AB844-ASA1, s. 99 10Section 99 . 149.14 (3) (c) 3. of the statutes is amended to read:
AB844-ASA1,38,1411 149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated
12by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats.,
13services for the chronically mentally ill in community support programs operated
14under s. 51.421.
AB844-ASA1, s. 100 15Section 100 . 149.14 (3) (c) 3. of the statutes, as affected by 2005 Wisconsin Act
16.... (this act), is amended to read:
AB844-ASA1,38,2017 149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated
18by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats.

191., services for the chronically mentally ill in community support programs operated
20under s. 51.421.
AB844-ASA1, s. 101 21Section 101. 149.14 (3) (d) of the statutes is amended to read:
AB844-ASA1,38,2222 149.14 (3) (d) Drugs requiring a physician's prescription, subject to sub. (4c).
AB844-ASA1, s. 102 23Section 102. 149.14 (3) (e) of the statutes is amended to read:
AB844-ASA1,39,524 149.14 (3) (e) Services For persons eligible for Medicare, services of a licensed
25skilled nursing facility for eligible persons eligible for medicare, to the extent

1required by s. 632.895 (3) and for not more than an aggregate 120 days during a
2calendar year, if the services are of the type which that would qualify as reimbursable
3services under medicare Medicare. Coverage under this paragraph which that is not
4required by s. 632.895 (3) is subject to the any deductible and coinsurance
5requirements under sub. (5) provided by the authority.
AB844-ASA1, s. 103 6Section 103. 149.14 (3) (f) of the statutes is created to read:
AB844-ASA1,39,87 149.14 (3) (f) Services of a home health agency, as defined in s. 50.49 (1) (a), only
8to the extent required under s. 632.895 (2).
AB844-ASA1, s. 104 9Section 104. 149.14 (3) (m) of the statutes is amended to read:
AB844-ASA1,39,1210 149.14 (3) (m) Oral surgery for excision of partially or completely unerupted,
11impacted teeth and oral surgery with respect to the gums and other tissues of the
12mouth when not performed in connection with the extraction or repair of teeth.
AB844-ASA1, s. 105 13Section 105. 149.14 (3) (o) of the statutes is amended to read:
AB844-ASA1,39,1614 149.14 (3) (o) Transportation Emergency and other medically necessary
15transportation
provided by a licensed ambulance service to the nearest facility
16qualified to treat the a covered condition.
AB844-ASA1, s. 106 17Section 106. 149.14 (3) (p) of the statutes is renumbered 149.14 (3) (em).
AB844-ASA1, s. 107 18Section 107. 149.14 (4) of the statutes, as affected by 2005 Wisconsin Act ....
19(this act), is repealed and recreated to read:
AB844-ASA1,40,320 149.14 (4) Plan design. Subject to subs. (1) to (3), (5), and (6), the authority
21shall establish the plan design, after taking into consideration the levels of health
22insurance coverage provided in the state and medical economic factors, as
23appropriate. Subject to subs. (1) to (3), (5), and (6), the authority shall provide benefit
24levels, deductibles, copayment and coinsurance requirements, exclusions, and
25limitations under the plan that the authority determines generally reflect and are

1commensurate with comprehensive health insurance coverage offered in the private
2individual market in the state. The authority may develop additional benefit designs
3that are responsive to market conditions.
AB844-ASA1, s. 108 4Section 108. 149.14 (4) (d) of the statutes is amended to read:
AB844-ASA1,40,85 149.14 (4) (d) That part of any charge for services or articles rendered or
6prescribed by a physician, dentist, or other health care personnel that exceeds the
7payment rate established by the department authority under s. 149.142 and reduced
8under ss. 149.143 and 149.144
or any charge not medically necessary.
AB844-ASA1, s. 109 9Section 109. 149.14 (4) (m) of the statutes is amended to read:
AB844-ASA1,40,1110 149.14 (4) (m) Experimental treatment, as determined by the department
11authority.
AB844-ASA1, s. 110 12Section 110. 149.14 (4c) of the statutes is repealed.
