LRBs0211/1
PJK/TJD/JK:jld/kjf/eev/cjs:jm
December 2013 Special Session
2013 - 2014 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 2,
TO 2013 ASSEMBLY BILL 1
December 4, 2013 - Offered by Representatives Barca,
Berceau, Bernard
Schaber, Billings, Danou, Doyle, Genrich, Hesselbein, Hintz, Johnson,
Jorgensen, Kessler, Mason, Pasch, Pope, Riemer, Ringhand, Sargent,
Shankland, Sinicki, Smith, C. Taylor, Wachs, Wright, Zamarripa, Zepnick,
Goyke, Richards, Hebl, Kahl, Clark, Bewley, Kolste, Young and Hulsey.
AB1-ASA2,2,2
1An Act to repeal 49.471 (1) (cr), 49.471 (4g), 49.471 (4m) and 49.67 (9m);
to
2amend 20.145 (5) (k), 71.07 (5g) (b), 71.07 (5g) (c) 1., 71.07 (5g) (d) 2., 71.28 (5g)
3(b), 71.28 (5g) (c) 1., 71.28 (5g) (d) 2., 71.47 (5g) (b), 71.47 (5g) (c) 1., 71.47 (5g)
4(d) 2., 76.655 (2), 76.655 (3) (a), 76.655 (5), 177.075 (3), 895.514 (2), 895.514 (3)
5(a) and 895.514 (3) (b);
to repeal and recreate 49.45 (23) (a), 49.45 (23) (a),
649.471 (4) (a) 4. b. and 49.471 (4) (a) 4. b.;
to create 49.471 (1) (cr) and 49.471
7(4g) of the statutes; and
to affect 2013 Wisconsin Act 20, section
9122 (1L) (b) 81. b.,
2013 Wisconsin Act 20, section
9122 (1L) (b) 1. c.,
2013 Wisconsin Act 20,
9section
9122 (1L) (b) 2. and 3. a. and c.,
2013 Wisconsin Act 20, section
9122 (1L)
10(b) 4.,
2013 Wisconsin Act 20, section
9122 (1L) (b) 8. (intro.) and
2013 Wisconsin
11Act 20, section
9122 (1L) (b) 8. a., 9. a., 10. a. and b. and 11. b.;
relating to:
12eligibility changes to BadgerCare Plus and BadgerCare Plus Core and
1extending coverage under, and the deadline for the dissolution of, the Health
2Insurance Risk-Sharing Plan.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB1-ASA2,2,85
20.145
(5) (k)
Operational expenses. All moneys transferred from the
6appropriation account under par. (g) for operational expenses related to
winding up 7the affairs of the Health Insurance Risk-Sharing Plan, including hiring consultants,
8limited-term employees, and experts.
AB1-ASA2,2,1711
49.45
(23) (a) The department shall request a waiver from the secretary of the
12federal department of health and human services to permit the department to
13conduct a demonstration project to provide health care coverage to adults who are
14under the age of 65, who have family incomes not to exceed 133 percent of the poverty
15line, except as provided in s. 49.471 (4g), and who are not otherwise eligible for
16medical assistance under this subchapter, the Badger Care health care program
17under s. 49.665, or Medicare under
42 USC 1395 et seq.
AB1-ASA2,3
18Section
3
. 49.45 (23) (a) of the statutes, as affected by 2013 Wisconsin Act ....
19(this act), is repealed and recreated to read:
AB1-ASA2,3,420
49.45
(23) (a) The department shall request a waiver from the secretary of the
21federal department of health and human services to permit the department to
22conduct a demonstration project to provide health care coverage to adults who are
23under the age of 65, who have family incomes not to exceed 100 percent of the poverty
1line before application of the 5 percent income disregard under
42 CFR 435.603 (d),
2and who are not otherwise eligible for medical assistance under this subchapter, the
3Badger Care health care program under s. 49.665, or Medicare under
42 USC 1395 4et seq.
AB1-ASA2,3p
5Section 3p. 49.471 (1) (cr) of the statutes is created to read:
AB1-ASA2,3,76
49.471
(1) (cr) "Enhanced federal medical assistance percentage" means a
7federal medical assistance percentage described under
42 USC 1396d (y) or (z).
AB1-ASA2,3q
8Section 3q. 49.471 (1) (cr) of the statutes, as created by 2013 Wisconsin Act
9.... (this act), is repealed.
AB1-ASA2,3,1312
49.471
(4) (a) 4. b. Except as provided in sub. (4g), the individual's family
13income does not exceed 133 percent of the poverty line.
