Amendment SSA1-AB416

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1995 - 1996 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, To 1995 ASSEMBLY BILL 416

January 30, 1996 - Offered by Committee on Insurance.

AB416-SSA1,2,10 An Act to repeal 40.51 (8c), 60.23 (25) (a), 66.184 (2), 111.70 (4) (n), 111.91 (2) (k), 120.13 (2) (gm), 619.145 (3) (e), 619.145 (4), 619.15 (3) (bc), 619.15 (3) (bm), 619.15 (4) (e), 635.01, 635.05 and 635.26; to renumber 66.184; to renumber and amend 60.23 (25) and 635.18 (1); to amend 40.51 (8), 66.184 (1), 111.70 (1) (a), 120.13 (2) (g), 185.983 (1g), 619.135 (2), 619.135 (3), 619.14 (5) (a), 619.14 (5) (d), 619.145 (1), 619.15 (1), 619.15 (3) (c), 619.165 (1) (a), 619.165 (1) (d), 619.165 (2), 619.17 (1), 619.175, 625.12 (2), 628.34 (3) (a), 628.34 (3) (b), 632.76 (2) (a), 632.896 (4), chapter 635 (title), 635.11 (intro.), 635.11 (1), 635.11 (4), 635.13, 635.15, 635.18 (title), 635.18 (2), 635.18 (3), 635.18 (4), 635.18 (5), 635.18 (6), 635.18 (7), 635.18 (8), 635.20 (1c), 635.20 (2), 635.23 (1) (a), (d), (dp), (dr) and (e) (intro.), 1., 2. and 3., 635.23 (4) and (5), 635.25 (title), 635.25 (1) (a) (intro.), 635.25 (1) (b), 635.25 (1m), 635.25 (2), 635.254, 635.272 (1) and 635.28; to repeal and recreate 111.70 (1) (a), 111.70 (1) (a), 619.10 (3m), 619.10 (3m), 619.13, 619.13, 619.135 (2), 619.135 (2), 619.135 (3), 619.135 (3), 619.15 (3) (c), 619.15 (4) (c), 619.15 (4) (c), 619.175, 619.175, 635.02, 635.07, 635.09, 635.17, 635.20 (1m), 635.20 (13) and 635.29 (title); and to create 40.51 (8c), 40.51 (8m), 60.23 (25) (a), 60.23 (25) (h), 60.23 (25) (i), 66.184 (2), 111.70 (4) (n), 111.70 (4) (o), 111.91 (2) (k), 111.91 (2) (L), 120.13 (2) (gm), 619.145 (1m), 619.145 (3) (e), 619.145 (4), 619.15 (3) (bc), 619.15 (3) (bm), 619.15 (3) (f) and (g), 619.15 (4) (e), 632.727, 635.03, 635.04, 635.16 and 635.18 (1) (a) and (b) of the statutes; relating to: health insurance market reform, including preexisting condition exclusions and limitations, guaranteed issue, guaranteed acceptance, portability, rating restrictions, contract termination and renewability and fair marketing standards; funding the health insurance risk-sharing plan; collective bargaining of certain health care coverage requirements; granting rule-making authority; and making an appropriation.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB416-SSA1, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

AB416-SSA1,2,14 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895 (5m) and (8) to (10) and, 632.896, 635.03 (1) to (3) and (5) and 635.04 (3).

AB416-SSA1, s. 2 Section 2. 40.51 (8c) of the statutes is created to read:

AB416-SSA1,2,19 40.51 (8c) Every health care coverage plan offered by the state under sub. (6) and every health care coverage plan offered by the group insurance board under sub. (7) shall comply with s. 619.13 (1) (am), (3) and (4). This subsection does not apply after June 30, 2000.

AB416-SSA1, s. 3 Section 3. 40.51 (8c) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 4 Section 4. 40.51 (8m) of the statutes is created to read:

AB416-SSA1,3,2 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 635.03 (1) to (3) and (5) and 635.04.

AB416-SSA1, s. 5 Section 5. 60.23 (25) of the statutes is renumbered 60.23 (25) (intro.) and amended to read:

AB416-SSA1,3,7 60.23 (25) Self-insured health plans. (intro.) Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. all of the following:

AB416-SSA1,3,8 (b) Section 631.89,.

AB416-SSA1,3,9 (c) Section 631.90,.

AB416-SSA1,3,10 (d) Section 631.93 (2),.

AB416-SSA1,3,11 (e) Section 632.87 (4) and (5),.

