Amendment DE3 SSA1-AB1

AB1-SSA1,15,21 d. No later than February 1, 2014, the authority shall provide notice that coverage shall terminate on March 31, 2014, to all covered persons, all insurers and providers that are affected by the termination of the coverage, the office, the legislative audit bureau, and the insurers described in paragraph (c) 1 .

AB1-SSA1,16,5 2. `Provider claims.' Providers of medical services and devices and prescription drugs to covered persons whose coverage is extended as provided in this paragraph must file claims for payment no later than June 1, 2014. Any claim filed after that date is not payable and may not be charged to the covered person who received the service, device, or drug. Except for copayments, coinsurance, or deductibles required under the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes, a provider may not bill a covered person who receives a covered service or article and shall accept as payment in full the payment rate determined under section 149.142 (1) of the statutes.

AB1-SSA1,16,6 3. `Grievances and review.'

AB1-SSA1,16,9 a. Any grievance by a covered person whose coverage is extended as provided in this paragraph must be in writing and received no later than July 1, 2014, or be barred.

AB1-SSA1,16,13 b. A covered person whose coverage is extended as provided in this paragraph who submits a grievance after March 31, 2014, must request an independent review, if any, with respect to the grievance no later than August 1, 2014, or be barred from requesting an independent review with respect to the grievance.

AB1-SSA1,16,14 4. `Payment of plan costs.'

AB1-SSA1,16,18 a. To the extent possible, the authority shall pay plan costs incurred in 2013 and 2014 and all other costs associated with operating and dissolving the plan that are incurred before administrative responsibility for the dissolution of the plan is transferred to the office on February 28, 2014.

AB1-SSA1,16,19 b. All provider claims shall be adjudicated by September 30, 2014.

AB1-SSA1,16,24 c. The authority, before March 1, 2014, and the office, on and after March 1, 2014, but no later than July 1, 2014, shall determine whether an assessment of insurers under section 149.13 of the statutes is necessary to cover in full the plan's expenses related to operations, winding up operations, and dissolution of the plan. Any such assessment shall be based on the 2013 filed plan assessment form.

AB1-SSA1,17,5 d. No later than 30 days before distribution of any surplus remaining after the dissolution of the plan, or within 30 days after completion of the dissolution of the plan if there is no surplus to distribute, the office shall submit a final report to the joint committee on finance on the operation and dissolution of the plan, including the proposed distribution of any remaining surplus.

AB1-SSA1,17,6 5. `Dissolution notice, claims, and updates.'

AB1-SSA1,17,16 a. On behalf of the commissioner, the authority shall provide notice of the plan's dissolution to all persons known, or reasonably expected from the plan's records, to have claims against the plan, including all covered persons. Notwithstanding 2013 Wisconsin Act 20, section 9122 (1L) (b) 10. a., the notice shall be sent by 1st class mail to the last-known addresses no later than February 1, 2014. Notice to potential claimants of the plan shall require the claimants to file their claims, together with proofs of claims, by June 1, 2014. The notice shall be consistent with any relevant terms of the policies under the plan and contracts and with section 645.47 (1) (a) of the statutes. The notice shall serve as final notice consistent with section 645.47 (3) of the statutes.

AB1-SSA1,18,2 b. Proofs of all claims must be filed with the office in the form provided by the office consistent with the proof of claim, as applicable, under section 645.62 of the statutes, on or before the last day for filing specified in the notice. For good cause shown, the office shall permit a claimant to make a late filing if the existence of the claim was not known to the claimant and the claimant files the claim within 30 days after learning of the claim, but not later than September 1, 2014. Any such late claim that would have been payable under the policy under the plan if it had been filed timely and that was not covered by a succeeding insurer shall be permitted unless the claimant had actual notice of the termination of the plan or the notice was mailed to the claimant by 1st class mail at least 10 days before the insured event occurred.

AB1-SSA1,18,3 (c) Medicare supplement and replacement policy issuance.

AB1-SSA1,18,7 1. In addition to the requirement under 2013 Wisconsin Act 20, section 9122 (1m), an insurer offering a Medicare supplement policy or a Medicare replacement policy in this state shall provide coverage under the policy to any individual who satisfies all of the following:

AB1-SSA1,18,8 a. The individual is eligible for Medicare.

AB1-SSA1,18,9 b. The individual had coverage under the plan.

AB1-SSA1,18,10 c. The individual's coverage under the plan terminated on March 31, 2014.

AB1-SSA1,18,12 d. The individual applies for coverage under the policy before 63 days after the date specified in subdivision 1 . c.

AB1-SSA1,18,13 e. The individual pays the premium for the coverage under the policy.

AB1-SSA1,18,16 2. An insurer under subdivision 1. may not deny coverage to any individual who satisfies the criteria under subdivision 1 . a. to e . on the basis of health status, receipt of health care, claims experience, or medical condition including disability.

AB1-SSA1,18,19 3. In addition to any other notice requirements to insurers, no later than February 1, 2014, the authority shall provide notice to the insurers described in subdivision 1. of the requirements under this paragraph.

AB1-SSA1,18,22 (2m) Medical Assistance eligibility; temporary extension. Beginning on January 1, 2014, the department of health services shall do all of the following until April 1, 2014:

AB1-SSA1,19,3 (a) Allow individuals whose family income does not exceed 200 percent of the federal poverty line, who were receiving benefits under section 49.471 (4) (a) 4. or (b) 4. of the statutes on December 31, 2013, and who would otherwise be eligible for benefits under section 49.471 (4) (a) 4. of the statutes except for the income limit to be eligible to continue receiving benefits under section 49.471 (4) (a) 4. of the statutes.

AB1-SSA1,19,8 (b) Allow individuals whose family income does not exceed 200 percent of the federal poverty line, who were receiving benefits under section 49.45 (23) of the statutes as of December 31, 2013, and who would otherwise be eligible for benefits under section 49.45 (23) of the statutes except for the income limit to be eligible to continue receiving benefits under section 49.45 (23) of the statutes.

AB1-SSA1,33 Section 33. Effective dates. This act takes effect on the day after publication, except as follows:

AB1-SSA1,19,12 (1) Health Insurance Risk-Sharing Plan. The treatment of section 895.514 (2) and (3) (a) and (b) of the statutes takes effect on January 1, 2015.

AB1-SSA1,19,15 (2) Medical Assistance eligibility. The treatment of sections 49.45 (23) (a) (by Section 2) and 49.471 (1) (cr), (4) (a) 4. b., and (4g) of the statutes takes effect on January 1, 2014.

AB1-SSA1,19,17 (3) Reconciliation with 2011 Wisconsin Act 32. The treatment of section 49.45 (23) (a) (by Section 3 ) of the statutes takes effect on January 1, 2015.

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