SB466: Bill Text

SB466, s. 62 Section 62. 149.146 (2) (b) (intro.) of the statutes is amended to read:

SB466,23,10 149.146 (2) (b) (intro.) The schedule of premiums for coverage under this section shall be promulgated by rule by the department board, as provided in s. 149.143. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 149.14 (2) (a) by the same percentage as the percentage difference between the following:

SB466, s. 63 Section 63. 149.146 (2) (b) 1. of the statutes is amended to read:

SB466,23,14 149.146 (2) (b) 1. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466, s. 64 Section 64. 149.146 (2) (b) 2. of the statutes is amended to read:

SB466,23,18 149.146 (2) (b) 2. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as the coverage offered under this section.

SB466, s. 65 Section 65. 149.15 (1) of the statutes is amended to read:

SB466,24,13 149.15 (1) The plan shall have operate under the direction of a board of governors consisting of representatives of 2 participating insurers that are nonprofit corporations, representatives of 2 other participating insurers, 3 4 health care provider industry representatives, including one representative of the State Wisconsin Medical Society of Wisconsin, one representative of the Wisconsin Health and Hospital Association, one representative of Pharmaceutical Research and Manufacturers of America, and one representative of an integrated multidisciplinary health system, and 4 public members, including one representative of small businesses in the state, appointed by the secretary for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the secretary, or a designated representative from the department, shall be members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital, or an insurer. At least one of the public members shall be an individual who has coverage under the plan. The secretary or the secretary's representative shall be board annually shall select the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the secretary or the secretary's representative, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.

SB466, s. 66 Section 66. 149.15 (3) (b) of the statutes is created to read:

SB466,24,22 149.15 (3) (b) Establish by rule the plan design, including covered benefits and exclusions. At least every 3 years, the board shall conduct a survey of health care plans available in the private market and make any adjustments to the plan that the board determines are advisable on the basis of the survey. Using the procedure under s. 227.24, the board may promulgate rules under this paragraph for the period before the effective date of any permanent rules promulgated under this paragraph, but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the board is not required to make a finding of emergency.

SB466, s. 67 Section 67. 149.15 (3) (c) of the statutes is repealed.

SB466, s. 68 Section 68. 149.15 (3) (e) of the statutes is created to read:

SB466,25,2 149.15 (3) (e) Select a plan administrator in a competitive, request-for-proposals process and enter into a contract with the person selected.

SB466, s. 69 Section 69. 149.15 (3) (f) of the statutes is repealed.

SB466, s. 70 Section 70. 149.15 (4) (c) of the statutes is created to read:

SB466,25,6 149.15 (4) (c) Contract with persons to provide professional services to the board and the plan.

SB466, s. 71 Section 71. 149.15 (4) (d) of the statutes is created to read:

SB466,25,19 149.15 (4) (d) Notwithstanding ss. 625.11 (4) and 628.34 (3) (a) and any requirements in this chapter related to setting premium rates or amounts, establish for eligible persons with household incomes that exceed $100,000 a separate schedule of premium rates that are higher than the rates set for other eligible persons. Premium rates established under this paragraph may not exceed 200 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and cost-sharing provisions that are provided under the plan. The board shall use excess premiums collected under a schedule established under this paragraph to reduce premiums for eligible persons with low household incomes, as determined by the board. Household income under this paragraph shall be determined in the same manner as household income is determined under s. 149.165 (2) and (3).

SB466, s. 72 Section 72. 149.15 (5) of the statutes is repealed.

SB466, s. 73 Section 73. 149.16 of the statutes, as affected by 2003 Wisconsin Act 33, is repealed.

SB466, s. 74 Section 74. 149.165 (1) of the statutes is amended to read:

SB466,26,2 149.165 (1) Except as provided in s. 149.146 (2) (a), the department board shall reduce the premiums established under s. 149.11 in conformity with ss. 149.14 (5m), 149.143, and 149.17 for the eligible persons and in the manner set forth in subs. (2) and (3).

SB466, s. 75 Section 75. 149.165 (2) of the statutes is amended to read:

SB466,26,8 149.165 (2) (a) Subject to sub. subs. (3m) and (3r), if the household income, as defined in s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage under s. 149.14 (2) (a) is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the department board shall reduce the premium for the eligible person to the rate shown after the amounts:

SB466,26,12 1. If equal to or greater than $0 and less than $10,000, to 100% 100 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466,26,16 2. If equal to or greater than $10,000 and less than $14,000, to 106.5% 106.5 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466,26,20 3. If equal to or greater than $14,000 and less than $17,000, to 115.5% 115.5 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466,26,24 4. If equal to or greater than $17,000 and less than $20,000, to 124.5% 124.5 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466,27,4 5. If equal to or greater than $20,000 and less than $25,000, to 130% 130 percent of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).

SB466,27,13 (bc) Subject to sub. subs. (3m) and (3r), if the household income, as defined in s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage under s. 149.14 (2) (b) is equal to or greater than the first amount and less than the 2nd amount listed in par. (a) 1., 2., 3., 4., or 5., the department board shall reduce the premium established for the eligible person by the same percentage as the department board reduces, under par. (a), the premium established for an eligible person with coverage under s. 149.14 (2) (a) who has a household income specified in the same subdivision under par. (a) as the household income of the eligible person with coverage under s. 149.14 (2) (b).

SB466, s. 76 Section 76. 149.165 (3) (a) of the statutes is amended to read:

SB466,27,17 149.165 (3) (a) Subject to par. (b), the department board shall establish and implement the method for determining the household income of an eligible person under sub. (2).

