SECTION 19. 49.85 (2) (b) of the statutes is amended to read:
49.85 (2) (b) At least annually, the department of workforce development shall certify to the department of revenue the amounts that, based on the notifications received under sub. (1) and on other information received by the department of workforce development, the department of workforce development has determined that it may recover under ss. 49.161, and 49.195 (3), and 49.793, and collect under s. 49.147 (6) (cm), except that the department of workforce development may not certify an amount under this subsection unless it has met the notice requirements under sub. (3) and unless its determination has either not been appealed or is no longer under appeal.
SECTION 20. 49.85 (3) (a) 1. of the statutes is amended to read:
49.85 (3) (a) 1. Inform the person that the department of health and family services intends to certify to the department of revenue an amount that the department of health and family services has determined to be due under s. 49.45 (2) (a) 10. or, 49.497, 49.793, or 49.847, for setoff from any state tax refund that may be due the person.
SECTION 21. 49.85 (3) (b) 1. of the statutes is amended to read:
49.85 (3) (b) 1. Inform the person that the department of workforce development intends to certify to the department of revenue an amount that the department of workforce development has determined to be due under s. 49.161, or 49.195 (3), or 49.793, or to be delinquent under a repayment agreement for a loan under s. 49.147 (6), for setoff from any state tax refund that may be due the person.
SECTION 22. 71.93 (1) (a) 3. of the statutes is amended to read:
71.93 (1) (a) 3. An amount that the department of health and family services may recover under s. 49.45 (2) (a) 10. or, 49.497, 49.793, or 49.847, if the department of health and family services has certified the amount under s. 49.85.
SECTION 23. 71.93 (1) (a) 4. of the statutes is amended to read:
71.93 (1) (a) 4. An amount that the department of workforce development may recover under s. 49.161, or 49.195 (3), or 49.793, or may collect under s. 49.147 (6) (cm), if the department of workforce development has certified the amount under s. 49.85.
SECTION 24. 978.05 (4m) of the statutes is amended to read:
978.05 (4m) WELFARE FRAUD INVESTIGATIONS. Cooperate with the department departments of workforce development and health and family services regarding the fraud investigation program programs under s. ss. 49.197 (1m) and 49.845 (1).
(End)
LRB-0267LRB-0267/1
PJK:kjf:jf
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0037 - Eliminate double-counting of HIRSP deductible subsidy
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law provides major medical health insurance coverage for persons who are covered under Medicare because they are disabled, persons who have tested positive for human immunodeficiency virus (HIV), persons who have been refused coverage, or coverage at an affordable price, in the private health insurance market because of their mental or physical health condition, as well as persons who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage for at least 18 months in the past. DHFS and a board of governors administer HIRSP.
Sixty percent of the operating costs of HIRSP are paid by premiums paid by HIRSP enrollees and 40 percent of the operating costs are paid in equal amounts through insurer assessments and provider payment rate discounts. Premiums, deductibles, and prescription drug copayments for low-income HIRSP enrollees are subsidized by increasing insurer assessments and further reducing provider payment rates, in equal amounts.
In the statutory formula that DHFS uses for setting premiums, insurer assessments, and provider payment rates, the amounts received for premium, deductible, and prescription drug copayment subsidies are included in the premium amount that DHFS must set to equal 60 percent of HIRSP's operating costs. As a result, when their premiums are determined, HIRSP enrollees are given credit for the amounts paid by insurers and providers for premium, deductible, and prescription drug copayment subsidies. This bill removes the amounts paid by insurers and providers for deductible and prescription drug copayment subsidies from inclusion in the amount in the formula that equals 60 percent of HIRSP's operating costs. That formula amount, however, still includes the premium subsidies paid by insurers and providers.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 149.143 (1) (intro.) of the statutes is amended to read:
149.143 (1) (intro.) The department shall pay or recover the operating costs of the plan from the appropriation under s. 20.435 (4) (v) and administrative costs of the plan from the appropriation under s. 20.435 (4) (u). For purposes of determining premiums, insurer assessments and provider payment rate adjustments, the department shall apportion and prioritize responsibility for payment or recovery of plan costs, excluding deductible reductions under s. 149.14 (5) (a) and prescription drug copayment reductions under s. 149.14 (5) (e), from among the moneys constituting the fund as follows:
SECTION 2. 149.143 (1) (am) 1. of the statutes is amended to read:
149.143 (1) (am) 1. First, from premiums from eligible persons with coverage under s. 149.14 (2) (a) set at a rate that is 140% to 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) set in accordance with s. 149.14 (5m), including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144, and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).
