Amendment AA8-ASA1-AB64

AB64-ASA1-AA8,51,2 16.85 (2) To furnish engineering, architectural, project management, and other building construction services whenever requisitions therefor are presented to the department by any agency. The department may deposit moneys received from the provision of these services in the account under s. 20.505 (1) (kc) or in the general fund as general purpose revenue — earned. In this subsection, “agency" means an office, department, independent 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 and the courts, but not including an authority created in subch. II of ch. 114 or subch. III of ch. 636 or in ch. 231, 233, 234, 237, 238, or 279.

AB64-ASA1-AA8,1bq Section 1bq. 16.865 (8) of the statutes is amended to read:

AB64-ASA1-AA8,51,18 16.865 (8) Annually in each fiscal year, allocate as a charge to each agency a proportionate share of the estimated costs attributable to programs administered by the agency to be paid from the appropriation under s. 20.505 (2) (k). The department may charge premiums to agencies to finance costs under this subsection and pay the costs from the appropriation on an actual basis. The department shall deposit all collections under this subsection in the appropriation account under s. 20.505 (2) (k). Costs assessed under this subsection may include judgments, investigative and adjustment fees, data processing and staff support costs, program administration costs, litigation costs, and the cost of insurance contracts under sub. (5). In this subsection, “agency" means an office, department, independent 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, that is entitled to expend moneys appropriated by law, including the legislature and the courts, but not including an authority created in subch. II of ch. 114 or subch. III of ch. 636 or in ch. 231, 232, 233, 234, 237, 238, or 279.

AB64-ASA1-AA8,1br Section 1br. 25.50 (1) (d) of the statutes is amended to read:

AB64-ASA1-AA8,52,4 25.50 (1) (d) “Local government" means any county, town, village, city, power district, sewerage district, drainage district, town sanitary district, public inland lake protection and rehabilitation district, local professional baseball park district created under subch. III of ch. 229, long-term care district under s. 46.2895, local professional football stadium district created under subch. IV of ch. 229, local cultural arts district created under subch. V of ch. 229, public library system, school district or technical college district in this state, any commission, committee, board or officer of any governmental subdivision of this state, any court of this state, other than the court of appeals or the supreme court, or any authority created under s. 114.61, 231.02, 233.02, or 234.02, or 636.70.

AB64-ASA1-AA8,1bs Section 1bs. 40.02 (54) (n) of the statutes is created to read:

AB64-ASA1-AA8,52,6 40.02 (54) (n) The Badger Health Benefit Authority.

AB64-ASA1-AA8,1bt Section 1bt. 49.45 (2) (a) 3. of the statutes is amended to read:

AB64-ASA1-AA8,52,12 49.45 (2) (a) 3. Determine Subject to s. 636.30 (1) (o), determine the eligibility of persons for medical assistance, rehabilitative, and social services under ss. 49.46, 49.468, 49.47, and 49.471 and rules and policies adopted by the department and may, under a contract under s. 49.78 (2), delegate all, or any portion, of this function to the county department under s. 46.215, 46.22, or 46.23 or a tribal governing body.

AB64-ASA1-AA8,1bu Section 1bu. 70.11 (41c) of the statutes is created to read:

AB64-ASA1-AA8,52,16 70.11 (41c) Badger Health Benefit Authority. All property owned by the Badger Health Benefit Authority, provided that the use of the property is primarily related to the purposes of the authority.

AB64-ASA1-AA8,1bv Section 1bv. 71.26 (1) (be) of the statutes is amended to read:

AB64-ASA1-AA8,52,21 71.26 (1) (be) Certain authorities. Income of the University of Wisconsin Hospitals and Clinics Authority, of the Badger Health Benefit Authority, of the Fox River Navigational System Authority, of the Wisconsin Economic Development Corporation, and of the Wisconsin Aerospace Authority.

AB64-ASA1-AA8,1bw Section 1bw. 77.54 (9a) (a) of the statutes is amended to read:

AB64-ASA1-AA8,53,2 77.54 (9a) (a) This state or any agency thereof, the University of Wisconsin Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Badger Health Benefit Authority, the Wisconsin Economic Development Corporation, and the Fox River Navigational System Authority.

