Amendment ASA1-AB40

AB40-ASA1,1291,2 1. "Department" means the department of health services.

AB40-ASA1,1291,4 2. "Family Care program" means the benefit program under section 46.286 of the statutes.

AB40-ASA1,1291,6 3. "Mental health institute" has the meaning given in section 51.01 (12) of the statutes.

AB40-ASA1,1291,10 (b) Before September 1, 2013, the department shall submit to the joint committee on finance a report that identifies issues relating to cost liability for counties with residents who were formerly enrolled in the Family Care program and who are admitted to a mental health institute.

AB40-ASA1,1291,20 (c) After submitting the report under paragraph (b) and during the 2013-15 fiscal biennium, the department shall submit one or more requests to the joint committee on finance under section 13.10 of the statutes to supplement the appropriation under section 20.435 (2) (bj) of the statutes from the appropriation under section 20.865 (4) (a) of the statutes for the purpose of paying a portion of the additional costs counties incur to support services provided by the mental health institutes to certain enrollees in the Family Care program. If the joint committee on finance releases the moneys, the department may reimburse the county for all of the following for a stay of an enrollee of the Family Care program at a mental health institute subject to paragraph (d):

AB40-ASA1,1291,23 1. For any portion of a stay longer than 30 days but not longer than 60 days at a mental health institute, 50 percent of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,3 2. For any portion of a stay longer than 60 days but not longer than 90 days, 75 percent of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,5 3. For any portion of a stay longer than 90 days, all of the state share of the cost of care incurred by the county for that portion of the stay.

AB40-ASA1,1292,14 (d) The department may provide reimbursement to counties for Family Care program enrollees admitted to mental health institutes on or after the effective date of this paragraph and, if the Family Care program enrollee is still at the mental health institute on the effective date of this paragraph, before the effective date of this paragraph. For a Family Care program enrollee admitted to a mental health institute before the effective date of this paragraph, the department shall base the reimbursement on the Family Care program enrollee's total length of stay since admission to the mental health institute using the calculations under paragraph (c) 1. to 3.

AB40-ASA1,1292,17 (e) The financial liability of the state to pay reimbursements for services at a mental health institute for Family Care program enrollees under this subsection is limited to services provided at a mental health institute before July 1, 2015.

AB40-ASA1,9119 Section 9119. Nonstatutory provisions; Higher Educational Aids Board.

AB40-ASA1,9120 Section 9120. Nonstatutory provisions; Historical Society.

AB40-ASA1,9121 Section 9121. Nonstatutory provisions; Housing and Economic Development Authority.

AB40-ASA1,9122 Section 9122. Nonstatutory provisions; Insurance.

AB40-ASA1,1292,22 (1L) Dissolution of the Health Insurance Risk-Sharing Plan and Authority.

AB40-ASA1,1292,23 (a) Definitions. In this subsection:

AB40-ASA1,1293,2 1. "Authority" means the Health Insurance Risk-Sharing Plan Authority under subchapter III of chapter 149 of the statutes.

AB40-ASA1,1293,3 2. "Board" means the board of directors of the authority.

AB40-ASA1,1293,4 3. "Commissioner" means the commissioner of insurance.

AB40-ASA1,1293,5 4. "Covered person" means a person who has coverage under the plan.

AB40-ASA1,1293,6 5. "Office" means the office of the commissioner of insurance.

AB40-ASA1,1293,8 6. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

AB40-ASA1,1293,11 (b) Dissolution of the plan and authority. Notwithstanding any statute, administrative rule, or provision of a policy or contract or of the plan to the contrary, the plan and the authority shall be dissolved in accordance with the following:

AB40-ASA1,1293,12 1. `Coverage provisions.'

AB40-ASA1,1293,16 a. New coverage under the plan may not be issued to any person after December 31, 2013, except that new coverage under the plan that is funded under a contract with the federal department of health and human services may not be issued to any person after December 1, 2013.

AB40-ASA1,1293,24 b. Coverage under the policies issued under the plan terminates on January 1, 2014, or on the date that any health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective, if later than January 1, 2014. At least 60 days before coverage terminates, the authority shall provide notice of the date on which coverage terminates 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 subsection (1m) (b) 1.

AB40-ASA1,1294,9 c. If coverage under the policies issued under the plan terminates on a date that is later than January 1, 2014, because no health insurance coverage that is accessed through an American health benefit exchange, as described in 42 USC 18031, in this state is effective on January 1, 2014, the authority may allow covered persons whose coverage under the plan is funded under a contract with the federal department of health and human services to elect to be covered, until coverage under the plan terminates, under the same coverage provided under the plan to covered persons whose coverage under the plan is not funded under a contract with the federal department of health and human services.

