AB1-SSA1,2,2
1An Act to repeal 49.471 (4m) and 49.67 (9m);
to amend 20.145 (5) (k), 71.07 (5g)
2(b), 71.07 (5g) (c) 1., 71.07 (5g) (d) 2., 71.28 (5g) (b), 71.28 (5g) (c) 1., 71.28 (5g)
3(d) 2., 71.47 (5g) (b), 71.47 (5g) (c) 1., 71.47 (5g) (d) 2., 76.655 (2), 76.655 (3) (a),
476.655 (5), 177.075 (3), 895.514 (2), 895.514 (3) (a) and 895.514 (3) (b);
to repeal
5and recreate 49.45 (23) (a), 49.45 (23) (a) and 49.471 (4) (a) 4. b.;
to create
649.471 (1) (cr) and 49.471 (4g) of the statutes; and
to affect 2013 Wisconsin Act
720, section
9122 (1L) (b) 1. b.,
2013 Wisconsin Act 20, section
9122 (1L) (b) 1. c.,
82013 Wisconsin Act 20, section
9122 (1L) (b) 2. and 3. a. and c.,
2013 Wisconsin
9Act 20, section
9122 (1L) (b) 4.,
2013 Wisconsin Act 20, section
9122 (1L) (b) 8.
10(intro.) and
2013 Wisconsin Act 20, section
9122 (1L) (b) 8. a., 9. a., 10. a. and
11b. and 11. b.;
relating to: eligibility changes to BadgerCare Plus and
12BadgerCare Plus Core, including Medical Assistance expansion; and extending
1coverage under, and the deadline for the dissolution of, the Health Insurance
2Risk-Sharing Plan.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB1-SSA1,2,85
20.145
(5) (k)
Operational expenses. All moneys transferred from the
6appropriation account under par. (g) for operational expenses related to
winding up 7the affairs of the Health Insurance Risk-Sharing Plan, including hiring consultants,
8limited-term employees, and experts.
AB1-SSA1,2,1911
49.45
(23) (a) The department shall request a waiver from the secretary of the
12federal department of health and human services to permit the department to
13conduct a demonstration project to provide health care coverage to adults who are
14under the age of 65, who have family incomes not to exceed 133 percent of the poverty
15line, except as provided in s. 49.471 (4g), and who are not otherwise eligible for
16medical assistance under this subchapter, the Badger Care health care program
17under s. 49.665, or Medicare under
42 USC 1395 et seq. If the department creates
18a policy under sub. (2m) (c) 10., this paragraph does not apply to the extent that it
19conflicts with the policy.
AB1-SSA1,3
20Section
3
. 49.45 (23) (a) of the statutes, as affected by
2013 Wisconsin Act 20,
21section
1047, and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
AB1-SSA1,3,522
49.45
(23) (a) The department shall request a waiver from the secretary of the
23federal department of health and human services to permit the department to
1conduct a demonstration project to provide health care coverage to adults who are
2under the age of 65, who have family incomes not to exceed 133 percent of the poverty
3line, except as provided in s. 49.471 (4g), and who are not otherwise eligible for
4medical assistance under this subchapter, the Badger Care health care program
5under s. 49.665, or Medicare under
42 USC 1395 et seq.
AB1-SSA1,3p
6Section 3p. 49.471 (1) (cr) of the statutes is created to read:
AB1-SSA1,3,87
49.471
(1) (cr) "Enhanced federal medical assistance percentage" means a
8federal medical assistance percentage described under
42 USC 1396d (y) or (z).
AB1-SSA1,3,1211
49.471
(4) (a) 4. b. Except as provided in sub. (4g), the individual's family
12income does not exceed 133 percent of the poverty line.
AB1-SSA1,4d
13Section 4d. 49.471 (4g) of the statutes is created to read:
AB1-SSA1,3,2214
49.471
(4g) Medicaid expansion; federal medical assistance percentage. For
15services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23), the
16department shall comply with all federal requirements to qualify for the highest
17available enhanced federal medical assistance percentage. The department shall
18submit any amendment to the state medical assistance plan, any request for a waiver
19of the federal Medicaid law, or any other approval required by the federal
20government to provide services to the individuals described under sub. (4) (a) 4. and
21s. 49.45 (23) and to qualify for the highest available enhanced federal medical
22assistance percentage.
AB1-SSA1,6
25Section
6. 49.67 (9m) of the statutes is repealed.
AB1-SSA1,4,83
71.07
(5g) (b)
Filing claims. Subject to the limitations provided under this
4subsection, for taxable years beginning after December 31, 2005, and before January
51,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
671.02 an amount that is equal to the amount of the assessment under s. 149.13, 2011
7stats., that the claimant paid in the claimant's taxable year, multiplied by the
8percentage determined under par. (c) 1.
