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Subchapter III
11
Health Insurance Risk-Sharing
12
Plan Authority
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13149.40 Definitions. In this subchapter:
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14(1) "Authority" means the Health Insurance Risk-Sharing Plan Authority.
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15(2) "Board" means the board of directors of the authority.
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16149.41 Creation and organization of authority. (1) There is created a
17public body corporate and politic to be known as the "Health Insurance Risk-Sharing
18Plan Authority." The board of directors of the authority shall consist of the
19commissioner of insurance, or his or her designee, as a nonvoting member, and the
20following members, who shall be nominated by the governor, and with the advice and
21consent of the senate appointed, for 3-year terms:
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(a) Four members who represent insurers participating in the plan.
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(b) Four members who represent health care providers, including one
24representative of the Wisconsin Medical Society, one representative of the Wisconsin
25Hospital Association, Inc., one representative of the Pharmacy Society of Wisconsin,
1and one representative of health care providers that provide services to persons with
2coverage under the plan.
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(c) Five other members, at least one of whom represents small businesses that
4purchase private health insurance and at least 2 of whom are persons with coverage
5under the plan.
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6(2) A vacancy on the board shall be filled in the same manner as the original
7appointment to the board for the remainder of the unexpired term, if any.
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8(3) A member of the board may not be compensated for his or her services but
9shall be reimbursed for actual and necessary expenses, including travel expenses,
10incurred in the performance of his or her duties.
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11(4) Annually, the governor shall appoint one member other than the
12commissioner as chairperson, and the members of the board may elect other officers
13as they consider appropriate. Seven voting members of the board constitute a
14quorum for the purpose of conducting the business and exercising the powers of the
15authority, notwithstanding the existence of any vacancy. The board may take action
16upon a vote of a majority of the members present, unless the bylaws of the authority
17require a larger number.
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18(5) The board may appoint an executive director who shall not be a member of
19the board and who shall serve at the pleasure of the board. The authority may
20delegate by resolution to one or more of its members or its executive director any
21powers and duties that it considers proper. The executive director shall receive such
22compensation as may be determined by the board. The executive director or other
23person designated by resolution of the board shall keep a record of the proceedings
24of the authority and shall be custodian of all books, documents, and papers filed with
25the authority, the minute book or journal of the authority, and its official seal. The
1executive director or other person may cause copies to be made of all minutes and
2other records and documents of the authority and may give certificates under the
3official seal of the authority to the effect that such copies are true copies, and all
4persons dealing with the authority may rely upon such certificates.
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5149.43 Duties of authority. In addition to all other duties imposed under this
6chapter, the authority shall do all of the following:
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7(1) Adopt policies for the administration of this chapter.
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8(2) Contract with the plan administrator under s. 149.16, 2003 stats., in the
9manner required under 2005 Wisconsin Act .... (this act), section 162 (1) (b) until the
10end of the contract term.
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11(3) Establish the authority's annual budget and monitor the fiscal
12management of the authority.
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13(4) Beginning on July 1, 2006, do, or contract with another person to do, all of
14the following:
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(a) Perform all eligibility and administrative claims payment functions
16relating to the plan.
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(b) Establish a premium billing procedure for collection of premiums from
18insured persons. Billings shall be made on a periodic basis as determined by the
19authority.
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(c) Perform all necessary functions to assure timely payment of benefits to
21covered persons under the plan, including:
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1. Making available information relating to the proper manner of submitting
23a claim for benefits under the plan and distributing forms upon which submissions
24shall be made.
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2. Evaluating the eligibility of each claim for payment under the plan.
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13. Notifying each claimant within 30 days after receiving a properly completed
2and executed proof of loss whether the claim is accepted, rejected, or compromised.
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3(5) Seek to qualify or maintain the plan as a state pharmacy assistance
4program, as defined in
42 CFR 423.464.
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5(6) Annually submit a report to the legislature under s. 13.172 (2) and to the
6governor on the operation of the plan.
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7149.45 Powers of authority. (1) Except as restricted under sub. (2), the
8authority shall have all the powers necessary or convenient to carry out the purposes
9and provisions of this chapter. In addition to all other powers granted by this chapter,
10the authority may:
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(a) Adopt bylaws and policies and procedures for the regulation of its affairs
12and the conduct of its business.
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(b) Have a seal and alter the seal at pleasure; have perpetual existence; and
14maintain an office.
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(c) Hire employees, define their duties, and fix their rate of compensation.
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(d) Incur debt, except as restricted under sub. (2).
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(e) Contract for any professional services required for the authority, subject to
18ss. 149.43 (2) and 149.47.
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(f) Appoint any technical or professional advisory committee that the authority
20finds necessary to assist the authority in exercising its duties and powers. The
21authority shall define the duties of the committee, and provide reimbursement for
22the expenses of the committee.
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(g) Execute contracts and other instruments.
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(h) Accept gifts, grants, loans, or other contributions from private or public
25sources.
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1(i) Procure liability insurance.
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2(2) The authority may not issue bonds.
