Amendment AA8-ASA1-AB64

AB64-ASA1-AA8,3,8 8. Page 424, line 21: after that line insert:

AB64-ASA1-AA8,3,9 “ Section 709p. 40.51 (8m) of the statutes is amended to read:

AB64-ASA1-AA8,3,13 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, 632.867, 632.885, 632.89, and 632.895 (11) (8) and (10) to (17).”.

AB64-ASA1-AA8,3,14 9. Page 424, line 21: after that line insert:

AB64-ASA1-AA8,3,15 “ Section 709n. 40.51 (8) of the statutes is amended to read:

AB64-ASA1-AA8,3,20 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, 632.867, 632.87 (3) to (6), 632.883, 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB64-ASA1-AA8,709p Section 709p. 40.51 (8m) of the statutes is amended to read:

AB64-ASA1-AA8,4,2 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, 632.867, 632.883, 632.885, 632.89, and 632.895 (11) to (17).”.

AB64-ASA1-AA8,4,3 10. Page 518, line 19: after that line insert:

AB64-ASA1-AA8,4,4 “ Section 925t. 49.45 (9d) of the statutes is created to read:

AB64-ASA1-AA8,4,5 49.45 (9d) Family planning services; private providers. (a) In this subsection:

AB64-ASA1-AA8,4,6 1. “Family planning” has the meaning given s. 253.07 (1) (a).

AB64-ASA1-AA8,4,10 2. “Federal funding prohibition” means an enacted federal law, a regulation, or an executive order or action that prohibits federal moneys from being paid by the state to a provider under the Medicaid program because of the scope of services offered by the provider or the scope of services for which the provider offers referrals.

AB64-ASA1-AA8,4,13 3. “Nonpublic family planning provider” means an entity other than a public entity or governmental unit that is a provider of services for family planning under the Medical Assistance program under this subchapter on December 31, 2016.

AB64-ASA1-AA8,4,15 (b) If a nonpublic family planning provider becomes subject to a federal funding prohibition, the department shall do all of the following:

AB64-ASA1-AA8,4,18 1. Ensure that enrollees in the Medical Assistance program under this subchapter are allowed access to the nonpublic family planning provider to the same extent as before the federal funding prohibition.

AB64-ASA1-AA8,4,21 2. Reimburse the nonpublic family planning provider for services provided to Medical Assistance enrollees under this subchapter for services for family planning that are covered under the Medical Assistance program.

AB64-ASA1-AA8,4,24 3. Maintain requirements for the nonpublic family planning provider to receive state payments under this subchapter that are the same requirements as before the federal funding prohibition.

AB64-ASA1-AA8,5,3 (c) The department may not limit the scope of services for which a nonpublic family planning provider may offer a referral in order to receive reimbursement under par. (b) 2.”.

AB64-ASA1-AA8,5,4 11. Page 521, line 19: after that line insert:

AB64-ASA1-AA8,5,5 “ Section 926w. 49.45 (23) (a) of the statutes is amended to read:

AB64-ASA1-AA8,5,13 49.45 (23) (a) The department shall request a waiver from the secretary of the federal department of health and human services to permit the department to conduct a demonstration project to provide health care coverage to adults who are under the age of 65, who have family incomes not to exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d), except as provided in s. 49.471 (4g), and who are not otherwise eligible for medical assistance under this subchapter, the Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395 et seq.”.

AB64-ASA1-AA8,5,14 12. Page 531, line 15: after that line insert:

AB64-ASA1-AA8,5,15 “ Section 933p. 49.471 (1) (cr) of the statutes is created to read:

AB64-ASA1-AA8,5,17 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

AB64-ASA1-AA8,933r Section 933r. 49.471 (4) (a) 4. b. of the statutes is amended to read:

AB64-ASA1-AA8,5,21 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family income does not exceed 100 133 percent of the poverty line before application of the 5 percent income disregard under 42 CFR 435.603 (d).

AB64-ASA1-AA8,933t Section 933t. 49.471 (4g) of the statutes is created to read:

AB64-ASA1-AA8,6,7 49.471 (4g) Medicaid expansion; federal medical assistance percentage. (a) For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23), the department shall comply with all federal requirements to qualify for the highest available enhanced federal medical assistance percentage. The department shall submit any amendment to the state medical assistance plan, request for a waiver of federal Medicaid law, or other approval request required by the federal government to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23) and qualify for the highest available enhanced federal medical assistance percentage.

AB64-ASA1-AA8,6,19 (b) If the department does not qualify for an enhanced federal medical assistance percentage, or if the enhanced federal medical assistance percentage obtained by the department is lower than printed in federal law as of July 1, 2013, for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall submit to the joint committee on finance a fiscal analysis comparing the cost to maintain coverage for adults who are not pregnant and not elderly with family incomes up to 133 percent of the poverty line to the cost of limiting eligibility to those adults with family incomes up to 100 percent of the poverty line. The department may reduce income eligibility for adults who are not pregnant and not elderly from family incomes of up to 133 percent of the poverty line to family incomes of up to 100 percent of the poverty line only if this reduction in income eligibility levels is approved by the joint committee on finance.”.

