(a) In the fiscal biennium in which the savings are calculated, reduce the 12
estimated general purpose revenue and program revenue expenditures, excluding
tuition and fee moneys from the University of Wisconsin System, for “Compensation 2
Reserves” shown in the schedule under s. 20.005 (1) by an amount equal to the 3
savings calculated under sub. (2), and transfer to the general fund the related 4
available balances in program revenue appropriation accounts related to the savings 5
under sub. (2) in an amount equal to the calculated program revenue saved under 6
(b) In the fiscal biennium following the fiscal biennium in which the savings 8
are calculated, adjust state agency employer contributions for state employee fringe 9
The secretary may transfer any amounts transferred under sub. (3) (a) 11
related to the savings under sub. (2) to the appropriation account under s. 20.145 (5) 12
20.005 (3) (schedule) of the statutes: at the appropriate place, insert 14
the following amounts for the purposes indicated:
- See PDF for table
20.145 (5) of the statutes is created to read:
20.145 (5) Wisconsin Healthcare Stability Plan.
(b) Reinsurance plan; state
A sum sufficient for the state subsidy of reinsurance payments for the 18
reinsurance program under subch. VII of ch. 601.
(k) Interagency and intra-agency programs; reinsurance plan.
All moneys 2
received from other state agencies and all moneys transferred under s. 16.5285 (4) 3
for the purposes of the healthcare stability plan under subch. VII of ch. 601 or for 4
(m) Federal funds; reinsurance plan.
All moneys received from the federal 6
government for reinsurance for the purposes for which received.
601.45 (1) of the statutes is amended to read:
601.45 (1) Costs to be paid by examinees.
The reasonable costs of examinations 9and audits
under ss. 601.43 and
601.44, and 601.83 (5) (f)
shall be paid by examinees 10
except as provided in sub. (4), either on the basis of a system of billing for actual 11
salaries and expenses of examiners and other apportionable expenses, including 12
office overhead, or by a system of regular annual billings to cover the costs relating 13
to a group of companies, or a combination of such systems, as the commissioner may 14
by rule prescribe. Additional funding, if any, shall be governed by s. 601.32. The 15
commissioner shall schedule annual hearings under s. 601.41 (5) to review current 16
problems in the area of examinations.
Subchapter VII (title) of chapter 601 [precedes 601.80] of the 18
statutes is created to read:
healthcare stability PLAN
601.80 of the statutes is created to read:
23601.80 Definitions; healthcare stability plan.
In this subchapter:
“Affordable Care Act” means the federal Patient Protection and Affordable 25
Care Act, P.L. 111-148
, as amended by the federal Health Care and Education
Reconciliation Act of 2010, P.L. 111-152
, and any amendments to or regulations or 2
guidance issued under those acts.
“Attachment point” means the amount set under s. 601.83 (2) for the 4
healthcare stability plan that is the threshold amount for claims costs incurred by 5
an eligible health carrier for an enrolled individual's covered benefits in a benefit 6
year, beyond which the claims costs are eligible for reinsurance payments.
“Benefit year” means the calendar year for which an eligible health carrier 8
provides coverage through an individual health plan.
“Coinsurance rate” means the rate set under s. 601.83 (2) for the healthcare 10
stability plan that is the rate at which the commissioner will reimburse an eligible 11
health carrier for claims incurred for an enrolled individual's covered benefits in a 12
benefit year above the attachment point and below the reinsurance cap.
“Eligible health carrier” means an insurer, as defined in s. 632.745 (15) that 14
offers an individual health plan and incurs claims costs for an enrolled individual's 15
covered benefits in the applicable benefit year.
“Grandfathered plan” means a health plan in which an individual was 17
enrolled on March 23, 2010, for as long as it maintains that status in accordance with 18
the Affordable Care Act.
“Health benefit plan” has the meaning given in s. 632.745 (11).
“Healthcare stability plan” means the state-based reinsurance program 21
known as the Wisconsin Healthcare Stability Plan administered under s. 601.83 (1).
“Individual health plan” means a health benefit plan that is not a group 23
health plan, as defined in s. 632.745 (10), or a grandfathered plan.
“Payment parameters” means the attachment point, reinsurance cap, and 25
coinsurance rate for the healthcare stability plan.
“Reinsurance cap” means the threshold amount set under s. 601.83 (2) for 2
the healthcare stability plan for claims costs incurred by an eligible health carrier 3
for an enrolled individual's covered benefits, after which the claims costs for benefits 4
are no longer eligible for reinsurance payments.
“Reinsurance payment” means an amount paid by the commissioner to an 6
eligible health carrier under the healthcare stability plan.
601.83 of the statutes is created to read:
8601.83 Healthcare stability plan; administration. (1) Plan established;
(a) Subject to par. (b), the commissioner shall administer 10
a state-based reinsurance program known as the healthcare stability plan.
