Amendment SSA1-AB416

AB416-SSA1,54,8 3. An evaluation of the plan's operation and, effectiveness and availability.

AB416-SSA1, s. 100 Section 100. 635.23 (4) and (5) of the statutes are amended to read:

AB416-SSA1,54,16 635.23 (4) In the formulation of the plan, for the purpose of cost containment the plan board shall encourage the use, to the extent possible, of the services of health care providers other than physicians. The plan board shall report any recommendations on ways to encourage the use of the services of health care providers other than physicians to the chief clerk of each house of the legislature for distribution under s. 13.172 (3) to the standing committees with jurisdiction over health insurance under s. 13.172 (3).

AB416-SSA1,54,20 (5) The plan board may submit any recommendations for legislation to improve the plan to the chief clerk of each house of the legislature for distribution under s. 13.172 (3) to the standing committees with jurisdiction over health insurance under s. 13.172 (3).

AB416-SSA1, s. 101 Section 101. 635.25 (title) of the statutes is amended to read:

AB416-SSA1,54,22 635.25 (title) Eligibility for participation in plan.

AB416-SSA1, s. 102 Section 102. 635.25 (1) (a) (intro.) of the statutes is amended to read:

AB416-SSA1,54,25 635.25 (1) (a) (intro.) To be eligible to participate in the plan by purchasing purchase a policy under this subchapter containing the basic benefits, an employer:

AB416-SSA1, s. 103 Section 103. 635.25 (1) (b) of the statutes is amended to read:

AB416-SSA1,55,5 635.25 (1) (b) Except as provided in ss. 645.43 and 646.35, an a small employer that purchases a policy under this subchapter containing the basic benefits and that ceases to be eligible to participate in the plan during a policy period shall retain coverage under the plan policy to the end of the policy period.

AB416-SSA1, s. 104 Section 104. 635.25 (1m) of the statutes is amended to read:

AB416-SSA1,55,10 635.25 (1m) Notwithstanding sub. (1), an a small employer is not eligible to participate in the plan purchase a policy under this subchapter containing the basic benefits if all of the individuals to be covered under the plan policy may be covered by a single under an individual policy providing individual single or family coverage.

AB416-SSA1, s. 105 Section 105. 635.25 (2) of the statutes is amended to read:

AB416-SSA1,55,14 635.25 (2) Employes and dependents. (a) All eligible employes of an eligible small employer that participates in the plan purchases a policy under this subchapter are eligible for coverage under the plan policy, subject to the policy terms.

AB416-SSA1,55,16 (b) Any dependent of an eligible employe who is covered under the plan policy is also eligible for coverage under the plan policy, subject to the policy terms.

AB416-SSA1, s. 106 Section 106. 635.254 of the statutes is amended to read:

AB416-SSA1,55,22 635.254 Employer premium contribution. (1) An A small employer that participates in the plan purchases a policy under this subchapter shall pay a premium contribution of not less than 50% of the premium rate on behalf of an eligible employe with individual single coverage and not less than 40% of the premium rate on behalf of an eligible employe with family coverage.

AB416-SSA1,55,25 (2) An A small employer under sub. (1) shall withhold from the earnings of an employe with coverage under the plan policy under this subchapter the amount of premium not contributed by the small employer under sub. (1).

AB416-SSA1,56,5 (3) For an eligible employe who obtains coverage under the health insurance risk-sharing plan under s. 619.12 (2) (e) 2., an a small employer under sub. (1) shall pay a premium contribution to the health insurance risk-sharing plan that is equal to the amount that the small employer would pay on behalf of the employe for coverage under the plan policy under this subchapter.

AB416-SSA1, s. 107 Section 107. 635.26 of the statutes is repealed.

AB416-SSA1, s. 108 Section 108. 635.272 (1) of the statutes is amended to read:

AB416-SSA1,56,12 635.272 (1) Contracting health care providers. A health care provider that contracts with a small employer insurer to provide services to individuals with coverage under the plan a policy under this subchapter shall accept amounts payable under the contract for the basic benefits under the policy as payment in full for those services. This subsection does not affect liability for deductibles or copayments.

