Amendment SA1-SB770

LRBa2106/1

TJD:emw

2017 - 2018 LEGISLATURE

SENATE AMENDMENT 1, TO SENATE BILL 770

February 13, 2018 - Offered by Joint Committee on Finance.

SB770-SA1,1,1 At the locations indicated, amend the bill as follows:

SB770-SA1,1,2 1. Page 5, line 6: after that line insert:

SB770-SA1,1,3 “ Section 3c. 49.45 (23) (a) of the statutes is amended to read:

SB770-SA1,1,11 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.

SB770-SA1,3d Section 3d. 49.471 (1) (cr) of the statutes is created to read:

SB770-SA1,2,2 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a federal medical assistance percentage described under 42 USC 1396d (y) or (z).

SB770-SA1,3e Section 3e. 49.471 (4) (a) 4. b. of the statutes is amended to read:

SB770-SA1,2,6 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).

SB770-SA1,3f Section 3f. 49.471 (4g) of the statutes is created to read:

SB770-SA1,2,16 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.

SB770-SA1,3,3 (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.”.

SB770-SA1,3,4 2. Page 8, line 18: delete lines 18 to 25.

SB770-SA1,3,5 3. Page 12, line 12: after that line insert:

SB770-SA1,3,9 “(i) To continue receiving reinsurance payments, an eligible health carrier shall apply any savings to the carrier resulting from the healthcare stability plan to reducing premium rates for individual enrollees purchasing coverage on the individual market.”.

SB770-SA1,3,10 4. Page 13, line 1: after “Reports." insert “(a)".

SB770-SA1,3,11 5. Page 13, line 5: after that line insert:

SB770-SA1,3,14 “(b) Annually, the commissioner shall submit to the joint committee on finance a report of an actuarial study regarding the reinsurance rates under the healthcare stability plan under this subchapter.”.

SB770-SA1,3,16 6. Page 13, line 12: delete the material beginning with “, any possible" and ending with “state" on line 13.

SB770-SA1,3,17 7. Page 13, line 20: after that line insert:

SB770-SA1,3,18 “ Section 10d. 625.02 (1) of the statutes is renumbered 625.02 (1m).

SB770-SA1,10f Section 10f. 625.02 (1j) of the statutes is created to read:

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.”.