Amendment AA8-AA8-ASA1-AB100

AB100-ASA1-AA8-AA8,16,11 (4) Using the procedure under s. 227.24, the commissioner may promulgate rules under sub. (2) or (3) for the period before the effective date of any permanent rules promulgated under sub. (2) or (3), but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the commissioner is not required to make a finding of emergency.

AB100-ASA1-AA8-AA8,16,16 (5) Notwithstanding sub. (2) (a) (intro.), the commissioner shall set premium rates, insurer assessments and provider discount rates for the period beginning on January 1, 1998, and ending on June 30, 1998, in the manner provided in subs. (1), (2) (a), (3) and (4). This subsection applies to policies in effect on January 1, 1998, as well as to policies issued or renewed on or after January 1, 1998.

AB100-ASA1-AA8-AA8, s. 4859cm Section 4859cm. 619.145 of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4859mm Section 4859mm. 619.146 of the statutes is created to read:

AB100-ASA1-AA8-AA8,16,22 619.146 Choice of coverage. (1) (a) Beginning on January 1, 1998, in addition to the coverage required under s. 619.14, the plan shall offer to all eligible persons a choice of coverage, as described in section 2744 (a) (1) (C) of P.L. 104-191. Any such choice of coverage shall be major medical expense coverage.

AB100-ASA1-AA8-AA8,17,6 (b) An eligible person may elect once each year, at the time and according to procedures established by the board, among the coverages offered under this section and s. 619.14. If an eligible person elects new coverage, any preexisting condition exclusion imposed under the new coverage is met to the extent that the eligible person has been previously and continuously covered under this subchapter. No preexisting condition exclusion may be imposed on an eligible person who elects new coverage if the person was an eligible individual when first covered under this subchapter and the person remained continuously covered under this subchapter up to the time of electing new coverage.

AB100-ASA1-AA8-AA8,17,10 (2) (a) Except as specified by the board, the terms of coverage under s. 619.14, including deductible reductions under s. 619.14 (5) (a), do not apply to the coverage offered under this section. Premium reductions under s. 619.165 do not apply to the coverage offered under this section.

AB100-ASA1-AA8-AA8,17,15 (b) The schedule of premiums for coverage under this section shall be promulgated by rule by the commissioner, as provided in s. 619.143. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 619.14 by the same percentage as the percentage difference between the following:

AB100-ASA1-AA8-AA8,17,18 1. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 619.14.

AB100-ASA1-AA8-AA8,17,21 2. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as the coverage offered under this section.

AB100-ASA1-AA8-AA8, s. 4862m Section 4862m. 619.15 (1) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,18,15 619.15 (1) The plan shall operate subject to the supervision and approval of a board of governors consisting of representatives of 2 participating insurers which are nonprofit corporations, representatives of 2 other participating insurers, 3 health care provider representatives, including one representative of the State Medical Society of Wisconsin, one representative of the Wisconsin Health and Hospital Association and one representative of an integrated multidisciplinary health system, and 3 public members, including one representative of small businesses in the state, appointed by the commissioner for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the chairperson of the standing committee of each house of the legislature with jurisdiction over insurance shall be a member members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital or an insurer. At least 2 of the public members shall be individuals reasonably expected to qualify for coverage under the plan or the parent or spouse of such an individual. The commissioner or the commissioner's representative shall be the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the chairpersons of the standing committees, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.

AB100-ASA1-AA8-AA8, s. 4863m Section 4863m. 619.15 (2) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,18,22 619.15 (2) Annually, the board shall make a report to the members of the plan and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3), and to the members of the plan summarizing the activities of the plan in the preceding calendar year. The annual report shall define the cost burden imposed by the plan on all policyholders in this state.

AB100-ASA1-AA8-AA8, s. 4863pm Section 4863pm. 619.15 (2m) of the statutes is created to read:

AB100-ASA1-AA8-AA8,19,3 619.15 (2m) Annually, beginning in 1999, the board shall submit a report on or before June 30 to the legislature under s. 13.172 (2) and to the governor on the operation of the plan, including any recommendations for changes to the plan.

AB100-ASA1-AA8-AA8, s. 4867cm Section 4867cm. 619.15 (3) (c) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,19,11 619.15 (3) (c) Collect assessments from all insurers to provide for claims paid under the plan and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made. The level of payments shall be established by the board as provided under s. 619.143. Assessment of the insurers shall occur at the end of each calendar year or other fiscal year end established by the board. Assessments are due and payable within 30 days of receipt by the insurer of the assessment notice.