AB64-ASA1-AA8,1bx Section 1bx. 101.055 (2) (a) of the statutes is amended to read:

AB64-ASA1-AA8,53,7 101.055 (2) (a) “Agency" means an office, department, independent agency, authority, institution, association, society, or other body in state government created or authorized to be created by the constitution or any law, and includes the legislature and the courts, but excludes the Badger Health Benefit Authority.

AB64-ASA1-AA8,1bxa Section 1bxa. 230.03 (3) of the statutes is amended to read:

AB64-ASA1-AA8,53,18 230.03 (3) “Agency" means any board, commission, committee, council, or department in state government or a unit thereof created by the constitution or statutes if such board, commission, committee, council, department, unit, or the head thereof, is authorized to appoint subordinate staff by the constitution or statute, except the Board of Regents of the University of Wisconsin System, a legislative or judicial board, commission, committee, council, department, or unit thereof or an authority created under subch. II of ch. 114 or subch. III of ch. 636 or under ch. 231, 232, 233, 234, 237, 238, or 279. “Agency" does not mean any local unit of government or body within one or more local units of government that is created by law or by action of one or more local units of government.

AB64-ASA1-AA8,1by Section 1by. 230.80 (4) of the statutes is amended to read:

AB64-ASA1-AA8,54,2 230.80 (4) “Governmental unit" means any association, authority, board, commission, department, independent agency, institution, office, society, or other body in state government created or authorized to be created by the constitution or any law, including the legislature, the office of the governor, and the courts, but excluding the Badger Health Benefit Authority. “Governmental unit" does not mean any political subdivision of the state or body within one or more political subdivisions that is created by law or by action of one or more political subdivisions.

AB64-ASA1-AA8,1bz Section 1bz. 230.90 (1) (c) of the statutes is amended to read:

AB64-ASA1-AA8,54,11 230.90 (1) (c) “Governmental unit" means any association, authority, board, commission, department, independent agency, institution, office, society or other body in state government created or authorized to be created by the constitution or any law, including the legislature, the office of the governor and the courts. “Governmental unit" does not mean the University of Wisconsin Hospitals and Clinics Authority, the Badger Health Benefit Authority, or any political subdivision of the state or body within one or more political subdivisions which is created by law or by action of one or more political subdivisions.

AB64-ASA1-AA8,1ca Section 1ca. 635.18 (1) of the statutes is amended to read:

AB64-ASA1-AA8,54,14 635.18 (1) Every Any small employer insurer shall may actively market health benefit plan coverage to small employers in the state.

AB64-ASA1-AA8,1cb Section 1cb. Chapter 636 of the statutes is created to read:

AB64-ASA1-AA8,54,17 chapter 636 health benefit plan exchange

AB64-ASA1-AA8,54,19 subchapter I general provisions

AB64-ASA1-AA8,54,20 636.01 Definitions. In this chapter:

AB64-ASA1-AA8,54,21 (1) “Authority" means the Badger Health Benefit Authority.

AB64-ASA1-AA8,54,24 (2) “Educated health care consumer" means an individual who is knowledgeable about the health care system and who has background or experience in making informed decisions regarding health, medical, and scientific matters.

AB64-ASA1-AA8,55,4 (3) “Federal 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), and any amendments to, or regulations or guidance issued under, those acts.

AB64-ASA1-AA8,55,7 (4) (a) Except as provided in pars. (b) to (e), “health benefit plan" means a policy, contract, certificate, or agreement offered or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.

AB64-ASA1-AA8,55,8 (b) “Health benefit plan" does not include any of the following:

AB64-ASA1-AA8,55,10 1. Coverage only for accident, or disability income insurance, or any combination of those.

AB64-ASA1-AA8,55,11 2. Coverage issued as a supplement to liability insurance.

AB64-ASA1-AA8,55,13 3. Liability insurance, including general liability insurance and automobile liability insurance.

AB64-ASA1-AA8,55,14 4. Worker's compensation or similar insurance.