SECTION 3. 149.143 (1) (am) 3. of the statutes is amended to read:
149.143 (1) (am) 3. Third, by increasing premiums from eligible persons with coverage under s. 149.14 (2) (a) to more than the rate at which premiums were set under subd. 1. but not more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan and from eligible persons with coverage under s. 149.14 (2) (b) by a comparable amount in accordance with s. 149.14 (5m), including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144, and by increasing premiums from eligible persons with coverage under s. 149.146 in accordance with s. 149.146 (2) (b), to the extent that the amounts under subds. 1. and 2. are insufficient to pay 60% of plan costs.
SECTION 4. 149.143 (2) (a) (intro.) of the statutes is amended to read:
149.143 (2) (a) (intro.) Prior to each plan year, the department shall estimate the operating and administrative costs of the plan and the costs of the premium reductions under s. 149.165, the deductible reductions under s. 149.14 (5) (a), and any prescription drug copayment reductions under s. 149.14 (5) (e) for the new plan year and do all of the following:
SECTION 5. 149.143 (2) (a) 1. a. of the statutes is amended to read:
149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be received in the new plan year if the enrollee premiums were set at a level sufficient, when including amounts received for premium, deductible, and prescription drug copayment subsidies under s. 149.144 and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to cover 60% of the estimated plan costs for the new plan year.
SECTION 6. 149.143 (2m) (a) 1. of the statutes is amended to read:
149.143 (2m) (a) 1. The amount of premiums received in a plan year from all eligible persons, including amounts received for premium, deductible, and prescription drug copayment subsidies.
SECTION 7. 149.143 (2m) (a) 2. of the statutes is amended to read:
149.143 (2m) (a) 2. The amount of premiums, including amounts received for premium, deductible, and prescription drug copayment subsidies, necessary to cover 60% of the plan costs for the plan year.
(End)
LRB-0269LRB-0269/1
PJK:jld:pg
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0039 - HIRSP Medicare deductible
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law provides major medical health insurance coverage for persons who are covered under Medicare because they are disabled, persons who have tested positive for human immunodeficiency virus (HIV), and persons who have been refused coverage, or coverage at an affordable price, in the private health insurance market because of their mental or physical health condition, as well as persons who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage for at least 18 months in the past (all called eligible persons). While an eligible person who is not covered under Medicare pays a deductible ranging from $500 to $2,500, generally depending on type of coverage and household income, an eligible person with Medicare coverage pays a deductible that is equal to the deductible under part A of Medicare.
The statutes provide that HIRSP will pay at least 80 percent of an eligible person's covered costs after those costs exceed the person's deductible, and will pay 100 percent of covered costs after the aggregate of covered costs not paid by HIRSP and the deductible exceeds $2,000 for an eligible person not covered under Medicare and $500 for an eligible person covered under Medicare. Currently, however, the deductible under part A of Medicare exceeds $500. Thus, under the statutes, HIRSP will begin paying 100 percent of covered costs incurred by an eligible person covered under Medicare before the person has paid the deductible. This bill corrects the inconsistency and provides that HIRSP will pay 100 percent of covered costs for an eligible person covered under Medicare after the covered costs exceed the lesser of $2,000 or the person's deductible, which is equal to the deductible under part A of Medicare.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 149.14 (5) (b) of the statutes is amended to read:
149.14 (5) (b) Except as provided in pars. (c) and (e), if the covered costs incurred in a calendar year by the an eligible person who is not eligible for Medicare exceed the deductible for major medical expense coverage in a calendar year, the plan shall pay at least 80% of any additional covered costs incurred by the person during the calendar year, and if the covered costs incurred in a calendar year by an eligible person who is eligible for Medicare exceed the deductible for major medical expense coverage or $2,000, whichever is less, the plan shall pay 100% of any additional covered costs incurred by the person during the calendar year.
SECTION 2. 149.14 (5) (c) of the statutes is amended to read:
149.14 (5) (c) Except as provided in par. (e), if the aggregate of the covered costs not paid by the plan under par. (b) and the deductible exceeds $500 for an eligible person receiving medicare, $2,000 for any other in a calendar year for an eligible person during a calendar year who is not eligible for Medicare, or $4,000 in a calendar year for all eligible persons in a family, the plan shall pay 100% of all covered costs incurred by the eligible person or the eligible persons in the family during the calendar year after the payment ceilings under this paragraph are exceeded.
