Amendment ASA1-AB531

Analysis by the Legislative Reference Bureau

On March 23, 2010, the federal government enacted the Patient Protection and Affordable Care Act (PPACA), which, among other things, imposes requirements and limitations on health insurance policies and health plans, requires the creation of state-based health insurance exchanges through which individuals and small employers can purchase insurance, changes the income eligibility criteria for Medicaid (known as Medical Assistance in this state), and creates incentives for improving access to health care. The insurance reforms, insurance exchange requirements, and changes to Medicaid are located in Titles I and II and Subtitles A and B of Title X of PPACA. This substitute amendment requires that, before a state agency takes any action to implement Title I or II or Subtitle A or B of Title X of PPACA for which the agency would typically promulgate a rule, the agency must request the Legislative Reference Bureau to prepare legislation that allows the agency to take the action. The agency must then submit the proposed legislation to each standing committee of each house of the legislature that has jurisdiction over health or insurance matters. The substitute amendment prohibits the agency from taking the action to implement Title I or II or Subtitle A or B of Title X of PPACA until the legislation allowing the agency to take the action takes effect. The substitute amendment also prohibits an agency from requesting a grant or other moneys from the federal government to implement Title I or II or Subtitle A or B of Title X of PPACA and from expending any state moneys, or federal moneys passing through the state treasury, to assist the federal government in implementing Title I or II or Subtitle A or B of Title X of PPACA. The substitute amendment specifies that an agency is not prohibited from exchanging or providing information about, communicating or advising about, or discussing PPACA with any person or agency; reviewing, analyzing, or researching PPACA, or addressing consumer complaints about PPACA. A secretary or commissioner of an agency is not prohibited from serving on a board that discusses and considers the effects of PPACA. The substitute amendment also specifies that if the Office of the Commissioner of Insurance (OCI) receives a report of an insurer's medical loss ratio, OCI may review that medical loss ratio to determine if the insurer is experiencing financial problems and may work with the insurer to resolve those financial problems. As an exception to the requirements under the substitute amendment, the substitute amendment allows an agency to request any grant or other moneys for certain purposes specified under Title I or II or Subtitle A or B of Title X of PPACA and to implement the project or program for which the grant or other moneys are received and expend the grant or other moneys.

The substitute amendment requires agencies of the state to submit annually to the legislature a report that describes the cost, since March 23, 2010, to that agency of implementing PPACA and any federal moneys received after March 23, 2010, related to implementing PPACA, with the first report due by September 1, 2012. In addition, certain agencies must include certain information in their annual reports for that year and in an analysis of any change in the information after March 23, 2010. DHS must include the average spending per recipient for Medical Assistance programs and the spending for Medical Assistance programs as a percentage of the state budget. The Department of Safety and Professional Services shall include the number of physicians practicing in the state. OCI must include the number of insurance companies that offer health care plans in the state. The substitute amendment also requires the commissioner of insurance to include in his or her annual report to the legislature a review of the effect the implementation of PPACA has on rates of health care plans that are not issued through a governmental body. That review must include the average rate for each health care plan.

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

AB531-ASA1, s. 1 Section 1. 20.9265 of the statutes is created to read:

AB531-ASA1,3,2 20.9265 Federal health reform cost reports. (1) Definitions. In this section:

AB531-ASA1,3,8 (a) "Agency" means an office, department, agency, institution of higher education, association, society, or other body in state government created or authorized to be created by the constitution or any law, which is entitled to expend moneys appropriated by law, including the legislature, the courts, and any authority created in subch. II of ch. 114 or subch. III of ch. 149 or in ch. 231, 233, 234, 238, or 279.

AB531-ASA1,3,12 (b) "Medical Assistance program" includes any program operated under subch. IV of ch. 49, demonstration program operated under 42 USC 1315, and program operated under a waiver of federal law relating to medical assistance that is granted by the federal department of health and human services.

AB531-ASA1,3,15 (c) "Patient Protection and Affordable Care Act" means the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152.

AB531-ASA1,3,21 (2) Report required. By September 1, 2012, and annually thereafter, subject to sub. (3), each agency shall submit to the legislature in the manner provided under s. 13.172 (2) a report that describes the cost, since March 23, 2010, to that agency of implementing the Patient Protection and Affordable Care Act and any moneys received from the federal government after March 23, 2010, that are related to implementing the Patient Protection and Affordable Care Act.

AB531-ASA1,4,2 (3) Specific agency requirements. (a) In the report under sub. (2), the department of health services shall include the average spending per recipient for Medical Assistance programs, and the spending for Medical Assistance programs as a percentage of the state budget, for that year and in an analysis of any change in spending after March 23, 2010.

AB531-ASA1,4,6 (b) In the report under sub. (2), the department of safety and professional services shall include the number of physicians practicing in the state in that year and in an analysis of any change in the number of physicians practicing after March 23, 2010.

AB531-ASA1,4,10 (c) In the report under sub. (2), the office of the commissioner of insurance shall include the number of insurance companies that offer health care plans, as defined in s. 628.36 (2) (a) 1., in the state for that year and in an analysis of any change in the number of insurers after March 23, 2010.