AB1-SSA1,4,2311
71.07
(5g) (c) 1. The department of revenue, in consultation with the office of
12the commissioner of insurance, shall determine the percentage under par. (b) for
13each claimant for each taxable year. The percentage shall be equal to $5,000,000
14divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
15taxable years beginning after December 31, 2013, and before January 1, 2015, the
16percentage shall be equal to $1,250,000 divided by the aggregate assessment under
17s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
18commissioner of insurance shall provide to each claimant that participates in the
19cost of administering the plan the aggregate assessment at the time that it notifies
20the claimant of the claimant's assessment. The aggregate amount of the credit under
21this subsection and ss. 71.28 (5g), 71.47 (5g), and 76.655 for all claimants
22participating in the cost of administering the plan under ch. 149, 2011 stats., shall
23not exceed $5,000,000 in each fiscal year.
AB1-SSA1,5,4
171.07
(5g) (d) 2. No credit may be claimed under this subsection for taxable
2years beginning after December 31,
2013 2014. Credits under this subsection for
3taxable years that begin before January 1,
2014 2015, may be carried forward to
4taxable years that begin after December 31,
2013
2014.
AB1-SSA1,5,127
71.28
(5g) (b)
Filing claims. Subject to the limitations provided under this
8subsection, for taxable years beginning after December 31, 2005, and before January
91,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1071.23 an amount that is equal to the amount of assessment under s. 149.13, 2011
11stats., that the claimant paid in the claimant's taxable year, multiplied by the
12percentage determined under par. (c) 1.
AB1-SSA1,6,215
71.28
(5g) (c) 1. The department of revenue, in consultation with the office of
16the commissioner of insurance, shall determine the percentage under par. (b) for
17each claimant for each taxable year. The percentage shall be equal to $5,000,000
18divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
19taxable years beginning after December 31, 2013, and before January 1, 2015, the
20percentage shall be equal to $1,250,000 divided by the aggregate assessment under
21s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
22commissioner of insurance shall provide to each claimant that participates in the
23cost of administering the plan the aggregate assessment at the time that it notifies
24the claimant of the claimant's assessment. The aggregate amount of the credit under
25this subsection and ss. 71.07 (5g), 71.47 (5g), and 76.655 for all claimants
1participating in the cost of administering the plan under ch. 149, 2011 stats., shall
2not exceed $5,000,000 in each fiscal year.
AB1-SSA1,6,85
71.28
(5g) (d) 2. No credit may be claimed under this subsection for taxable
6years beginning after December 31,
2013 2014. Credits under this subsection for
7taxable years that begin before January 1,
2014 2015, may be carried forward to
8taxable years that begin after December 31,
2013
2014.
AB1-SSA1,6,1611
71.47
(5g) (b)
Filing claims. Subject to the limitations provided under this
12subsection, for taxable years beginning after December 31, 2005, and before January
131,
2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1471.43 an amount that is equal to the amount of assessment under s. 149.13, 2011
15stats., that the claimant paid in the claimant's taxable year, multiplied by the
16percentage determined under par. (c) 1.
AB1-SSA1,7,619
71.47
(5g) (c) 1. The department of revenue, in consultation with the office of
20the commissioner of insurance, shall determine the percentage under par. (b) for
21each claimant for each taxable year. The percentage shall be equal to $5,000,000
22divided by the aggregate assessment under s. 149.13, 2011 stats.
, except that for
23taxable years beginning after December 31, 2013, and before January 1, 2015, the
24percentage shall be equal to $1,250,000 divided by the aggregate assessment under
25s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
1commissioner of insurance shall provide to each claimant that participates in the
2cost of administering the plan the aggregate assessment at the time that it notifies
3the claimant of the claimant's assessment. The aggregate amount of the credit under
4this subsection and ss. 71.07 (5g), 71.28 (5g), and 76.655 for all claimants
5participating in the cost of administering the plan under ch. 149, 2011 stats., shall
6not exceed $5,000,000 in each fiscal year.
AB1-SSA1,7,129
71.47
(5g) (d) 2. No credit may be claimed under this subsection for taxable
10years beginning after December 31,
2013 2014. Credits under this subsection for
11taxable years that begin before January 1,
2014 2015, may be carried forward to
12taxable years that begin after December 31,
2013
2014.
