SB451,30,98 149.10 (7) "Medicare" means coverage under both part A and, part B, and part
9D
of Title XVIII of the federal social security act, 42 USC 1395 et seq., as amended.
SB451, s. 70 10Section 70. 149.10 (8) of the statutes is amended to read:
SB451,30,1211 149.10 (8) "Plan" means the health care insurance plan established and
12administered under subchapter II of this chapter.
SB451, s. 71 13Section 71. 149.10 (9) of the statutes is amended to read:
SB451,30,2414 149.10 (9) "Resident" means a person who has been legally domiciled in this
15state for a period of at least 30 days 3 months or, with respect to an eligible individual,
16an individual who resides in this state. For purposes of this chapter, legal domicile
17is established by living in this state and obtaining a Wisconsin motor vehicle
18operator's license, registering to vote in Wisconsin, or filing a Wisconsin income tax
19return. A child is legally domiciled in this state if the child lives in this state and if
20at least one of the child's parents or the child's guardian is legally domiciled in this
21state. A person with a developmental disability or another disability which that
22prevents the person from obtaining a Wisconsin motor vehicle operator's license,
23registering to vote in Wisconsin, or filing a Wisconsin income tax return, is legally
24domiciled in this state by living in this state.
SB451, s. 72 25Section 72. 149.10 (10) of the statutes is repealed.
SB451, s. 73
1Section 73. 149.105 of the statutes is created to read:
SB451,31,8 2149.105 Immunity. No cause of action of any nature may arise against, and
3no liability may be imposed upon, the authority, plan, or board; or any agent,
4employee, or director of any of them; or participating insurers; or the commissioner;
5or any of the commissioner's agents, employees, or representatives, for any act or
6omission by any of them in the performance of their powers and duties under this
7chapter, unless the person asserting liability proves that the act or omission
8constitutes willful misconduct.
SB451, s. 74 9Section 74. Subchapter II (title) of chapter 149 [precedes 149.11] of the
10statutes is created to read:
SB451,31,1111 CHAPTER 149
SB451,31,1412 subchapter II
13 Health insurance risk-sharing
14 plan provisions
SB451, s. 75 15Section 75. 149.11 of the statutes is repealed and recreated to read:
SB451,31,18 16149.11 Administration of plan. (1) Authority. The authority shall be
17responsible for the operation of the plan and, subject to ss. 149.143 (2) and 149.47,
18may enter into contracts for the plan's administration.
SB451,31,21 19(2) Fund. (a) The authority shall pay the operating and administrative
20expenses of the plan from the fund, which shall be outside the state treasury and
21which shall consist of all of the following:
SB451,31,2222 3. Federal moneys paid to the authority under s. 20.145 (5) (m).
SB451,31,2423 4. The moneys transferred under 2005 Wisconsin Act .... (this act), section 163
24(1).
SB451,31,2525 5. The earnings resulting from investments under par. (b).
SB451,32,1
16. Any other moneys received by the authority from time to time.
SB451,32,52 (b) The authority controls the assets of the fund and shall select regulated
3financial institutions in this state that receive deposits in which to establish and
4maintain accounts for assets needed on a current basis. If practicable, the accounts
5shall earn interest.
SB451,32,76 (c) Moneys in the fund may be expended only for the purposes specified in par.
7(a).
SB451, s. 76 8Section 76. 149.115 of the statutes is amended to read:
SB451,32,13 9149.115 Rules relating to creditable coverage. The commissioner, in
10consultation with the department,
shall promulgate rules that specify how
11creditable coverage is to be aggregated for purposes of s. 149.10 (2t) (a) and that
12determine the creditable coverage to which s. 149.10 (2t) (b) and (d) applies. The
13rules shall comply with section 2701 (c) of P.L. 104-191.
