648.45(8)(a)
(a) No director or officer of a permittee or of an affiliate of a permittee may permit, participate in, or assent to a transaction or payment or acceptance of a dividend or distribution prohibited under this chapter.
648.45(8)(b)
(b) An officer or director of a permittee or of an affiliate of a permittee who knows, or reasonably should know, that the permittee or affiliate has entered into a transaction or paid a dividend or distribution that violates this chapter shall report the transaction, dividend, or distribution to the commissioner in writing within 30 days after attaining that knowledge. Section
648.15 (6) applies to a report under this section, and the report is confidential unless the commissioner finds it necessary to disclose the report for the purpose of enforcing this chapter.
648.45 History
History: 2009 a. 28;
2011 a. 257 s.
56.
648.50
648.50
Management changes. 648.50(1)(1)
Approval required. No proposed plan of merger or other plan for acquisition of control of a permittee may be executed unless the commissioner, after consulting with the department, approves the plan.
648.50(2)
(2)
Grounds for approval. The commissioner shall approve the plan under this section if the commissioner finds, after a hearing, that it would not violate the law or be contrary to the interests of the public, the department, or the enrollees.
648.50(3)
(3)
Information required. A permittee shall report to the commissioner any changes in directors or principal officers after a permit is issued, together with biographical data on the new director or officer that the commissioner requires by rule.
648.50 History
History: 2009 a. 28.
648.55
648.55
Commissioner's summary orders. 648.55(1)(1)
The commissioner, after consulting with the department, may make and serve an order on a permittee, requiring it to stop providing services under the department contract, or to take corrective measures, without notice and before hearing, if it appears to the commissioner that irreparable harm to the property or business of the permittee or to the interests of its enrollees or the public, will occur unless the commissioner acts with immediate effect and one of the following applies:
648.55(1)(a)
(a) The permittee is not in compliance with a rule establishing standards for the financial condition of care management organizations.
648.55(1)(b)
(b) Grounds exist to suspend or revoke the permittee's permit.
648.55(2)
(2) An order issued under this subsection is effective immediately.
648.55(3)
(3) The permittee has the rights provided under s.
601.62. The commissioner may serve upon the permittee notice of hearing under the procedures under s.
601.62 simultaneously with service of the order under sub.
(1).
648.55(4)
(4) The commissioner may keep proceedings under this section confidential.
648.55 History
History: 2009 a. 28.
648.65
648.65
Enrollee immunity. 648.65(1)(1)
Immunity. An enrollee of a care management organization is not liable for health care, service, equipment, or supply charges that are covered under the care management organization's contract with the department.
648.65(2)
(2)
Prohibited recovery attempts. No person may bill, charge, collect a deposit from, seek compensation from, file or threaten to file with a credit reporting agency with respect to, or have any recourse against an enrollee or any person acting on the enrollee's behalf, for any health care, service, equipment, or supply charges for which the enrollee or person acting on his or her behalf is not liable under sub.
(1).
648.65(3)
(3)
Immunity not affected. The immunity of an enrollee under subs.
(1) and
(2) is not affected by any of the following:
648.65(3)(a)
(a) A breach or default on an agreement by the care management organization or the failure of any person to compensate the provider.
648.65(3)(b)
(b) The insolvency of the care management organization or any person contracting with the care management organization or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency, or bankruptcy proceedings involving the care management organization or other person, regardless of whether the care management organization or other person has agreed to compensate, directly or indirectly, the provider for health care, services, equipment, or supplies for which the enrollee is not liable under sub.
(1) 648.65(3)(c)
(c) The inability of the provider or other person who is owed compensation for health care, services, equipment, or supplies to obtain compensation from the care management organization.
648.65 History
History: 2009 a. 28.
648.75
648.75
Insolvency funding. 648.75(1)(1)
Deposit required. A permittee shall deposit an amount established by the contract with the department, and not less than $250,000, using the procedures under s.
601.13.
648.75(2)
(2)
Release of deposit. A deposit under this section may be released only with the approval of the commissioner, after consulting with the department, by the procedures under s.
601.13 (10) and only in one of the following circumstances:
648.75(2)(b)
(b) To pay creditors of the permittee according to the priority determined by the department if the permittee is insolvent, dissolves, or is subject to an insolvency proceeding, including a bankruptcy proceeding.
648.75(3)
(3)
Assessment. The department may assess an amount from each permittee's deposit for the purpose of funding arrangements for, or to pay expenses related to, services for enrollees of an insolvent or financially hazardous permittee. The department's assessment shall be allocated to each permittee's deposit in an amount that reflects the permittee's proportionate share of projected enrollment in the department's annual contracting period. The commissioner may authorize release, and the department of administration shall pay to the department the assessed amount for the purposes of this subsection.
648.75(4)
(4)
Restoration. A permittee shall restore its deposit that is subject to an assessment under sub.
(3) within 30 days after the assessment, unless the office, after consulting with the department, authorizes a longer period, which shall not exceed 2 years.
648.75(5)
(5)
Recovery. The department may recover, and may file a claim or bring civil action to recover, from the insolvent or financially hazardous permittee any amount that the department assesses and pays under sub.
(3). Any amount recovered shall be restored to each permittee's deposit in the same proportion as the assessment.
648.75 History
History: 2009 a. 28.