AB416-SSA1,3,12 (f) Section 632.895 (9) and.

AB416-SSA1,3,13 (g) Section 632.896.

AB416-SSA1, s. 6 Section 6. 60.23 (25) (a) of the statutes is created to read:

AB416-SSA1,3,15 60.23 (25) (a) Before July 1, 2000, s. 619.13 (1) (am), (3) and (4).

AB416-SSA1, s. 7 Section 7. 60.23 (25) (a) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 8 Section 8. 60.23 (25) (h) of the statutes is created to read:

AB416-SSA1,3,19 60.23 (25) (h) Section 635.03 (2), (3) and (5) (a) 2. and (b) 2.

AB416-SSA1, s. 9 Section 9. 60.23 (25) (i) of the statutes is created to read:

AB416-SSA1,3,21 60.23 (25) (i) Section 635.04 (3).

AB416-SSA1, s. 10 Section 10. 66.184 of the statutes is renumbered 66.184 (1).

AB416-SSA1, s. 11 Section 11. 66.184 (1) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is amended to read:

AB416-SSA1,4,6 66.184 (1) If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10), 632.896, 635.03 (2), (3) and (5) (a) 2. and (b) 2., 635.04 (3), 767.25 (4m) (d) and 767.51 (3m) (d).

AB416-SSA1, s. 12 Section 12. 66.184 (2) of the statutes is created to read:

AB416-SSA1,4,9 66.184 (2) A self-insured plan under sub. (1) shall comply with s. 619.13 (1) (am), (3) and (4). This subsection does not apply after June 30, 2000.

AB416-SSA1, s. 13 Section 13. 66.184 (2) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 14 Section 14 . 111.70 (1) (a) of the statutes, as affected by 1995 Wisconsin Act 27, is amended to read:

AB416-SSA1,5,11 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representative of its municipal employes in a collective bargaining unit, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employe to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m) and (n) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employes under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The municipal employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the municipal employes in a collective bargaining unit. In creating this subchapter the legislature recognizes that the municipal employer must exercise its powers and responsibilities to act for the government and good order of the jurisdiction which it serves, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to municipal employes by the constitutions of this state and of the United States and by this subchapter.

AB416-SSA1, s. 15 Section 15 . 111.70 (1) (a) of the statutes, as affected by 1995 Wisconsin Act .... (this act), section 14, is repealed and recreated to read:

AB416-SSA1,6,11 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representative of its municipal employes in a collective bargaining unit, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employe to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m), (n) and (o) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employes under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The municipal employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the municipal employes in a collective bargaining unit. In creating this subchapter the legislature recognizes that the municipal employer must exercise its powers and responsibilities to act for the government and good order of the jurisdiction which it serves, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to municipal employes by the constitutions of this state and of the United States and by this subchapter.

AB416-SSA1, s. 16 Section 16 . 111.70 (1) (a) of the statutes, as affected by 1995 Wisconsin Act .... (this act), sections 14 and 15, is repealed and recreated to read:

AB416-SSA1,7,11 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representative of its municipal employes in a collective bargaining unit, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employe to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m) and (o) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employes under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The municipal employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the municipal employes in a collective bargaining unit. In creating this subchapter the legislature recognizes that the municipal employer must exercise its powers and responsibilities to act for the government and good order of the jurisdiction which it serves, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to municipal employes by the constitutions of this state and of the United States and by this subchapter.

AB416-SSA1, s. 17 Section 17. 111.70 (4) (n) of the statutes is created to read:

AB416-SSA1,7,17 111.70 (4) (n) Health insurance risk-sharing plan surcharge. The municipal employer is prohibited from bargaining collectively with respect to compliance with the requirements under s. 619.13 (1) (am), (3) and (4) related to payment of the surcharge for the health insurance risk-sharing plan. This paragraph does not apply after June 30, 2000.

AB416-SSA1, s. 18 Section 18. 111.70 (4) (n) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 19 Section 19. 111.70 (4) (o) of the statutes is created to read:

AB416-SSA1,7,23 111.70 (4) (o) Health benefit plan requirements. 1. Except as provided in subd. 2., the municipal employer is prohibited from bargaining collectively with respect to compliance with the health benefit plan requirements under subch. I of ch. 635.

AB416-SSA1,8,3 2. If a municipal employer offers its employes a health care coverage plan through a program offered by the group insurance board under s. 40.51 (7), the municipal employer is prohibited from bargaining collectively with respect to compliance with the health benefit plan requirements under ss. 635.03 (1) to (3) and (5) and 635.04 with respect to the health care coverage plan.