AB416-SSA1, s. 109 Section 109. 635.28 of the statutes is amended to read:

AB416-SSA1,56,17 635.28 Liability of state and plan board. Neither the state nor the plan board is liable for any obligation arising under the plan. Plan board members are immune from civil liability for acts or omissions while performing in the performance of their duties under this subchapter.

AB416-SSA1, s. 110 Section 110. 635.29 (title) of the statutes is repealed and recreated to read:

AB416-SSA1,56,19 635.29 (title) Applicability of health insurance mandates.

AB416-SSA1, s. 111 Section 111. Nonstatutory provisions.

AB416-SSA1,57,2 (1)  Risk adjustment committee. The commissioner of insurance shall appoint a committee on risk adjustment under section 15.04 (1) (c) of the statutes, consisting of 5 to 8 members, to advise the commissioner on, and to assist the commissioner in developing rules for, the group risk adjustment mechanism under section 635.07 (4) of the statutes, as affected by this act. The commissioner shall appoint at least 5 representatives of insurers to be members of the committee.

AB416-SSA1,57,10 (2)  Risk adjustment mechanism emergency rule-making authority. Using the procedure under section 227.24 of the statutes, the commissioner of insurance may promulgate rules under section 635.07 (4) (e) of the statutes, as affected by this act, for the period before the effective date of the permanent rules promulgated under section 635.07 (4) (e) of the statutes, as affected by this act, but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) and (3) of the statutes, the commissioner is not required to make a finding of emergency.

AB416-SSA1,57,11 (3)  Health insurance risk-sharing plan board member terms.

AB416-SSA1,57,15 (a)  Notwithstanding section 15.07 (1) (c) of the statutes and section 619.15 (1) of the statutes, as affected by this act, the terms of the 7 appointed members currently serving on the board of governors of the health insurance risk-sharing plan shall expire on July 1, 1996.

AB416-SSA1,57,18 (b)  Notwithstanding section 619.15 (1) of the statutes, as affected by this act, the new members of the board of governors of the health insurance risk-sharing plan shall be appointed for the following terms:

AB416-SSA1,57,21 1. One representative of an insurer, one representative of a health care provider and one public member, to be determined by the commissioner, for terms expiring on May 1, 1997.

AB416-SSA1,57,24 2. One representative of an insurer, one representative of a health care provider and one public member, to be determined by the commissioner, for terms expiring on May 1, 1998.

AB416-SSA1,58,3 3. One representative of an insurer, one representative of a health care provider and one public member, to be determined by the commissioner, for terms expiring on May 1, 1999.

AB416-SSA1,58,4 (4)  Study by health insurance risk-sharing plan board.

AB416-SSA1,58,7 (a)  The board of governors of the health insurance risk-sharing plan shall study alternatives for reducing costs under the plan through the use of managed care plans. The board shall study at least all of the following:

AB416-SSA1,58,10 1.  The feasibility of including plan enrollees in the program administered by the department of health and social services that provides health care services to medical assistance recipients through managed care providers.

AB416-SSA1,58,13 2.  The development of a competitive bid process for the provision of covered services to plan enrollees. As part of this requirement, the board shall consider all of the following competitive bidding and pricing alternatives:

AB416-SSA1,58,14 a.  Fully capitated bids.

AB416-SSA1,58,18 b.  Bids under which the health insurance risk-sharing plan and the health care plan providing the covered services share the risk that costs will exceed a predetermined amount and the savings when costs are below a predetermined amount.

AB416-SSA1,58,19 c.  Bids under which only specified services are provided on a capitated basis.

AB416-SSA1,58,21 d.  Bids under which only identified groups of plan enrollees are covered on a capitated basis.

AB416-SSA1,58,24 (b)  The board shall submit a report of the results of the study and its recommendations to the legislature under section 13.172 (2) of the statutes no later than July 1, 1996.