AB100-ASA1-AA8-AA8, s. 4869cm Section 4869cm. 619.15 (3) (e) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,19,17 619.15 (3) (e) Establish for payment of covered expenses, a payment rate that is 10% less than the charges approved by the administering carrier for reimbursement of covered expenses under s. 619.14 (3). A provider of a covered service or article may not bill an eligible person who receives the service or article for any amount by which the charge is reduced under this paragraph.

AB100-ASA1-AA8-AA8, s. 4869mm Section 4869mm. 619.15 (3) (f) of the statutes is created to read:

AB100-ASA1-AA8-AA8,19,20 619.15 (3) (f) In consultation with the office, establish a choice of coverage under s. 619.146.

AB100-ASA1-AA8-AA8, s. 4872mm Section 4872mm. 619.15 (4) (c) of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4873mm Section 4873mm. 619.15 (4) (d) of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4873pm Section 4873pm. 619.15 (4) (e) of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4887cm Section 4887cm. 619.16 (3) (em) of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4890c Section 4890c. 619.165 (1) (a) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,20,4 619.165 (1) (a) The Except as provided in s. 619.146 (2) (a), the board shall reduce the premiums established by the commissioner under s. 619.11 in conformity with ss. 619.14 (5) 619.143 and 619.17, for the eligible persons and in the manner set forth in pars. (b) to (d).

AB100-ASA1-AA8-AA8, s. 4891cm Section 4891cm. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d) 1. and amended to read:

AB100-ASA1-AA8-AA8,20,9 619.165 (1) (d) 1. The Subject to subd. 2., the board shall establish and implement the method for determining the household income of an eligible person under par. (b).

AB100-ASA1-AA8-AA8, s. 4891mm Section 4891mm. 619.165 (1) (d) 2. of the statutes is created to read:

AB100-ASA1-AA8-AA8,20,13 619.165 (1) (d) 2. In determining household income under par. (b), the board may consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:

AB100-ASA1-AA8-AA8,20,14 a. The person is a farmer, as defined in s. 102.04 (3).

AB100-ASA1-AA8-AA8,20,16 b. The person was not eligible to claim the homestead credit under subch. VIII of ch. 71 in the preceding taxable year.

AB100-ASA1-AA8-AA8, s. 4891rm Section 4891rm. 619.165 (3) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,20,20 619.165 (3) The commissioner shall forward to the board moneys received under s. 20.145 (7) (a) and (g) in an amount sufficient to reimburse the plan for premium reductions under sub. (1) and deductible reductions under s. 619.14 (5) (a).

AB100-ASA1-AA8-AA8, s. 4895c Section 4895c. 619.167 of the statutes is repealed.

AB100-ASA1-AA8-AA8, s. 4897m Section 4897m. 619.17 (1) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,20,24 619.17 (1) Subject to s. 619.14 (5) (a) ss. 619.143 and 619.146 (2) (b), a rating plan calculated in accordance with generally accepted actuarial principles.

AB100-ASA1-AA8-AA8, s. 4900m Section 4900m. 619.17 (4) (a) of the statutes is amended to read:

AB100-ASA1-AA8-AA8,21,2 619.17 (4) (a) Cost containment provisions established by the commissioner by rule, including managed care requirements.

AB100-ASA1-AA8-AA8, s. 4901cm Section 4901cm. 619.175 of the statutes is amended to read:

AB100-ASA1-AA8-AA8,21,8 619.175 Waiver or exemption from provisions prohibited. Except as provided in s. 619.13 (1) (a), the commissioner may not waive, or authorize the board to waive, any of the requirements of this subchapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this subchapter.".".

AB100-ASA1-AA8-AA8,21,9 15. Page 445, line 23: after that line insert:

AB100-ASA1-AA8-AA8,21,11 "1371w. Page 1825, line 22: delete the material beginning with that line and ending with page 1826, line 2.".

AB100-ASA1-AA8-AA8,21,12 16. Page 473, line 12: after that line insert:

AB100-ASA1-AA8-AA8,21,14 "1373c. Page 1826, line 23: delete the material beginning with that line and ending with page 1827, line 5.".

AB100-ASA1-AA8-AA8,21,15 17. Page 521, line 2: after that line insert:

AB100-ASA1-AA8-AA8,21,16 "1455c. Page 1978, line 1: delete lines 1 to 9.".

