Amendment SSA2-SB451

SB451-SSA2, s. 150 Section 150. Subchapter III of chapter 149 [precedes 149.40] of the statutes is created to read:

SB451-SSA2,47,8 CHapter 149

SB451-SSA2,47,11 Subchapter III Health Insurance Risk-Sharing Plan Authority

SB451-SSA2,47,12 149.40 Definitions. In this subchapter:

SB451-SSA2,47,13 (1) "Authority" means the Health Insurance Risk-Sharing Plan Authority.

SB451-SSA2,47,14 (2) "Board" means the board of directors of the authority.

SB451-SSA2,47,20 149.41 Creation and organization of authority. (1) There is created a public body corporate and politic to be known as the "Health Insurance Risk-Sharing Plan Authority." The board of directors of the authority shall consist of the commissioner of insurance, or his or her designee, as a nonvoting member, and the following members, who shall be nominated by the governor, and with the advice and consent of the senate appointed, for 3-year terms:

SB451-SSA2,47,21 (a) Four members who represent insurers participating in the plan.

SB451-SSA2,48,2 (b) Four members who represent health care providers, including one representative of the Wisconsin Medical Society, one representative of the Wisconsin Hospital Association, Inc., one representative of the Pharmacy Society of Wisconsin, and one representative of health care providers that provide services to persons with coverage under the plan.

SB451-SSA2,48,6 (c) Five other members, at least one of whom represents small businesses that purchase private health insurance, one of whom is a professional consumer advocate who is familiar with the plan, and at least 2 of whom are persons with coverage under the plan.

SB451-SSA2,48,8 (2) A vacancy on the board shall be filled in the same manner as the original appointment to the board for the remainder of the unexpired term, if any.

SB451-SSA2,48,11 (3) A member of the board may not be compensated for his or her services but shall be reimbursed for actual and necessary expenses, including travel expenses, incurred in the performance of his or her duties.

SB451-SSA2,48,18 (4) Annually, the governor shall appoint one member other than the commissioner as chairperson, and the members of the board may elect other officers as they consider appropriate. Seven voting members of the board constitute a quorum for the purpose of conducting the business and exercising the powers of the authority, notwithstanding the existence of any vacancy. The board may take action upon a vote of a majority of the members present, unless the bylaws of the authority require a larger number.

SB451-SSA2,49,5 (5) The board may appoint an executive director who shall not be a member of the board and who shall serve at the pleasure of the board. The authority may delegate by resolution to one or more of its members or its executive director any powers and duties that it considers proper. The executive director shall receive such compensation as may be determined by the board. The executive director or other person designated by resolution of the board shall keep a record of the proceedings of the authority and shall be custodian of all books, documents, and papers filed with the authority, the minute book or journal of the authority, and its official seal. The executive director or other person may cause copies to be made of all minutes and other records and documents of the authority and may give certificates under the official seal of the authority to the effect that such copies are true copies, and all persons dealing with the authority may rely upon such certificates.

SB451-SSA2,49,7 149.43 Duties of authority. In addition to all other duties imposed under this chapter, the authority shall do all of the following:

SB451-SSA2,49,8 (1) Adopt policies for the administration of this chapter.

SB451-SSA2,49,11 (2) Contract with the plan administrator under s. 149.16, 2003 stats., in the manner required under 2005 Wisconsin Act .... (this act), section 165 (1) (b) until the end of the contract term.

SB451-SSA2,49,13 (3) Establish the authority's annual budget and monitor the fiscal management of the authority.

SB451-SSA2,49,15 (4) Beginning on July 1, 2006, do, or contract with another person to do, all of the following:

SB451-SSA2,49,17 (a) Perform all eligibility and administrative claims payment functions relating to the plan.

SB451-SSA2,49,20 (b) Establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the authority.

SB451-SSA2,49,22 (c) Perform all necessary functions to assure timely payment of benefits to covered persons under the plan, including:

SB451-SSA2,49,25 1. Making available information relating to the proper manner of submitting a claim for benefits under the plan and distributing forms upon which submissions shall be made.

SB451-SSA2,50,1 2. Evaluating the eligibility of each claim for payment under the plan.

SB451-SSA2,50,3 3. Notifying each claimant within 30 days after receiving a properly completed and executed proof of loss whether the claim is accepted, rejected, or compromised.

