2017 - 2018 LEGISLATURE
ASSEMBLY AMENDMENT 1,
TO ASSEMBLY BILL 885
February 13, 2018 - Offered by
Joint Committee on Finance.
49.45 (23) (a) of the statutes is amended to read:
(a) The department shall request a waiver from the secretary of the 5
federal department of health and human services to permit the department to 6
conduct a demonstration project to provide health care coverage to adults who are 7
under the age of 65, who have family incomes not to exceed 100 133
percent of the 8
poverty line before application of the 5 percent income disregard under 42 CFR
, except as provided in s. 49.471 (4g),
and who are not otherwise eligible 10
for medical assistance under this subchapter, the Badger Care health care program 11
under s. 49.665, or Medicare under 42 USC 1395
49.471 (1) (cr) of the statutes is created to read:
(cr) “Enhanced federal medical assistance percentage" means a 2
federal medical assistance percentage described under 42 USC 1396d
(y) or (z).
49.471 (4) (a) 4. b. of the statutes is amended to read:
(a) 4. b. The Except as provided in sub. (4g), the
individual's family 5
income does not exceed 100 133
percent of the poverty line before application of the
65 percent income disregard under 42 CFR 435.603 (d)
49.471 (4g) of the statutes is created to read:
49.471 (4g) Medicaid expansion; federal medical assistance percentage.
For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23), 10
the department shall comply with all federal requirements to qualify for the highest 11
available enhanced federal medical assistance percentage. The department shall 12
submit any amendment to the state medical assistance plan, request for a waiver of 13
federal Medicaid law, or other approval request required by the federal government 14
to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23) 15
and qualify for the highest available enhanced federal medical assistance 16
(b) If the department does not qualify for an enhanced federal medical 18
assistance percentage, or if the enhanced federal medical assistance percentage 19
obtained by the department is lower than printed in federal law as of July 1, 2013, 20
for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall 21
submit to the joint committee on finance a fiscal analysis comparing the cost to 22
maintain coverage for adults who are not pregnant and not elderly with family 23
incomes up to 133 percent of the poverty line to the cost of limiting eligibility to those 24
adults with family incomes up to 100 percent of the poverty line. The department 25
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 2
percent of the poverty line only if this reduction in income eligibility levels is 3
approved by the joint committee on finance.”.
“(i) To continue receiving reinsurance payments, an eligible health carrier shall 7
apply any savings to the carrier resulting from the healthcare stability plan to 8
reducing premium rates for individual enrollees purchasing coverage on the 9
“(b) Annually, the commissioner shall submit to the joint committee on finance 13
a report of an actuarial study regarding the reinsurance rates under the healthcare 14
stability plan under this subchapter.”.
625.02 (1) of the statutes is renumbered 625.02 (1m).
625.02 (1j) of the statutes is created to read:
“Health insurance" has the meaning given in s. 632.745 (12).
625.03 (1m) (intro.) of the statutes is amended to read:
(intro.) This Except as specifically provided otherwise in 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, 2
625.13 (1) of the statutes is amended to read:
625.13 (1) Filing procedure.
Except as provided in sub. (2) and s. 625.25 (2)
, every authorized insurer and every rate service organization licensed under s. 6
625.31 which has been designated by any insurer for the filing of rates under s. 7
625.15 (2) shall file with the commissioner all rates and supplementary rate 8
information and all changes and amendments thereof made by it for use in this state 9
within 30 days after they become effective.
625.15 (2) of the statutes is amended to read:
625.15 (2) Rate filing.
An insurer may discharge its obligation under s. 625.13 12
(1) or 625.25 (2) (a)
by giving notice to the commissioner that it uses rates and 13
supplementary rate information prepared by a designated rate service organization, 14
with such information about modifications thereof as is necessary fully to inform the 15
commissioner. The insurer's rates or proposed rates
and supplementary rate 16
information shall be those filed from time to time by the rate service organization, 17
including any amendments or proposed amendments
thereto as filed, subject, 18
however, to the modifications filed by the insurer.
