Amendment ASA1-AB40

AB40-ASA1,1193,11 (1) "Exchange" means the American health benefit exchange, as described in 42 USC 18031.

AB40-ASA1,1193,12 (2) "Health benefit plan" has the meaning given in s. 632.745 (11).

AB40-ASA1,1193,14 (3) (a) Except as provided in par. (b), "navigator" means a natural person, or an entity that supervises or employs a natural person, who does all of the following:

AB40-ASA1,1193,16 1. Performs any of the activities and duties identified in 42 USC 18031 (i) and 45 CFR 155.210 on behalf of the exchange.

AB40-ASA1,1193,18 2. Receives funding to perform any of the activities and duties identified in 42 USC 18031 (i) and 45 CFR 155.210 on behalf of the exchange.

AB40-ASA1,1193,21 (b) "Navigator" does not include a person acting as an insurance intermediary licensed under subch. II, but an insurance intermediary may apply to be licensed as a navigator under this subchapter.

AB40-ASA1,1193,25 (4) "Nonnavigator assister" means a natural person who has been designated by the exchange, or could reasonably be described as working at the behest of the exchange, as a nonnavigator assister, including an in-person assister, enrollment assister, application assister, or certified application counselor.

AB40-ASA1,1194,3 628.91 Requirement of licensure or registration. No natural person or entity may act as a navigator in this state unless licensed or registered as a navigator under s. 628.92.

AB40-ASA1,1194,10 628.92 Issuance of license and registration. (1) Individual license. A natural person applying for a navigator license shall make application to the commissioner on a form developed by the commissioner and shall declare under penalty of refusal, suspension, or revocation of the license that the statements made in the application are true, correct, and complete to the best of the individual's knowledge and belief. Before approving the application, the commissioner shall find that the person satisfies all of the following:

AB40-ASA1,1194,11 (a) Is at least 18 years of age.

AB40-ASA1,1194,13 (b) Resides in this state or maintains his or her principal place of business in this state.

AB40-ASA1,1194,15 (c) Has completed the training and course of study requirements under sub. (7) and any training and course of study requirements mandated by the exchange.

AB40-ASA1,1194,19 (d) Has successfully passed a written examination approved by the commissioner under sub. (7) that tests the applicant's knowledge concerning the duties and responsibilities of a navigator, the insurance laws and regulations of this state, and state public assistance programs and eligibility.

AB40-ASA1,1194,22 (e) Has submitted a full set of fingerprints to the commissioner and successfully completed a regulatory and criminal history background investigation in a manner prescribed by the commissioner under sub. (6).

AB40-ASA1,1194,25 (f) Possesses the requisite character, integrity, competency, and trustworthiness as determined in accordance with the criteria under the rules promulgated under s. 628.04.

AB40-ASA1,1195,2 (g) Has not committed any act that the commissioner finds would warrant the denial, suspension, or revocation of a license under this subchapter.

AB40-ASA1,1195,4 (h) Has identified the entity with which he or she is, or will be, affiliated and by which he or she is, or will be, supervised, if any.

AB40-ASA1,1195,5 (i) Has paid the applicable licensing fee as set forth in s. 601.31 (1) (nm).

AB40-ASA1,1195,13 (2) Entity registration. An entity that acts or intends to operate as a navigator, supervises the activities of individual navigators, or receives funding to perform such activities shall first register as a navigator entity with the commissioner. This registration shall be on an application form developed by the commissioner, which shall include such documentation as the commissioner determines is necessary and appropriate. Before the commissioner may register the entity, the entity must establish to the satisfaction of the commissioner that it satisfies all of the following:

AB40-ASA1,1195,16 (a) The entity has policies and procedures in place to ensure that all acts that may be performed only by a navigator or licensed intermediary are performed by persons who are appropriately licensed under this subchapter or subch. II, or both.

AB40-ASA1,1195,19 (b) The entity will assume full legal responsibility for the acts of the individual navigators that it employs, supervises, or is affiliated with that are performed in this state and that are within the scope of the navigator's apparent authority.