AB64-ASA1-AA8,6,20 13. Page 531, line 15: after that line insert:

AB64-ASA1-AA8,6,21 “ Section 933t. 49.471 (4m) of the statutes is created to read:

AB64-ASA1-AA8,7,11 49.471 (4m) Purchase options for BadgerCare Plus and the assistance for childless adults demonstration project. (a) 1. The department shall, if required, request a waiver from or submit amendments to the state Medical Assistance plan to the secretary of the federal department of health and human services to establish a program that allows individuals with income above the maximum income eligibility limit applicable under this section or the assistance for childless adults demonstration project under s. 49.45 (23), and who otherwise meet the eligibility requirements under this section or under s. 49.45 (23), the option of purchasing coverage through this section or through the demonstration project under s. 49.45 (23) instead of purchasing an individual health plan through private insurance. The department shall also include a request for any federal waiver or state Medical Assistance plan amendments necessary to allow an option for small businesses to purchase coverage for their employees under this section as part of the small business health options program through an exchange under 42 USC 18031.

AB64-ASA1-AA8,7,15 2. The department shall seek any federal waiver and state Medical Assistance plan amendments necessary to allow individuals who qualify under subd. 1. to use advanced tax credits and cost-sharing credits, if eligible, to purchase one of the options described under subd. 1.

AB64-ASA1-AA8,7,24 (b) 1. The department shall coordinate the administration of the purchase options under this subsection with the programs under this section and s. 49.45 (23) to maximize efficiency and improve the continuity of care, consistent with the requirements of this section and s. 49.45 (23). The department shall seek to implement mechanisms to ensure the long-term financial sustainability of the programs under this section and s. 49.45 (23). These mechanisms must address issues related to minimizing adverse selection, the state financial risk and contribution, and negative impacts to premiums in the individual and group insurance markets.

AB64-ASA1-AA8,8,2 2. The purchase option program shall include, at a minimum, all of the following attributes:

AB64-ASA1-AA8,8,4 a. Establishment of an annual per enrollee premium rate similar to the average rate paid by the state to managed care plan contractors.

AB64-ASA1-AA8,8,6 b. Establishment of a benefit set equal to the benefits covered under this section and s. 49.45 (23).

AB64-ASA1-AA8,8,8 c. Annual enrollment that is limited to the same annual open enrollment periods established for the programs under this section and s. 49.45 (23).

AB64-ASA1-AA8,8,10 d. The ability for the department to adjust the purchase option's actuarial value to a value no lower than 87 percent.

AB64-ASA1-AA8,8,12 e. Reimbursement mechanisms for addressing potential increased costs to the programs under this section and s. 49.45 (23).

AB64-ASA1-AA8,8,17 (c) By March 1, 2018, the department of health services shall submit a report to the appropriate standing committee in each house of the legislature under s. 13.172 (3) that provides information on the status of the request for a federal waiver and the results from actuarial and economic analyses that are necessary for a waiver proposal.

AB64-ASA1-AA8,8,23 (d) If any necessary waiver or amendments to the state plan described under par. (a) 1. are approved, the department shall implement the program. If the department is authorized to implement the program, and if any waiver or state plan amendment described under par. (a) 2. is necessary and is approved, or if the department determines neither a waiver nor state plan amendment is necessary, the department shall allow the purchase options described under par. (a) 2.”.

AB64-ASA1-AA8,8,24 14. Page 563, line 2: after that line insert:

AB64-ASA1-AA8,9,2 “ Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,9,9 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), 632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,9,10 15. Page 563, line 2: after that line insert:

AB64-ASA1-AA8,9,12 “ Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,9,18 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, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,9,19 16. Page 563, line 2: after that line insert:

AB64-ASA1-AA8,9,21 “ Section 983a. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,9,24 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, 632.867, 632.87 (4) to (6), 632.883, 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,10,5 17. Page 831, line 3: after that line insert:

AB64-ASA1-AA8,10,7 “ Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,10,11 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,10,12 18. Page 831, line 3: after that line insert:

AB64-ASA1-AA8,10,14 “ Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,10,18 120.13 (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, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,10,19 19. Page 831, line 3: after that line insert:

AB64-ASA1-AA8,10,21 “ Section 1624k. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,11,2 120.13 (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, 632.867, 632.87 (4) to (6), 632.883, 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).”.

AB64-ASA1-AA8,11,3 20. Page 857, line 18: after that line insert:

AB64-ASA1-AA8,11,5 “ Section 1691am. 185.983 (1) (intro.) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB64-ASA1-AA8,11,13 185.983 (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), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but the sponsoring association shall:”.