SB466, s. 77 Section 77. 149.165 (3) (b) (intro.) of the statutes is amended to read:

SB466,27,22 149.165 (3) (b) (intro.) In determining household income under sub. (2), the department board shall 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:

SB466, s. 78 Section 78. 149.165 (3r) of the statutes is created to read:

SB466,28,3 149.165 (3r) The board shall use any excess premiums collected under a schedule established under s. 149.15 (4) (d) to further reduce the premium rates under sub. (2) (a) 1. to 5. and (bc).

SB466, s. 79 Section 79. 149.17 (4) of the statutes is amended to read:

SB466,28,6 149.17 (4) Cost containment provisions established by the department board by rule, including managed care requirements.

SB466, s. 80 Section 80. 149.175 of the statutes is amended to read:

SB466,28,12 149.175 Waiver or exemption from provisions prohibited. Except as provided in s. ss. 149.13 (1) and 149.132 (1) (b), the department or the board may not waive, or authorize the board to waive, any of the requirements of this chapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this chapter.

SB466, s. 81 Section 81. 149.20 of the statutes is amended to read:

SB466,28,17 149.20 Rule-making in consultation with Rules to be approved by board. In promulgating any Any rules proposed by the department under this chapter, the department shall consult with may not be promulgated without the approval of the board.

SB466, s. 82 Section 82. 149.25 (2) (a) of the statutes is amended to read:

SB466,28,22 149.25 (2) (a) The department shall conduct a 3-year pilot program, beginning on July 1, 2002, under which eligible persons who qualify under par. (b) are provided community-based case management services. The department shall consult with the board as necessary in conducting the pilot program.

SB466, s. 83 Section 83. 149.25 (4) of the statutes is amended to read:

SB466,29,7 149.25 (4) Evaluation study. The department, in consultation with the board, shall conduct a study that evaluates the pilot program in terms of health care outcomes and cost avoidance. In the study, the department shall measure and compare, for pilot program participants and similarly situated eligible persons not participating in the pilot program, plan costs and utilization of services, including inpatient hospital days, rates of hospital readmission within 30 days for the same diagnosis, and prescription drug utilization. The department shall submit a report on the results of the study, including the department's conclusions and recommendations, to the legislature under s. 13.172 (2) and to the governor.

SB466, s. 84 Section 84. 450.10 (2m) of the statutes is created to read:

SB466,29,11 450.10 (2m) If a manufacturer or labeler fails to pay an assessment levied under s. 149.132 within the time required for payment, the board may assess a forfeiture of not more than $1,000 for each day that the payment is past due.

SB466, s. 85 Section 85. Nonstatutory provisions.

SB466,29,20 (1) Federal grant funds. Notwithstanding section 149.143 (1) of the statutes, as affected by this act, any federal grant moneys received by the state under the Trade Adjustment Assistance Reform Act of 2002 and allocated to the Health Insurance Risk-Sharing Plan shall be used to pay plan costs before any moneys specified under section 149.143 (1) (am) and (bm) of the statutes, as affected by this act, are used. After the federal grant money has been used, plan costs shall be paid as provided under section 149.143 (1) (am) and (bm) of the statutes, as affected by this act.

SB466,29,24 (2) Selection of plan administrator. The board of governors of the Health Insurance Risk-Sharing Plan shall, no later than July 1, 2004, issue a request-for-proposals under section 149.15 (3) (e) of the statutes, as created by this act, for administration of the Health Insurance Risk-Sharing Plan.

SB466,30,6 (3) Drug manufacturer and labeler assessments. Notwithstanding section 149.132 of the statutes, as created by this act, the first assessment under section 149.132 of the statutes, as created by this act, that is payable by prescription drug manufacturers and labelers shall be calculated on prescription drug claims paid by the Health Insurance Risk-Sharing Plan from July 1, 2004, to December 31, 2004, rather than on total prescription drug claims paid in 2004.

SB466, s. 86 Section 86 . Initial applicability.

SB466,30,12 (1) Design. With respect to changes in plan design, including covered expenses and exclusions, deductibles, copayments, coinsurance, and out-of-pocket limits, the treatment of sections 149.11, 149.14 (3) (intro.) and (a) to (r), (4), (5) (d) and (e), and (8), 149.146 (1) (b) and (2) (a), (am) 4. and 5., and (b) (intro.) and 1., 149.15 (3) (b), and 149.17 (4) of the statutes first applies to the plan year beginning on January 1, 2005.

SB466,30,15 (2) Eligibility. The treatment of section 149.12 (1) (a), (am), (b), and (c) of the statutes first applies to applications for coverage under the Health Insurance Risk-Sharing Plan that are received on the effective date of this subsection.

SB466,30,20 (3) Drug manufacturer and labeler assessments. The treatment of sections 25.55 (3), 149.10 (5f) and (5r), 149.132, 149.143 (1) (bm) 1., 1m., 2., and 2m. (intro.), (2) (a) 3. and 4., (3) (a) (by Section 49), and (5) (a) (by Section 53), 149.145 (by Section 57), and 450.10 (2m) of the statutes first applies to drug manufacturer and labeler assessments that are payable with respect to claims paid on July 1, 2004.

SB466, s. 87 Section 87. Effective dates. This act takes effect on the day after publication, except as follows:

SB466,30,25 (1) Eligibility. The treatment of section 149.12 (1) (a), (am), (b), and (c) of the statutes and Section 86 (2) of this act take effect on the first day of the 4th month beginning after publication.

SB466,31,4 (2) Drug manufacturer and labeler assessments. The treatment of sections 25.55 (3), 149.10 (5f) and (5r), 149.132, 149.143 (1) (bm) 1., 1m., 2., and 2m. (intro.), (2) (a) 3. and 4., (3) (a) (by Section 49), and (5) (a) (by Section 53), 149.145 (by Section 57), and 450.10 (2m) of the statutes takes effect on July 1, 2004.

SB466,31,5 (End)