AB40-ASA1,1195,20 (c) The entity is sound, reliable, and entitled to public confidence.

AB40-ASA1,1195,22 (d) The entity has paid the applicable registration fee as set forth in s. 601.31 (1) (np).

AB40-ASA1,1195,24 (e) The entity has identified on the registration form a designated responsible individual navigator who is licensed under this subchapter.

AB40-ASA1,1196,2 (3) Documentation. The commissioner may require any documents necessary to verify the information contained in an application submitted under sub. (1) or (2).

AB40-ASA1,1196,10 (4) List of individual navigators. Upon initial registration, navigator entities shall, in a manner prescribed by the commissioner, provide the commissioner with a list of all individual navigators that it employs, supervises, or is affiliated with. Thereafter, the navigator entity shall provide updates, if any, to the list of individual navigators on a monthly basis. A navigator entity is bound by the acts of each individual navigator who has been, or should have been, reported under this subsection that are performed in this state and that are within the scope of the individual navigator's apparent authority.

AB40-ASA1,1196,15 (5) Financial responsibility requirement. (a) Each entity that is a navigator shall furnish a bond in an amount no less than $100,000 from an insurer authorized to do business in this state or provide other evidence of financial responsibility capable of protecting all persons against the wrongful acts, misrepresentations, errors, omissions, or negligence of the navigator.

AB40-ASA1,1196,20 (b) An individual navigator not affiliated with an entity shall furnish a bond in an amount no less than $100,000 from an insurer authorized to do business in this state or provide other evidence of financial responsibility capable of protecting all persons against the wrongful acts, misrepresentations, errors, omissions, or negligence of the navigator.

AB40-ASA1,1196,23 (c) The commissioner may by rule define the amount of the financial responsibility requirement and alternative requirements for complying with this section.

AB40-ASA1,1197,5 (6) Fingerprints and criminal and regulatory background check. Each applicant for licensure as an individual navigator shall provide fingerprints in a format specified by the commissioner and complete a criminal and regulatory background check as a condition for being granted a license to act as a navigator. The commissioner shall use the fingerprints to conduct a state criminal history background investigation of the applicant and a national criminal history background investigation of the applicant with the federal bureau of investigation.

AB40-ASA1,1197,15 (7) Training and examination. An individual navigator shall complete at least 16 hours of prelicensing training and satisfactorily complete an approved written examination for navigators before applying for an individual navigator's license. After licensure, an individual navigator shall complete a course of study of at least 8 hours of approved training every one-year period. The commissioner may approve and designate courses and programs that an applicant for a navigator's license may complete to fulfill the prelicensing training requirement or that a licensed navigator may complete to fulfill the annual training requirement. The commissioner may make arrangements, including contracting with an outside testing service or other appropriate entity, to administer examinations and collect fees.

AB40-ASA1,1197,19 628.93 Other applicable provisions. (1) Social security and federal employer identification numbers on applications or at time of fee payment. Applicants for individual navigator licensure and navigator entity registration are subject to s. 628.095.

AB40-ASA1,1197,22 (2) Refusal to issue license; failure to pay support or to comply with subpoena or warrant; tax delinquency. Applicants for individual navigator licensure and navigator entity registration are subject to s. 628.097.

AB40-ASA1,1197,24 (3) Termination of license. Individual navigator licenses are subject to s. 628.10.

AB40-ASA1,1198,3 628.95 Navigator and nonnavigator assister conduct. (1) General. For purposes of this subchapter, a navigator or nonnavigator assister, in the performance of its duties, shall be considered to be transacting the business of insurance.

AB40-ASA1,1198,5 (2) Prohibited practices. A navigator or nonnavigator assister may not do any of the following:

AB40-ASA1,1198,7 (a) Receive compensation from an insurer who offers a health benefit plan or stop loss insurance or from a 3rd-party administrator.

AB40-ASA1,1198,9 (b) Provide any information or services related to enrollment in health benefit plans or other insurance products not offered in the exchange.

