AB100-ASA1,800,721 146.70 (3m) (d) 1g. If an application under par. (c) includes an estimate of costs
22identified in par. (c) 1. d. incurred during the reimbursement period or between
23January 1, 1999, and September 3, 2003, the commission may approve the
24application only if the commission determines that the local government's collection
25of land information, as defined in s. 16.967 (1) (b), and development of a land

1information system, as defined in s. 16.967 (1) (c), that is related to that purpose are
2consistent with the applicable county land records modernization plans developed
3under s. 59.72 (3) (b), conform to the standards on which such plans are based, and
4do not duplicate land information collection and other efforts funded through the
5land information program under s. 16.967 (7). The commission shall obtain the
6advice of the department of administration in making determinations under this
7subdivision.
AB100-ASA1, s. 2032m 8Section 2032m. Chapter 149 (title) of the statutes is amended to read:
AB100-ASA1,800,119 CHAPTER 149
10Mandatory health insurance
11 risk-sharing plan
AB100-ASA1, s. 2033m 12Section 2033m. 149.10 (2) of the statutes is amended to read:
AB100-ASA1,800,1413 149.10 (2) "Board" means the board of governors established directors under
14s. 149.15 149.11 (1).
AB100-ASA1, s. 2033r 15Section 2033r. 149.10 (2j) (a) 3. of the statutes is amended to read:
AB100-ASA1,800,1716 149.10 (2j) (a) 3. Part A or, part B, or part D of title XVIII of the federal Social
17Security Act.
AB100-ASA1, s. 2034c 18Section 2034c. 149.10 (2m) of the statutes is repealed.
AB100-ASA1, s. 2034m 19Section 2034m. 149.10 (2t) (c) of the statutes is amended to read:
AB100-ASA1,800,2320 149.10 (2t) (c) The individual does not have creditable coverage and is not
21eligible for coverage under a group health plan, part A or , part B, or part D of title
22XVIII of the federal Social Security Act or a state plan under title XIX of the federal
23Social Security Act or any successor program.
AB100-ASA1, s. 2035c 24Section 2035c. 149.10 (3) of the statutes is amended to read:
AB100-ASA1,801,3
1149.10 (3) "Eligible person" means a resident of this state who qualifies under
2s. 149.12 whether or not the person is legally responsible for the payment of medical
3expenses incurred on the person's behalf.
AB100-ASA1, s. 2035m 4Section 2035m. 149.10 (3e) of the statutes is amended to read:
AB100-ASA1,801,65 149.10 (3e) "Fund" means the health insurance risk-sharing plan Health
6Insurance Risk-Sharing Plan
fund under s. 149.11 (2).
AB100-ASA1, s. 2036c 7Section 2036c. 149.10 (7) of the statutes is amended to read:
AB100-ASA1,801,98 149.10 (7) "Medicare" means coverage under both part A and, part B, and part
9D
of Title XVIII of the federal social security act, 42 USC 1395 et seq., as amended.
AB100-ASA1, s. 2036m 10Section 2036m. 149.10 (9) of the statutes is amended to read:
AB100-ASA1,801,2111 149.10 (9) "Resident" means a person who has been legally domiciled in this
12state for a period of at least 30 days 6 months or, with respect to an eligible individual,
13an individual who resides in this state. For purposes of this chapter, legal domicile
14is established by living in this state and obtaining a Wisconsin motor vehicle
15operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax
16return. A child is legally domiciled in this state if the child lives in this state and if
17at least one of the child's parents or the child's guardian is legally domiciled in this
18state. A person with a developmental disability or another disability which prevents
19the person from obtaining a Wisconsin motor vehicle operator's license, registering
20to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in
21this state by living in this state.
AB100-ASA1, s. 2037c 22Section 2037c. 149.10 (10) of the statutes is repealed.