SB451, s. 77 14Section 77. 149.12 (1) (intro.) of the statutes is amended to read:
SB451,32,2215 149.12 (1) (intro.) Except as provided in subs. (1m) and, (2), and (3), the board
16or plan administrator authority shall certify as eligible a person who is covered by
17medicare Medicare because he or she is disabled under 42 USC 423, a person who
18submits evidence that he or she has tested positive for the presence of HIV, antigen
19or nonantigenic products of HIV, or an antibody to HIV, a person who is an eligible
20individual, and any person who receives and submits any of the following based
21wholly or partially on medical underwriting considerations within 9 months prior to
22making application for coverage by the plan:
SB451, s. 78 23Section 78. 149.12 (1) (a) of the statutes is amended to read:
SB451,32,2424 149.12 (1) (a) A notice of rejection of coverage from one 2 or more insurers.
SB451, s. 79 25Section 79. 149.12 (1m) of the statutes is amended to read:
SB451,33,4
1149.12 (1m) The board or plan administrator authority may not certify a
2person as eligible under circumstances requiring notice under sub. (1) (a) to (d) if the
3required notices were issued by an insurance intermediary who is not acting as an
4administrator, as defined in s. 633.01.
SB451, s. 80 5Section 80. 149.12 (2) (f) of the statutes is renumbered 149.12 (2) (f) 1. and
6amended to read:
SB451,33,87 149.12 (2) (f) 1. No Except as provided in subd. 2., no person who is eligible for
8medical assistance is eligible for coverage under the plan.
SB451, s. 81 9Section 81. 149.12 (2) (f) 2. of the statutes is created to read:
SB451,33,1210 149.12 (2) (f) 2. Subdivision 1. does not apply to a person who is otherwise
11eligible for coverage under the plan and who is eligible for only any of the following
12types of medical assistance:
SB451,33,1313 a. Family planning services under s. 49.45 (24r).
SB451,33,1514 b. Care and services for the treatment of an emergency medical condition under
1542 USC 1396b (v), as provided in s. 49.45 (27).
SB451,33,1616 c. Medical assistance under s. 49.46 (1) (a) 15.
SB451,33,1717 d. Ambulatory prenatal care under s. 49.465.
SB451,33,1918 e. Medicare premium, coinsurance, and deductible payments under s. 49.46 (2)
19(c) 2. or 3., 49.468 (1) (b) or (c), or 49.47 (6) (a) 6. b. or c.
SB451,33,2120 f. Medicare premium payments under s. 49.46 (2) (cm), 49.468 (1m) or (2), or
2149.47 (6) (a) 6m.
SB451, s. 82 22Section 82. 149.12 (2) (g) of the statutes is created to read:
SB451,33,2423 149.12 (2) (g) A person is not eligible for coverage under the plan if the person
24is eligible for any of the following:
SB451,33,2525 1. Services under s. 46.27 (11), 46.275, 46.277, or 46.278.
SB451,34,2
12. Medical assistance provided as part of a family care benefit, as defined in s.
246.2805 (4).
SB451,34,433. Services provided under a waiver requested under 2001 Wisconsin Act 16,
4section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
SB451,34,65 4. Services provided under the program of all-inclusive care for persons aged
655 or older authorized under 42 USC 1396u-4.
SB451,34,87 5. Services provided under the demonstration program under a federal waiver
8authorized under 42 USC 1315.
SB451,34,109 6. Health care coverage under the Badger Care health care program under s.
1049.665.
SB451, s. 83 11Section 83. 149.12 (3) (a) of the statutes is amended to read:
SB451,34,1712 149.12 (3) (a) Except as provided in pars. (b) to (c) and (bm), no person is eligible
13for coverage under the plan for whom a premium, deductible, or coinsurance amount
14is paid or reimbursed by a federal, state, county, or municipal government or agency
15as of the first day of any term for which a premium amount is paid or reimbursed and
16as of the day after the last day of any term during which a deductible or coinsurance
17amount is paid or reimbursed.
SB451, s. 84 18Section 84. 149.12 (3) (c) of the statutes is repealed.
SB451, s. 85 19Section 85. 149.12 (4) and (5) of the statutes are created to read:
SB451,34,2520 149.12 (4) Subject to subs. (1m), (2), and (3), the authority may establish
21criteria that would enable additional persons to be eligible for coverage under the
22plan. The authority shall ensure that any expansion of eligibility is consistent with
23the purpose of the plan to provide health care coverage for those who are unable to
24obtain health insurance in the private market and does not endanger the solvency
25of the plan.