(b) 1. The commissioner may submit a request to the federal department of 12
health and human services for one or more waivers under 42 USC 18052
implement the healthcare stability plan for benefit years beginning January 1, 2019. 14
The commissioner may adjust the payment parameters under sub. (2) to the extent 15
necessary to secure federal approval of the waiver request under this paragraph.
2. If the federal department of health and human services does not approve the 17
healthcare stability plan in the waiver request submitted under subd. 1. or a 18
substantially similar healthcare stability plan, the commissioner may not 19
implement the healthcare stability plan.
(c) If the federal government enacts into law Senate Bill 1835 of the 115th 21
Congress or a similar bill providing support to states to establish reinsurance 22
programs, the commissioner shall seek, if necessary, and receive federal moneys for 23
the purpose of reinsurance programs that result from that enacted law to expend for 24
the purposes of this subchapter.
(d) In accordance with sub. (5) (c), the commissioner shall collect the data from 2
an eligible health carrier as necessary to determine reinsurance payments.
(e) Beginning on a date determined by the commissioner, the commissioner 4
shall require each eligible health carrier to calculate the rates the eligible health 5
carrier would have charged for a benefit year if the healthcare stability plan had not 6
been established and submit the calculated rates as part of its rate filing submitted 7
to the commissioner. The commissioner shall consider the calculated rate 8
information provided under this paragraph as part of the rate filing review.
(f) 1. For each applicable benefit year, the commissioner shall notify eligible 10
health carriers of reinsurance payments to be made for the applicable benefit year 11
no later than June 30 of the calendar year following the applicable benefit year.
2. Quarterly during the applicable benefit year, the commissioner shall provide 13
each eligible health carrier with the calculation of total amounts of reinsurance 14
3. By August 15 of the calendar year following the applicable benefit year, the 16
commissioner shall disburse all applicable reinsurance payments to an eligible 17
(g) The commissioner may promulgate any rules necessary to implement the 19
healthcare stability plan under this section. The commissioner may promulgate 20
rules necessary to implement this section as emergency rules under s. 227.24. 21
Notwithstanding s. 227.24 (1) (a) and (3), the commissioner is not required to provide 22
evidence that promulgating a rule under this paragraph as an emergency rule is 23
necessary for the preservation of the public peace, health, safety, or welfare and is 24
not required to provide a finding of emergency for a rule promulgated under this 25
1(2) Payment parameters.
The commissioner, after consulting with an actuarial 2
firm, shall design and adjust payment parameters with the goal to do all of the 3
(a) Stabilize or reduce premium rates in the individual market.
(b) Increase participation by health carriers in the individual market.
(c) Improve access to health care providers and services for individuals 7
purchasing coverage in the individual market.
(d) Mitigate the impact high-risk individuals have on premium rates in the 9
(e) Take into account any federal funding available for the plan.
(f) Take into account the total amount available to fund the plan.
(a) The commissioner shall set the payment parameters as 13
described under sub. (2) by no later than March 30 of the calendar year before the 14
applicable benefit year or, if the commissioner specifies a different date by rule, the 15
date specified by the commissioner by rule.
(b) If the amount available for expenditure for the healthcare stability plan is 17
not anticipated to be adequate to fully fund the payment parameters set under par. 18
(a) as of July 1 of the calendar year before the applicable benefit year, the 19
commissioner shall adjust the payment parameters in accordance within the moneys 20
available to expend for the healthcare stability plan. The commissioner shall allow 21
an eligible health carrier to revise its rate filing based on the final payment 22
parameters for the applicable benefit year.
(c) If funding is not available to make all reinsurance payments to eligible 24
health carriers in a benefit year, the commissioner shall make reinsurance payments 25
in proportion to the eligible health carrier's share of aggregate health benefit plan
premiums from residents of this state for all health benefit plans during the given 2
benefit year, as determined by the commissioner. The commissioner shall notify 3
eligible health carriers if there are insufficient funds available to make reinsurance 4
payments in full and the estimated amount of payment as soon as practicable after 5
the commissioner becomes aware of the insufficiency.
6(4) Reinsurance payment calculation.
(a) The commissioner shall calculate 7
a reinsurance payment with respect to each eligible health carrier's incurred claims 8
costs for an enrolled individual's covered benefits in the applicable benefit year. If 9
the claims costs for an enrolled individual do not exceed the attachment point set 10
under sub. (2), the commissioner may not make a reinsurance payment with respect 11
to that enrollee. If the claims costs for an enrolled individual exceed the attachment 12
point, subject to par. (b), the commissioner shall make a reinsurance payment that 13
is calculated as the product of the coinsurance rate and whichever of the following 14
1. The claims costs minus the attachment point.
2. The reinsurance cap minus the attachment point.
(b) The commissioner shall ensure that any reinsurance payment made to an 18
eligible health carrier does not exceed the total amount paid by the eligible health 19
carrier for any claim. For purposes of this paragraph, the total amount paid of a 20
claim is the amount paid by the eligible health carrier based upon the allowed 21
amount less any deductible, coinsurance, or copayment paid by another person as of 22
the time the data are submitted or made accessible under sub. (5) (c).
