Amendment ASA1-AB445

AB445-ASA1, s. 1 Section 1. 20.145 (5) of the statutes is repealed.

AB445-ASA1, s. 2 Section 2. 25.14 (1) (a) (intro.) of the statutes is amended to read:

AB445-ASA1,3,7 25.14 (1) (a) (intro.) There is created a state investment fund under the jurisdiction and management of the board to be operated as an investment trust for the purpose of managing the securities of all funds that are required by law to be invested in the state investment fund and all of the state's funds consisting of the funds specified in s. 25.17 (1), except all of the following:

AB445-ASA1, s. 3 Section 3. 25.17 (63) of the statutes is created to read:

AB445-ASA1,3,11 25.17 (63) If requested by the Health Insurance Risk-Sharing Plan Authority, invest funds of the Health Insurance Risk-Sharing Plan Authority in the state investment fund.

AB445-ASA1, s. 4 Section 4. 40.02 (54) (L) of the statutes is created to read:

AB445-ASA1,4,1 40.02 (54) (L) The Health Insurance Risk-Sharing Plan Authority.

AB445-ASA1, s. 5 Section 5. 149.11 (2) (a) 1. of the statutes is amended to read:

AB445-ASA1,4,4 149.11 (2) (a) 1. Insurer assessments under s. 149.13 , paid to the authority under s. 20.145 (5) (g).

AB445-ASA1, s. 6 Section 6. 149.11 (2) (a) 3. of the statutes is repealed and recreated to read:

AB445-ASA1,4,7 149.11 (2) (a) 3. Moneys received from the federal government in high risk pool grants.

AB445-ASA1, s. 7 Section 7. 149.11 (2) (b) of the statutes is amended to read:

AB445-ASA1,4,12 149.11 (2) (b) The authority controls the assets of the fund and shall select regulated financial institutions in this state that receive deposits in which to establish and maintain accounts for assets needed on a current basis. If practicable, the accounts shall earn interest.

AB445-ASA1, s. 8 Section 8. 149.12 (2) (e) of the statutes is renumbered 149.12 (2) (e) 1. and amended to read:

AB445-ASA1,4,18 149.12 (2) (e) 1. No Subject to subd. 2., no person who is eligible for creditable coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that is provided by an employer on a self-insured basis or through health insurance is eligible for coverage under the plan.

AB445-ASA1, s. 9 Section 9. 149.12 (2) (e) 2. of the statutes is created to read:

AB445-ASA1,4,22 149.12 (2) (e) 2. The board may specify, subject to the approval of the commissioner, other types of coverage provided by an employer that do not render a person ineligible for coverage under the plan.

AB445-ASA1, s. 10 Section 10. 149.13 (3) (a) of the statutes is amended to read:

AB445-ASA1,5,4 149.13 (3) (a) Each insurer's proportion of participation under sub. (2) shall be determined annually by the commissioner based on annual statements and other reports filed by the insurer with the commissioner. The commissioner shall assess an insurer for the insurer's proportion of participation based on the total assessments estimated by the authority. An insurer shall pay the amount of the assessment directly to the authority.

AB445-ASA1, s. 11 Section 11. 149.14 (2) (c) 1. of the statutes is renumbered 149.14 (2) (c).

AB445-ASA1, s. 12 Section 12. 149.14 (2) (c) 2. of the statutes is repealed.

AB445-ASA1, s. 13 Section 13. 149.14 (3) (intro.) of the statutes is amended to read:

AB445-ASA1,5,16 149.14 (3) Covered expenses. (intro.) Covered expenses for coverage under the plan shall be the payment rates established by the authority for services provided by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Covered expenses for coverage under the plan shall also be the payment rates established by the authority for, at a minimum, the following services and articles if the service or article is prescribed by a physician who is licensed under ch. 448 or in another state and who is certified under s. 49.45 (2) (a) 11. and if the service or article, except for prescription drugs that are provided by a network of pharmacies approved by the board, is provided by a provider certified under s. 49.45 (2) (a) 11.:

AB445-ASA1, s. 14 Section 14. 149.14 (3c) of the statutes is created to read:

AB445-ASA1,5,24 149.14 (3c) Temporary provider certification. Notwithstanding the provider licensing and certification requirements under sub. (3) (intro.), for coverage of services or articles provided to an eligible person the authority may certify on a temporary basis a provider that is not licensed under ch. 446 or 448 but that is licensed in another state to provide the service or article, or a provider that is not certified under s. 49.45 (2) (a) 11. The certification under this subsection may be retroactive.

