For 2005-07 Budget -- Not Ready For Introduction
ASSEMBLY AMENDMENT ,
TO 2005 ASSEMBLY BILL 100
At the locations indicated, amend the bill as follows:
1.
Page 575, line 14: after "department" insert "of workforce development".
2.
Page 758, line 6: after "denial" insert ", suspension,".
(End)
LRBb0301LRBb0301/1
PJK/JK/CMH:wlj&jld:jf
2005 - 2006 LEGISLATURE
LFB:......Ebersberger (CM) - Privatization of HIRSP administration
For 2005-07 Budget -- Not Ready For Introduction
ASSEMBLY AMENDMENT ,
TO 2005 ASSEMBLY BILL 100
At the locations indicated, amend the bill as follows:
1.
Page 300, line 6: after that line insert:
"SECTION 156m. 20.145 (5) of the statutes is created to read:
20.145 (5) HEALTH INSURANCE RISK-SHARING PLAN. (g) Insurer assessments. All moneys received in insurer assessments under s. 149.13, to be paid to the board of directors under ch. 149.".
2.
Page 340, line 7: after that line insert:
"SECTION 320p. 20.435 (4) (u) of the statutes is repealed.
SECTION 320r. 20.435 (4) (v) of the statutes is repealed.".
3.
Page 391, line 4: after that line insert:
"SECTION 522c. 25.17 (1) (gf) of the statutes is repealed.".
4.
Page 394, line 7: after that line insert:
"SECTION 535m. 25.55 (intro.) of the statutes is repealed.
SECTION 535p. 25.55 (3) of the statutes is renumbered 149.11 (2) (a) 1. and amended to read:
149.11 (2) (a) 1. Insurer assessments under ch. 149 s. 149.13, paid to the board under s. 20.145 (5) (g).
SECTION 535r. 25.55 (4) of the statutes is renumbered 149.11 (2) (a) 2. and amended to read:
149.11 (2) (a) 2. Premiums paid by eligible persons under ch. 149.".
5.
Page 630, line 6: after that line insert:
"SECTION 1286p. 71.05 (1) (bm) of the statutes is created to read:
71.05 (1) (bm) Health Insurance Risk-Sharing Plan. Income of the organization administering the Health Insurance Risk-Sharing Plan under ch. 149.".
6.
Page 672, line 20: after that line insert:
"SECTION 1354n. 71.26 (1) (bn) of the statutes is created to read:
71.26 (1) (bn) Health Insurance Risk-Sharing Plan. Income of the organization administering the Health Insurance Risk-Sharing Plan under ch. 149.".
7.
Page 735, line 8: after that line insert:
"SECTION 1406r. 71.45 (1m) of the statutes is created to read:
71.45 (1m) HEALTH INSURANCE RISK-SHARING PLAN. The income of the organization administering the Health Insurance Risk-Sharing Plan under ch. 149 is exempt from taxation under this subchapter.".
8.
Page 953, line 1: delete the material beginning with that line and ending with page 963, line 25, and substitute:
"SECTION 2032m. Chapter 149 (title) of the statutes is amended to read:
CHAPTER 149
Mandatory health insurance
risk-sharing plan
SECTION 2033m. 149.10 (2) of the statutes is amended to read:
149.10 (2) "Board" means the board of governors established directors under s. 149.15 149.11 (1).
SECTION 2033r. 149.10 (2j) (a) 3. of the statutes is amended to read:
149.10 (2j) (a) 3. Part A or, part B, or part D of title XVIII of the federal Social Security Act.
SECTION 2034c. 149.10 (2m) of the statutes is repealed.
SECTION 2034m. 149.10 (2t) (c) of the statutes is amended to read:
149.10 (2t) (c) The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A or, part B, or part D of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.
SECTION 2035c. 149.10 (3) of the statutes is amended to read:
149.10 (3) "Eligible person" means a resident of this state who qualifies under s. 149.12 whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.
SECTION 2035m. 149.10 (3e) of the statutes is amended to read:
149.10 (3e) "Fund" means the health insurance risk-sharing plan Health Insurance Risk-Sharing Plan fund under s. 149.11 (2).
SECTION 2036c. 149.10 (7) of the statutes is amended to read:
149.10 (7) "Medicare" means coverage under both part A and, part B, and part D of Title XVIII of the federal social security act, 42 USC 1395 et seq., as amended.
SECTION 2036m. 149.10 (9) of the statutes is amended to read:
149.10 (9) "Resident" means a person who has been legally domiciled in this state for a period of at least 30 days 6 months or, with respect to an eligible individual, an individual who resides in this state. For purposes of this chapter, legal domicile is established by living in this state and obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax return. A child is legally domiciled in this state if the child lives in this state and if at least one of the child's parents or the child's guardian is legally domiciled in this state. A person with a developmental disability or another disability which prevents the person from obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in this state by living in this state.
SECTION 2037c. 149.10 (10) of the statutes is repealed.
SECTION 2037m. 149.11 of the statutes is repealed and recreated to read:
149.11 Administration of plan. (1) APPOINTMENT OF BOARD OF DIRECTORS; FORMATION OF ADMINISTERING ORGANIZATION. (a) No later than September 1, 2005, the commissioner shall nominate 13 individuals to be appointed with the advice and consent of the senate to serve as the initial directors of the board of the organization to be formed under par. (b). The board shall consist of 4 representatives of participating insurers; 4 representatives of health care providers, including one representative of the Wisconsin Medical Society, one representative of the Wisconsin Hospital Association, Inc., one representative of the Pharmacy Society of Wisconsin, and one representative of health care providers that provide services to persons with coverage under the plan; and 5 other members, at least one of whom represents small businesses that purchase private health insurance and at least one of whom is a person with coverage under the plan. In making the nominations to the board, the commissioner shall first consult with one or more trade or professional associations whose members include participating insurers, one or more trade or professional associations whose members include health care providers that provide services to persons with coverage under the plan, and one or more trade or professional associations whose members include small business owners.