AB1-SSA1,7,2015
76.655
(2) Filing claims. Subject to the limitations provided under this section,
16for taxable years beginning after December 31, 2005, and before January 1,
2014 172015, a claimant may claim as a credit against the fees imposed under ss. 76.60,
1876.63, 76.65, 76.66 or 76.67 an amount that is equal to the amount of assessment
19under s. 149.13, 2011 stats., that the claimant paid in the claimant's taxable year,
20multiplied by the percentage determined under sub. (3).
AB1-SSA1,8,1023
76.655
(3) (a) The department of revenue, in consultation with the office of the
24commissioner of insurance, shall determine the percentage under sub. (2) for each
25claimant for each taxable year. The percentage shall be equal to $5,000,000 divided
1by the aggregate assessment under s. 149.13, 2011 stats.
, except that for taxable
2years beginning after December 31, 2013, and before January 1, 2015, the
3percentage shall be equal to $1,250,000 divided by the aggregate assessment under
4s. 149.13, 2011 stats., and shall not exceed 100 percent. The office of the
5commissioner of insurance shall provide to each claimant that participates in the
6cost of administering the plan the aggregate assessment at the time that it notifies
7the claimant of the claimant's assessment. The aggregate amount of the credit under
8this subsection and ss. 71.07 (5g), 71.28 (5g), and 71.47 (5g) for all claimants
9participating in the cost of administering the plan under ch. 149, 2011 stats., shall
10not exceed $5,000,000 in each fiscal year.
AB1-SSA1,8,1613
76.655
(5) Sunset. No credit may be claimed under this section for taxable
14years beginning after December 31,
2013 2014. Credits under this section for taxable
15years that begin before January 1,
2014 2015, may be carried forward to taxable
16years that begin after December 31,
2013 2014.
AB1-SSA1,8,2319
177.075
(3) Any intangible property distributable in the course of the
20dissolution of the Health Insurance Risk-Sharing Plan under
2013 Wisconsin Act
2120, section
9122 (1L),
and 2013 Wisconsin Act .... (this act), section 32 (1) (b
), is
22presumed abandoned as otherwise provided under this chapter if sub. (1) (a), (b), or
23(c) does not apply with respect to the distribution.
AB1-SSA1,9,8
1895.514
(2) No cause of action of any nature may arise against, and no liability
2may be imposed upon, the authority, plan, or board; or any agent, employee, or
3director of any of them; or insurers participating in the plan; or the commissioner;
4or any agent, employee, or representative of the commissioner, for any act or
5omission by any of them in the performance of their powers and duties under ch. 149,
62011 stats.,
or under
2013 Wisconsin Act 20, section
9122 (1L),
or under 2013
7Wisconsin Act .... (this act), section 32 (1) (b
), unless the person asserting liability
8proves that the act or omission constitutes willful misconduct.
AB1-SSA1,9,1511
895.514
(3) (a) Except as provided in
2013 Wisconsin Act 20, section
9122 (1L),
12and 2013 Wisconsin Act .... (this act), section 32 (1
) (b), neither the state nor any
13political subdivision of the state nor any officer, employee, or agent of the state or a
14political subdivision acting within the scope of employment or agency is liable for any
15debt, obligation, act, or omission of the authority.
AB1-SSA1,9,2318
895.514
(3) (b) All of the expenses incurred by the authority, or the
19commissioner, or any agent, employee, or representative of the commissioner, in
20exercising its duties and powers under ch. 149, 2011 stats.,
or under
2013 Wisconsin
21Act 20, section
9122 (1L),
or under 2013 Wisconsin Act .... (this act), section 32 (1) (b
), 22shall be payable only from funds of the authority or from the appropriation under s.
2320.145 (5) (g) or (k), or from any combination of those payment sources.
AB1-SSA1,10,8
1[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 1. b. Coverage under the policies
2issued under the plan, including to persons whose coverage under the plan is funded
3under a contract with the federal department of health and human services,
4terminates at 11:59 p.m. on December 31, 2013. At least 60 days before coverage
5terminates, the authority shall provide notice of the date on which coverage
6terminates to all covered persons, all insurers and providers that are affected by the
7termination of the coverage, the office, the legislative audit bureau, and the insurers
8described in subsection (1m) (b) 1.
AB1-SSA1,10,2012[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 2. `Provider claims.' Providers
13of medical services and devices and prescription drugs to covered persons must file
14claims for payment no later than June 1, 2014. Any claim filed after that date is not
15payable and may not be charged to the covered person who received the service,
16device, or drug. Except for copayments, coinsurance, or deductibles required under
17the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes, a
18provider may not bill a covered person who receives a covered service or article and
19shall accept as payment in full the payment rate determined under section 149.142
20(1) of the statutes.
