1(2) Payment parameters. The commissioner, after consulting with an actuarial
2firm, shall design and adjust payment parameters with the goal to do all of the
SB770,9,44 (a) Stabilize or reduce premium rates in the individual market.
SB770,9,55 (b) Increase participation by health carriers in the individual market.
SB770,9,76 (c) Improve access to health care providers and services for individuals
7purchasing coverage in the individual market.
SB770,9,98 (d) Mitigate the impact high-risk individuals have on premium rates in the
9individual market.
SB770,9,1010 (e) Take into account any federal funding available for the plan.
SB770,9,1111 (f) Take into account the total amount available to fund the plan.
SB770,9,15 12(3) Operation. (a) The commissioner shall set the payment parameters as
13described under sub. (2) by no later than March 30 of the calendar year before the
14applicable benefit year or, if the commissioner specifies a different date by rule, the
15date specified by the commissioner by rule.
SB770,9,2216 (b) If the amount available for expenditure for the healthcare stability plan is
17not 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
19commissioner shall adjust the payment parameters in accordance within the moneys
20available to expend for the healthcare stability plan. The commissioner shall allow
21an eligible health carrier to revise its rate filing based on the final payment
22parameters for the applicable benefit year.
SB770,9,2523 (c) If funding is not available to make all reinsurance payments to eligible
24health carriers in a benefit year, the commissioner shall make reinsurance payments
25in proportion to the eligible health carrier's share of aggregate health benefit plan

1premiums from residents of this state for all health benefit plans during the given
2benefit year, as determined by the commissioner. The commissioner shall notify
3eligible health carriers if there are insufficient funds available to make reinsurance
4payments in full and the estimated amount of payment as soon as practicable after
5the commissioner becomes aware of the insufficiency.
SB770,10,14 6(4) Reinsurance payment calculation. (a) The commissioner shall calculate
7a reinsurance payment with respect to each eligible health carrier's incurred claims
8costs for an enrolled individual's covered benefits in the applicable benefit year. If
9the claims costs for an enrolled individual do not exceed the attachment point set
10under sub. (2), the commissioner may not make a reinsurance payment with respect
11to that enrollee. If the claims costs for an enrolled individual exceed the attachment
12point, subject to par. (b), the commissioner shall make a reinsurance payment that
13is calculated as the product of the coinsurance rate and whichever of the following
14is less:
SB770,10,1515 1. The claims costs minus the attachment point.
SB770,10,1616 2. The reinsurance cap minus the attachment point.
SB770,10,2217 (b) The commissioner shall ensure that any reinsurance payment made to an
18eligible health carrier does not exceed the total amount paid by the eligible health
19carrier for any claim. For purposes of this paragraph, the total amount paid of a
20claim is the amount paid by the eligible health carrier based upon the allowed
21amount less any deductible, coinsurance, or copayment paid by another person as of
22the time the data are submitted or made accessible under sub. (5) (c).
SB770,10,25 23(5) Reinsurance payment requests. (a) An eligible health carrier may request
24reinsurance payments from the commissioner when the eligible health carrier meets
25the requirements of this subsection and sub. (4).
1(b) An eligible health carrier shall make any requests for a reinsurance
2payment in accordance with any requirements established by the commissioner.
SB770,11,83 (c) Each eligible health carrier shall provide the commissioner with access to
4the data within the dedicated data environment established by the eligible health
5carrier under the federal risk adjustment program under 42 USC 18063. Each
6eligible health carrier shall submit to the commissioner attesting to compliance with
7the dedicated data environments, data requirements, establishment and usage of
8masked enrollee identification numbers, and data submission deadlines.
SB770,11,119 (d) Each eligible health carrier shall provide the access under par. (c) for each
10applicable benefit year by April 30 of the calendar year following the end of the
11applicable benefit year.
SB770,11,1712 (e) Each eligible health carrier shall maintain for at least 6 years documents
13and records, by paper, electronic, or other media, sufficient to substantiate a request
14for a reinsurance payment made under this section. An eligible health carrier shall
15make the documents and records available to the commissioner, upon request, for
16purposes of verification, investigation, audit, or other review of a reinsurance
17payment request.
SB770,12,218 (f) The commissioner may have an eligible health carrier audited to assess the
19health carrier's compliance with the requirements of this section. The eligible health
20carrier shall ensure that its contractors, subcontractors, or agents cooperate with
21any audit under this paragraph. Within 30 days of receiving notice that an audit
22results in a proposed finding of material weakness or significant deficiency with
23respect to compliance with any requirement of this section, the eligible health carrier
24may provide a response to the proposed finding. Within 60 days of the issuance of