AB844-ASA1, s. 111 13Section 111. 149.14 (4m) of the statutes is renumbered 149.142 (2m) and
14amended to read:
AB844-ASA1,40,2015 149.142 (2m) Payment is payment in full. Except for copayments, coinsurance,
16or deductibles required or authorized under the plan, a provider of a covered service
17or article shall accept as payment in full for the covered service or article the payment
18rate determined under ss. 149.142, 149.143 and 149.144 sub. (1) and may not bill an
19eligible person who receives the service or article for any amount by which the charge
20for the service or article is reduced under s. 149.142, 149.143 or 149.144 sub. (1).
AB844-ASA1, s. 112 21Section 112. 149.14 (5) of the statutes, as affected by 2005 Wisconsin Act ....
22(this act), is repealed and recreated to read:
AB844-ASA1,40,2523 149.14 (5) Deductible and copayment subsidies. (a) The authority shall
24establish and provide subsidies for deductibles paid by eligible persons with coverage
25under s. 149.14 (2) (a) and household incomes specified in s. 149.165 (2) (a) 1. to 5.
AB844-ASA1,41,2
1(b) The authority may provide subsidies for prescription drug copayment
2amounts paid by eligible persons specified in par. (a).
AB844-ASA1, s. 113 3Section 113. 149.14 (5) (b) of the statutes is amended to read:
AB844-ASA1,41,74 149.14 (5) (b) Except as provided in pars. (c) and (e) par. (c), if the covered costs
5incurred by the eligible person exceed the deductible for major medical expense
6coverage in a calendar year, the plan shall pay at least 80% of any additional covered
7costs incurred by the person during the calendar year.
AB844-ASA1, s. 114 8Section 114. 149.14 (5) (c) of the statutes is amended to read:
AB844-ASA1,41,149 149.14 (5) (c) Except as provided in par. (e), if If the aggregate of the covered
10costs not paid by the plan under par. (b) and the deductible exceeds $500 for an
11eligible person receiving medicare, $2,000 for any other eligible person during a
12calendar year or $4,000 for all eligible persons in a family, the plan shall pay 100%
13of all covered costs incurred by the eligible person during the calendar year after the
14payment ceilings under this paragraph are exceeded.
AB844-ASA1, s. 115 15Section 115. 149.14 (5) (d) of the statutes is repealed.
AB844-ASA1, s. 116 16Section 116. 149.14 (5) (e) of the statutes is repealed.
AB844-ASA1, s. 117 17Section 117. 149.14 (5m) of the statutes is repealed.
AB844-ASA1, s. 118 18Section 118. 149.14 (6) (a) of the statutes is repealed.
AB844-ASA1, s. 119 19Section 119. 149.14 (6) (b) of the statutes is renumbered 149.14 (6).
AB844-ASA1, s. 120 20Section 120. 149.14 (7) (b) of the statutes is amended to read:
AB844-ASA1,41,2421 149.14 (7) (b) The department authority has a cause of action against an
22eligible participant for the recovery of the amount of benefits paid which that are not
23for covered expenses under the plan. Benefits under the plan may be reduced or
24refused as a setoff against any amount recoverable under this paragraph.
AB844-ASA1, s. 121 25Section 121. 149.14 (7) (c) of the statutes is amended to read:
AB844-ASA1,42,4
1149.14 (7) (c) The department authority is subrogated to the rights of an
2eligible person to recover special damages for illness or injury to the person caused
3by the act of a 3rd person to the extent that benefits are provided under the plan.
4Section 814.03 (3) applies to the department under this paragraph.
AB844-ASA1, s. 122 5Section 122. 149.14 (8) of the statutes is repealed.
AB844-ASA1, s. 123 6Section 123. 149.141 of the statutes is created to read:
AB844-ASA1,42,9 7149.141 Premiums. (1) Percentage of costs. Except as provided in sub. (2),
8the authority shall set premium rates for coverage under the plan at a level that is
9sufficient to cover 60 percent of plan costs, as provided in s. 149.143 (1).
AB844-ASA1,42,11 10(2) Limitation. In no event may plan premium rates exceed 200 percent of rates
11applicable to individual standard risks.
AB844-ASA1, s. 124 12Section 124. 149.142 (1) (a) of the statutes is renumbered 149.142 (1) and
13amended to read:
AB844-ASA1,42,2414 149.142 (1) Establishment of rates. Except as provided in par. (b), the
15department
The authority shall establish provider payment rates for covered
16expenses that consist of the allowable charges paid under s. 49.46 (2) for the services
17and articles provided plus an enhancement determined by the department authority.