AB1-ASA2,4b
14Section 4b. 49.471 (4) (a) 4. b. of the statutes, as affected by 2013 Wisconsin
15Act .... (this act), is repealed and recreated to read:
AB1-ASA2,3,1816
49.471
(4) (a) 4. b. The individual's family income does not exceed 100 percent
17of the poverty line before application of the 5 percent income disregard under
42 CFR
18435.603 (d).
AB1-ASA2,4d
19Section 4d. 49.471 (4g) of the statutes is created to read:
AB1-ASA2,4,320
49.471
(4g) Medicaid expansion; federal medical assistance percentage. For
21services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23), the
22department shall comply with all federal requirements to qualify for the highest
23available enhanced federal medical assistance percentage. The department shall
24submit any amendment to the state medical assistance plan, any request for a waiver
25of the federal Medicaid law, or any other approval required by the federal
1government to provide services to the individuals described under sub. (4) (a) 4. and
2s. 49.45 (23) and to qualify for the highest available enhanced federal medical
3assistance percentage.
AB1-ASA2,4e
4Section 4e. 49.471 (4g) of the statutes, as affected by 2013 Wisconsin Act ....
5(this act), is repealed.
AB1-ASA2,6
8Section
6. 49.67 (9m) of the statutes is repealed.
AB1-ASA2,4,1611
71.07
(5g) (b)
Filing claims. Subject to the limitations provided under this
12subsection, for taxable years beginning after December 31, 2005, and before January
131,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1471.02 an amount that is equal to the amount of the assessment under s. 149.13, 2011
15stats., that the claimant paid in the claimant's taxable year, multiplied by the
16percentage determined under par. (c) 1.
AB1-ASA2,5,619
71.07
(5g) (c) 1. The department of revenue, in consultation with the office of
20the commissioner of insurance, shall determine the percentage under par. (b) for
21each claimant for each taxable year. The percentage shall be equal to $5,000,000
22divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
23taxable years beginning after December 31, 2013, and before January 1, 2015, the
24percentage shall be equal to $1,250,000 divided by the aggregate assessment under
25s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
1commissioner of insurance shall provide to each claimant that participates in the
2cost of administering the plan the aggregate assessment at the time that it notifies
3the claimant of the claimant's assessment. The aggregate amount of the credit under
4this subsection and ss. 71.28 (5g), 71.47 (5g), and 76.655 for all claimants
5participating in the cost of administering the plan under ch. 149, 2011 stats., shall
6not exceed $5,000,000 in each fiscal year.
AB1-ASA2,5,129
71.07
(5g) (d) 2. No credit may be claimed under this subsection for taxable
10years beginning after December 31,
2013 2014. Credits under this subsection for
11taxable years that begin before January 1,
2014 2015, may be carried forward to
12taxable years that begin after December 31,
2013
2014.
AB1-ASA2,5,2015
71.28
(5g) (b)
Filing claims. Subject to the limitations provided under this
16subsection, for taxable years beginning after December 31, 2005, and before January
171,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1871.23 an amount that is equal to the amount of assessment under s. 149.13, 2011
19stats., that the claimant paid in the claimant's taxable year, multiplied by the
20percentage determined under par. (c) 1.
AB1-ASA2,6,1023
71.28
(5g) (c) 1. The department of revenue, in consultation with the office of
24the commissioner of insurance, shall determine the percentage under par. (b) for
25each claimant for each taxable year. The percentage shall be equal to $5,000,000
1divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
2taxable years beginning after December 31, 2013, and before January 1, 2015, the
3percentage shall be equal to $1,250,000 divided by the aggregate assessment under
4s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
5commissioner of insurance shall provide to each claimant that participates in the
6cost of administering the plan the aggregate assessment at the time that it notifies
7the claimant of the claimant's assessment. The aggregate amount of the credit under
8this subsection and ss. 71.07 (5g), 71.47 (5g), and 76.655 for all claimants
9participating in the cost of administering the plan under ch. 149, 2011 stats., shall
10not exceed $5,000,000 in each fiscal year.
AB1-ASA2,6,1613
71.28
(5g) (d) 2. No credit may be claimed under this subsection for taxable
14years beginning after December 31,
2013 2014. Credits under this subsection for
15taxable years that begin before January 1,
2014 2015, may be carried forward to
16taxable years that begin after December 31,
2013
2014.
AB1-ASA2,6,2419
71.47
(5g) (b)
Filing claims. Subject to the limitations provided under this
20subsection, for taxable years beginning after December 31, 2005, and before January
211,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
2271.43 an amount that is equal to the amount of assessment under s. 149.13, 2011
23stats., that the claimant paid in the claimant's taxable year, multiplied by the
24percentage determined under par. (c) 1.