AB40-ASA1,1198,14 (c) Make or cause to be made any communication relating to the exchange, health benefit plans, an insurance contract, the insurance business, any insurer, any navigator, any nonnavigator assister, or any intermediary that contains false, deceptive, or misleading information, including information that is misleading because of incompleteness.

AB40-ASA1,1198,16 (d) Provide advice about which health benefit plan is better or worse for a particular individual or employer.

AB40-ASA1,1198,18 (e) Recommend a particular health benefit plan or insurer or advise consumers about which health benefit plan to choose.

AB40-ASA1,1198,20 (f) Engage in any unfair method of competition or any other unfair, fraudulent, deceptive, or dishonest act or practice.

AB40-ASA1,1198,22 (g) Receive compensation that is dependent, in whole or in part, on whether an individual enrolls in or renews a health benefit plan.

AB40-ASA1,1198,25 (3) Restitution. The commissioner may require that any person that violates this subchapter make restitution to any individual who suffers financial injury because of the violation of this subchapter.

AB40-ASA1,1199,9 628.96 Nonnavigator assisters. (1) Registration required. Any entity that employs one or more nonnavigator assisters shall, in a manner prescribed by the commissioner, provide the commissioner with a list of all nonnavigator assisters that it employs, supervises, or is affiliated with upon the nonnavigator assisters first becoming authorized by the exchange to provide nonnavigator assistance. Thereafter, the entity shall provide updates, if any, to the list of nonnavigator assisters on a monthly basis. No nonnavigator assister may act as a nonnavigator assister in this state until registered with the commissioner. The commissioner may refuse to register any nonnavigator assister to which any of the following applies:

AB40-ASA1,1199,12 (a) The nonnavigator assister does not possess the requisite character, integrity, competency, and trustworthiness as determined in accordance with the criteria under the rules promulgated under s. 628.04.

AB40-ASA1,1199,15 (b) The nonnavigator assister has committed any act that the commissioner finds would warrant the denial, suspension, or revocation of a license or registration under this subchapter.

AB40-ASA1,1199,19 (2) Application counselors. In addition to the requirements of this section, certified application counselors, as established by 45 CFR 155.225, shall be required to meet the training and examination requirements set forth in s. 628.92 (7). Certified application counselors may also become licensed as individual navigators.

AB40-ASA1,1199,24 (3) Entity liability. An entity that employs, supervises, or is formally affiliated with a nonnavigator assister assumes legal responsibility for the acts of the nonnavigator assister that are performed in this state and that are within the scope of the nonnavigator assister's apparent authority to act as a nonnavigator assister on behalf of that entity.

AB40-ASA1,1200,2 (4) Exemption for government entities. This section does not apply to any government entity or any person acting on behalf of a government entity.

AB40-ASA1,1200,8 628.98 Rules. The commissioner may promulgate any rules necessary to carry out the purposes of this subchapter. Notwithstanding s. 227.24 (1) (a) and (3), the commissioner may promulgate rules under this section as emergency rules under s. 227.24 without providing evidence that promulgating a rule under this section as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and without a finding of emergency.

AB40-ASA1,2265m Section 2265m. 631.20 (1) (c) 5. of the statutes is repealed.

AB40-ASA1,2265mp Section 2265mp. 631.20 (2) (f) of the statutes is repealed.

AB40-ASA1,2265n Section 2265n. 631.36 (7) (a) (intro.) and 2. of the statutes are consolidated, renumbered 631.36 (7) (a) and amended to read:

AB40-ASA1,1200,18 631.36 (7) (a) Notice Except as provided in par. (b), notice of cancellation or nonrenewal required under sub. (2) (b) or (4) is not effective: 2. Unless unless the notice contains adequate instructions to the policyholder for applying for insurance through a risk-sharing plan under ch. 619, if a risk-sharing plan exists under ch. 619 for the kind of coverage being canceled or nonrenewed, except as provided in par. (b).

AB40-ASA1,2265nr Section 2265nr. 631.36 (7) (a) 1. of the statutes is repealed.