23(5) Reinsurance payment requests.
(a) An eligible health carrier may request 24
reinsurance payments from the commissioner when the eligible health carrier meets 25
the requirements of this subsection and sub. (4).
(b) An eligible health carrier shall make any requests for a reinsurance 2
payment in accordance with any requirements established by the commissioner.
(c) Each eligible health carrier shall provide the commissioner with access to 4
the data within the dedicated data environment established by the eligible health 5
carrier under the federal risk adjustment program under 42 USC 18063
. Each 6
eligible health carrier shall submit to the commissioner attesting to compliance with 7
the dedicated data environments, data requirements, establishment and usage of 8
masked enrollee identification numbers, and data submission deadlines.
(d) Each eligible health carrier shall provide the access under par. (c) for each 10
applicable benefit year by April 30 of the calendar year following the end of the 11
applicable benefit year.
(e) Each eligible health carrier shall maintain for at least 6 years documents 13
and records, by paper, electronic, or other media, sufficient to substantiate a request 14
for a reinsurance payment made under this section. An eligible health carrier shall 15
make the documents and records available to the commissioner, upon request, for 16
purposes of verification, investigation, audit, or other review of a reinsurance 17
(f) The commissioner may have an eligible health carrier audited to assess the 19
health carrier's compliance with the requirements of this section. The eligible health 20
carrier shall ensure that its contractors, subcontractors, or agents cooperate with 21
any audit under this paragraph. Within 30 days of receiving notice that an audit 22
results in a proposed finding of material weakness or significant deficiency with 23
respect to compliance with any requirement of this section, the eligible health carrier 24
may provide a response to the proposed finding. Within 60 days of the issuance of
a final audit report that includes a finding of material weakness or significant 2
deficiency, the eligible health carrier shall do all of the following:
1. Provide a written corrective action plan to the commissioner for approval.
2. Implement the corrective action plan under subd. 1. as approved by the 5
3. Provide the commissioner with written documentation of the corrective 7
action after implementation.
(g) The commissioner may recover from an eligible health carrier any 9
overpayment of reinsurance payments as determined under the audit under par. (f).
(h) A health carrier is not eligible to receive a reinsurance payment unless the 11
health carrier agrees not to bring a lawsuit over any delay in reinsurance payments 12
or any reduction in reinsurance payments in accordance with sub. (3) (c).
13(6) Access to information.
Information submitted by an eligible health carrier 14
or obtained by the commissioner for purposes of the healthcare stability plan is 15
proprietary and confidential under s. 601.465.
601.85 of the statutes is created to read:
17601.85 Accounting, reports, and audits. (1) Accounting.
commissioner shall keep an accounting for each benefit year of all of the following:
(a) Funds appropriated for reinsurance payments and administrative and 20
(b) Requests for reinsurance payments received from eligible health carriers.
(c) Reinsurance payments made to eligible health carriers.
(d) Administrative and operational expenses incurred for the healthcare 24
By November 1 of the calendar year following the applicable 2
benefit year or by 60 days following the final disbursement of reinsurance payments 3
for the applicable benefit year, whichever is later, the commissioner shall make 4
available to the public a report summarizing the healthcare stability plan's 5
operations for each benefit year by posting the summary on the office's Internet site.
6(3) Legislative auditor.
The healthcare stability plan is subject to audit by the 7
legislative audit bureau. The commissioner shall ensure that its contractors, 8
subcontractors, or agents cooperate with any audit of the healthcare stability plan 9
performed by the legislative audit bureau.
10(4) Required recommendation report.
By December 31, 2018, the 11
commissioner shall submit to the governor recommendations on implementing a 12
waiver under s. 601.83 (1) (b), any possible additional waivers to be requested, and 13
any other options to stabilize the individual health care market in this state.
Subchapter VIII (title) of chapter 601 [precedes 601.93] of the 15
statutes is created to read:
FIRE DEPARTMENT DUES
Subchapter VI (title) of chapter 601 [precedes 601.93] of the 20
statutes is repealed.
(1) Payment parameters.
For the 2019 benefit year, the commissioner of 23
insurance shall set as payment parameters for the healthcare stability plan under 24
subchapter VII of chapter 601 an attachment point of $50,000, a coinsurance rate of 25
between 50 and 80 percent, and a reinsurance cap of $250,000. The commissioner
of insurance may adjust the payment parameters to the extent necessary to secure 2
federal approval of the waiver request under section 601.83 (1) (b) of the statutes. For 3
subsequent benefit years, the commissioner of insurance may adjust the payment 4
parameters in accordance with section 601.83 (2) of the statutes.
(1) Lapse from Medical Assistance general purpose revenue appropriation.
The secretary of health services shall ensure that there is lapsed to the general fund 8
from the appropriation under section 20.435 (4) (b) of the statutes an amount up to 9
$80,000,000, as determined by the secretary of administration.