AB100-ASA1-AA8-AA8,21,17 18. Page 521, line 19: delete that line and substitute:

AB100-ASA1-AA8-AA8,21,18 "1459c. Page 1982, line 6: delete lines 6 to 17.".

AB100-ASA1-AA8-AA8,21,19 19. Page 525, line 15: after that line insert:

AB100-ASA1-AA8-AA8,21,21 "1470c. Page 1987, line 18: delete the material beginning with that line and ending with page 1989, line 25.".

AB100-ASA1-AA8-AA8,21,22 20. Page 525, line 15: after that line insert:

AB100-ASA1-AA8-AA8,21,23 "1470h. Page 1990, line 25: after that line insert:

AB100-ASA1-AA8-AA8,22,12 "(5mpx) Study on family coverage under the mandatory health insurance risk-sharing plan. The office of the commissioner of insurance shall study the feasibility of providing family coverage under the mandatory health insurance risk-sharing plan under subchapter II of chapter 619 of the statutes, as affected by this act, for an individual who is eligible for coverage under that plan and for the members of the individual's family. The office shall also determine whether providing such a plan of family coverage would satisfy the requirements under the federal Health Insurance Portability and Accountability Act of 1996 to provide a choice of coverage. On or before April 1, 1998, the office shall report its findings, conclusions and recommendations to the appropriate standing committees in the manner provided under section 13.172 (3) of the statutes and to the joint committee on finance.".".

AB100-ASA1-AA8-AA8,22,13 21. Page 525, line 15: after that line insert:

AB100-ASA1-AA8-AA8,22,14 "1470j. Page 1991, line 1: before that line insert:

AB100-ASA1-AA8-AA8,22,24 "(5xt)  Collection of assessments and penalties. For each person who, before the effective date of this subsection, became eligible for and obtained coverage under the health insurance risk-sharing plan under subchapter II of chapter 619 of the statutes, as affected by this act, as a result of receiving a notice under section 619.12 (1) (am), (b) or (c) of the statutes, the commissioner of insurance shall levy and collect the assessment specified in section 619.135 (1) (a) of the statutes and, if applicable, impose and collect the penalty specified in section 619.135 (1) (c) of the statutes. The commissioner shall credit all assessments and penalties collected under this subsection to the appropriation account under section 20.145 (7) (g) of the statutes, as affected by this act.".".

AB100-ASA1-AA8-AA8,23,1 22. Page 566, line 5: delete lines 5 to 16 and substitute:

AB100-ASA1-AA8-AA8,23,3 "1637c. Page 2067, line 12: delete the material beginning with that line and ending with page 2068, line 7, and substitute:

AB100-ASA1-AA8-AA8,23,13 "(1gmx)  Mandatory health insurance risk-sharing plan. The treatment of sections 20.145 (7) (af), (b) and (g), 619.10 (1m), (2c), (2j), (2t), (3c), (3d), (3g), (3j), (8j) and (9), 619.115, 619.12 (1) (intro.) and (2) (b) 2., (c), (d), (e) (by Section 4830km) and (f), 619.123, 619.13 (1) (a), (b), (c) and (d) and (2), 619.135 (2) and (3), 619.14 (2) (a), (3) (intro.), (4) (intro.), (4m) and (5) (title), (a), (d) and (e), 619.143, 619.145, 619.146, 619.15 (1), (2), (2m), (3) (c), (e) and (f) and (4) (c), (d) and (e), 619.16 (3) (em), 619.165 (1) (a) and (3), 619.167, 619.17 (1) and (4) (a) and 619.175 of the statutes, the renumbering and amendment of sections 619.14 (6) and 619.165 (1) (d) of the statutes, the creation of sections 619.14 (6) (b) and 619.165 (1) (d) 2. of the statutes and Sections 9127 (5xt) and 9327 (3m) of this act take effect on January 1, 1998.".".

AB100-ASA1-AA8-AA8,23,16 23. Page 566, line 22: delete that line and substitute "111.91 (2) (n), 120.13 (2) (g) (by Section 2860f), 185.981 (4t) (by Section 3133m), 185.983 (1) (intro.) (by Section 3134m), 609.77, 609.78, 609.79, 619.14 (4) (a) and 632.895".

AB100-ASA1-AA8-AA8,23,17 (End)