1a final audit report that includes a finding of material weakness or significant
2deficiency, the eligible health carrier shall do all of the following:
SB770,12,33 1. Provide a written corrective action plan to the commissioner for approval.
SB770,12,54 2. Implement the corrective action plan under subd. 1. as approved by the
SB770,12,76 3. Provide the commissioner with written documentation of the corrective
7action after implementation.
SB770,12,98 (g) The commissioner may recover from an eligible health carrier any
9overpayment of reinsurance payments as determined under the audit under par. (f).
SB770,12,1210 (h) A health carrier is not eligible to receive a reinsurance payment unless the
11health carrier agrees not to bring a lawsuit over any delay in reinsurance payments
12or any reduction in reinsurance payments in accordance with sub. (3) (c).
SB770,12,15 13(6) Access to information. Information submitted by an eligible health carrier
14or obtained by the commissioner for purposes of the healthcare stability plan is
15proprietary and confidential under s. 601.465.
SB770,8 16Section 8. 601.85 of the statutes is created to read:
SB770,12,18 17601.85 Accounting, reports, and audits. (1) Accounting. The
18commissioner shall keep an accounting for each benefit year of all of the following:
SB770,12,2019 (a) Funds appropriated for reinsurance payments and administrative and
20operational expenses.
SB770,12,2121 (b) Requests for reinsurance payments received from eligible health carriers.
SB770,12,2222 (c) Reinsurance payments made to eligible health carriers.
SB770,12,2423 (d) Administrative and operational expenses incurred for the healthcare
24stability plan.
1(2) Reports. By November 1 of the calendar year following the applicable
2benefit year or by 60 days following the final disbursement of reinsurance payments
3for the applicable benefit year, whichever is later, the commissioner shall make
4available to the public a report summarizing the healthcare stability plan's
5operations for each benefit year by posting the summary on the office's Internet site.
SB770,13,9 6(3) Legislative auditor. The healthcare stability plan is subject to audit by the
7legislative audit bureau. The commissioner shall ensure that its contractors,
8subcontractors, or agents cooperate with any audit of the healthcare stability plan
9performed by the legislative audit bureau.
SB770,13,13 10(4) Required recommendation report. By December 31, 2018, the
11commissioner shall submit to the governor recommendations on implementing a
12waiver under s. 601.83 (1) (b), any possible additional waivers to be requested, and
13any other options to stabilize the individual health care market in this state.
SB770,9 14Section 9 . Subchapter VIII (title) of chapter 601 [precedes 601.93] of the
15statutes is created to read:
SB770,13,1616 Chapter 601
SB770,13,1717 Subchapter VIII
SB770,10 19Section 10 . Subchapter VI (title) of chapter 601 [precedes 601.93] of the
20statutes is repealed.
SB770,11 21Section 11 . Nonstatutory provisions.
SB770,14,422 (1) Payment parameters. For the 2019 benefit year, the commissioner of
23insurance shall set as payment parameters for the healthcare stability plan under
24subchapter VII of chapter 601 an attachment point of $50,000, a coinsurance rate of
25between 50 and 80 percent, and a reinsurance cap of $250,000. The commissioner

1of insurance may adjust the payment parameters to the extent necessary to secure
2federal approval of the waiver request under section 601.83 (1) (b) of the statutes. For
3subsequent benefit years, the commissioner of insurance may adjust the payment
4parameters in accordance with section 601.83 (2) of the statutes.
SB770,12 5Section 12 . Fiscal changes.
SB770,14,96 (1) Lapse from Medical Assistance general purpose revenue appropriation.
7The secretary of health services shall ensure that there is lapsed to the general fund
8from 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.
SB770,14,1010 (End)