AB1-ASA2,7,153
71.47
(5g) (c) 1. The department of revenue, in consultation with the office of
4the commissioner of insurance, shall determine the percentage under par. (b) for
5each claimant for each taxable year. The percentage shall be equal to $5,000,000
6divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
7taxable years beginning after December 31, 2013, and before January 1, 2015, the
8percentage shall be equal to $1,250,000 divided by the aggregate assessment under
9s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
10commissioner of insurance shall provide to each claimant that participates in the
11cost of administering the plan the aggregate assessment at the time that it notifies
12the claimant of the claimant's assessment. The aggregate amount of the credit under
13this subsection and ss. 71.07 (5g), 71.28 (5g), and 76.655 for all claimants
14participating in the cost of administering the plan under ch. 149, 2011 stats., shall
15not exceed $5,000,000 in each fiscal year.
AB1-ASA2,7,2118
71.47
(5g) (d) 2. No credit may be claimed under this subsection for taxable
19years beginning after December 31,
2013 2014. Credits under this subsection for
20taxable years that begin before January 1,
2014 2015, may be carried forward to
21taxable years that begin after December 31,
2013
2014.
AB1-ASA2,8,424
76.655
(2) Filing claims. Subject to the limitations provided under this section,
25for taxable years beginning after December 31, 2005, and before January 1,
2014
12015, a claimant may claim as a credit against the fees imposed under ss. 76.60,
276.63, 76.65, 76.66 or 76.67 an amount that is equal to the amount of assessment
3under s. 149.13, 2011 stats., that the claimant paid in the claimant's taxable year,
4multiplied by the percentage determined under sub. (3).
AB1-ASA2,8,197
76.655
(3) (a) The department of revenue, in consultation with the office of the
8commissioner of insurance, shall determine the percentage under sub. (2) for each
9claimant for each taxable year. The percentage shall be equal to $5,000,000 divided
10by the aggregate assessment under s. 149.13, 2011 stats.
, except that for taxable
11years beginning after December 31, 2013, and before January 1, 2015, the
12percentage shall be equal to $1,250,000 divided by the aggregate assessment under
13s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
14commissioner of insurance shall provide to each claimant that participates in the
15cost of administering the plan the aggregate assessment at the time that it notifies
16the claimant of the claimant's assessment. The aggregate amount of the credit under
17this subsection and ss. 71.07 (5g), 71.28 (5g), and 71.47 (5g) for all claimants
18participating in the cost of administering the plan under ch. 149, 2011 stats., shall
19not exceed $5,000,000 in each fiscal year.
AB1-ASA2,8,2522
76.655
(5) Sunset. No credit may be claimed under this section for taxable
23years beginning after December 31,
2013 2014. Credits under this section for taxable
24years that begin before January 1,
2014 2015, may be carried forward to taxable
25years that begin after December 31,
2013 2014.
AB1-ASA2,9,73
177.075
(3) Any intangible property distributable in the course of the
4dissolution of the Health Insurance Risk-Sharing Plan under
2013 Wisconsin Act
520, section
9122 (1L),
and 2013 Wisconsin Act .... (this act), section 32 (1) (b
), is
6presumed abandoned as otherwise provided under this chapter if sub. (1) (a), (b), or
7(c) does not apply with respect to the distribution.
AB1-ASA2,9,1710
895.514
(2) No cause of action of any nature may arise against, and no liability
11may be imposed upon, the authority, plan, or board; or any agent, employee, or
12director of any of them; or insurers participating in the plan; or the commissioner;
13or any agent, employee, or representative of the commissioner, for any act or
14omission by any of them in the performance of their powers and duties under ch. 149,
152011 stats.,
or under
2013 Wisconsin Act 20, section
9122 (1L),
or under 2013
16Wisconsin Act .... (this act), section 32 (1) (b
), unless the person asserting liability
17proves that the act or omission constitutes willful misconduct.
AB1-ASA2,9,2420
895.514
(3) (a) Except as provided in
2013 Wisconsin Act 20, section
9122 (1L),
21and 2013 Wisconsin Act .... (this act), section 32 (1
) (b), neither the state nor any
22political subdivision of the state nor any officer, employee, or agent of the state or a
23political subdivision acting within the scope of employment or agency is liable for any
24debt, obligation, act, or omission of the authority.
AB1-ASA2,10,83
895.514
(3) (b) All of the expenses incurred by the authority, or the
4commissioner, or any agent, employee, or representative of the commissioner, in
5exercising its duties and powers under ch. 149, 2011 stats.,
or under
2013 Wisconsin
6Act 20, section
9122 (1L),
or under 2013 Wisconsin Act .... (this act), section 32 (1) (b
), 7shall be payable only from funds of the authority or from the appropriation under s.
820.145 (5) (g) or (k), or from any combination of those payment sources.