AB1-SSA1,10,2321
3. a. Except for a grievance related to a prior authorization, any grievance by
22a covered person must be in writing and received no later than July 1, 2014, or be
23barred.
AB1-SSA1,11,224
c. A covered person who submits a grievance after March 31, 2014, must
25request an independent review, if any, with respect to the grievance no later than
1August 1, 2014, or be barred from requesting an independent review with respect to
2the grievance.
AB1-SSA1,11,104[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 4. `Payment of plan costs.'
The 5To the extent possible, the authority shall pay plan costs incurred in 2013 and all
6other costs associated with dissolving the plan that are incurred before
7administrative responsibility for the dissolution of the plan is transferred to the
8office under subdivision 8. The authority and the office shall make every effort to pay
9plan costs in accordance with, or as closely as possible to, the manner provided in
10section 149.143 of the statutes.
AB1-SSA1,11,1413[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. `Transfer to the office.' (intro.)
14On February 28, 2014, all of the following shall occur:
AB1-SSA1,11,2517[
2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. a. Administrative
18responsibility for the
operations and dissolution of the plan is transferred to the
19office. The commissioner shall take any action necessary or advisable to
manage and
20wind up the affairs of the plan and shall notify the legislative audit bureau when the
21windup is completed and provide to the legislative audit bureau the final financial
22statements of the plan. For purposes of chapter 177 of the statutes, as affected by
23this act, the dissolution, and winding up of the affairs, of the plan shall be considered
24a dissolution of an insurer in accordance with section 645.44 of the statutes, except
25that a court order of dissolution is not required to effect the dissolution of the plan.
AB1-SSA1,12,5
19. a. There is created,
60 days after the date coverage under the plan terminates
2under subdivision 1. b. on March 1, 2014, a Health Insurance Risk-Sharing Plan
3advisory committee consisting of the commissioner, or his or her designee, and the
4other 13 members of the board holding office on the date the advisory committee is
5created.
AB1-SSA1,12,166
10. a. On behalf of the commissioner, the authority shall provide notice of the
7plan's dissolution to all persons known, or reasonably expected from the plan's
8records, to have claims against the plan, including all covered persons. The notice
9shall be sent by first class mail to the last-known addresses at least 60 days before
10the date on which coverage terminates under subdivision 1. b. Notice to potential
11claimants of the plan shall require the claimants to file their claims, together with
12proofs of claims,
within 90 days after the date on which coverage terminates under
13subdivision 1. b. by June 1, 2014. The notice shall be consistent with any relevant
14terms of the policies under the plan and contracts and with section 645.47 (1) (a) of
15the statutes. The notice shall serve as final notice consistent with section 645.47 (3)
16of the statutes.
AB1-SSA1,13,317
b. Proofs of all claims must be filed with the office in the form provided by the
18office consistent with the proof of claim, as applicable, under section 645.62 of the
19statutes, on or before the last day for filing specified in the notice. For good cause
20shown, the office shall permit a claimant to make a late filing if the existence of the
21claim was not known to the claimant and the claimant files the claim within 30 days
22after learning of the claim, but not
more than 210 days after the date on which
23coverage terminates under subdivision 1. b. later than September 1, 2014. Any such
24late claim that would have been payable under the policy under the plan if it had been
25filed timely and that was not covered by a succeeding insurer shall be permitted
1unless the claimant had actual notice of the termination of the plan or the notice was
2mailed to the claimant by first class mail at least 10 days before the insured event
3occurred.
AB1-SSA1,13,64
11. b. Complete a final audit of the plan, after the termination of the plan in
52014,
within 90 days after the office provides the final financial statements of the
6plan under subdivision 8. a. by June 30, 2015.
AB1-SSA1,13,98
(1)
Coverage extension of the Health Insurance Risk-Sharing Plan;
9issuance of Medicare supplement and replacement policies.
AB1-SSA1,13,1010
(a)
Definitions. In this subsection:
AB1-SSA1,13,12
111. "Authority" means the Health Insurance Risk-Sharing Plan Authority
12under subchapter III of chapter 149 of the statutes.
AB1-SSA1,13,13
132. "Commissioner" means the commissioner of insurance.
AB1-SSA1,13,14
143. "Covered person" means a person who has coverage under the plan.
AB1-SSA1,13,15
154. "Medicare" has the meaning given in section 149.10 (7) of the statutes.
AB1-SSA1,13,17
165. "Medicare Advantage" has the meaning given in section INS 3.39 (3) (r),
17Wisconsin Administrative Code.
AB1-SSA1,13,19
186. "Medicare replacement policy" has the meaning given in section 600.03 (28p)
19of the statutes.