SECTION 9421. Effective dates; health and family services.
(1) HEALTH INSURANCE RISK-SHARING PLAN DEDUCTIBLE. The treatment of section 149.14 (5) (b) and (c) of the statutes takes effect on January 1, 2006.
(End)
LRB-0270LRB-0270/1
PJK:jld:rs
2005 - 2006 LEGISLATURE
DOA:......Jablonsky, BB0040 - HIRSP eligibility
For 2005-07 Budget -- Not Ready For Introduction
2005 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Health and human services
Other health and human services
The Health Insurance Risk-Sharing Plan (HIRSP) under current law provides major medical health insurance coverage for persons who are covered under Medicare because they are disabled, persons who have tested positive for human immunodeficiency virus (HIV), persons who have been refused coverage, or coverage at an affordable price, in the private health insurance market because of their mental or physical health condition, as well as persons who do not currently have health insurance coverage, but who were covered under certain types of health insurance coverage for at least 18 months in the past. Specifically excluded from coverage under HIRSP are persons who are eligible for coverage under the Medical Assistance (MA) program, which is a program funded partially with state moneys and partially with federal moneys providing comprehensive, as well as various types of limited, health care services to persons who are eligible, which is generally based on a person's income.
This bill provides that persons who are eligible for only certain limited services provided under MA are not ineligible for HIRSP coverage because of their eligibility for those MA services, which include family planning services for low-income women between the ages of 15 and 44 years; payment of Medicare premiums, deductibles, and coinsurance for persons eligible for Medicare who meet the income and resource limitations; emergency medical services for persons who are not U.S. citizens; health care services for persons with tuberculosis who meet the income and resource requirements for the federal Supplemental Security Income program; and outpatient prenatal care for pregnant women who meet the income limitation.
The bill also specifically provides that persons who are eligible for the following programs or benefits are ineligible for HIRSP coverage: the Badger Care health care program (commonly known as BadgerCare), under which low-income families and children who do not reside with a parent receive comprehensive health care services; a program providing long-term care for children with disabilities and their families, including in-home habilitation services for children with autism spectrum disorders; the community integration programs commonly known as "CIP IA," "CIP IB," and "CIP II," under which persons who reside in state centers for the developmentally disabled or other institutions are relocated into their communities and provided home and community-based services; the waiver program under the Long-Term Support Community Options Program (commonly known as "COP-Waiver"), under which persons who are elderly, physically or developmentally disabled, chronically mentally ill, or chemically dependent receive long-term community support services; the Program for All-inclusive Care for the Elderly (known as PACE) or the Wisconsin Partnership Program (known as Partnership), both of which are managed care programs providing acute health and long-term care for elderly and disabled individuals who are eligible for nursing home care; and medical assistance provided under the Family Care Program, under which financial assistance is provided for long-term care and support items to persons who who have physical or developmental disabilities or infirmities of aging and who meet certain financial and functional criteria.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 49.46 (1) (a) 15. of the statutes is amended to read:
49.46 (1) (a) 15. Any individual who is infected with tuberculosis and meets the income and resource eligibility requirements for the federal supplemental security Supplemental Security Income program under 42 USC 1381 to 1383d.
SECTION 2. 149.12 (2) (f) of the statutes is renumbered 149.12 (2) (f) 1. and amended to read:
149.12 (2) (f) 1. No Except as provided in subd. 2., no person who is eligible for medical assistance is eligible for coverage under the plan.
SECTION 3. 149.12 (2) (f) 2. of the statutes is created to read:
149.12 (2) (f) 2. Subdivision 1. does not apply to a person who is eligible for only any of the following types of medical assistance:
a. Family planning services under s. 49.45 (24r).
b. Care and services for the treatment of an emergency medical condition under 42 USC 1396b (v), as provided in s. 49.45 (27).
c. Medical assistance under s. 49.46 (1) (a) 15.
d. Ambulatory prenatal care under s. 49.465.
e. Medicare premium, coinsurance, and deductible payments under s. 49.46 (2) (c) 2. or 3., 49.468 (1) (b) or (c), or 49.47 (6) (a) 6. b. or c.
f. Medicare premium payments under s. 49.46 (2) (cm), 49.468 (1m) or (2), or 49.47 (6) (a) 6m.
SECTION 4. 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.