AB64-ASA1-AA8,11,14 21. Page 857, line 18: after that line insert:

AB64-ASA1-AA8,11,15 “ Section 1691am. 185.983 (1) (intro.) of the statutes is amended to read:

AB64-ASA1-AA8,11,23 185.983 (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, 632.867, 632.87 (2) to (6), 632.883, 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but the sponsoring association shall:”.

AB64-ASA1-AA8,11,24 22. Page 876, line 22: after that line insert:

AB64-ASA1-AA8,12,1 “ Section 1791df. 253.07 (title) of the statutes is amended to read:

AB64-ASA1-AA8,12,2 253.07 (title) Women's health block grant; state family planning funds.

AB64-ASA1-AA8,1791dh Section 1791dh. 253.07 (6) of the statutes is created to read:

AB64-ASA1-AA8,12,4 253.07 (6) State-funded family planning program. (a) In this subsection:

AB64-ASA1-AA8,12,9 1. “Federal funding prohibition” means an enacted federal law, a regulation, or an executive order or action that prohibits federal moneys from being paid by the state to or directly to a provider under Title X of the federal Public Health Service Act, 42 USC 300 to 300a-6, because of the scope of services offered by the provider or the scope of services for which the provider offers referrals.

AB64-ASA1-AA8,12,13 2. “Nonpublic family planning provider” means an entity other than a public entity or governmental unit that is a provider of services for family planning and that is eligible to apply for grant funding under Title X of the federal Public Health Service Act, 42 USC 300 to 300a-6, on December 31, 2016.

AB64-ASA1-AA8,12,19 (b) Notwithstanding sub. (5), if a nonpublic family planning provider becomes subject to a federal funding prohibition, the department shall establish a state-funded family planning program to ensure continuity of family planning services in the state and distribute state funds to any nonpublic family planning providers that are subject to a federal funding prohibition to be used to provide family planning services.”.

AB64-ASA1-AA8,12,20 23. Page 925, line 14: after that line insert:

AB64-ASA1-AA8,12,21 “ Section 2218s. 625.02 (1) of the statutes is renumbered 625.02 (1m).

AB64-ASA1-AA8,2218t Section 2218t. 625.02 (1j) of the statutes is created to read:

AB64-ASA1-AA8,12,23 625.02 (1j) “Health insurance" has the meaning given in s. 632.745 (12).

AB64-ASA1-AA8,2218u Section 2218u. 625.03 (1m) (intro.) of the statutes is amended to read:

AB64-ASA1-AA8,13,4 625.03 (1m) (intro.) This Except as specifically provided otherwise in this chapter, this chapter applies to all kinds and lines of direct insurance written on risks or operations in this state by any insurer authorized to do business in this state, except:

AB64-ASA1-AA8,2218v Section 2218v. 625.13 (1) of the statutes is amended to read:

AB64-ASA1-AA8,13,11 625.13 (1) Filing procedure. Except as provided in sub. (2) and s. 625.25 (2) (a), every authorized insurer and every rate service organization licensed under s. 625.31 which has been designated by any insurer for the filing of rates under s. 625.15 (2) shall file with the commissioner all rates and supplementary rate information and all changes and amendments thereof made by it for use in this state within 30 days after they become effective.

AB64-ASA1-AA8,2218w Section 2218w. 625.15 (2) of the statutes is amended to read:

AB64-ASA1-AA8,13,20 625.15 (2) Rate filing. An insurer may discharge its obligation under s. 625.13 (1) or 625.25 (2) (a) by giving notice to the commissioner that it uses rates and supplementary rate information prepared by a designated rate service organization, with such information about modifications thereof as is necessary fully to inform the commissioner. The insurer's rates or proposed rates and supplementary rate information shall be those filed from time to time by the rate service organization, including any amendments or proposed amendments thereto as filed, subject, however, to the modifications filed by the insurer.

AB64-ASA1-AA8,2218x Section 2218x. 625.21 (1) of the statutes is amended to read:

AB64-ASA1-AA8,14,8 625.21 (1) Rule instituting delayed effect. If the commissioner finds that competition is not an effective regulator of the rates charged or that a substantial number of companies are competing irresponsibly through the rates charged, or that there are widespread violations of this chapter, in any kind or line of insurance or subdivision thereof or in any rating class or rating territory, he or she may promulgate a rule requiring that in the kind or line of insurance or subdivision thereof or rating class or rating territory comprehended by the finding any subsequent changes in the rates or supplementary rate information be filed with the commissioner at least 15 days before they become effective. The commissioner may extend the waiting period for not to exceed 15 additional days by written notice to the filer before the first 15-day period expires. This subsection does not apply to health insurance, which is subject to s. 625.25 (2) (a).

AB64-ASA1-AA8,2218y Section 2218y. 625.22 (1) of the statutes is amended to read:

AB64-ASA1-AA8,14,13 625.22 (1) Order in event of violation. If the commissioner finds after a hearing that a rate or proposed rate is not in compliance with s. 625.11, the commissioner shall order that its use be discontinued, or that it may not be used, for any policy issued or renewed after a date specified in the order.