SB451-SSA2,50,5 (5) Seek to qualify or maintain the plan as a state pharmacy assistance program, as defined in 42 CFR 423.464.

SB451-SSA2,50,7 (6) Annually submit a report to the legislature under s. 13.172 (2) and to the governor on the operation of the plan.

SB451-SSA2,50,11 149.45 Powers of authority. (1) Except as restricted under sub. (2), the authority shall have all the powers necessary or convenient to carry out the purposes and provisions of this chapter. In addition to all other powers granted by this chapter, the authority may:

SB451-SSA2,50,13 (a) Adopt bylaws and policies and procedures for the regulation of its affairs and the conduct of its business.

SB451-SSA2,50,15 (b) Have a seal and alter the seal at pleasure; have perpetual existence; and maintain an office.

SB451-SSA2,50,16 (c) Hire employees, define their duties, and fix their rate of compensation.

SB451-SSA2,50,17 (d) Incur debt, except as restricted under sub. (2).

SB451-SSA2,50,19 (e) Contract for any professional services required for the authority, subject to ss. 149.43 (2) and 149.47.

SB451-SSA2,50,23 (f) Appoint any technical or professional advisory committee that the authority finds necessary to assist the authority in exercising its duties and powers. The authority shall define the duties of the committee, and provide reimbursement for the expenses of the committee.

SB451-SSA2,50,24 (g) Execute contracts and other instruments.

SB451-SSA2,51,2 (h) Accept gifts, grants, loans, or other contributions from private or public sources.

SB451-SSA2,51,3 (i) Procure liability insurance.

SB451-SSA2,51,4 (2) The authority may not issue bonds.

SB451-SSA2,51,9 149.47 Contracting for professional services. (1) Whenever contracting for professional services, the authority shall solicit competitive sealed bids or competitive sealed proposals, whichever is appropriate. Each request for competitive sealed proposals shall state the relative importance of price and other evaluation factors.

SB451-SSA2,51,17 (2) (a) When the estimated cost exceeds $25,000, the authority may invite competitive sealed bids or proposals by publishing a class 2 notice under ch. 985 or by posting notice on the Internet at a site determined or approved by the authority. The notice shall describe the contractual services to be purchased, the intent to make the procurement by solicitation of bids or proposals, any requirement for surety, and the date the bids or proposals will be opened, which shall be at least 7 days after the date of the last insertion of the notice or at least 7 days after the date of posting on the Internet.

SB451-SSA2,51,20 (b) When the estimated cost is $25,000 or less, the authority may award the contract in accordance with simplified procedures established by the authority for such transactions.

SB451-SSA2,51,24 (c) For purposes of clarification, the authority may discuss the requirements of the proposed contract with any person who submits a bid or proposal and shall permit any offerer to revise his or her bid or proposal to ensure its responsiveness to those requirements.

SB451-SSA2,52,8 (3) (a) The authority shall determine which bids or proposals are reasonably likely to be awarded the contract and shall provide each offerer of such a bid or proposal a fair and equal opportunity to discuss the bid or proposal. The authority may negotiate with each offerer in order to obtain terms that are advantageous to the authority. Prior to the award of the contract, any offerer may revise his or her bid or proposal. The authority shall keep a written record of all meetings, conferences, oral presentations, discussions, negotiations, and evaluations of bids or proposals under this section.

SB451-SSA2,52,11 (b) In opening, discussing, and negotiating bids or proposals, the authority may not disclose any information that would reveal the terms of a competing bid or proposal.

SB451-SSA2,52,17 (4) (a) After receiving each offerer's best and final offer, the authority shall determine which proposal is most advantageous and shall award the contract to the person who offered it. The authority's determination shall be based only on price and the other evaluation factors specified in the request for bids or proposals. The authority shall state in writing the reason for the award and shall place the statement in the contract file.

SB451-SSA2,52,19 (b) Following the award of the contract, the authority shall prepare a register of all bids or proposals.

SB451-SSA2,53,4 149.50 Political activities. (1) No employee of the authority may directly or indirectly solicit or receive subscriptions or contributions for any partisan political party or any political purpose while engaged in his or her official duties as an employee. No employee of the authority may engage in any form of political activity calculated to favor or improve the chances of any political party or any person seeking or attempting to hold partisan political office while engaged in his or her official duties as an employee or engage in any political activity while not engaged in his or her official duties as an employee to such an extent that the person's efficiency during working hours will be impaired or that he or she will be tardy or absent from work. Any violation of this section is adequate grounds for dismissal.