AB445-ASA1, s. 15 Section 15. 149.14 (5) (a) of the statutes is amended to read:

AB445-ASA1,6,3 149.14 (5) (a) The authority shall establish and provide subsidies for deductibles paid by eligible persons with coverage under s. 149.14 (2) (a) and household incomes specified in s. 149.165 (2) (a) 1. to 5 to (e).

AB445-ASA1, s. 16 Section 16. 149.142 (1) of the statutes is amended to read:

AB445-ASA1,6,15 149.142 (1) Establishment of rates. The authority shall establish provider payment rates for covered expenses that consist of the allowable charges paid under s. 49.46 (2) usual and customary payment rates, as determined by the authority, for the services and articles provided plus an enhancement adjustment determined by the authority. The rates shall be based on the allowable charges paid under s. 49.46 (2), projected plan costs, and trend factors. Using the same methodology that applies to medical assistance under subch. IV of ch. 49, the authority shall establish hospital outpatient per visit reimbursement rates and hospital inpatient reimbursement rates that are specific to diagnostically related groups of eligible persons. The adjustments to the usual and customary rates shall be sufficient to cover the portion of plan costs specified in s. 149.143 (1) (c) and (2) (b).

AB445-ASA1, s. 17 Section 17. 149.143 (1) (intro.) of the statutes is amended to read:

AB445-ASA1,6,22 149.143 (1) Costs excluding subsidies. (intro.) The authority shall pay plan costs, excluding any premium, deductible, and copayment subsidies, first from any federal funds, if any, that are transferred to the fund under s. 20.145 (5) (m) and under s. 149.11 (2) (a) 3. that exceed premium, deductible, and copayment subsidy costs in a policy year. The remainder of the plan costs, excluding premium, deductible, and copayment subsidy costs, shall be paid as follows:

AB445-ASA1, s. 18 Section 18. 149.143 (2) (intro.) of the statutes is amended to read:

AB445-ASA1,7,2 149.143 (2) Subsidy costs. (intro.) The authority shall pay for premium, deductible, and copayment subsidies in a policy year first from any federal funds, if any, that are transferred to the fund under s. 20.145 (5) (m) under s. 149.11 (2) (a) 3. received in that year. The remainder of the subsidy costs shall be paid as follows:

AB445-ASA1, s. 19 Section 19. 149.165 (2) (a) of the statutes is renumbered 149.165 (2) and amended to read:

AB445-ASA1,7,10 149.165 (2) Subject to sub. (3m), if the household income, as defined in s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage under s. 149.14 (2) (a) is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the authority shall reduce the premium for the eligible person to the rate by the percentage of the premium shown after the amounts:

AB445-ASA1,7,14 (a) If equal to or greater than $0 and less than $10,000, to 100% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by at least 30 percent.

AB445-ASA1,7,18 (b) If equal to or greater than $10,000 and less than $14,000, to 106.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by at least 25 percent.

AB445-ASA1,7,22 (c) If equal to or greater than $14,000 and less than $17,000, to 115.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by at least 20 percent.

AB445-ASA1,8,2 (d) If equal to or greater than $17,000 and less than $20,000, to 124.5% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by at least 15 percent.

AB445-ASA1,8,6 (e) If equal to or greater than $20,000 and less than $25,000, to 130% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by at least 10 percent.

AB445-ASA1, s. 20 Section 20. 149.165 (2) (bc) of the statutes is repealed.

AB445-ASA1, s. 21 Section 21. 149.165 (3m) of the statutes is amended to read:

AB445-ASA1,8,12 149.165 (3m) The authority may approve adjustment of the household income dollar amounts listed in sub. (2) (a) 1. to 5. to (e), except for the first dollar amount listed in sub. (2) (a) 1., to reflect changes in the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.

AB445-ASA1, s. 22 Section 22. Subchapter IV of chapter 149 [precedes 149.60] of the statutes is repealed.

AB445-ASA1, s. 23 Section 23. Nonstatutory provisions.

AB445-ASA1,8,22 (1) Payment of health insurance premiums for employees of the Health Insurance Risk-Sharing Plan Authority. Notwithstanding section 40.05 (4) (a) 2. of the statutes, for an insured employee, as defined in section 40.02 (39) of the statutes, who is employed by the Health Insurance Risk-Sharing Plan Authority on the effective date of this subsection, the employer shall pay required employer contributions toward the health insurance premium beginning on the date on which the employee becomes insured.

AB445-ASA1, s. 24 Section 24. Initial applicability.

AB445-ASA1,9,3 (1) Premium discounts. The treatment of sections 149.14 (2) (c) 1. and 2. and (5) (a) and 149.165 (2) (a) and (bc) and (3m) of the statutes first applies to policy years beginning on January 1, 2008.

AB445-ASA1,9,4 (End)