SB451,35,2
1(5) The authority shall establish policies for determining and verifying the
2continued eligibility of an eligible person.
SB451, s. 86 3Section 86. 149.13 (1) of the statutes is amended to read:
SB451,35,84 149.13 (1) Every insurer shall participate in the cost of administering the plan,
5except the commissioner may by rule exempt as a class those insurers whose share
6as determined under sub. (2) would be so minimal as to not exceed the estimated cost
7of levying the assessment. The commissioner shall advise the department authority
8of the insurers participating in the cost of administering the plan.
SB451, s. 87 9Section 87. 149.13 (3) (a) of the statutes is amended to read:
SB451,35,1410 149.13 (3) (a) Each insurer's proportion of participation under sub. (2) shall be
11determined annually by the commissioner based on annual statements and other
12reports filed by the insurer with the commissioner. The commissioner shall assess
13an insurer for the insurer's proportion of participation based on the total
14assessments estimated by the department under s. 149.143 (2) (a) 3. authority.
SB451, s. 88 15Section 88. 149.13 (3) (b) of the statutes is amended to read:
SB451,35,2216 149.13 (3) (b) If the department authority or the commissioner finds that the
17commissioner's authority to require insurers to report under chs. 600 to 646 and 655
18is not adequate to permit the department, the commissioner or the board authority
19to carry out the department's, commissioner's or board's authority's responsibilities
20under this chapter subchapter, the commissioner shall promulgate rules requiring
21insurers to report the information necessary for the department, commissioner and
22board authority to make the determinations required under this chapter subchapter.
SB451, s. 89 23Section 89. 149.13 (4) of the statutes is amended to read:
SB451,36,224 149.13 (4) Notwithstanding subs. (1) to (3), the department authority, with the
25agreement of the commissioner, may perform various administrative functions

1related to the assessment of insurers participating in the cost of administering the
2plan.
SB451, s. 90 3Section 90. 149.14 (1) (a) of the statutes is amended to read:
SB451,36,104 149.14 (1) (a) The plan shall offer coverage for each eligible person in an
5annually renewable policy the coverage specified in this section for each eligible
6person
. If an eligible person is also eligible for medicare Medicare coverage, the plan
7shall not pay or reimburse any person for expenses paid for by medicare Medicare.
8If an eligible person is eligible for a type of medical assistance specified in s. 149.12
9(2) (f) 2., the plan shall not pay or reimburse the person for expenses paid for by
10Medical Assistance
.
SB451, s. 91 11Section 91. 149.14 (2) (a) of the statutes is amended to read:
SB451,36,1812 149.14 (2) (a) The plan shall provide every eligible person who is not eligible
13for medicare Medicare with major medical expense coverage. Major medical expense
14coverage offered under the plan under this section shall pay an eligible person's
15covered expenses, subject to sub. (3) and deductible, copayment, and coinsurance
16payments authorized under sub. (5), up to a lifetime limit of $1,000,000 per covered
17individual. The maximum limit under this paragraph shall not be altered by the
18board, and no actuarially equivalent benefit may be substituted by the board.
SB451, s. 92 19Section 92. 149.14 (3) (intro.) of the statutes is amended to read:
SB451,37,820 149.14 (3) Covered expenses. (intro.) Except as provided in sub. (4), except
21as restricted by cost containment provisions under s. 149.17 (4) and except as
22reduced by the department under ss. 149.143 and 149.144, covered
Covered expenses
23for the coverage under this section the plan shall be the payment rates established
24by the department under s. 149.142 authority for the services provided by persons
25licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Except as provided in

1sub. (4), except as restricted by cost containment provisions under s. 149.17 (4) and
2except as reduced by the department under ss. 149.143 and 149.144, covered
Covered
3expenses for the coverage under this section the plan shall also be the payment rates
4established by the department under s. 149.142 authority for, at a minimum, the
5following services and articles if the service or article is prescribed by a physician
6who is licensed under ch. 448 or in another state and who is certified under s. 49.45
7(2) (a) 11. and if the service or article is provided by a provider certified under s. 49.45
8(2) (a) 11.:
SB451, s. 93 9Section 93. 149.14 (3) (b) of the statutes is repealed and recreated to read:
SB451,37,1110 149.14 (3) (b) Professional services for the diagnosis or treatment of injuries,
11illnesses, or conditions, other than mental or dental.