AB1-ASA2,10,1811[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 1. b. Coverage under the policies
12issued under the plan, including to persons whose coverage under the plan is funded
13under a contract with the federal department of health and human services,
14terminates at 11:59 p.m. on December 31, 2013. At least 60 days before coverage
15terminates, the authority shall provide notice of the date on which coverage
16terminates to all covered persons, all insurers and providers that are affected by the
17termination of the coverage, the office, the legislative audit bureau, and the insurers
18described in subsection (1m) (b) 1.
AB1-ASA2,11,522[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 2. `Provider claims.' Providers
23of medical services and devices and prescription drugs to covered persons must file
24claims for payment no later than June 1, 2014. Any claim filed after that date is not
25payable and may not be charged to the covered person who received the service,
1device, or drug. Except for copayments, coinsurance, or deductibles required under
2the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes, a
3provider may not bill a covered person who receives a covered service or article and
4shall accept as payment in full the payment rate determined under section 149.142
5(1) of the statutes.
AB1-ASA2,11,86
3. a. Except for a grievance related to a prior authorization, any grievance by
7a covered person must be in writing and received no later than July 1, 2014, or be
8barred.
AB1-ASA2,11,129
c. A covered person who submits a grievance after March 31, 2014, must
10request an independent review, if any, with respect to the grievance no later than
11August 1, 2014, or be barred from requesting an independent review with respect to
12the grievance.
AB1-ASA2,11,2014[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 4. `Payment of plan costs.'
The 15To the extent possible, the authority shall pay plan costs incurred in 2013 and all
16other costs associated with dissolving the plan that are incurred before
17administrative responsibility for the dissolution of the plan is transferred to the
18office under subdivision 8. The authority and the office shall make every effort to pay
19plan costs in accordance with, or as closely as possible to, the manner provided in
20section 149.143 of the statutes.
AB1-ASA2,11,2423[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. `Transfer to the office.' (intro.)
24On February 28, 2014, all of the following shall occur:
AB1-ASA2,12,113[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. a. Administrative
4responsibility for the
operations and dissolution of the plan is transferred to the
5office. The commissioner shall take any action necessary or advisable to
manage and
6wind up the affairs of the plan and shall notify the legislative audit bureau when the
7windup is completed and provide to the legislative audit bureau the final financial
8statements of the plan. For purposes of chapter 177 of the statutes, as affected by
9this act, the dissolution, and winding up of the affairs, of the plan shall be considered
10a dissolution of an insurer in accordance with section 645.44 of the statutes, except
11that a court order of dissolution is not required to effect the dissolution of the plan.
AB1-ASA2,12,1612
9. a. There is created,
60 days after the date coverage under the plan terminates
13under subdivision 1. b. on March 1, 2014, a Health Insurance Risk-Sharing Plan
14advisory committee consisting of the commissioner, or his or her designee, and the
15other 13 members of the board holding office on the date the advisory committee is
16created.
AB1-ASA2,13,217
10. a. On behalf of the commissioner, the authority shall provide notice of the
18plan's dissolution to all persons known, or reasonably expected from the plan's
19records, to have claims against the plan, including all covered persons. The notice
20shall be sent by first class mail to the last-known addresses at least 60 days before
21the date on which coverage terminates under subdivision 1. b. Notice to potential
22claimants of the plan shall require the claimants to file their claims, together with
23proofs of claims,
within 90 days after the date on which coverage terminates under
24subdivision 1. b. by June 1, 2014. The notice shall be consistent with any relevant
25terms of the policies under the plan and contracts and with section 645.47 (1) (a) of
1the statutes. The notice shall serve as final notice consistent with section 645.47 (3)
2of the statutes.
AB1-ASA2,13,143
b. Proofs of all claims must be filed with the office in the form provided by the
4office consistent with the proof of claim, as applicable, under section 645.62 of the
5statutes, on or before the last day for filing specified in the notice. For good cause
6shown, the office shall permit a claimant to make a late filing if the existence of the
7claim was not known to the claimant and the claimant files the claim within 30 days
8after learning of the claim, but not
more than 210 days after the date on which
9coverage terminates under subdivision 1. b. later than September 1, 2014. Any such
10late claim that would have been payable under the policy under the plan if it had been
11filed timely and that was not covered by a succeeding insurer shall be permitted
12unless the claimant had actual notice of the termination of the plan or the notice was
13mailed to the claimant by first class mail at least 10 days before the insured event
14occurred.
AB1-ASA2,13,1715
11. b. Complete a final audit of the plan, after the termination of the plan in
162014,
within 90 days after the office provides the final financial statements of the
17plan under subdivision 8. a. by June 30, 2015.