or disapproving the proposed change to the rate.
AB64-ASA1-AA8,16,1210 (c) The commissioner may disapprove a proposed rate or change to a rate filed
11under par. (a) that the commissioner determines is not justified based on underlying
12medical costs.
AB64-ASA1-AA8,16,16 13(3) Publication of increases, negotiated rates. (a) The commissioner shall
14publish on the office's Internet site, in a format that is readily understandable by
15members of the public, all rate changes filed under sub. (2) (a) that increase an
16existing rate by any amount and that are approved.
AB64-ASA1-AA8,16,2117 (b) If the commissioner approves a rate increase after holding a hearing under
18sub. (2) (b) and the insurer justified the rate increase based on increased medical
19costs, the commissioner shall publish on the office's Internet site, in a format that is
20readily understandable by members of the public, the discounted payment rates the
21insurer has negotiated with each of the insurer's provider networks.
AB64-ASA1-AA8,16,25 22(4) Notice of rate increase to insureds. If the commissioner approves a rate
23increase filed under sub. (2) (a), the insurer shall provide notice of the rate increase
24to each insured under the health benefit plan at least 60 days before the rate increase
25goes into effect.”.
AB64-ASA1-AA8,17,1
124. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,17,2 2 Section 2218u. 609.713 of the statutes is created to read:
AB64-ASA1-AA8,17,4 3609.713 Essential health benefits. Defined network plans and preferred
4provider plans are subject to s. 632.895 (14m).
AB64-ASA1-AA8,2218y 5Section 2218y. 632.895 (14m) of the statutes is created to read:
AB64-ASA1-AA8,17,76 632.895 (14m) Essential health benefits. (a) In this subsection,
7“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB64-ASA1-AA8,17,108 (b) On a date specified by the commissioner, by rule, every disability insurance
9policy and every self-insured health plan shall provide coverage for essential health
10benefits as determined by the commissioner, by rule, subject to par. (c).
AB64-ASA1-AA8,17,1211 (c) In determining the essential health benefits for which coverage is required
12under par. (b), the commissioner shall do all of the following:
AB64-ASA1-AA8,17,1413 1. Include benefits, items, and services in, at least, all of the following
14categories:
AB64-ASA1-AA8,17,1515 a. Ambulatory patient services.
AB64-ASA1-AA8,17,1616 b. Emergency services.
AB64-ASA1-AA8,17,1717 c. Hospitalization.
AB64-ASA1-AA8,17,1818 d. Maternity and newborn care.
AB64-ASA1-AA8,17,2019 e. Mental health and substance use disorder services, including behavioral
20health treatment.
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