SB451, s. 94 12Section 94. 149.14 (3) (c) 1. of the statutes is repealed and recreated to read:
SB451,37,1613 149.14 (3) (c) 1. Inpatient hospital services, as defined in s. 632.89 (1) (d),
14outpatient services, as defined in s. 632.89 (1) (e), and transitional treatment
15arrangements, as defined in s. 632.89 (1) (f), only to the extent required under s.
16632.89.
SB451, s. 95 17Section 95. 149.14 (3) (c) 2. of the statutes is repealed.
SB451, s. 96 18Section 96 . 149.14 (3) (c) 3. of the statutes is amended to read:
SB451,37,2219 149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated
20by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats.,
21services for the chronically mentally ill in community support programs operated
22under s. 51.421.
SB451, s. 97 23Section 97 . 149.14 (3) (c) 3. of the statutes, as affected by 2005 Wisconsin Act
24.... (this act), is amended to read:
SB451,38,4
1149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated
2by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats.

31., services for the chronically mentally ill in community support programs operated
4under s. 51.421.
SB451, s. 98 5Section 98. 149.14 (3) (d) of the statutes is amended to read:
SB451,38,66 149.14 (3) (d) Drugs requiring a physician's prescription, subject to sub. (4c).
SB451, s. 99 7Section 99. 149.14 (3) (e) of the statutes is amended to read:
SB451,38,148 149.14 (3) (e) Services For persons eligible for Medicare, services of a licensed
9skilled nursing facility for eligible persons eligible for medicare, to the extent
10required by s. 632.895 (3) and for not more than an aggregate 120 days during a
11calendar year, if the services are of the type which that would qualify as reimbursable
12services under medicare Medicare. Coverage under this paragraph which that is not
13required by s. 632.895 (3) is subject to the any deductible and coinsurance
14requirements under sub. (5) provided by the authority.
SB451, s. 100 15Section 100. 149.14 (3) (f) of the statutes is created to read:
SB451,38,1716 149.14 (3) (f) Services of a home health agency, as defined in s. 50.49 (1) (a), only
17to the extent required under s. 632.895 (2).
SB451, s. 101 18Section 101. 149.14 (3) (m) of the statutes is amended to read:
SB451,38,2119 149.14 (3) (m) Oral surgery for excision of partially or completely unerupted,
20impacted teeth and oral surgery with respect to the gums and other tissues of the
21mouth when not performed in connection with the extraction or repair of teeth.
SB451, s. 102 22Section 102. 149.14 (3) (o) of the statutes is amended to read:
SB451,38,2523 149.14 (3) (o) Transportation Emergency and other medically necessary
24transportation
provided by a licensed ambulance service to the nearest facility
25qualified to treat the a covered condition.
SB451, s. 103
1Section 103. 149.14 (3) (p) of the statutes is renumbered 149.14 (3) (em).
SB451, s. 104 2Section 104. 149.14 (4) of the statutes, as affected by 2005 Wisconsin Act ....
3(this act), is repealed and recreated to read:
SB451,39,124 149.14 (4) Plan design. Subject to subs. (1) to (3), (5), and (6), the authority
5shall establish the plan design, after taking into consideration the levels of health
6insurance coverage provided in the state and medical economic factors, as
7appropriate. Subject to subs. (1) to (3), (5), and (6), the authority shall provide benefit
8levels, deductibles, copayment and coinsurance requirements, exclusions, and
9limitations under the plan that the authority determines generally reflect and are
10commensurate with comprehensive health insurance coverage offered in the private
11individual market in the state. The authority may develop additional benefit designs
12that are responsive to market conditions.
SB451, s. 105 13Section 105. 149.14 (4) (d) of the statutes is amended to read:
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