AB64-ASA1-AA8,55,15 5. Automobile medical payment insurance.

AB64-ASA1-AA8,55,16 6. Credit-only insurance.

AB64-ASA1-AA8,55,17 7. Coverage for on-site medical clinics.

AB64-ASA1-AA8,55,20 8. Other similar insurance coverage, specified in federal regulations issued under P.L. 104-191, under which benefits for health care services are secondary or incidental to other insurance benefits.

AB64-ASA1-AA8,55,23 (c) “Health benefit plan" does not include any of the following benefits if they are provided under a separate policy, certificate, or contract of insurance or otherwise not an integral part of the plan:

AB64-ASA1-AA8,55,24 1. Limited scope dental or vision benefits.

AB64-ASA1-AA8,56,2 2. Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of those.

AB64-ASA1-AA8,56,4 3. Other similar, limited benefits specified in federal regulations issued under P.L. 104-191.

AB64-ASA1-AA8,56,11 (d) “Health benefit plan" does not include any of the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:

AB64-ASA1-AA8,56,12 1. Coverage only for a specified disease or illness.

AB64-ASA1-AA8,56,13 2. Hospital indemnity or other fixed indemnity insurance.

AB64-ASA1-AA8,56,15 (e) “Health benefit plan" does not include any of the following if offered as a separate policy, certificate, or contract of insurance:

AB64-ASA1-AA8,56,17 1. Medicare supplemental health insurance as defined under section 1882 (g) (1) of the federal Social Security Act.

AB64-ASA1-AA8,56,19 2. Coverage supplemental to the coverage provided under the Civilian Health and Medical Program of the Uniformed Services 10 USC ch. 55.

AB64-ASA1-AA8,56,21 3. Similar coverage supplemental to coverage provided under a group health plan.

AB64-ASA1-AA8,57,3 (5) “Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.

AB64-ASA1-AA8,57,5 (5m) “Minimum essential coverage" has the meaning given in 26 USC 5000A (f) (1).

AB64-ASA1-AA8,57,7 (6) “Qualified dental plan" means a limited scope dental plan that has been certified in accordance with s. 636.42 (5).

AB64-ASA1-AA8,57,11 (7) “Qualified employer" means a small employer that elects to make its full-time employees eligible for one or more qualified health plans offered through the SHOP Exchange and, at the option of the employer, some or all of its part-time employees, provided that the employer satisfies any of the following:

AB64-ASA1-AA8,57,14 (a) The employer has its principal place of business in this state and elects to provide coverage through the SHOP Exchange to all of its eligible employees, wherever employed.

AB64-ASA1-AA8,57,16 (b) The employer elects to provide coverage through the SHOP Exchange to all of its eligible employees who are principally employed in this state.

AB64-ASA1-AA8,57,19 (8) “Qualified health plan" means a health benefit plan that has in effect a certification that the plan meets the criteria for certification described in section 1311 (c) of the federal act and s. 636.42.

AB64-ASA1-AA8,57,21 (9) “Qualified individual" means an individual, including a minor, who satisfies all of the following:

AB64-ASA1-AA8,57,23 (a) The individual is seeking to enroll in a qualified health plan offered to individuals through the exchange under subch. II.

AB64-ASA1-AA8,57,24 (b) The individual resides in this state.

AB64-ASA1-AA8,58,2 (c) At the time of enrollment, the individual is not incarcerated in a correctional facility, other than incarceration pending the disposition of charges.

AB64-ASA1-AA8,58,5 (d) The individual is, and is reasonably expected to be for the entire period for which enrollment is sought, a citizen or national of the United States or an alien lawfully present in the United States.

AB64-ASA1-AA8,58,7 (10) “Secretary" means the secretary of the federal department of health and human services.

AB64-ASA1-AA8,58,9 (11) “SHOP Exchange" means a small business health options program established under s. 636.30 (1) (q).

AB64-ASA1-AA8,58,11 (12) (a) “Small employer" means an employer that employed an average of not more than 100 employees during the preceding calendar year.