SB451-SSA2,53,8 (2) If an employee of the authority declares an intention to run for partisan political office, the employee shall be placed on a leave of absence for the duration of the election campaign and if elected shall no longer be employed by the authority on assuming the duties and responsibilities of such office.

SB451-SSA2,53,10 (3) An employee of the authority may be granted, by the executive director, a leave of absence to participate in partisan political campaigning.

SB451-SSA2,53,13 (4) Persons on leave of absence under sub. (2) or (3) shall not be subject to the restrictions of sub. (1), except as they apply to the solicitation of assistance, subscription, or support from any other employee in the authority.

SB451-SSA2,53,17 149.53 Liability limited. (1) Neither the state nor any political subdivision of the state nor any officer, employee, or agent of the state or a political subdivision who is acting within the scope of employment or agency is liable for any debt, obligation, act, or omission of the authority.

SB451-SSA2,53,19 (2) All of the expenses incurred by the authority in exercising its duties and powers under this chapter shall be payable only from funds of the authority.

SB451-SSA2, s. 151 Section 151. 149.40 of the statutes, as created by 2005 Wisconsin Act .... (this act), is repealed.

SB451-SSA2, s. 152 Section 152. Subchapter IV of chapter 149 [precedes 149.60] of the statutes is created to read:

SB451-SSA2,53,24 Chapter 149

SB451-SSA2,54,2 Subchapter IV Health Care Tax Credit Program

SB451-SSA2,54,4 149.60 Definition. In this subchapter, "eligible individual" has the meaning given in 26 USC 35 (c).

SB451-SSA2,54,10 149.65 Program requirements. (1) Subject to sub. (2), the authority shall design and administer a program of health care coverage, called the Health Care Tax Credit Program, under which a covered eligible individual may receive an income tax credit under 26 USC 35 for a portion of premiums paid for the coverage. The Health Care Tax Credit Program shall be designed to satisfy the requirements of qualified health insurance under 26 USC 35 (e) (1) (E), (2), and (3).

SB451-SSA2,54,13 (2) Subsection (1) applies only as long as federal law provides for income tax credits for premiums paid for coverage that satisfies the requirements specified in sub. (1).

SB451-SSA2,54,15 149.70 Eligibility. An individual shall be eligible for coverage under the Health Care Tax Credit Program if the individual is any of the following:

SB451-SSA2,54,16 (1) An eligible individual for whom all of the following apply:

SB451-SSA2,54,18 (a) The aggregate of the individual's periods of creditable coverage, determined in the manner provided by rule under s. 149.115, is 3 months or more.

SB451-SSA2,54,19 (b) The individual does not have other health care coverage.

SB451-SSA2,54,20 (c) The individual is not confined in a prison, jail, or house of correction.

SB451-SSA2,54,23 (2) An individual who is a qualifying family member, as defined in 26 USC 35 (d), of an eligible individual described in sub. (1) and who does not have other health care coverage.

SB451-SSA2, s. 153 Section 153. 230.03 (3) of the statutes is amended to read:

SB451-SSA2,55,9 230.03 (3) "Agency" means any board, commission, committee, council, or department in state government or a unit thereof created by the constitution or statutes if such board, commission, committee, council, department, unit, or the head thereof, is authorized to appoint subordinate staff by the constitution or statute, except a legislative or judicial board, commission, committee, council, department, or unit thereof or an authority created under chs. subch. III of ch. 149 or under ch. 231, 232, 233, 234, 235, or 237. "Agency" does not mean any local unit of government or body within one or more local units of government that is created by law or by action of one or more local units of government.

SB451-SSA2, s. 154 Section 154. 230.80 (4) of the statutes is amended to read:

SB451-SSA2,55,18 230.80 (4) "Governmental unit" means any association, authority, board, commission, department, independent agency, institution, office, society , or other body in state government created or authorized to be created by the constitution or any law, including the legislature, the office of the governor, and the courts, but excluding the Health Insurance Risk-Sharing Plan Authority. "Governmental unit" does not mean any political subdivision of the state or body within one or more political subdivisions which that is created by law or by action of one or more political subdivisions.