AB40-ASA1,1294,19 2. `Provider claims.' Providers of medical services and devices and prescription drugs to covered persons must file claims for payment no later than 90 days after the date coverage terminates under subdivision 1. b. 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, during the 90 days after the date coverage terminates under subdivision 1. b., consistent with section 149.14 (3) of the statutes and section 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.

AB40-ASA1,1294,20 3. `Grievances and review.'

AB40-ASA1,1294,24 a. Except for a grievance related to a prior authorization denial, a covered person must submit any grievance, in writing, no later than 180 days after the date coverage terminates under subdivision 1. b. or be barred from submitting the grievance.

AB40-ASA1,1295,6 b. A covered person must submit any grievance related to a prior authorization denial no later than 45 days before the date on which coverage terminates under subdivision 1. b. or be barred from submitting the grievance, except that a grievance related to a prior authorization denial that meets the requirements for an expedited grievance must be submitted no later than the date on which coverage terminates under subdivision 1. b. or be barred.

AB40-ASA1,1295,11 c. A covered person who submits a grievance after the date coverage terminates under subdivision 1. b. must request an independent review, if any, with respect to the grievance no later than 60 days after he or she receives notice of the disposition of the grievance or be barred from requesting an independent review with respect to the grievance.

AB40-ASA1,1295,17 4. `Payment of plan costs.' The authority shall pay plan costs incurred in 2013 and all other costs associated with dissolving the plan that are incurred before administrative responsibility for the dissolution of the plan is transferred to the office under subdivision 8. The authority and the office shall make every effort to pay plan costs in accordance with, or as closely as possible to, the manner provided in section 149.143 of the statutes.

AB40-ASA1,1295,20 5. `Contracts.' The authority may extend any administrative contracts that are in effect into 2014, regardless of a contract's expiration date and without having to comply with the requirements under section 149.47 of the statutes for the extension.

AB40-ASA1,1295,23 6. `Report to legislature.' The authority shall submit a final report on plan operation to the legislature under section 13.172 of the statutes no later than September 30, 2013.

AB40-ASA1,1295,24 7. `Board responsibilities.' The board shall do all of the following:

AB40-ASA1,1296,8 a. Develop a proposal, which shall be followed by the office, for the dispensation of the plan's cash assets after all financial obligations of the plan and authority are satisfied. To the extent feasible and practical, the proposal shall provide for the return of any remaining equity to the source from which derived, including insurers, providers, and covered persons. The proposal shall provide for alternative dispensations in the event that returning any remaining equity is not feasible or practical, such as using remaining cash assets in support of activities providing an indirect benefit to the insurers, providers, and covered persons.

AB40-ASA1,1296,10 b. Dispose of the noncash assets of the authority as soon as possible after the administrative offices of the authority are closed.

AB40-ASA1,1296,14 c. Make any other decisions and take any other actions necessary to effectively wind up the operations and affairs of the authority and plan and transfer responsibility to the office. All actions taken by the board must be consistent with the purpose of, and may not endanger the solvency of, the plan.

AB40-ASA1,1296,16 8. `Transfer to the office.' On the date that is 60 days after the date coverage under the plan terminates under subdivision 1. b., all of the following shall occur:

AB40-ASA1,1296,25 a. Administrative responsibility for the dissolution of the plan is transferred to the office. The commissioner shall take any action necessary or advisable to wind up the affairs of the plan in accordance with the proposal developed by the board under subdivision 7. a. and shall notify the legislative audit bureau when the windup is completed and provide to the legislative audit bureau the final financial statements of the plan. For purposes of chapter 177 of the statutes, as affected by this act, the dissolution, and winding up of the affairs, of the plan shall be considered a dissolution of an insurer in accordance with section 645.44 of the statutes, except that a court order of dissolution is not required to effect the dissolution of the plan.

AB40-ASA1,1297,3 b. All remaining cash assets of the plan, including the balance in the Health Insurance Risk-Sharing Plan fund, are transferred to the appropriation account under section 20.145 (5) (g) of the statutes, as created by this act.

AB40-ASA1,1297,5 c. All tangible personal property, including records, of the authority not already disposed of by the board is transferred to the office.

AB40-ASA1,1297,11 d. All contracts and agreements entered into by the board that are in effect are transferred to the office. The office shall carry out any contractual obligations under such a contract or agreement until the contract or agreement terminates or is modified or rescinded by the office to the extent allowed under the contract or agreement. The office may enter into such other contracts as are necessary to carry out the dissolution of the plan.