625.21 (1) of the statutes is amended to read:
625.21 (1) Rule instituting delayed effect.
If the commissioner finds that 21
competition is not an effective regulator of the rates charged or that a substantial 22
number of companies are competing irresponsibly through the rates charged, or that 23
there are widespread violations of this chapter, in any kind or line of insurance or 24
subdivision thereof or in any rating class or rating territory, he or she may 25
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 2
subsequent changes in the rates or supplementary rate information be filed with the 3
commissioner at least 15 days before they become effective. The commissioner may 4
extend the waiting period for not to exceed 15 additional days by written notice to 5
the filer before the first 15-day period expires. This subsection does not apply to
6health insurance, which is subject to s. 625.25 (2) (a).
625.22 (1) of the statutes is amended to read:
625.22 (1) Order in event of violation.
If the commissioner finds after a 9
hearing that a rate or proposed rate
is not in compliance with s. 625.11, the 10
commissioner shall order that its use be discontinued, or that it may not be used,
any policy issued or renewed after a date specified in the order.
625.22 (3) of the statutes is amended to read:
625.22 (3) Approval of substituted rate. Within Except for rates for health
14insurance, which is subject to s. 625.25 (2) (a), within
one year after the effective date 15
of an order under sub. (1), no rate promulgated to replace a disapproved one may be 16
used until it has been filed with the commissioner and not disapproved within 30 17
625.23 of the statutes is amended to read:
19625.23 Special restrictions on individual insurers.
The commissioner 20
may by order require that a particular insurer file any or all of its rates and 21
supplementary rate information 15 days prior to their effective date, if and to the 22
extent that he or she finds, after a hearing, that the protection of the interests of its 23
insureds and the public in this state requires closer supervision of its rates because 24
of the insurer's financial condition or rating practices. The commissioner may extend 25
the waiting period for any filing for not to exceed 15 additional days by written notice
to the insurer before the first 15-day period expires. A filing not disapproved before 2
the expiration of the waiting period shall be deemed to meet the requirements of this 3
chapter, subject to the possibility of subsequent disapproval under s. 625.22. This
4section does not apply to an insurer with respect to rates for health insurance, which
5is subject to s. 625.25 (2) (a).
625.25 of the statutes is created to read:
7625.25 Rates for health insurance.
In this section:
(a) “Group health benefit plan" has the meaning given in s. 632.745 (9).
(b) “Health benefit plan" has the meaning given in s. 632.745 (11).
(c) “Insurer" has the meaning given in s. 632.745 (15).
(d) “Large group market" has the meaning given in s. 632.745 (17).
(e) “Small group market" has the meaning given in s. 632.745 (26).
13(2) Filing of rates; hearing.
(a) Every insurer, and every rate service 14
organization licensed under s. 625.31 that has been designated by any insurer for the 15
filing of rates under s. 625.15 (2), shall file with the commissioner all proposed rates 16
and supplementary rate information, and all proposed changes and amendments to 17
rates and supplementary rate information, for use in this state for any health benefit 18
plan offered by the insurer before the proposed rates or changes to rates become 19
effective. An insurer may not use a proposed rate or change to a rate until it has been 20
filed with and approved by the commissioner. Unless the commissioner holds a 21
hearing on the proposed rate or change to a rate, a proposed rate or change to a rate 22
is approved if the commissioner does not disapprove the proposed rate or change 23
within 30 days after filing, or within a 30-day extension of that period ordered by the 24
commissioner prior to the expiration of the first 30 days. The requirement under this 25
paragraph applies with respect to rates and changes to rates for all health benefit
plans, including individual health benefit plans, group health benefit plans offered 2
in the small group market, and group health benefit plans offered in the large group 3
market, that have not gone into effect by the effective date of this paragraph .... [LRB 4
(b) If any proposed change to a rate filed under par. (a) increases the existing 6
rate by more than 10 percent of that rate, the commissioner shall hold a public 7
hearing before approving or disapproving the proposed change to the rate.
(c) The commissioner may disapprove a proposed rate or change to a rate filed 9
under par. (a) that the commissioner determines is not justified based on underlying 10