AB40-ASA1,2265z Section 2265z. 631.36 (7) (b) of the statutes is amended to read:

AB40-ASA1,1200,23 631.36 (7) (b) Paragraph (a) 2. does not apply to a notice of cancellation or nonrenewal issued by the mandatory health care liability risk-sharing plan established under s. 619.04.

AB40-ASA1,2266 Section 2266. 632.697 of the statutes is created to read:

AB40-ASA1,1201,8 632.697 Benefits subject to department's right to recover. Death benefits payable under a life insurance policy or an annuity are subject to the right of the department of health services to recover under s. 46.27 (7g), 49.496, 49.682, or 49.849 an amount equal to the medical assistance that is recoverable under s. 49.496 (3) (a), an amount equal to aid under s. 49.68, 49.683, or 49.685 that is recoverable under s. 49.682 (2) (a), or an amount equal to long-term community support services under s. 46.27 that is recoverable under s. 46.27 (7g) (c) 1. and that was paid on behalf of the deceased policyholder or annuitant.

AB40-ASA1,2266j Section 2266j. 632.785 of the statutes is repealed.

AB40-ASA1,2266n Section 2266n. 632.897 (11) (a) of the statutes is amended to read:

AB40-ASA1,1201,19 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t), 2011 stats.

AB40-ASA1,2267 Section 2267. 635.02 (7) (b) 3. of the statutes is amended to read:

AB40-ASA1,1201,24 635.02 (7) (b) 3. A professional employer organization, as defined in s. 461.01 202.21 (5), or a professional employer group, as defined in s. 461.01 202.21 (4), that provides health care benefits to more than 50 employees performing services for a client, as defined in s. 461.01 202.21 (2).

AB40-ASA1,2267b Section 2267b. 645.73 (1) of the statutes is amended to read:

AB40-ASA1,1202,6 645.73 (1) Unclaimed funds. The liquidator, as provided in ch. 177, shall report and deliver to the state treasurer secretary of revenue all unclaimed funds subject to distribution remaining in the liquidator's hands when he or she is ready to apply to the court for discharge, including the amount distributable to any creditor, shareholder, member or other person who is unknown or cannot be found or who is under disability with no person legally competent to receive a distributive share.

AB40-ASA1,2267d Section 2267d. 645.73 (2) of the statutes is amended to read:

AB40-ASA1,1202,14 645.73 (2) Withheld funds. All funds withheld under s. 645.64 and not distributed shall upon discharge of the liquidator be deposited with the state treasurer secretary of revenue and paid by the treasurer secretary in accordance with s. 645.64. Any sums remaining which under s. 645.64 would revert to the undistributed assets of the insurer shall be transferred to the state treasurer secretary of revenue and become the property of the state under sub. (1), unless the commissioner petitions the court to reopen the liquidation under s. 645.75.

AB40-ASA1,2267e Section 2267e. 646.01 (1) (a) 2. k. of the statutes is amended to read:

AB40-ASA1,1202,16 646.01 (1) (a) 2. k. Risk-sharing plans under chs. 149 and ch. 619.

AB40-ASA1,2267f Section 2267f. 655.001 (1) of the statutes is renumbered 655.001 (1r).

AB40-ASA1,2267g Section 2267g. 655.001 (1g) of the statutes is created to read:

AB40-ASA1,1202,21 655.001 (1g) "Affiliated health care providers" includes health care providers employed by a common health care provider and health care providers affiliated under a controlling legal entity.

AB40-ASA1,2267h Section 2267h. 655.001 (14) of the statutes is created to read:

AB40-ASA1,1203,2 655.001 (14) "Self-insurance plan" means a plan approved by the commissioner to self-insure health care providers against medical malpractice claims in accordance with this chapter. A "self-insurance plan" may provide coverage to a single health care provider or affiliated health care providers.

