AB445, s. 1
1Section 1. 149.12 (2) (e) of the statutes is renumbered 149.12 (2) (e) 1. and
2amended to read:
AB445,3,63 149.12 (2) (e) 1. No Subject to subd. 2., no person who is eligible for creditable
4coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that is
5provided by an employer on a self-insured basis or through health insurance is
6eligible for coverage under the plan.
AB445, s. 2 7Section 2. 149.12 (2) (e) 2. of the statutes is created to read:
AB445,3,98 149.12 (2) (e) 2. The board may specify other types of coverage provided by an
9employer that do not render a person ineligible for coverage under the plan.
AB445, s. 3 10Section 3. 149.14 (2) (c) 1. of the statutes is renumbered 149.14 (2) (c).
AB445, s. 4 11Section 4. 149.14 (2) (c) 2. of the statutes is repealed.
AB445, s. 5 12Section 5. 149.14 (3) (intro.) of the statutes is amended to read:
AB445,3,2013 149.14 (3) Covered expenses. (intro.) Covered expenses for coverage under the
14plan shall be the payment rates established by the authority for services provided
15by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Covered
16expenses for coverage under the plan shall also be the payment rates established by
17the authority for, at a minimum, the following services and articles if the service or
18article is prescribed by a physician who is licensed under ch. 448 or in another state
19and who is certified under s. 49.45 (2) (a) 11. and, except as provided in sub. (3m), if
20the service or article is provided by a provider certified under s. 49.45 (2) (a) 11.:
AB445, s. 6 21Section 6. 149.14 (3c) of the statutes is created to read:
AB445,4,322 149.14 (3c) Temporary provider certification. Notwithstanding the provider
23licensing and certification requirements under sub. (3) (intro.), for coverage of
24services or articles provided to an eligible person the authority may certify on a
25temporary basis a provider that is not licensed under ch. 446 or 448 but that is

1licensed in another state to provide the service or article, or a provider that is not
2certified under s. 49.45 (2) (a) 11. The certification under this subsection may be
3retroactive.
AB445, s. 7 4Section 7. 149.14 (3m) of the statutes is created to read:
AB445,4,95 149.14 (3m) Pharmacy network. Covered expenses for prescription drugs
6shall be the payment rates established by the authority for prescription drugs that
7are provided to eligible persons by a network of pharmacists and pharmacies
8approved by the board, regardless of whether the provider of the drug is certified
9under s. 49.45 (2) (a) 11.
AB445, s. 8 10Section 8. 149.14 (5) (a) of the statutes is amended to read:
AB445,4,1311 149.14 (5) (a) The authority shall establish and provide subsidies for
12deductibles paid by eligible persons with coverage under s. 149.14 (2) (a) and
13household incomes specified in s. 149.165 (2) (a) 1. to 5 to (e).
AB445, s. 9 14Section 9. 149.142 (1) of the statutes is amended to read:
AB445,4,2515 149.142 (1) Establishment of rates. The authority shall establish provider
16payment rates for covered expenses that consist of the allowable charges paid under
17s. 49.46 (2)
usual and customary payment rates, as determined by the authority, for
18the services and articles provided plus an enhancement adjustment determined by
19the authority. The rates shall be based on the allowable charges paid under s. 49.46
20(2), projected plan costs, and trend factors. Using the same methodology that applies
21to medical assistance under subch. IV of ch. 49, the authority shall establish hospital
22outpatient per visit reimbursement rates and hospital inpatient reimbursement
23rates that are specific to diagnostically related groups of eligible persons.
The
24adjustments to the usual and customary rates shall be sufficient to cover the portion
25of plan costs specified in s. 149.143 (1) (c) and (2) (b).
AB445, s. 10
1Section 10. 149.165 (2) (a) of the statutes is renumbered 149.165 (2) and
2amended to read:
AB445,5,83 149.165 (2) Subject to sub. (3m), if the household income, as defined in s. 71.52
4(5) and as determined under sub. (3), of an eligible person with coverage under s.
5149.14 (2) (a)
is equal to or greater than the first amount and less than the 2nd
6amount listed in any of the following, the authority shall reduce the premium for the
7eligible person to the rate by the percentage of the premium shown after the
8amounts:
AB445,5,129 (a) If equal to or greater than $0 and less than $10,000, to 100% of the rate that
10a standard risk would be charged under an individual policy providing substantially
11the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a)
by
12at least 30 percent
.
AB445,5,1613 (b) If equal to or greater than $10,000 and less than $14,000, to 106.5% of the
14rate that a standard risk would be charged under an individual policy providing
15substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
16and (5) (a)
by at least 25 percent.
AB445,5,2017 (c) If equal to or greater than $14,000 and less than $17,000, to 115.5% of the
18rate that a standard risk would be charged under an individual policy providing
19substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
20and (5) (a)
by at least 20 percent.
AB445,5,2421 (d) If equal to or greater than $17,000 and less than $20,000, to 124.5% of the
22rate that a standard risk would be charged under an individual policy providing
23substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
24and (5) (a)
by at least 15 percent.
AB445,6,4
1(e) If equal to or greater than $20,000 and less than $25,000, to 130% of the rate
2that a standard risk would be charged under an individual policy providing
3substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
4and (5) (a)
by at least 10 percent.
AB445, s. 11 5Section 11. 149.165 (2) (bc) of the statutes is repealed.
AB445, s. 12 6Section 12. 149.165 (3m) of the statutes is amended to read:
AB445,6,107 149.165 (3m) The authority may approve adjustment of the household income
8dollar amounts listed in sub. (2) (a) 1. to 5. to (e), except for the first dollar amount
9listed in sub. (2) (a) 1., to reflect changes in the consumer price index for all urban
10consumers, U.S. city average, as determined by the U.S. department of labor.
AB445, s. 13 11Section 13. Subchapter IV of chapter 149 [precedes 149.60] of the statutes is
12repealed.
AB445, s. 14 13Section 14. Initial applicability.
AB445,6,1614 (1) Premium discounts. The treatment of sections 149.14 (2) (c) 1. and 2. and
15(5) (a) and 149.165 (2) (a) and (bc) and (3m) of the statutes first applies to policy years
16beginning on January 1, 2008.
AB445,6,1717 (End)
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