SB451-SSA2, s. 155 Section 155. 601.41 (1) of the statutes is amended to read:

SB451-SSA2,55,23 601.41 (1) Duties. The commissioner shall administer and enforce chs. 600 to 655 and ss. 59.52 (11) (c), 66.0137 (4) and (4m), 100.203, 120.13 (2) (b) to (g), and 149.13, and 149.144 and shall act as promptly as possible under the circumstances on all matters placed before the commissioner.

SB451-SSA2, s. 156 Section 156. 601.415 (12) of the statutes is amended to read:

SB451-SSA2,56,4 601.415 (12) Health insurance risk-sharing plan Insurance Risk-Sharing Plan. The commissioner shall perform the duties specified to be performed by the commissioner in ss. s. 149.13 and 149.144. The commissioner, or his or her designee, shall serve as a member of the board under s. 149.15.

SB451-SSA2, s. 157 Section 157. 601.64 (1) of the statutes is amended to read:

SB451-SSA2,56,11 601.64 (1) Injunctions and restraining orders. The commissioner may commence an action in circuit court in the name of the state to restrain by temporary or permanent injunction or by temporary restraining order any violation of chs. 600 to 655, or s. 149.13 or 149.144, any rule promulgated under chs. 600 to 655, or any order issued under s. 601.41 (4). The commissioner need not show irreparable harm or lack of an adequate remedy at law in an action commenced under this subsection.

SB451-SSA2, s. 158 Section 158. 601.64 (3) (a) of the statutes is amended to read:

SB451-SSA2,56,16 601.64 (3) (a) Restitutionary forfeiture. Whoever violates an effective order issued under s. 601.41 (4), any insurance statute or rule, or s. 149.13 or 149.144 shall forfeit to the state twice the amount of any profit gained from the violation, in addition to any other forfeiture or penalty imposed.

SB451-SSA2, s. 159 Section 159. 601.64 (3) (c) of the statutes is amended to read:

SB451-SSA2,56,24 601.64 (3) (c) Forfeiture for violation of statute or rule. Whoever violates an insurance statute or rule or s. 149.13 or 149.144, intentionally aids a person in violating an insurance statute or rule or s. 149.13 or 149.144, or knowingly permits a person over whom he or she has authority to violate an insurance statute or rule or s. 149.13 or 149.144 shall forfeit to the state not more than $1,000 for each violation. If the statute or rule imposes a duty to make a report to the commissioner, each week of delay in complying with the duty is a new violation.

SB451-SSA2, s. 160 Section 160. 601.64 (4) of the statutes is amended to read:

SB451-SSA2,57,6 601.64 (4) Criminal penalty. Whoever intentionally violates or intentionally permits any person over whom he or she has authority to violate or intentionally aids any person in violating any insurance statute or rule of this state, s. 149.13 or 149.144, or any effective order issued under s. 601.41 (4) is guilty of a Class I felony, unless a specific penalty is provided elsewhere in the statutes. Intent has the meaning expressed under s. 939.23.

SB451-SSA2, s. 161 Section 161. 613.03 (4) of the statutes is amended to read:

SB451-SSA2,57,11 613.03 (4) Mandatory health insurance risk-sharing plan Health Insurance Risk-Sharing Plan. Service insurance corporations organized or operating under this chapter are subject to the requirements that apply to insurers and insurance under ch. 149.

SB451-SSA2, s. 162 Section 162. 631.20 (2) (f) of the statutes is created to read:

SB451-SSA2,57,14 631.20 (2) (f) In the case of a policy form under ch. 149, that any of the following applies:

SB451-SSA2,57,16 1. The benefit design is not comparable to a typical comprehensive individual health insurance policy offered in the private sector market in this state.

SB451-SSA2,57,19 2. The benefit levels are not generally reflective of and commensurate with comprehensive health insurance coverage offered in the private individual market in the state.

SB451-SSA2,57,21 3. The copayments, deductibles, and coinsurance are not actuarially equivalent to comprehensive individual plans and would create undue financial hardship.

SB451-SSA2,57,23 4. It is inconsistent with the purpose of providing health care coverage to those unable to obtain coverage in the private market.