AB1-SSA1,13,21
207. "Medicare supplement policy" has the meaning given in section 600.03 (28r)
21of the statutes.
AB1-SSA1,13,22
228. "Office" means the office of the commissioner of insurance.
AB1-SSA1,13,24
239. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II
24of chapter 149 of the statutes.
AB1-SSA1,14,4
1(b)
Extension of the plan and authority. Notwithstanding any statute,
2administrative rule, or provision of a policy or contract or of the plan to the contrary,
3the dissolution of the plan and the authority as provided in
2013 Wisconsin Act 20,
4section
9122 (1L), is modified as follows:
AB1-SSA1,14,6
51. `Coverage provisions.' Notwithstanding
2013 Wisconsin Act 20, section
9122
6(1L) (b) 1. b., all of the following apply:
AB1-SSA1,14,19
7a. A covered person whose coverage under the plan was in effect on December
81, 2013, who paid his or her December premium, and who, if eligible for Medicare,
9had not enrolled in Medicare Advantage during the federal open enrollment period
10in 2013 may elect to obtain a policy under the plan by making a timely payment of
11the January 2014 premium. The covered person must maintain the same policy
12benefits, including the same deductible amount, that were in effect on December 1,
132013. A new deductible period will commence on January 1, 2014. The premium for
14January 2014 must be paid no later than February 1, 2014. Thereafter, the covered
15person must pay premiums in accordance with the terms of the contract for coverage,
16which may not extend beyond 11:59 p.m. on March 31, 2014. Any medical claims that
17the covered person incurs after December 31, 2013, and before the plan receives the
18premium payment for January 2014 shall be held in abeyance and the plan shall not
19be responsible for payment until the premium payment is received.
AB1-SSA1,15,2
20b. If a covered person's coverage under the plan is funded under a contract with
21the federal department of health and human services, the covered person's coverage
22will end as provided in
2013 Wisconsin Act 20, section
9122 (1L) (b) 1. b., unless the
23federal department of health and human services issues a contract amendment that
24extends the contract and coverage to a date later than December 31, 2013, and the
25terms of the contract amendment are such that the federal government will be
1financially liable for all costs related to the operation of the contract that exceed
2member premium collections.
AB1-SSA1,15,17
3c. If the requirements under subdivision 1
. b. are satisfied, a covered person
4whose coverage is funded under a contract with the federal department of health and
5human services, whose coverage under the plan was in effect on December 1, 2013,
6who paid his or her December premium, and who had not enrolled in Medicare
7Advantage during the federal open enrollment period in 2013 may elect to obtain a
8policy under the plan by making a timely payment of the January 2014 premium.
9The covered person must maintain the same policy benefits, including the same
10deductible amount, that were in effect on December 1, 2013. A new deductible period
11will commence on January 1, 2014. The premium for January 2014 must be paid no
12later than February 1, 2014. Thereafter, the covered person must pay premiums in
13accordance with the terms of the contract for coverage, which may not extend beyond
1411:59 p.m. on March 31, 2014. Any medical claims that the covered person incurs
15after December 31, 2013, and before the plan receives the premium payment for
16January 2014 shall be held in abeyance and the plan shall not be responsible for
17payment until the premium payment is received.
AB1-SSA1,15,21
18d. No later than February 1, 2014, the authority shall provide notice that
19coverage shall terminate on March 31, 2014, to all covered persons, all insurers and
20providers that are affected by the termination of the coverage, the office, the
21legislative audit bureau, and the insurers described in paragraph (c) 1
.
AB1-SSA1,16,5
222. `Provider claims.' Providers of medical services and devices and prescription
23drugs to covered persons whose coverage is extended as provided in this paragraph
24must file claims for payment no later than June 1, 2014. Any claim filed after that
25date is not payable and may not be charged to the covered person who received the
1service, device, or drug. Except for copayments, coinsurance, or deductibles required
2under the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes,
3a provider may not bill a covered person who receives a covered service or article and
4shall accept as payment in full the payment rate determined under section 149.142
5(1) of the statutes.
AB1-SSA1,16,6
63. `Grievances and review.'
AB1-SSA1,16,9
7a. Any grievance by a covered person whose coverage is extended as provided
8in this paragraph must be in writing and received no later than July 1, 2014, or be
9barred.
AB1-SSA1,16,13
10b. A covered person whose coverage is extended as provided in this paragraph
11who submits a grievance after March 31, 2014, must request an independent review,
12if any, with respect to the grievance no later than August 1, 2014, or be barred from
13requesting an independent review with respect to the grievance.
AB1-SSA1,16,14
144. `Payment of plan costs.'