Amendment SA1-SB770

SB770-SA1,3,20 625.02 (1j) “Health insurance" has the meaning given in s. 632.745 (12).

SB770-SA1,10h Section 10h. 625.03 (1m) (intro.) of the statutes is amended to read:

SB770-SA1,4,2 625.03 (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:

SB770-SA1,10j Section 10j. 625.13 (1) of the statutes is amended to read:

SB770-SA1,4,9 625.13 (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.

SB770-SA1,10m Section 10m. 625.15 (2) of the statutes is amended to read:

SB770-SA1,4,18 625.15 (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.

SB770-SA1,10p Section 10p. 625.21 (1) of the statutes is amended to read:

SB770-SA1,5,6 625.21 (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).

SB770-SA1,10r Section 10r. 625.22 (1) of the statutes is amended to read:

SB770-SA1,5,11 625.22 (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.

SB770-SA1,10t Section 10t. 625.22 (3) of the statutes is amended to read:

SB770-SA1,5,17 625.22 (3) Approval of substituted rate. Within Except for rates for health insurance, which is subject to s. 625.25 (2) (a), within one year after the effective date of an order under sub. (1), no rate promulgated to replace a disapproved one may be used until it has been filed with the commissioner and not disapproved within 30 days thereafter.

SB770-SA1,10w Section 10w. 625.23 of the statutes is amended to read:

SB770-SA1,6,5 625.23 Special restrictions on individual insurers. The commissioner may by order require that a particular insurer file any or all of its rates and supplementary rate information 15 days prior to their effective date, if and to the extent that he or she finds, after a hearing, that the protection of the interests of its insureds and the public in this state requires closer supervision of its rates because of the insurer's financial condition or rating practices. The commissioner may extend 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 the expiration of the waiting period shall be deemed to meet the requirements of this chapter, subject to the possibility of subsequent disapproval under s. 625.22. This section does not apply to an insurer with respect to rates for health insurance, which is subject to s. 625.25 (2) (a).

SB770-SA1,10y Section 10y. 625.25 of the statutes is created to read:

SB770-SA1,6,7 625.25 Rates for health insurance. (1) Definitions. In this section:

SB770-SA1,6,8 (a) “Group health benefit plan" has the meaning given in s. 632.745 (9).

SB770-SA1,6,9 (b) “Health benefit plan" has the meaning given in s. 632.745 (11).

SB770-SA1,6,10 (c) “Insurer" has the meaning given in s. 632.745 (15).

SB770-SA1,6,11 (d) “Large group market" has the meaning given in s. 632.745 (17).

SB770-SA1,6,12 (e) “Small group market" has the meaning given in s. 632.745 (26).

SB770-SA1,7,4 (2) Filing of rates; hearing. (a) Every insurer, and every rate service organization licensed under s. 625.31 that has been designated by any insurer for the filing of rates under s. 625.15 (2), shall file with the commissioner all proposed rates and supplementary rate information, and all proposed changes and amendments to rates and supplementary rate information, for use in this state for any health benefit plan offered by the insurer before the proposed rates or changes to rates become effective. An insurer may not use a proposed rate or change to a rate until it has been filed with and approved by the commissioner. Unless the commissioner holds a hearing on the proposed rate or change to a rate, a proposed rate or change to a rate is approved if the commissioner does not disapprove the proposed rate or change within 30 days after filing, or within a 30-day extension of that period ordered by the commissioner prior to the expiration of the first 30 days. The requirement under this 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 in the small group market, and group health benefit plans offered in the large group market, that have not gone into effect by the effective date of this paragraph .... [LRB inserts date].

SB770-SA1,7,7 (b) If any proposed change to a rate filed under par. (a) increases the existing rate by more than 10 percent of that rate, the commissioner shall hold a public hearing before approving or disapproving the proposed change to the rate.

SB770-SA1,7,10 (c) The commissioner may disapprove a proposed rate or change to a rate filed under par. (a) that the commissioner determines is not justified based on underlying medical costs.

SB770-SA1,7,14 (3) Publication of increases, negotiated rates. (a) The commissioner shall publish on the office's Internet site, in a format that is readily understandable by members of the public, all rate changes filed under sub. (2) (a) that increase an existing rate by any amount and that are approved.

SB770-SA1,7,19 (b) If the commissioner approves a rate increase after holding a hearing under sub. (2) (b) and the insurer justified the rate increase based on increased medical costs, the commissioner shall publish on the office's Internet site, in a format that is readily understandable by members of the public, the discounted payment rates the insurer has negotiated with each of the insurer's provider networks.

SB770-SA1,7,23 (4) Notice of rate increase to insureds. If the commissioner approves a rate increase filed under sub. (2) (a), the insurer shall provide notice of the rate increase to each insured under the health benefit plan at least 60 days before the rate increase goes into effect.”.

SB770-SA1,7,24 8. Page 14, line 4: after that line insert:

SB770-SA1,8,4 “(2m) Increasing Medical Assistance reimbursement rates. The department of health services shall amend the state Medicaid plan to increase reimbursement rates for providers of medical and long-term care services providers under the Medical Assistance program for dates of service on and after July 1, 2018.”.

SB770-SA1,8,5 9. Page 14, line 6: delete lines 6 to 9 and substitute:

SB770-SA1,8,10 “(2m) Medicaid expansion. In the schedule under section 20.005 (3) of the statutes for the appropriation to the department of health services under section 20.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19 is decreased by $203,000,000 to provide Medical Assistance to certain adults with family incomes up to 133 percent of the federal poverty line.

SB770-SA1,8,15 (3m) Medical Assistance reimbursement rates. In the schedule under section 20.005 (3) of the statutes for the appropriation to the department of health services under section 20.435 (4) (b) of the statutes, the dollar amount for fiscal year 2018-19 is increased by $123,000,000 to increase reimbursement rates to providers under the Medical Assistance program in accordance with Section 11 (2m) of this act.

SB770-SA1,13m Section 13m. Effective dates. This act takes effect on the day after publication, except as follows:

SB770-SA1,8,20 (1) Medicaid expansion. The treatment of sections 49.45 (23) (a) and 49.471 (1) (cr), (4) (a) 4. b., and (4g) of the statutes and Section 12 (2m) and (3m) of this act take effect on July 1, 2018, or on the day after publication, whichever is later.”.

SB770-SA1,8,21 (End)