18The rates shall be based on the allowable charges paid under s. 49.46 (2), projected
19plan costs, and trend factors. Using the same methodology that applies to medical
20assistance under subch. IV of ch. 49, the department authority shall establish
21hospital outpatient per visit reimbursement rates and hospital inpatient
22reimbursement rates that are specific to diagnostically related groups of eligible
23persons. The adjustments to the usual and customary rates shall be sufficient to
24cover 20 percent of plan costs, as provided in s. 149.143 (3).
AB844-ASA1, s. 125 25Section 125. 149.142 (1) (b) of the statutes is repealed.
AB844-ASA1, s. 126
1Section 126. 149.142 (2) of the statutes is repealed.
AB844-ASA1, s. 127 2Section 127. 149.143 of the statutes is repealed and recreated to read:
AB844-ASA1,43,8 3149.143 Payment of plan costs. (1) Costs excluding subsidies. The
4authority shall pay plan costs, excluding any premium, deductible, and copayment
5subsidies, first from federal funds, if any, that are transferred to the fund under s.
620.145 (5) (m) and that exceed premium, deductible, and copayment subsidy costs in
7a policy year. The remainder of the plan costs, excluding premium, deductible, and
8copayment subsidy costs, shall be paid as follows:
AB844-ASA1,43,99 (a) Sixty percent from premiums paid by eligible persons.
AB844-ASA1,43,1010 (b) Twenty percent from insurer assessments under s. 149.13.
AB844-ASA1,43,1211 (c) Twenty percent from adjustments to provider payment rates under s.
12149.142.
AB844-ASA1,43,16 13(2) Subsidy costs. The authority shall pay for premium, deductible, and
14copayment subsidies in a policy year first from federal funds, if any, that are
15transferred to the fund under s. 20.145 (5) (m) in that year. The remainder of the
16subsidy costs shall be paid as follows:
AB844-ASA1,43,1717 (a) Fifty percent from insurer assessments under s. 149.13.
AB844-ASA1,43,1818 (b) Fifty percent from adjustments to provider payment rates under s. 149.142.
AB844-ASA1, s. 128 19Section 128. 149.144 of the statutes is repealed.
AB844-ASA1, s. 129 20Section 129. 149.145 of the statutes is repealed.
AB844-ASA1, s. 130 21Section 130. 149.146 (1) (a) and (b) of the statutes are consolidated,
22renumbered 149.14 (2) (c) 1. and amended to read:
AB844-ASA1,44,1223 149.14 (2) (c) 1. Beginning on January 1, 1998, in In addition to the coverage
24required under s. 149.14 pars. (a) and (b), the plan shall offer to all eligible persons
25who are not eligible for medicare Medicare a choice of coverage, as described in

1section 2744 (a) (1) (C), P.L. 104-191. Any such choice of coverage shall be major
2medical expense coverage. (b) An eligible person under par. (a) who is not eligible
3for Medicare
may elect once each year, at the time and according to procedures
4established by the department authority, among the coverages offered under this
5section and s. 149.14 paragraph and par. (a). If an eligible person elects new
6coverage, any preexisting condition exclusion imposed under the new coverage is met
7to the extent that the eligible person has been previously and continuously covered
8under this chapter the plan. No preexisting condition exclusion may be imposed on
9an eligible person who elects new coverage if the person was an eligible individual
10when first covered under this chapter the plan and the person remained
11continuously covered under this chapter the plan up to the time of electing the new
12coverage.
AB844-ASA1, s. 131 13Section 131. 149.146 (2) (a) of the statutes is renumbered 149.14 (2) (c) 2. and
14amended to read:
AB844-ASA1,44,2015 149.14 (2) (c) 2. Except as specified by the department, the terms of coverage
16under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and
17prescription drug copayment reductions under s. 149.14 (5) (e), do not apply to the
18coverage offered under this section.
Premium reductions under s. 149.165 and
19deductible subsidies and prescription drug copayment subsidies under s. 149.14 (5)

20do not apply to the coverage offered under this section paragraph.
AB844-ASA1, s. 132 21Section 132. 149.146 (2) (am) of the statutes is repealed.