AB40-ASA1,1297,16 e. Any matters pending with the authority or plan, including grievances and independent reviews, payment claims, subrogation claims, drug rebate claims, and legal actions or causes of action, are transferred to the office and all materials submitted to and actions taken by the office with respect to a pending matter are considered as having been submitted to or taken by the authority or plan.

AB40-ASA1,1297,17 9. `Health Insurance Risk-Sharing Plan advisory committee.'

AB40-ASA1,1297,21 a. There is created, 60 days after the date coverage under the plan terminates under subdivision 1. b., a Health Insurance Risk-Sharing Plan advisory committee consisting of the commissioner, or his or her designee, and the other 13 members of the board holding office on the date the advisory committee is created.

AB40-ASA1,1297,24 b. If a vacancy occurs on the Health Insurance Risk-Sharing Plan advisory committee, the governor shall appoint a successor, who must meet the same qualifications and criteria as the member who is being replaced.

AB40-ASA1,1298,4 c. The Health Insurance Risk-Sharing Plan advisory committee shall advise and assist the office with its duties under subdivision 8. related to the dissolution and winding up of the plan. The office shall staff and provide funding for the Health Insurance Risk-Sharing Plan advisory committee.

AB40-ASA1,1298,7 d. The Health Insurance Risk-Sharing Plan advisory committee shall terminate 60 days after the final audit of the plan is conducted by the legislative audit bureau under subdivision 11. b.

AB40-ASA1,1298,8 10. `Dissolution notice, claims, and updates.'

AB40-ASA1,1298,18 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. The notice shall be sent by first class mail to the last-known addresses at least 60 days before the date on which coverage terminates under subdivision 1. b. Notice to potential claimants of the plan shall require the claimants to file their claims, together with proofs of claims, within 90 days after the date on which coverage terminates under subdivision 1. b. 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.

AB40-ASA1,1299,4 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 more than 210 days after the date on which coverage terminates under subdivision 1. b. 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 first class mail at least 10 days before the insured event occurred.

AB40-ASA1,1299,7 c. The commissioner shall provide periodic updates to the Health Insurance Risk-Sharing Plan advisory committee under subdivision 9. regarding the plan's dissolution, including, at a minimum, information about expenses and claims paid.

AB40-ASA1,1299,8 11. `Audits.' The legislative audit bureau shall do all of the following:

AB40-ASA1,1299,10 a. Conduct its annual audit of the plan under section 13.94 (1) (dh) of the statutes for calendar year 2013 by June 30, 2014.

AB40-ASA1,1299,13 b. Complete a final audit of the plan, after the termination of the plan in 2014, within 90 days after the office provides the final financial statements of the plan under subdivision 8. a.

AB40-ASA1,1299,18 c. File copies of the reports of both audits with the distributees specified in section 13.94 (1) (b) of the statutes. The costs of the audits shall be paid from the funds of the authority or from the appropriation under section 20.145 (5) (g) or (k) of the statutes, as created by this act, or from any combination of those payment sources.

AB40-ASA1,1299,19 (1m) Medicare supplement and replacement policy issuance.

AB40-ASA1,1299,20 (a) Definitions. In this subsection:

AB40-ASA1,1299,21 1. "Medicare" has the meaning given in section 149.10 (7) of the statutes.

AB40-ASA1,1299,23 2. "Medicare replacement policy" has the meaning given in section 600.03 (28p) of the statutes.

AB40-ASA1,1299,25 3. "Medicare supplement policy" has the meaning given in section 600.03 (28r) of the statutes.

AB40-ASA1,1300,2 4. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

AB40-ASA1,1300,3 (b) Time-limited guaranteed issue.

AB40-ASA1,1300,6 1. 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:

AB40-ASA1,1300,7 a. The individual is eligible for Medicare.

AB40-ASA1,1300,8 b. The individual had coverage under the plan.

AB40-ASA1,1300,10 c. The individual's coverage under the plan terminated on the date specified in subsection (1L) (b) 1. b.

AB40-ASA1,1300,12 d. The individual applies for coverage under the policy before the date that is 63 days after the date specified in subsection (1L) (b) 1. b.

AB40-ASA1,1300,13 e. The individual pays the premium for the coverage under the policy.

AB40-ASA1,1300,16 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.

AB40-ASA1,1300,22 (c) Notice of requirement. In addition to the requirement under subsection (1L) (b) 1. b. to provide notice to the insurers described in paragraph (b) 1. of the date on which coverage under the plan terminates, within 60 days after the effective date of this paragraph the Health Insurance Risk-Sharing Plan Authority under subchapter III of chapter 149 of the statutes shall provide notice to the insurers described in paragraph (b) 1. of the requirement under this subsection.