AB40-ASA1,2267k Section 2267k. 655.23 (3) (a) of the statutes is amended to read:

AB40-ASA1,1203,13 655.23 (3) (a) Except as provided in par. (d), every health care provider either shall insure and keep insured the health care provider's liability by a policy of health care liability insurance issued by an insurer authorized to do business in this state or shall qualify as a self-insurer. Qualification as a self-insurer is subject to conditions established by the commissioner and is valid only when approved by the commissioner. The commissioner may establish conditions that permit a self-insurer to self-insure for claims that are against employees who are health care practitioners and that are not covered by the fund. An approved self-insurance plan may provide coverage for all affiliated health care providers under a controlling legal entity.

AB40-ASA1,2268 Section 2268. 700.24 of the statutes is amended to read:

AB40-ASA1,1203,21 700.24 Death of a joint tenant; effect of liens. A real estate mortgage, a security interest under ch. 409, or a lien under s. 72.86 (2), 1985 stats., or s. 71.91 (5) (b), or ch. 49 or 779 or rules promulgated under s. 46.286 (7) on or against the interest of a joint tenant does not defeat the right of survivorship in the event of the death of such joint tenant, but the surviving joint tenant or tenants take the interest such deceased joint tenant could have transferred prior to death subject to such mortgage, security interest, or statutory lien.

AB40-ASA1,2269 Section 2269. 701.065 (1) (b) 1. of the statutes is amended to read:

AB40-ASA1,1204,4 701.065 (1) (b) 1. The claim is a claim based on tort, on a marital property agreement that is subject to the time limitations under s. 766.58 (13) (b) or (c), on Wisconsin income, franchise, sales, withholding, gift, or death taxes, or on unemployment compensation contributions due or benefits overpaid; a claim for funeral or administrative expenses; a claim of this state under s. 46.27 (7g), 49.496 or, 49.682, or rules promulgated under s. 46.286 (7) 49.849; or a claim of the United States.

AB40-ASA1,2270 Section 2270. 701.065 (5) of the statutes is created to read:

AB40-ASA1,1204,7 701.065 (5) Claims of department of health services. (a) Definitions. In this subsection:

AB40-ASA1,1204,8 1. "Department" means the department of health services.

AB40-ASA1,1204,9 2. "Long-term care program" has the meaning given in s. 49.496 (1) (bk).

AB40-ASA1,1204,20 (b) Living trusts. 1. Notwithstanding sub. (1) (a), if a settlor of a living trust, or if the predeceased spouse of a settlor of a living trust, at any time received any services provided as a benefit under a long-term care program, medical assistance under subch. IV of ch. 49, long-term community support services funded under s. 46.27 (7), or aid under s. 49.68, 49.683, or 49.685, the trustee shall provide written notice to the department by registered or certified mail, within 30 days after the death of the settlor and before any property held in the trust is distributed. The notice shall include demographic information about the settlor and the settlor's predeceased spouse, if any, information about how to file a claim, a copy of the trust document, and documentation supporting the value of the trust on the settlor's date of death.

AB40-ASA1,1205,6 2. After the death of a settlor who, or whose predeceased spouse, received services, medical assistance, long-term community support services, or aid described in subd. 1., the department may recover under s. 46.27 (7g), 49.496, 49.682, or 49.849, from property held in the living trust immediately before the settlor's death, an amount equal to the medical assistance that is recoverable under s. 49.496 (3) (a), an amount equal to aid under s. 49.68, 49.683, or 49.685 that is recoverable under s. 49.682 (2) (a), or an amount equal to long-term community support services under s. 46.27 that is recoverable under s. 46.27 (7g) (c) 1. and that was paid on behalf of the settlor or the settlor's predeceased spouse. The deadline for the department to file a claim for recovery under this subdivision shall be the date that is 4 months after the date of the trustee's notice under subd. 1.

AB40-ASA1,1205,14 3. Within 90 days after receipt of a claim for recovery from the department, a trustee under subd. 1. shall pay to the department any amount that the department may recover under subd. 2. If the trustee distributes property from the trust before the department makes a claim to the trustee for the recovery of any amount specified in subd. 2., the trustee shall provide the department with information about the distributed property and to whom it was distributed or transferred. The department is entitled to recover any amounts specified in subd. 2. from the persons to whom the property was distributed or transferred.