AB100-ASA1, s. 2037m 23Section 2037m. 149.11 of the statutes is repealed and recreated to read:
AB100-ASA1,802,15 24149.11 Administration of plan. (1) Appointment of board of directors;
25formation of administering organization.
(a) No later than September 1, 2005, the

1commissioner shall nominate 13 individuals to be appointed with the advice and
2consent of the senate to serve as the initial directors of the board of the organization
3to be formed under par. (b). The board shall consist of 4 representatives of
4participating insurers; 4 representatives of health care providers, including one
5representative of the Wisconsin Medical Society, one representative of the Wisconsin
6Hospital Association, Inc., one representative of the Pharmacy Society of Wisconsin,
7and one representative of health care providers that provide services to persons with
8coverage under the plan; and 5 other members, at least one of whom represents small
9businesses that purchase private health insurance and at least one of whom is a
10person with coverage under the plan. In making the nominations to the board, the
11commissioner shall first consult with one or more trade or professional associations
12whose members include participating insurers, one or more trade or professional
13associations whose members include health care providers that provide services to
14persons with coverage under the plan, and one or more trade or professional
15associations whose members include small business owners.
AB100-ASA1,802,1916 (b) The individuals appointed as initial directors under par. (a) shall form a
17private, nonprofit organization under ch. 181 and shall take all actions necessary to
18exempt the organization from federal taxation under section 501 (a) of the Internal
19Revenue Code. The articles of incorporation shall include all of the following:
AB100-ASA1,802,2020 1. The names and addresses of the 13 individuals as the initial directors.
AB100-ASA1,802,2121 2. That the purpose of the organization is to administer the plan.
AB100-ASA1,802,2322 3. That the directors, including the initial directors, shall serve staggered
233-year terms.
AB100-ASA1,803,3
14. That the directors shall satisfy the criteria specified in par. (a) and shall be
2nominated by the commissioner, after consultation as specified in par. (a), and
3appointed with the advice and consent of the senate.
AB100-ASA1,803,74 (c) As a condition for the release of funds under s. 20.145 (5) (g), the
5organization, through the board, shall administer the plan in conformity with this
6chapter and perform any other duties required of the organization or board under
7this chapter.
AB100-ASA1,803,10 8(2) Fund. (a) The board shall pay the operating and administrative expenses
9of the plan from the fund, which shall be outside the state treasury and which shall
10consist of all of the following:
AB100-ASA1,803,1111 3. The earnings resulting from investments under par. (b).
AB100-ASA1,803,1212 4. Any other moneys received by the organization or board from time to time.
AB100-ASA1,803,1613 (b) The board controls the assets of the fund and shall select regulated financial
14institutions in this state that receive deposits in which to establish and maintain
15accounts for assets needed on a current basis. If practicable, the accounts shall earn
16interest.
AB100-ASA1,803,1817 (c) Moneys in the fund may be expended only for the purposes specified in par.
18(a).
AB100-ASA1,803,24 19(3) Immunity. No cause of action of any nature may arise against and no
20liability may be imposed upon the organization, plan, or board; or any agent,
21employee, or director of any of them; or contributor insurers; or the commissioner;
22or any of the commissioner's agents, employees, or representatives, for any act or
23omission by any of them in the performance of their powers and duties under this
24chapter.
AB100-ASA1, s. 2038c 25Section 2038c. 149.115 of the statutes is amended to read:
AB100-ASA1,804,5
1149.115 Rules relating to creditable coverage. The commissioner, in
2consultation with the department,
shall promulgate rules that specify how
3creditable coverage is to be aggregated for purposes of s. 149.10 (2t) (a) and that
4determine the creditable coverage to which s. 149.10 (2t) (b) and (d) applies. The
5rules shall comply with section 2701 (c) of P.L. 104-191.