AB40-ASA1,9123 Section 9123. Nonstatutory provisions; Investment Board.

AB40-ASA1,9124 Section 9124. Nonstatutory provisions; Joint Committee on Finance.

AB40-ASA1,1301,14 (1L) Out-of-home care for youths with individualized education programs. Of the amounts appropriated to the joint committee on finance under section 20.865 (4) (a) of the statutes, $945,700 is allocated in fiscal year 2014-15 to supplement the appropriation accounts under sections 20.410 (3) (cd) and 20.437 (1) (b), (cx), and (dd) of the statutes for the purpose of providing funding for the out-of-home care of persons who are 18 years of age or older, but under 21 years of age, who were in out-of-home care prior to attaining 18 years of age, who are full-time students in good academic standing at a secondary school or its vocational or technical equivalent, and for whom an individualized education program under section 115.787 of the statutes is in effect. The joint committee on finance may supplement those appropriation accounts from that allocation if legislation is enacted authorizing those persons to continue in out-of-home care under an order of the court assigned to exercise jurisdiction under chapters 48 and 938 of the statutes or under a voluntary agreement.

AB40-ASA1,9125 Section 9125. Nonstatutory provisions; Judicial Commission.

AB40-ASA1,9126 Section 9126. Nonstatutory provisions; Justice.

AB40-ASA1,1301,17 (1) Biological specimen; legislative study and rules.

AB40-ASA1,1301,22 (am) Joint legislative council study. The joint legislative council is requested to review all misdemeanor and felony provisions in statutes to determine if penalties are appropriate and if violations are outdated. The joint legislative council shall report any findings, conclusions, and recommendations by February 1, 2014, to the chief clerk of the senate and the chief clerk of the assembly.

AB40-ASA1,1302,2 (b) Rules. The department of justice may, in rules it promulgates under section 165.76 of the statutes, as affected by this act, bring the method to obtain or to submit a biological specimen in conformity with the act of Congress known as the Katie Sepich Enhanced DNA Collection Act of 2012 (HR-6014) to apply for nonsupplanting grant funding under that act.

AB40-ASA1,1302,3 (2) Youth diversion grant reductions.

AB40-ASA1,1302,7 (a) Notwithstanding the amount specified under section 165.987 (1) of the statutes, as affected by this act, the department of justice shall reduce the amount of money allocated under section 165.987 (1) of the statutes, as affected by this act, by $85,900 in each of fiscal years 2013-14 and 2014-15.

AB40-ASA1,1302,11 (b) Notwithstanding the amount specified under section 165.987 (2) of the statutes, as affected by this act, the department of justice shall reduce the amount of money allocated under section 165.987 (2) of the statutes, as affected by this act, by $18,400 in each of fiscal years 2013-14 and 2014-15.

AB40-ASA1,1302,19 (c) Notwithstanding the amounts specified under section 165.987 (3) of the statutes, as affected by this act, the department of justice shall reduce the amount of money allocated for each of the 4 contracts that are funded with moneys from the appropriation accounts under section 20.455 (2) (cr) and (kj) of the statutes, as affected by this act, by $25,650 in each of fiscal years 2013-14 and 2014-15 and shall reduce the amount of money allocated for the contract that is funded only with moneys from the appropriation account under section 20.455 (2) (kj) of the statutes, as affected by this act, by $18,100 in each of fiscal years 2013-14 and 2014-15.

AB40-ASA1,9127 Section 9127. Nonstatutory provisions; Legislature.

AB40-ASA1,1303,2 (1i) Rural schools task force. The joint legislative council is requested to establish a rural schools task force by August 1, 2013, to identify funding challenges faced by rural school districts, particularly with respect to transportation and technology issues. If established, the task force shall develop a long-term plan to address these issues, especially in the context of declining enrollments, and an aging population, and submit a report to the joint legislative council by April 1, 2014.

AB40-ASA1,1303,4 (1q) Statements of scope of proposed rules published prior to effective date of 2011 Wisconsin Act 21.

AB40-ASA1,1303,12 (a) Notwithstanding section 227.14 (4m) of the statutes, as affected by this act, if an agency's statement of the scope of a proposed rule under section 227.135 of the statutes was published in the Wisconsin Administrative Register prior to June 8, 2011, the notice required under section 227.14 (4m) of the statutes, as affected by this act, need not include an identifying number for the statement of scope for the proposed rule or the date of approval of the statement of scope for the proposed rule by the individual or body with policy-making powers over the subject matter of the proposed rule under section 227.135 (2) of the statutes.