AB416-SSA1,59,5 (5)  Rules on health insurance risk-sharing plan managed care initiative. The board of governors of the health insurance risk-sharing plan shall submit in proposed form the rules required under section 619.145 (1m) of the statutes, as created by this act, to the legislative council staff under section 227.15 (1) of the statutes no later than January 1, 1997.

AB416-SSA1,59,6 (6)  Study on establishing a basic health insurance plan.

AB416-SSA1,59,9 (a)  The department of health and social services and the office of the commissioner of insurance shall jointly study the establishment of a basic health insurance plan. The study shall include consideration of all of the following:

AB416-SSA1,59,13 1. The feasibility of including coverage under the basic health insurance plan for different groups of people, including low-income persons, persons with coverage under the health insurance risk-sharing plan and recipients of medical assistance or health care benefits under another public assistance program.

AB416-SSA1,59,14 2.  The benefits to be provided under the basic health insurance plan.

AB416-SSA1,59,18 3.  A plan and a timetable for phasing out the imposition of surcharges under section 619.13 of the statutes, as affected by this act, for the health insurance risk-sharing plan and for replacing the lost revenues with other funds, including premiums collected for the basic health insurance plan or state or federal funds.

AB416-SSA1,59,22 (b)  The department of health and social services and the office of the commissioner of insurance shall submit a report of the study with their recommendations, addressing each of the items under paragraph (a), to the legislature under section 13.172 (2) of the statutes no later than January 1, 1997.

AB416-SSA1,59,23 (7)  Evaluation of market reforms.

AB416-SSA1,60,3 (a) The commissioner of insurance shall evaluate the effectiveness of the health insurance market reforms under chapter 635 of the statutes, as affected by this act, including the effectiveness of the reforms with respect to all of the following:

AB416-SSA1,60,5 1. Accessibility of health insurance coverage, including such accessibility for persons who reside in rural areas of the state.

AB416-SSA1,60,6 2.  Availability of health insurance coverage for uninsured persons.

AB416-SSA1,60,7 3.  Affordability of health insurance coverage.

AB416-SSA1,60,10 (b) The commissioner shall submit a report of the results of the evaluation and any recommendations to the legislature under section 13.172 (2) of the statutes no later than the first day of the 24th month beginning after publication.

AB416-SSA1, s. 112 Section 112 . Initial applicability.

AB416-SSA1,60,22 (1) Health insurance market reform. The treatment of sections 40.51 (8) and (8m), 111.70 (4) (o), 111.91 (2) (L), 120.13 (2) (g), 185.983 (1g), 625.12 (2), 628.34 (3) (a) and (b), 632.76 (2) (a), 632.896 (4), 635.01, 635.02, 635.03, 635.04, 635.05, 635.07, 635.09, 635.11 (intro.), (1) and (4), 635.13, 635.15, 635.16, 635.17, 635.18 (title), (1) (a) and (b), (2), (3), (4), (5), (6), (7) and (8), 635.20 (1c), (1m), (2) and (13), 635.23 (1) (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3., (4) and (5), 635.25 (1) (a) (intro.) and (b), (1m) and (2), 635.254, 635.26, 635.272 (1) and 635.28 of the statutes, the renumbering of section 635.18 (1) of the statutes, the amendment of section 66.184 (1) of the statutes, the repeal and recreation of section 111.70 (1) (a) (by Section 14 of the statutes and the creation of section 60.23 (25) (h) and (i) of the statutes first apply to all of the following:

AB416-SSA1,60,25 (a)  Except as provided in paragraphs (b) and (c), health benefit plans that are issued or renewed, and self-insured health plans that are established, extended, modified or renewed, on the effective date of this paragraph.

AB416-SSA1,61,3 (b) Health benefit plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

AB416-SSA1,61,4 1.  The day on which the collective bargaining agreement expires.

AB416-SSA1,61,6 2.  The day on which the collective bargaining agreement is extended, modified or renewed.

AB416-SSA1,61,9 (c) Self-insured health plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified or renewed on the earlier of the following:

AB416-SSA1,61,10 1.  The day on which the collective bargaining agreement expires.