(b) The individuals appointed as initial directors under par. (a) shall form a private, nonprofit organization under ch. 181 and shall take all actions necessary to exempt the organization from federal taxation under section 501 (a) of the Internal Revenue Code. The articles of incorporation shall include all of the following:
1. The names and addresses of the 13 individuals as the initial directors.
2. That the purpose of the organization is to administer the plan.
3. That the directors, including the initial directors, shall serve staggered 3-year terms.
4. That the directors shall satisfy the criteria specified in par. (a) and shall be nominated by the commissioner, after consultation as specified in par. (a), and appointed with the advice and consent of the senate.
(c) As a condition for the release of funds under s. 20.145 (5) (g), the organization, through the board, shall administer the plan in conformity with this chapter and perform any other duties required of the organization or board under this chapter.
(2) FUND. (a) The board shall pay the operating and administrative expenses of the plan from the fund, which shall be outside the state treasury and which shall consist of all of the following:
3. The earnings resulting from investments under par. (b).
4. Any other moneys received by the organization or board from time to time.
(b) The board controls the assets of the fund and shall select regulated financial institutions in this state that receive deposits in which to establish and maintain accounts for assets needed on a current basis. If practicable, the accounts shall earn interest.
(c) Moneys in the fund may be expended only for the purposes specified in par. (a).
(3) IMMUNITY. No cause of action of any nature may arise against and no liability may be imposed upon the organization, plan, or board; or any agent, employee, or director of any of them; or contributor insurers; or the commissioner; or any of the commissioner's agents, employees, or representatives, for any act or omission by any of them in the performance of their powers and duties under this chapter.
SECTION 2038c. 149.115 of the statutes is amended to read:
149.115 Rules relating to creditable coverage. The commissioner, in consultation with the department, shall promulgate rules that specify how creditable coverage is to be aggregated for purposes of s. 149.10 (2t) (a) and that determine the creditable coverage to which s. 149.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L. 104-191.
SECTION 2038m. 149.12 (1) (intro.) of the statutes is amended to read:
149.12 (1) (intro.) Except as provided in subs. (1m) and, (2), and (3), the board or plan administrator shall certify as eligible a person who is covered by medicare Medicare because he or she is disabled under 42 USC 423, a person who submits evidence that he or she has tested positive for the presence of HIV, antigen or nonantigenic products of HIV, or an antibody to HIV, a person who is an eligible individual, and any person who receives and submits any of the following based wholly or partially on medical underwriting considerations within 9 months prior to making application for coverage by the plan:
SECTION 2039c. 149.12 (1) (a) of the statutes is amended to read:
149.12 (1) (a) A notice of rejection of coverage from one 2 or more insurers.
SECTION 2039m. 149.12 (1m) of the statutes is amended to read:
149.12 (1m) The board or plan administrator may not certify a person as eligible under circumstances requiring notice under sub. (1) (a) to (d) if the required notices were issued by an insurance intermediary who is not acting as an administrator, as defined in s. 633.01.
SECTION 2040c. 149.12 (2) (g) of the statutes is created to read:
149.12 (2) (g) A person is not eligible for coverage under the plan if the person is eligible for any of the following:
1. Services under s. 46.27 (11), 46.275, 46.277, or 46.278.
2. Medical assistance provided as part of a family care benefit, as defined in s. 46.2805 (4).
3. Services provided under a waiver requested under 2001 Wisconsin Act 16, section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
4. Services provided under the program of all-inclusive care for persons aged 55 or older authorized under 42 USC 1396u-4.
5. Services provided under the demonstration program under a federal waiver authorized under 42 USC 1315.
6. Health care coverage under the Badger Care health care program under s. 49.665.
SECTION 2040m. 149.12 (3) (a) of the statutes is amended to read:
149.12 (3) (a) Except as provided in pars. (b) to (c) and (bm), no person is eligible for coverage under the plan for whom a premium, deductible, or coinsurance amount is paid or reimbursed by a federal, state, county, or municipal government or agency as of the first day of any term for which a premium amount is paid or reimbursed and as of the day after the last day of any term during which a deductible or coinsurance amount is paid or reimbursed.
SECTION 2041c. 149.12 (3) (c) of the statutes is repealed.
SECTION 2041m. 149.12 (4) and (5) of the statutes are created to read:
149.12 (4) Subject to subs. (1m), (2), and (3), the board may establish criteria that would enable additional persons to be eligible for coverage under the plan. The board shall ensure that any expansion of eligibility is consistent with the purpose of the plan to provide health care coverage for those who are unable to obtain health insurance in the private market and does not endanger the solvency of the plan.
(5) The board shall establish policies for determining and verifying the continued eligibility of an eligible person.
SECTION 2042c. 149.13 (1) of the statutes is amended to read:
149.13 (1) Every insurer shall participate in the cost of administering the plan, except the commissioner may by rule exempt as a class those insurers whose share as determined under sub. (2) would be so minimal as to not exceed the estimated cost of levying the assessment. The commissioner shall advise the department board of the insurers participating in the cost of administering the plan.
SECTION 2042m. 149.13 (3) (a) of the statutes is amended to read:
149.13 (3) (a) Each insurer's proportion of participation under sub. (2) shall be determined annually by the commissioner based on annual statements and other reports filed by the insurer with the commissioner. The commissioner shall assess an insurer for the insurer's proportion of participation based on the total assessments estimated by the department under s. 149.143 (2) (a) 3. board.