AB100-ASA1, s. 2038m 6Section 2038m. 149.12 (1) (intro.) of the statutes is amended to read:
AB100-ASA1,804,147 149.12 (1) (intro.) Except as provided in subs. (1m) and, (2), and (3), the board
8or plan administrator shall certify as eligible a person who is covered by medicare
9Medicare because he or she is disabled under 42 USC 423, a person who submits
10evidence that he or she has tested positive for the presence of HIV, antigen or
11nonantigenic products of HIV, or an antibody to HIV, a person who is an eligible
12individual, and any person who receives and submits any of the following based
13wholly or partially on medical underwriting considerations within 9 months prior to
14making application for coverage by the plan:
AB100-ASA1, s. 2039c 15Section 2039c. 149.12 (1) (a) of the statutes is amended to read:
AB100-ASA1,804,1616 149.12 (1) (a) A notice of rejection of coverage from one 2 or more insurers.
AB100-ASA1, s. 2039m 17Section 2039m. 149.12 (1m) of the statutes is amended to read:
AB100-ASA1,804,2118 149.12 (1m) The board or plan administrator may not certify a person as
19eligible under circumstances requiring notice under sub. (1) (a) to (d) if the required
20notices were issued by an insurance intermediary who is not acting as an
21administrator, as defined in s. 633.01.
AB100-ASA1, s. 2040c 22Section 2040c. 149.12 (2) (g) of the statutes is created to read:
AB100-ASA1,804,2423 149.12 (2) (g) A person is not eligible for coverage under the plan if the person
24is eligible for any of the following:
AB100-ASA1,804,2525 1. Services under s. 46.27 (11), 46.275, 46.277, or 46.278.
AB100-ASA1,805,2
12. Medical assistance provided as part of a family care benefit, as defined in s.
246.2805 (4).
AB100-ASA1,805,433. Services provided under a waiver requested under 2001 Wisconsin Act 16,
4section 9123 (16rs), or 2003 Wisconsin Act 33, section 9124 (8c).
AB100-ASA1,805,65 4. Services provided under the program of all-inclusive care for persons aged
655 or older authorized under 42 USC 1396u-4.
AB100-ASA1,805,87 5. Services provided under the demonstration program under a federal waiver
8authorized under 42 USC 1315.
AB100-ASA1,805,109 6. Health care coverage under the Badger Care health care program under s.
1049.665.
AB100-ASA1, s. 2040m 11Section 2040m. 149.12 (3) (a) of the statutes is amended to read:
AB100-ASA1,805,1712 149.12 (3) (a) Except as provided in pars. (b) to (c) and (bm), no person is eligible
13for coverage under the plan for whom a premium, deductible, or coinsurance amount
14is paid or reimbursed by a federal, state, county, or municipal government or agency
15as of the first day of any term for which a premium amount is paid or reimbursed and
16as of the day after the last day of any term during which a deductible or coinsurance
17amount is paid or reimbursed.
AB100-ASA1, s. 2041c 18Section 2041c. 149.12 (3) (c) of the statutes is repealed.
AB100-ASA1, s. 2041m 19Section 2041m. 149.12 (4) and (5) of the statutes are created to read:
AB100-ASA1,805,2420 149.12 (4) Subject to subs. (1m), (2), and (3), the board may establish criteria
21that would enable additional persons to be eligible for coverage under the plan. The
22board shall ensure that any expansion of eligibility is consistent with the purpose of
23the plan to provide health care coverage for those who are unable to obtain health
24insurance in the private market and does not endanger the solvency of the plan.
AB100-ASA1,806,2
1(5) The board shall establish policies for determining and verifying the
2continued eligibility of an eligible person.
AB100-ASA1, s. 2042c 3Section 2042c. 149.13 (1) of the statutes is amended to read:
AB100-ASA1,806,84 149.13 (1) Every insurer shall participate in the cost of administering the plan,
5except the commissioner may by rule exempt as a class those insurers whose share
6as determined under sub. (2) would be so minimal as to not exceed the estimated cost
7of levying the assessment. The commissioner shall advise the department board of
8the insurers participating in the cost of administering the plan.