AB416-SSA1,61,12 2.  The day on which the collective bargaining agreement is extended, modified or renewed.

AB416-SSA1, s. 113 Section 113. Effective dates. This act takes effect on the day after publication, except as follows:

AB416-SSA1,62,2 (1)  Health insurance market reform. The treatment of sections 40.51 (8) and (8m), 111.70 (4) (o), 111.91 (2) (L), 120.13 (2) (g), 185.983 (1g), 625.12 (2), 628.34 (3) (a) and (b), 632.76 (2) (a), 632.896 (4), 635.01, 635.02, 635.03, 635.04, 635.05, 635.07, 635.09, 635.11 (intro.), (1) and (4), 635.13, 635.15, 635.16, 635.17, 635.18 (title), (1) (a) and (b), (2), (3), (4), (5), (6), (7) and (8), 635.20 (1c), (1m), (2) and (13), 635.23 (1) (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3., (4) and (5), 635.25 (title), (1) (a) (intro.) and (b), (1m) and (2), 635.254, 635.26, 635.272 (1), 635.28 and 635.29 (title) and chapter 635 (title) of the statutes, the renumbering of section 635.18 (1) of the statutes, the amendment of section 66.184 (1) of the statutes, the repeal and recreation of section 111.70 (1) (a) (by Section 15) of the statutes, the creation of section 60.23 (25) (h) and (i) of the statutes and Section 112 of this act take effect on the first day of the 12th month beginning after publication.

AB416-SSA1,62,12 (2) Health insurance risk-sharing plan surcharge. The treatment of sections 619.14 (5) (d), 619.145 (1) and (1m), 619.15 (1) and 619.165 (1) (a) and (2) of the statutes, the repeal of sections 619.145 (3) (e) and (4) and 619.15 (4) (e) of the statutes, the renumbering of section 66.184 of the statutes, the renumbering and amendment of section 60.23 (25) of the statutes, the amendment of sections 111.70 (1) (a), 619.135 (2) and (3), 619.15 (3) (c) and 619.175 of the statutes, the repeal and recreation of sections 619.10 (3m) (by Section 27 ), 619.13 (by Section 29 ) and 619.15 (4) (c) (by Section 53) of the statutes and the creation of sections 40.51 (8c), 60.23 (25) (a), 66.184 (2), 111.70 (4) (n), 111.91 (2) (k), 120.13 (2) (gm) and 619.15 (3) (bc) and (bm) of the statutes take effect on July 1, 1996.

AB416-SSA1,62,22 (3)  Invalid surcharge and insurer assessment. The repeal of sections 40.51 (8c), 60.23 (25) (a), 66.184 (2), 111.70 (4) (n), 111.91 (2) (k), 120.13 (2) (gm) and 619.15 (3) (bc) and (bm) of the statutes, the repeal and recreation of sections 111.70 (1) (a) (by Section 16), 619.10 (3m) (by Section 28 ), 619.13 (by Section 30 ), 619.135 (2) (by Section 32) and (3) (by Section 35 ), 619.15 (3) (c) and (4) (c) (by Section 54) and 619.175 (by Section 62 ) of the statutes and the creation of sections 619.145 (3) (e) and (4) and 619.15 (4) (e) of the statutes take effect on the date on which the commissioner of insurance certifies to the revisor of statutes under section 619.13 (6) (b) of the statutes, as affected by this act, that the surcharge or its application is invalid with respect to all persons.

AB416-SSA1,63,3 (4)  Health insurance risk-sharing plan waiver or exemption. The repeal and recreation of sections 619.135 (2) (by Section 33) and (3) (by Section 36) and 619.175 (by Section 63) of the statutes takes effect on the day after 2 years after the date on which the commissioner of insurance certifies to the revisor of statutes under section 619.13 (6) (b) of the statutes, as affected by this act, that the surcharge or its application is invalid with respect to all persons.

AB416-SSA1,63,4 (End)