AB416-SSA1, s. 20 Section 20. 111.91 (2) (k) of the statutes is created to read:

AB416-SSA1,8,6 111.91 (2) (k) Compliance with the requirements under s. 619.13 (1) (am), (3) and (4). This paragraph does not apply after June 30, 2000.

AB416-SSA1, s. 21 Section 21. 111.91 (2) (k) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 22 Section 22. 111.91 (2) (L) of the statutes is created to read:

AB416-SSA1,8,11 111.91 (2) (L) Compliance with the health benefit plan requirements under ss. 635.03 (1) to (3) and (5) and 635.04.

AB416-SSA1, s. 23 Section 23. 120.13 (2) (g) of the statutes is amended to read:

AB416-SSA1,8,16 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10), 632.896, 635.03 (2), (3) and (5) (a) 2. and (b) 2., 635.04 (3), 767.25 (4m) (d) and 767.51 (3m) (d).

AB416-SSA1, s. 24 Section 24. 120.13 (2) (gm) of the statutes is created to read:

AB416-SSA1,8,19 120.13 (2) (gm) Every self-insured plan under par. (b) shall comply with s. 619.13 (1) (am), (3) and (4). This paragraph does not apply after June 30, 2000.

AB416-SSA1, s. 25 Section 25. 120.13 (2) (gm) of the statutes, as created by 1995 Wisconsin Act .... (this act), is repealed.

AB416-SSA1, s. 26 Section 26. 185.983 (1g) of the statutes is amended to read:

AB416-SSA1,9,2 185.983 (1g) A cooperative association that is a small employer insurer, as defined in s. 635.02 (8) 635.20 (13), is subject to the health insurance mandates, as defined in s. 601.423 (1), to the same extent as any other small employer insurer, as defined in s. 635.02 (8) 635.20 (13).

AB416-SSA1, s. 27 Section 27 . 619.10 (3m) of the statutes is repealed and recreated to read:

AB416-SSA1,9,6 619.10 (3m) "Health care provider" means a person that may be a provider of a covered service or article under s. 619.14 (3), as specified by the board by rule under s. 619.15 (3) (bc). This subsection does not apply after June 30, 2000.

AB416-SSA1, s. 28 Section 28 . 619.10 (3m) of the statutes, as affected by 1995 Wisconsin Act .... (this act), is repealed and recreated to read:

AB416-SSA1,9,9 619.10 (3m) (a) "Health care coverage revenue" means any of the following:

AB416-SSA1,9,10 1. Premiums received for health care coverage.

AB416-SSA1,9,11 2. Subscriber contract charges received for health care coverage.

AB416-SSA1,9,13 3. Health maintenance organization, limited service health organization or preferred provider plan charges received for health care coverage.

AB416-SSA1,9,15 4. The sum of benefits paid and administrative costs incurred for health care coverage under a medical reimbursement plan.

AB416-SSA1,9,17 (b) This subsection does not apply after 2 years after the effective date of this paragraph .... [revisor inserts date].

AB416-SSA1, s. 29 Section 29 . 619.13 of the statutes is repealed and recreated to read:

AB416-SSA1,9,23 619.13 Health care surcharges. (1) (a) Except as provided in sub. (2), to cover claims paid under the plan and the operating and administrative expenses of the plan, every health care provider shall impose and collect on every charge billed by the health care provider a surcharge in an amount set by the board under s. 619.15 (3) (bm) or (4) (c).

AB416-SSA1,9,25 (am) Each individual or insurer or other 3rd-party payer subject to the surcharge under par. (a) shall pay the surcharge to the health care provider.

AB416-SSA1,10,11 (b) A health care provider may retain up to 15% of the surcharge amounts under par. (a) that are collected before July 1, 1997, for its own administrative expenses. The board shall establish by rule the amount that a health care provider may retain of surcharges collected on and after July 1, 1997, for its administrative expenses at a level sufficient to cover the health care provider's administrative expenses. The health care provider shall remit the remainder of the surcharge amounts collected, after deducting its administrative expenses, to the board on a quarterly basis, on or before the last day of the next month following the end of each calendar quarter, along with a report that identifies any insurer or other 3rd-party payer that has failed to pay a significant surcharge amount billed during that calendar quarter.

AB416-SSA1,10,12 (2) Subsection (1) does not apply to any of the following:

AB416-SSA1,10,13 (a) Charges billed for services or articles provided to any of the following:

AB416-SSA1,10,14 1. Medical assistance recipients.