AB844-ASA1, s. 133 22Section 133. 149.146 (2) (b) of the statutes is repealed.
AB844-ASA1, s. 134 23Section 134. 149.15 of the statutes is repealed.
AB844-ASA1, s. 135 24Section 135. 149.16 of the statutes is repealed.
AB844-ASA1, s. 136 25Section 136. 149.165 (1) of the statutes is amended to read:
AB844-ASA1,45,4
1149.165 (1) Except as provided in s. 149.146 (2) (a), the department The
2authority
shall reduce the premiums established under s. 149.11 in conformity with
3ss. 149.14 (5m), 149.143 and 149.17
s. 149.141 for the eligible persons and in the
4manner set forth in subs. (2) and (3).
AB844-ASA1, s. 137 5Section 137. 149.165 (2) (a) (intro.) of the statutes is amended to read:
AB844-ASA1,45,106 149.165 (2) (a) (intro.) Subject to sub. (3m), if the household income, as defined
7in s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage
8under s. 149.14 (2) (a) is equal to or greater than the first amount and less than the
92nd amount listed in any of the following, the department authority shall reduce the
10premium for the eligible person to the rate shown after the amounts:
AB844-ASA1, s. 138 11Section 138. 149.165 (2) (bc) of the statutes is amended to read:
AB844-ASA1,45,2012 149.165 (2) (bc) Subject to sub. (3m), if the household income, as defined in s.
1371.52 (5) and as determined under sub. (3), of an eligible person with coverage under
14s. 149.14 (2) (b) is equal to or greater than the first amount and less than the 2nd
15amount listed in par. (a) 1., 2., 3., 4., or 5., the department authority shall reduce the
16premium established for the eligible person by the same percentage as the
17department authority reduces, under par. (a), the premium established for an
18eligible person with coverage under s. 149.14 (2) (a) who has a household income
19specified in the same subdivision under par. (a) as the household income of the
20eligible person with coverage under s. 149.14 (2) (b).
AB844-ASA1, s. 139 21Section 139. 149.165 (3) (a) of the statutes is amended to read:
AB844-ASA1,45,2422 149.165 (3) (a) Subject to par. (b), the department authority shall establish and
23implement the method for determining the household income of an eligible person
24under sub. (2).
AB844-ASA1, s. 140 25Section 140. 149.165 (3) (b) (intro.) of the statutes is amended to read:
AB844-ASA1,46,4
1149.165 (3) (b) (intro.) In determining household income under sub. (2), the
2department authority shall consider information submitted by an eligible person on
3a completed federal profit or loss from farming form, schedule F, if all of the following
4apply:
AB844-ASA1, s. 141 5Section 141. 149.165 (3m) of the statutes is amended to read:
AB844-ASA1,46,96 149.165 (3m) The board authority may approve adjustment of the household
7income dollar amounts listed in sub. (2) (a) 1. to 5., except for the first dollar amount
8listed in sub. (2) (a) 1., to reflect changes in the consumer price index for all urban
9consumers, U.S. city average, as determined by the U.S. department of labor.
AB844-ASA1, s. 142 10Section 142. 149.165 (4) of the statutes is repealed.
AB844-ASA1, s. 143 11Section 143. 149.17 (1) of the statutes is amended to read:
AB844-ASA1,46,1312 149.17 (1) Subject to ss. 149.14 (5m), s. 149.143 and 149.146 (2) (b), a rating
13plan calculated in accordance with generally accepted actuarial principles.
AB844-ASA1, s. 144 14Section 144. 149.17 (2) of the statutes is repealed.
AB844-ASA1, s. 145 15Section 145. 149.17 (4) of the statutes is repealed.
AB844-ASA1, s. 146 16Section 146. 149.175 of the statutes is repealed.
AB844-ASA1, s. 147 17Section 147. 149.18 of the statutes is amended to read:
AB844-ASA1,46,20 18149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this
19chapter subchapter, the plan shall comply and be administered in compliance with
20chs. 600 to 645.
AB844-ASA1, s. 148 21Section 148. 149.20 of the statutes is repealed.
AB844-ASA1, s. 149 22Section 149. 149.25 of the statutes is repealed.
AB844-ASA1, s. 150 23Section 150. Subchapter III of chapter 149 [precedes 149.40] of the statutes
24is created to read:
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