Amendment ASA1-AB210

LRBs0181/1

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2011 - 2012 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 1, TO 2011 ASSEMBLY BILL 210

October 11, 2011 - Offered by Committee on Insurance.

AB210-ASA1,2,2 An Act to repeal 609.755, 632.83, 632.835 and 632.885; to renumber 625.02 (1); to renumber and amend 625.03 (1m) (e); to amend 40.51 (8), 40.51 (8), 40.51 (8m), 40.51 (8m), 49.67 (3) (am) 2. b., 66.0137 (4), 66.0137 (4), 111.91 (2) (n), 111.91 (2) (nm), 111.91 (2) (s), 111.998 (2) (n), 111.998 (2) (s), 120.13 (2) (g), 120.13 (2) (g), 185.983 (1) (intro.), 185.983 (1) (intro.), 600.01 (2) (b), 601.31 (1) (Lp), 601.31 (1) (Lr), 601.42 (4), 609.655 (4) (b), 625.13 (1), 625.14, 632.76 (2) (ac) 1., 632.76 (2) (ac) 2., 632.76 (2) (ac) 3. (intro.) and 632.895 (15) (c) (intro.); and to create 601.465 (1m) (d), 625.02 (1h), 625.02 (1p), 625.02 (2f), 625.02 (2s), 625.03 (1m) (e) 2., 625.03 (1m) (e) 3., 625.13 (3), 632.76 (2) (ac) 4. and chapter 636 of the statutes; relating to: implementing health insurance reform, extending the time limit for emergency rule procedures, specifying that any health benefit exchange must be established by legislation, and granting rule-making authority.

Analysis by the Legislative Reference Bureau

This substitute amendment differs from 2011 Assembly Bill 210 (the bill) in the following respects:

1. In the bill, the Office of the Commissioner of Insurance (OCI) may promulgate any rule related to the provisions created in the bill as an emergency rule and is not required to provide evidence that promulgating the rule as an emergency rule is necessary for the preservation of public peace, health, safety, or welfare and is not required to provide a finding of emergency. The substitute amendment removes this exception so that OCI, in promulgating an emergency rule, would be required to provide evidence that the emergency rule is necessary for the preservation of public peace, health, safety, or welfare and required to provide a finding of emergency.

2. Under the bill, grandfathered plans are required to comply with the federal Patient Protection and Affordable Care Act (PPACA) relating to requirements for coverage of preventive health services. The substitute amendment removes this requirement for grandfathered plans.

3. PPACA defines a small employer as one that employs not more than 100 employees, but allows states to elect to define a small employer, for plan years beginning before January 1, 2016, as an employer with not more than 50 employees. The bill defines a small employer for purposes of the PPACA requirements as an employer with not more than 100 employees but specifically reserves the right to elect to substitute 50 for 100 for the definition of small employer. The substitute amendment provides that this election must be done through legislation.

4. The bill provides that if PPACA is found unconstitutional in its entirety and all appeals are exhausted or the time for appeal expires, insurers and self-insured governmental health plans are exempt from a number of provisions in the bill. The substitute amendment adds that, if PPACA is found unconstitutional in its entirety, the powers of OCI with respect to promulgating rules for, and enforcing, the PPACA requirements, as well as any rules or requirements already established related to those requirements, do not apply. The substitute amendment also provides that if any of PPACA's provisions are repealed, insurers and self-insured governmental health plans are exempt from those provisions, or if PPACA is found unconstitutional in part, insurers and self-insured governmental health plans are exempt from any rebate and report and coverage requirements that are found unconstitutional, and the powers of OCI with respect to promulgating rules for, and enforcing, provisions from which insurers and self-insured governmental health plans are exempt, as well as any rules or requirements already established related to those provisions, do not apply.

5. The substitute amendment specifies that any health benefit exchange established in this state under PPACA must be done so by legislation. The bill does not address the establishment of a health benefit exchange.

For further information, see the analysis for the bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB210-ASA1, s. 1 Section 1 . 40.51 (8) of the statutes is amended to read:

AB210-ASA1,3,6 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896 and, so far as applicable, ch. 636.

AB210-ASA1, s. 2 Section 2 . 40.51 (8) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,3,13 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.85, 632.853, 632.855, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896 and, so far as applicable, ch. 636.

AB210-ASA1, s. 3 Section 3 . 40.51 (8m) of the statutes is amended to read:

AB210-ASA1,3,18 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885, 632.89, and 632.895 (11) to (17) and, so far as applicable, ch. 636.

AB210-ASA1, s. 4 Section 4 . 40.51 (8m) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,4,4 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.85, 632.853, 632.855, 632.885, 632.89, and 632.895 (11) to (17) and, so far as applicable, ch. 636.

AB210-ASA1, s. 5 Section 5. 49.67 (3) (am) 2. b. of the statutes, as affected by 2011 Wisconsin Act 32, is amended to read:

AB210-ASA1,4,11 49.67 (3) (am) 2. b. If the applicant is under 26 years of age, notice that he or she may be eligible for coverage as a dependent under his or her parent's health care plan in accordance with s. 632.885 636.25 (1) (h) or (3) (b), and that his or her parent's plan must include coverage for services that are not covered under the plan under this section.

AB210-ASA1, s. 6 Section 6 . 66.0137 (4) of the statutes is amended to read:

AB210-ASA1,4,19 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 7 Section 7 . 66.0137 (4) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,5,3 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 8 Section 8. 111.91 (2) (n) of the statutes is amended to read:

AB210-ASA1,5,7 111.91 (2) (n) The provision to employees of the health insurance coverage required under s. 632.895 (11) to (14), (16), and (16m), and (17) and, so far as applicable, s. 636.25.

AB210-ASA1, s. 9 Section 9. 111.91 (2) (nm) of the statutes is amended to read:

AB210-ASA1,5,11 111.91 (2) (nm) The requirements related to providing coverage for a dependent under s. 632.885 and to continuing coverage for a dependent student on a medical leave of absence under s. 632.895 (15).

AB210-ASA1, s. 10 Section 10. 111.91 (2) (s) of the statutes is amended to read:

AB210-ASA1,5,15 111.91 (2) (s) The requirements related to internal grievance procedures under s. 632.83 and independent review and external appeals of certain health benefit plan determinations established under s. 632.835 636.12.

AB210-ASA1, s. 11 Section 11. 111.998 (2) (n) of the statutes is amended to read:

AB210-ASA1,5,18 111.998 (2) (n) The provision to employees of the health insurance coverage required under s. 632.895 (11) to (14) and, so far as applicable, s. 636.25.

AB210-ASA1, s. 12 Section 12. 111.998 (2) (s) of the statutes is amended to read:

AB210-ASA1,5,22 111.998 (2) (s) The requirements related to internal grievance procedures under s. 632.83 and independent review and external appeals of certain health benefit plan determinations established under s. 632.835 636.12.

AB210-ASA1, s. 13 Section 13 . 120.13 (2) (g) of the statutes is amended to read:

AB210-ASA1,6,2 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 14 Section 14 . 120.13 (2) (g) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,6,8 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 15 Section 15 . 185.983 (1) (intro.) of the statutes is amended to read:

AB210-ASA1,6,17 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645, and 646, but the sponsoring association shall:

AB210-ASA1, s. 16 Section 16 . 185.983 (1) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,7,2 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645, and 646, but the sponsoring association shall:

AB210-ASA1, s. 17 Section 17. 600.01 (2) (b) of the statutes is amended to read:

AB210-ASA1,7,5 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not exempt from ss. 632.745 to 632.749, 632.83 or 632.835 or 636.12 or ch. 633 or 635.