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3149.47 Contracting for professional services. (1) Whenever contracting
4for professional services, the authority shall solicit competitive sealed bids or
5competitive sealed proposals, whichever is appropriate. Each request for
6competitive sealed proposals shall state the relative importance of price and other
7evaluation factors.
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8(2) (a) When the estimated cost exceeds $25,000, the authority may invite
9competitive sealed bids or proposals by publishing a class 2 notice under ch. 985 or
10by posting notice on the Internet at a site determined or approved by the authority.
11The notice shall describe the contractual services to be purchased, the intent to make
12the procurement by solicitation of bids or proposals, any requirement for surety, and
13the date the bids or proposals will be opened, which shall be at least 7 days after the
14date of the last insertion of the notice or at least 7 days after the date of posting on
15the Internet.
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(b) When the estimated cost is $25,000 or less, the authority may award the
17contract in accordance with simplified procedures established by the authority for
18such transactions.
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(c) For purposes of clarification, the authority may discuss the requirements
20of the proposed contract with any person who submits a bid or proposal and shall
21permit any offerer to revise his or her bid or proposal to ensure its responsiveness to
22those requirements.
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23(3) (a) The authority shall determine which bids or proposals are reasonably
24likely to be awarded the contract and shall provide each offerer of such a bid or
25proposal a fair and equal opportunity to discuss the bid or proposal. The authority
1may negotiate with each offerer in order to obtain terms that are advantageous to
2the authority. Prior to the award of the contract, any offerer may revise his or her
3bid or proposal. The authority shall keep a written record of all meetings,
4conferences, oral presentations, discussions, negotiations, and evaluations of bids or
5proposals under this section.
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(b) In opening, discussing, and negotiating bids or proposals, the authority may
7not disclose any information that would reveal the terms of a competing bid or
8proposal.
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9(4) (a) After receiving each offerer's best and final offer, the authority shall
10determine which proposal is most advantageous and shall award the contract to the
11person who offered it. The authority's determination shall be based only on price and
12the other evaluation factors specified in the request for bids or proposals. The
13authority shall state in writing the reason for the award and shall place the
14statement in the contract file.
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(b) Following the award of the contract, the authority shall prepare a register
16of all bids or proposals.
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17149.50 Political activities. (1) No employee of the authority may directly
18or indirectly solicit or receive subscriptions or contributions for any partisan political
19party or any political purpose while engaged in his or her official duties as an
20employee. No employee of the authority may engage in any form of political activity
21calculated to favor or improve the chances of any political party or any person seeking
22or attempting to hold partisan political office while engaged in his or her official
23duties as an employee or engage in any political activity while not engaged in his or
24her official duties as an employee to such an extent that the person's efficiency during
1working hours will be impaired or that he or she will be tardy or absent from work.
2Any violation of this section is adequate grounds for dismissal.
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3(2) If an employee of the authority declares an intention to run for partisan
4political office, the employee shall be placed on a leave of absence for the duration
5of the election campaign and if elected shall no longer be employed by the authority
6on assuming the duties and responsibilities of such office.
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7(3) An employee of the authority may be granted, by the executive director, a
8leave of absence to participate in partisan political campaigning.
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9(4) Persons on leave of absence under sub. (2) or (3) shall not be subject to the
10restrictions of sub. (1), except as they apply to the solicitation of assistance,
11subscription, or support from any other employee in the authority.
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12149.53 Liability limited. (1) Neither the state nor any political subdivision
13of the state nor any officer, employee, or agent of the state or a political subdivision
14who is acting within the scope of employment or agency is liable for any debt,
15obligation, act, or omission of the authority.
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16(2) All of the expenses incurred by the authority in exercising its duties and
17powers under this chapter shall be payable only from funds of the authority.
SB451, s. 148
18Section
148. 149.40 of the statutes, as created by 2005 Wisconsin Act .... (this
19act), is repealed.
SB451, s. 149
20Section
149. Subchapter IV of chapter 149 [precedes 149.60] of the statutes
21is created to read:
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Chapter 149
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Subchapter IV
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Health Care Tax Credit Program
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1149.60 Definition. In this subchapter, "eligible individual" has the meaning
2given in
26 USC 35 (c).
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3149.65 Program requirements. (1) Subject to sub. (2), the authority shall
4design and administer a program of health care coverage, called the Health Care Tax
5Credit Program, under which a covered eligible individual may receive an income tax
6credit under
26 USC 35 for a portion of premiums paid for the coverage. The Health
7Care Tax Credit Program shall be designed to satisfy the requirements of qualified
8health insurance under
26 USC 35 (e) (1) (E), (2), and (3).
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9(2) Subsection (1) applies only as long as federal law provides for income tax
10credits for premiums paid for coverage that satisfies the requirements specified in
11sub. (1).
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12149.70 Eligibility. An individual shall be eligible for coverage under the
13Health Care Tax Credit Program if the individual is any of the following:
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14(1) An eligible individual for whom all of the following apply:
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(a) The aggregate of the individual's periods of creditable coverage, determined
16in the manner provided by rule under s. 149.115, is 3 months or more.
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(b) The individual does not have other health care coverage.
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(c) The individual is not confined in a prison, jail, or house of correction.