AB100-ASA1, s. 2042m 9Section 2042m. 149.13 (3) (a) of the statutes is amended to read:
AB100-ASA1,806,1410 149.13 (3) (a) Each insurer's proportion of participation under sub. (2) shall be
11determined annually by the commissioner based on annual statements and other
12reports filed by the insurer with the commissioner. The commissioner shall assess
13an insurer for the insurer's proportion of participation based on the total
14assessments estimated by the department under s. 149.143 (2) (a) 3. board.
AB100-ASA1, s. 2043c 15Section 2043c. 149.13 (3) (b) of the statutes is amended to read:
AB100-ASA1,806,2216 149.13 (3) (b) If the department board or the commissioner finds that the
17commissioner's authority to require insurers to report under chs. 600 to 646 and 655
18is not adequate to permit the department, the commissioner or the board to carry out
19the department's, commissioner's or board's responsibilities under this chapter, the
20commissioner shall promulgate rules requiring insurers to report the information
21necessary for the department, commissioner and board to make the determinations
22required under this chapter.
AB100-ASA1, s. 2043m 23Section 2043m. 149.13 (4) of the statutes is amended to read:
AB100-ASA1,807,224 149.13 (4) Notwithstanding subs. (1) to (3), the department board, with the
25agreement of the commissioner, may perform various administrative functions

1related to the assessment of insurers participating in the cost of administering the
2plan.
AB100-ASA1, s. 2044c 3Section 2044c. 149.14 (1) (a) of the statutes is amended to read:
AB100-ASA1,807,74 149.14 (1) (a) The plan shall offer coverage for each eligible person in an
5annually renewable policy the coverage specified in this section for each eligible
6person
. If an eligible person is also eligible for medicare Medicare coverage, the plan
7shall not pay or reimburse any person for expenses paid for by medicare Medicare.
AB100-ASA1, s. 2044m 8Section 2044m. 149.14 (2) (a) of the statutes is amended to read:
AB100-ASA1,807,159 149.14 (2) (a) The plan shall provide every eligible person who is not eligible
10for medicare Medicare with major medical expense coverage. Major medical expense
11coverage offered under the plan under this section shall pay an eligible person's
12covered expenses, subject to sub. (3) and deductible, copayment, and coinsurance
13payments authorized under sub. (5), up to a lifetime limit of $1,000,000 per covered
14individual. The maximum limit under this paragraph shall not be altered by the
15board, and no actuarially equivalent benefit may be substituted by the board.
AB100-ASA1, s. 2045c 16Section 2045c. 149.14 (3) (intro.) of the statutes is renumbered 149.14 (3) and
17amended to read:
AB100-ASA1,808,518 149.14 (3) Covered expenses. Except as provided in sub. (4), except as
19restricted by cost containment provisions under s. 149.17 (4) and except as reduced
20by the department under ss. 149.143 and 149.144, covered
Covered expenses for the
21coverage under this section the plan shall be the payment rates established by the
22department under s. 149.142
board for the services provided by persons licensed
23under ch. 446 and certified under s. 49.45 (2) (a) 11. Except as provided in sub. (4),
24except as restricted by cost containment provisions under s. 149.17 (4) and except as
25reduced by the department under ss. 149.143 and 149.144, covered
Covered expenses

1for the coverage under this section the plan shall also be the payment rates
2established by the department under s. 149.142 board for the following services and
3articles if the service or article is prescribed by a physician who is licensed under ch.
4448 or in another state and who is certified under s. 49.45 (2) (a) 11. and if the service
5or article is provided by a provider certified under s. 49.45 (2) (a) 11.:
AB100-ASA1, s. 2045m 6Section 2045m. 149.14 (3) (a) to (r) of the statutes are repealed.