AB531-ASA1, s. 2 Section 2. 49.45 (2m) (c) (intro.) of the statutes, as affected by 2011 Wisconsin Act 32, section 1423k, is amended to read:

AB531-ASA1,4,17 49.45 (2m) (c) (intro.) Subject to par. pars. (d) and (dm), if the department determines, as a result of the study under par. (b), that revision of existing statutes or rules would be necessary to advance a purpose described in par. (b) 1. to 7., the department may propose a policy that makes any of the following changes related to Medical Assistance programs:

AB531-ASA1, s. 3 Section 3. 49.45 (2m) (dm) of the statutes is created to read:

AB531-ASA1,4,24 49.45 (2m) (dm) The department may not follow the procedures under this section to implement a policy that involves an action to implement the Patient Protection and Affordable Care Act, as defined in s. 146.965 (1) (b). If the department proposes a policy under par. (c) that involves an action to implement the Patient Protection and Affordable Care Act, the department shall comply with the procedure under s. 146.965 (2) before taking the action.

AB531-ASA1, s. 4 Section 4. 146.965 of the statutes is created to read:

AB531-ASA1,5,2 146.965 Implementation of federal health reform. (1) Definitions. In this section:

AB531-ASA1,5,5 (a) "Agency" means a board, commission, committee, department, or officer in the state government, except the governor, a district attorney, or a military or judicial officer.

AB531-ASA1,5,8 (b) "Patient Protection and Affordable Care Act" means the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152.

AB531-ASA1,5,17 (2) Legislation required; exceptions. (a) Notwithstanding s. 227.11 (2), before an agency takes any action to implement any portion of title I or II or subtitle A or B of title X of the Patient Protection and Affordable Care Act for which the agency would typically promulgate a rule, the agency shall request that the legislative reference bureau prepare legislation that allows the agency to take the action. The agency shall submit the proposed legislation to each standing committee of each house of the legislature that has jurisdiction over health or insurance matters under s. 13.172 (3). The agency may not take the action until the legislation allowing the agency to take the action takes effect.

AB531-ASA1,5,22 (b) No agency may request a grant or other moneys from the federal government to implement title I or II or subtitle A or B of title X of the Patient Protection and Affordable Care Act, unless the state legislature has enacted legislation to allow the request for the grant or other moneys and the legislation is in effect.

AB531-ASA1,6,3 (c) No agency may expend any moneys of this state, or of any subdivision or agency of this state, or any federal moneys passing through the state treasury to assist the federal government in implementing any portion of title I or II or subtitle A or B of title X of the Patient Protection and Affordable Care Act unless the state legislature has enacted legislation to allow the agency to expend those moneys and the legislation is in effect.

AB531-ASA1,6,5 (d) 1. This subsection does not prohibit an agency from taking any of the following actions in the absence of legislation allowing the agency to take the action:

AB531-ASA1,6,8 a. Exchanging or providing information about, communicating or advising about, or discussing the Patient Protection and Affordable Care Act with any person or agency.

AB531-ASA1,6,10 b. Reviewing, analyzing, or researching the Patient Protection and Affordable Care Act.

AB531-ASA1,6,12 c. Addressing consumer complaints regarding the Patient Protection and Affordable Care Act.

AB531-ASA1,6,16 2. If the office of the commissioner of insurance receives a report of a medical loss ratio from an insurer, the office of the commissioner of insurance may review the medical loss ratio to determine if the insurer is experiencing financial problems and may work with the insurer to resolve those financial problems.

AB531-ASA1,6,19 3. This subsection does not prohibit a secretary or commissioner of an agency from serving on any board that discusses and considers the effects of the Patient Protection and Affordable Care Act.

AB531-ASA1,7,6 (e) Notwithstanding pars. (a) to (c), an agency may request any grant or other moneys from the federal government under the Patient and Protection and Affordable Care Act for the purposes under section 1003, 2403, 2405, 2703, 2704, 2706, or 2954 of the Patient Protection and Affordable Care Act; for aging and disability options counseling and assistance programs; for smoking cessation programs for Medical Assistance program recipients; for the Family Care program as described in ss. 46.2805 to 46.2895 or any other long-term care program operated under the Medical Assistance program; and for any purpose for which the grant or other moneys were available from the federal government before March 24, 2010. If the agency receives the grant or other moneys under this paragraph, the agency may implement the project or program for which the grant or other moneys are received and may expend the grant or other moneys.

AB531-ASA1, s. 5 Section 5. 601.46 (3) (k) of the statutes is created to read:

AB531-ASA1,7,12 601.46 (3) (k) A review of the effect the implementation of the Patient Protection and Affordable Care Act, as defined in s. 20.9265 (1) (c), has on rates of health care plans, as defined in s. 628.36 (2) (a) 1., whether offered inside or outside of any health insurance exchange, that are not issued through a governmental body. The review shall include the average rate for each health care plan.

AB531-ASA1,7,13 (End)