AB64-ASA1-AA8,58,12 (b) For purposes of this subsection, all of the following apply:

AB64-ASA1-AA8,58,14 1. All persons treated as a single employer under section 414 (b), (c), (m), or (o) of the Internal Revenue Code shall be treated as a single employer.

AB64-ASA1-AA8,58,16 2. An employer and any predecessor employer shall be treated as a single employer.

AB64-ASA1-AA8,58,18 3. All employees shall be counted, including part-time employees and employees who are not eligible for coverage through the employer.

AB64-ASA1-AA8,58,22 4. If an employer was not in existence during the entire preceding calendar year, the determination of whether that employer is a small employer shall be based on the average number of employees that it is reasonably expected that employer will employ on business days in the current calendar year.

AB64-ASA1-AA8,59,2 5. An employer that makes enrollment in qualified health plans available to its employees through the SHOP Exchange and that would cease to be a small employer by reason of an increase in the number of its employees shall continue to be treated as a small employer for purposes of this chapter as long as it continuously makes enrollment through the SHOP Exchange available to its employees.

AB64-ASA1-AA8,59,4 subchapter II operation of exchange

AB64-ASA1-AA8,59,8 636.25 General matters. (1) The authority shall establish and operate a Wisconsin Health Benefit Exchange and shall make qualified health plans, with effective dates on or before January 1, 2018, available to qualified individuals and qualified employers.

AB64-ASA1-AA8,59,10 (2) (a) The authority may not make available any health benefit plan that is not a qualified health plan.

AB64-ASA1-AA8,59,15 (b) The authority shall allow a health carrier to offer a plan that provides limited scope dental benefits meeting the requirements of section 9832 (c) (2) (A) of the Internal Revenue Code through the exchange, either separately or in conjunction with a qualified health plan, if the plan provides pediatric dental benefits meeting the requirements of section 1302 (b) (1) (J) of the federal act.

AB64-ASA1-AA8,59,21 (3) Neither the authority nor a health carrier offering health benefit plans through the exchange may charge an individual a fee or penalty for termination of coverage if the individual enrolls in another type of minimum essential coverage because the individual has become newly eligible for that coverage or because the individual's employer-sponsored coverage has become affordable under the standards of section 36B (c) (2) (C) of the Internal Revenue Code.

AB64-ASA1-AA8,60,2 (4) The authority may enter into information-sharing agreements with federal and state agencies and entities operating exchanges in other states to carry out its responsibilities under this chapter, provided that such agreements include adequate protections with respect to the confidentiality of the information to be shared and comply with all state and federal laws and rules and regulations.

AB64-ASA1-AA8,60,5 636.30 Exchange duties and powers. (1) In addition to all other duties imposed under this chapter, the authority shall do all of the following relating to the exchange:

AB64-ASA1-AA8,60,9 (a) Implement procedures for the certification, recertification, and decertification, consistent with guidelines developed by the secretary under section 1311 (c) of the federal act and s. 636.42, of health benefit plans as qualified health plans.

AB64-ASA1-AA8,60,11 (b) Provide for the operation of a toll-free telephone hotline to respond to requests for assistance.

AB64-ASA1-AA8,60,13 (c) Provide for enrollment periods, as provided under section 1311 (c) (6) of the federal act.

AB64-ASA1-AA8,60,16 (d) Maintain an Internet site through which enrollees and prospective enrollees of qualified health plans may obtain standardized comparative information on such plans.

AB64-ASA1-AA8,60,21 (e) Assign a rating to each qualified health plan offered through the exchange in accordance with the criteria developed by the secretary under section 1311 (c) (3) of the federal act, and determine each qualified health plan's level of coverage in accordance with regulations issued by the secretary under section 1302 (d) (2) (A) of the federal act.

AB64-ASA1-AA8,60,24 (f) Use a standardized format for presenting health benefit options in the exchange, including the use of the uniform outline of coverage established under 42 USC 300gg-15.

AB64-ASA1-AA8,61,2 (g) Establish quality improvement standards for health benefit plans offered through the exchange.

AB64-ASA1-AA8,61,4 (h) Establish a system for enrolling eligible groups and individuals, using a standard application form developed by the commissioner under s. 636.46 (2).