AB100-ASA1, s. 2046c 7Section 2046c. 149.14 (4) of the statutes is repealed and recreated to read:
AB100-ASA1,808,138 149.14 (4) Benefit design. Except as provided in subs. (2) (a) and (6), the board
9shall determine the benefit design of the plan, including the covered expenses,
10expenses excluded from coverage, deductibles, copayments, coinsurance,
11out-of-pocket limits, and coverage limitations. The board may establish more than
12one benefit design under the plan. All benefit designs shall be comparable to typical
13individual health insurance policies offered in the private sector market in this state.
AB100-ASA1, s. 2046m 14Section 2046m. 149.14 (4c) of the statutes is repealed.
AB100-ASA1, s. 2047c 15Section 2047c. 149.14 (4m) of the statutes is renumbered 149.142 (2m) and
16amended to read:
AB100-ASA1,808,2217 149.142 (2m) Payment is payment in full. Except for copayments, coinsurance,
18or deductibles required or authorized under the plan, a provider of a covered service
19or article shall accept as payment in full for the covered service or article the payment
20rate determined under ss. 149.142, 149.143 and 149.144 sub. (1) and may not bill an
21eligible person who receives the service or article for any amount by which the charge
22for the service or article is reduced under s. 149.142, 149.143 or 149.144 sub. (1).
AB100-ASA1, s. 2047m 23Section 2047m. 149.14 (5) of the statutes is repealed.
AB100-ASA1, s. 2048c 24Section 2048c. 149.14 (5m) of the statutes is repealed.
AB100-ASA1, s. 2048m 25Section 2048m. 149.14 (6) (a) of the statutes is repealed.
AB100-ASA1, s. 2049c
1Section 2049c. 149.14 (6) (b) of the statutes is renumbered 149.14 (6).
AB100-ASA1, s. 2049m 2Section 2049m. 149.14 (7) (b) of the statutes is amended to read:
AB100-ASA1,809,63 149.14 (7) (b) The department organization has a cause of action against an
4eligible participant for the recovery of the amount of benefits paid which are not for
5covered expenses under the plan. Benefits under the plan may be reduced or refused
6as a setoff against any amount recoverable under this paragraph.
AB100-ASA1, s. 2050c 7Section 2050c. 149.14 (7) (c) of the statutes is amended to read:
AB100-ASA1,809,118 149.14 (7) (c) The department organization is subrogated to the rights of an
9eligible person to recover special damages for illness or injury to the person caused
10by the act of a 3rd person to the extent that benefits are provided under the plan.
11Section 814.03 (3) applies to the department organization under this paragraph.
AB100-ASA1, s. 2050m 12Section 2050m. 149.14 (8) of the statutes is repealed and recreated to read:
AB100-ASA1,809,1513 149.14 (8) Subsidies. The board shall provide for subsidies for premiums,
14deductibles, and copayments for eligible persons with household incomes below a
15level established by the board.
AB100-ASA1, s. 2051c 16Section 2051c. 149.141 of the statutes is created to read:
AB100-ASA1,809,19 17149.141 Premiums. The board shall set premiums for coverage under the
18plan at a level that is sufficient to cover 60 percent of plan costs, as provided in s.
19149.143 (1).
AB100-ASA1, s. 2051m 20Section 2051m. 149.142 (1) (a) of the statutes is renumbered 149.142 (1) and
21amended to read:
AB100-ASA1,810,722 149.142 (1) Establishment of rates. Except as provided in par. (b), the
23department
The board shall establish provider payment rates for covered expenses
24that consist of the allowable charges paid under s. 49.46 (2) for the services and
25articles provided plus an enhancement determined by the department board. The

1rates shall be based on the allowable charges paid under s. 49.46 (2), projected plan
2costs, and trend factors. Using the same methodology that applies to medical
3assistance under subch. IV of ch. 49, the department board shall establish hospital
4outpatient per visit reimbursement rates and hospital inpatient reimbursement
5rates that are specific to diagnostically related groups of eligible persons. The
6adjustments to the usual and customary rates shall be sufficient to cover 20 percent
7of plan costs, as provided in s. 149.143 (3).
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