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19(2) An individual who is a qualifying family member, as defined in
26 USC 35 20(d), of an eligible individual described in sub. (1) and who does not have other health
21care coverage.
SB451, s. 150
22Section
150. 230.03 (3) of the statutes is amended to read:
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230.03
(3) "Agency" means any board, commission, committee, council, or
24department in state government or a unit thereof created by the constitution or
25statutes if such board, commission, committee, council, department, unit, or the
1head thereof, is authorized to appoint subordinate staff by the constitution or
2statute, except a legislative or judicial board, commission, committee, council,
3department, or unit thereof or an authority created under
chs. subch. III of ch. 149
4or under ch. 231, 232, 233, 234, 235, or 237. "Agency" does not mean any local unit
5of government or body within one or more local units of government that is created
6by law or by action of one or more local units of government.
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7Section
151. 230.80 (4) of the statutes is amended to read:
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230.80
(4) "Governmental unit" means any association, authority, board,
9commission, department, independent agency, institution, office, society
, or other
10body in state government created or authorized to be created by the constitution or
11any law, including the legislature, the office of the governor
, and the courts
, but
12excluding the Health Insurance Risk-Sharing Plan Authority. "Governmental unit"
13does not mean any political subdivision of the state or body within one or more
14political subdivisions
which that is created by law or by action of one or more political
15subdivisions.
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16Section
152. 601.41 (1) of the statutes is amended to read:
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601.41
(1) Duties. The commissioner shall administer and enforce chs. 600 to
18655 and ss. 59.52 (11) (c), 66.0137 (4) and (4m), 100.203, 120.13 (2) (b) to (g),
and 19149.13
, and 149.144 and shall act as promptly as possible under the circumstances
20on all matters placed before the commissioner.
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21Section
153. 601.415 (12) of the statutes is amended to read:
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601.415
(12) Health insurance risk-sharing plan Insurance Risk-Sharing
23Plan. The commissioner shall perform the duties specified to be performed by the
24commissioner in
ss. s. 149.13
and 149.144. The commissioner, or his or her designee,
25shall serve as a member of the board under s. 149.15.
SB451, s. 154
1Section
154. 601.64 (1) of the statutes is amended to read:
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601.64
(1) Injunctions and restraining orders. The commissioner may
3commence an action in circuit court in the name of the state to restrain by temporary
4or permanent injunction or by temporary restraining order any violation of chs. 600
5to 655
, or s. 149.13
or 149.144, any rule promulgated under chs. 600 to 655
, or any
6order issued under s. 601.41 (4). The commissioner need not show irreparable harm
7or lack of an adequate remedy at law in an action commenced under this subsection.
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8Section
155. 601.64 (3) (a) of the statutes is amended to read:
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601.64
(3) (a)
Restitutionary forfeiture. Whoever violates an effective order
10issued under s. 601.41 (4), any insurance statute or rule
, or s. 149.13
or 149.144 shall
11forfeit to the state twice the amount of any profit gained from the violation, in
12addition to any other forfeiture or penalty imposed.
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13Section
156. 601.64 (3) (c) of the statutes is amended to read:
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601.64
(3) (c)
Forfeiture for violation of statute or rule. Whoever violates an
15insurance statute or rule or s. 149.13
or 149.144, intentionally aids a person in
16violating an insurance statute or rule or s. 149.13
or 149.144, or knowingly permits
17a person over whom he or she has authority to violate an insurance statute or rule
18or s. 149.13
or 149.144 shall forfeit to the state not more than $1,000 for each
19violation. If the statute or rule imposes a duty to make a report to the commissioner,
20each week of delay in complying with the duty is a new violation.
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21Section
157. 601.64 (4) of the statutes is amended to read:
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601.64
(4) Criminal penalty. Whoever intentionally violates or intentionally
23permits any person over whom he or she has authority to violate or intentionally aids
24any person in violating any insurance statute or rule of this state, s. 149.13
or
25149.144, or any effective order issued under s. 601.41 (4) is guilty of a Class I felony,
1unless a specific penalty is provided elsewhere in the statutes. Intent has the
2meaning expressed under s. 939.23.
SB451, s. 158
3Section
158. 613.03 (4) of the statutes is amended to read:
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613.03
(4) Mandatory health insurance risk-sharing plan Health Insurance
5Risk-Sharing Plan. Service insurance corporations organized or operating under
6this chapter are subject to
the requirements that apply to insurers and insurance
7under ch. 149.
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8Section
159. 631.20 (2) (f) of the statutes is created to read:
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631.20
(2) (f) In the case of a policy form under ch. 149, that any of the following
10applies:
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1. The benefit design is not comparable to a typical comprehensive individual
12health insurance policy offered in the private sector market in this state.
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2. The benefit levels are not generally reflective of and commensurate with
14comprehensive health insurance coverage offered in the private individual market
15in the state.
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3. The copayments, deductibles, and coinsurance are not actuarially equivalent
17to comprehensive individual plans and would create undue financial hardship.
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4. It is inconsistent with the purpose of providing health care coverage to those
19unable to obtain coverage in the private market.
SB451, s. 160
20Section
160. 632.785 (title) of the statutes is amended to read: