SB770-SSA1,6,17 14(2) “Attachment point” means the amount set under s. 601.83 (2) for the
15healthcare stability plan that is the threshold amount for claims costs incurred by
16an eligible health carrier for an enrolled individual's covered benefits in a benefit
17year, beyond which the claims costs are eligible for reinsurance payments.
SB770-SSA1,6,19 18(3) “Benefit year” means the calendar year for which an eligible health carrier
19provides coverage through an individual health plan.
SB770-SSA1,6,23 20(4) “Coinsurance rate” means the rate set under s. 601.83 (2) for the healthcare
21stability plan that is the rate at which the commissioner will reimburse an eligible
22health carrier for claims incurred for an enrolled individual's covered benefits in a
23benefit year above the attachment point and below the reinsurance cap.
SB770-SSA1,7,3
1(5) “Eligible health carrier” means an insurer, as defined in s. 632.745 (15) that
2offers an individual health plan and incurs claims costs for an enrolled individual's
3covered benefits in the applicable benefit year.
SB770-SSA1,7,6 4(6) “Grandfathered plan” means a health plan in which an individual was
5enrolled on March 23, 2010, for as long as it maintains that status in accordance with
6the Affordable Care Act.
SB770-SSA1,7,7 7(7) “Health benefit plan” has the meaning given in s. 632.745 (11).
SB770-SSA1,7,9 8(8) “Healthcare stability plan” means the state-based reinsurance program
9known as the Wisconsin Healthcare Stability Plan administered under s. 601.83 (1).
SB770-SSA1,7,11 10(9) “Individual health plan” means a health benefit plan that is not a group
11health plan, as defined in s. 632.745 (10), or a grandfathered plan.
SB770-SSA1,7,13 12(10) “Payment parameters” means the attachment point, reinsurance cap, and
13coinsurance rate for the healthcare stability plan.
SB770-SSA1,7,17 14(12) “Reinsurance cap” means the threshold amount set under s. 601.83 (2) for
15the healthcare stability plan for claims costs incurred by an eligible health carrier
16for an enrolled individual's covered benefits, after which the claims costs for benefits
17are no longer eligible for reinsurance payments.
SB770-SSA1,7,19 18(13) “Reinsurance payment” means an amount paid by the commissioner to an
19eligible health carrier under the healthcare stability plan.
SB770-SSA1,7 20Section 7. 601.83 of the statutes is created to read:
SB770-SSA1,7,23 21601.83 Healthcare stability plan; administration. (1) Plan established;
22general administration.
(a) Subject to par. (b), the commissioner shall administer
23a state-based reinsurance program known as the healthcare stability plan.
SB770-SSA1,8,324 (b) 1. The commissioner may submit a request to the federal department of
25health and human services for one or more waivers under 42 USC 18052 to

1implement the healthcare stability plan for benefit years beginning January 1, 2019.
2The commissioner may adjust the payment parameters under sub. (2) to the extent
3necessary to secure federal approval of the waiver request under this paragraph.
SB770-SSA1,8,74 2. If the federal department of health and human services does not approve the
5healthcare stability plan in the waiver request submitted under subd. 1. or a
6substantially similar healthcare stability plan, the commissioner may not
7implement the healthcare stability plan.
SB770-SSA1,8,128 (c) If the federal government enacts into law Senate Bill 1835 of the 115th
9Congress or a similar bill providing support to states to establish reinsurance
10programs, the commissioner shall seek, if necessary, and receive federal moneys for
11the purpose of reinsurance programs that result from that enacted law to expend for
12the purposes of this subchapter.
SB770-SSA1,8,1413 (d) In accordance with sub. (5) (c), the commissioner shall collect the data from
14an eligible health carrier as necessary to determine reinsurance payments.
SB770-SSA1,8,2015 (e) Beginning on a date determined by the commissioner, the commissioner
16shall require each eligible health carrier to calculate the rates the eligible health
17carrier would have charged for a benefit year if the healthcare stability plan had not
18been established and submit the calculated rates as part of its rate filing submitted
19to the commissioner. The commissioner shall consider the calculated rate
20information provided under this paragraph as part of the rate filing review.
SB770-SSA1,8,2321 (f) 1. For each applicable benefit year, the commissioner shall notify eligible
22health carriers of reinsurance payments to be made for the applicable benefit year
23no later than June 30 of the calendar year following the applicable benefit year.
SB770-SSA1,9,3
12. Quarterly during the applicable benefit year, the commissioner shall provide
2each eligible health carrier with the calculation of total amounts of reinsurance
3payment requests.
SB770-SSA1,9,64 3. By August 15 of the calendar year following the applicable benefit year, the
5commissioner shall disburse all applicable reinsurance payments to an eligible
6health carrier.
SB770-SSA1,9,157 (g) The commissioner may promulgate any rules necessary to implement the
8healthcare stability plan under this section, except that any rules promulgated
9under this paragraph shall seek to maximize federal funding for the healthcare
10stability plan. The commissioner may promulgate rules necessary to implement this
11section as emergency rules under s. 227.24. Notwithstanding s. 227.24 (1) (a) and
12(3), the commissioner is not required to provide evidence that promulgating a rule
13under this paragraph as an emergency rule is necessary for the preservation of the
14public peace, health, safety, or welfare and is not required to provide a finding of
15emergency for a rule promulgated under this paragraph.
SB770-SSA1,9,1916 (h) In 2019 and in each subsequent year, the commissioner may expend no more
17than $200,000,000 from all revenue sources for the healthcare stability plan under
18this section, unless the joint committee on finance under s. 13.10 has increased this
19amount upon request by the commissioner.
SB770-SSA1,9,22 20(2) Payment parameters. The commissioner, after consulting with an actuarial
21firm, shall design and adjust payment parameters with the goal to do all of the
22following:
SB770-SSA1,9,2323 (a) Stabilize or reduce premium rates in the individual market.
SB770-SSA1,9,2424 (b) Increase participation by health carriers in the individual market.
SB770-SSA1,10,2
1(c) Improve access to health care providers and services for individuals
2purchasing coverage in the individual market.
SB770-SSA1,10,43 (d) Mitigate the impact high-risk individuals have on premium rates in the
4individual market.
SB770-SSA1,10,55 (e) Take into account any federal funding available for the plan.
SB770-SSA1,10,66 (f) Take into account the total amount available to fund the plan.
SB770-SSA1,10,10 7(3) Operation. (a) The commissioner shall set the payment parameters as
8described under sub. (2) by no later than March 30 of the calendar year before the
9applicable benefit year or, if the commissioner specifies a different date by rule, the
10date specified by the commissioner by rule.
SB770-SSA1,10,1711 (b) If the amount available for expenditure for the healthcare stability plan is
12not anticipated to be adequate to fully fund the payment parameters set under par.
13(a) as of July 1 of the calendar year before the applicable benefit year, the
14commissioner shall adjust the payment parameters in accordance within the moneys
15available to expend for the healthcare stability plan. The commissioner shall allow
16an eligible health carrier to revise its rate filing based on the final payment
17parameters for the applicable benefit year.
SB770-SSA1,10,2518 (c) If funding is not available to make all reinsurance payments to eligible
19health carriers in a benefit year, the commissioner shall make reinsurance payments
20in proportion to the eligible health carrier's share of aggregate individual health plan
21claims costs eligible for reinsurance payments during the given benefit year, as
22determined by the commissioner. The commissioner shall notify eligible health
23carriers if there are insufficient funds available to make reinsurance payments in
24full and the estimated amount of payment as soon as practicable after the
25commissioner becomes aware of the insufficiency.
SB770-SSA1,11,9
1(4) Reinsurance payment calculation. (a) The commissioner shall calculate
2a reinsurance payment with respect to each eligible health carrier's incurred claims
3costs for an enrolled individual's covered benefits in the applicable benefit year. If
4the claims costs for an enrolled individual do not exceed the attachment point set
5under sub. (2), the commissioner may not make a reinsurance payment with respect
6to that enrollee. If the claims costs for an enrolled individual exceed the attachment
7point, subject to par. (b), the commissioner shall make a reinsurance payment that
8is calculated as the product of the coinsurance rate and whichever of the following
9is less:
SB770-SSA1,11,1010 1. The claims costs minus the attachment point.
SB770-SSA1,11,1111 2. The reinsurance cap minus the attachment point.
SB770-SSA1,11,1712 (b) The commissioner shall ensure that any reinsurance payment made to an
13eligible health carrier does not exceed the total amount paid by the eligible health
14carrier for any claim. For purposes of this paragraph, the total amount paid of a
15claim is the amount paid by the eligible health carrier based upon the allowed
16amount less any deductible, coinsurance, or copayment paid by another person as of
17the time the data are submitted or made accessible under sub. (5) (c).
SB770-SSA1,11,20 18(5) Reinsurance payment requests. (a) An eligible health carrier may request
19reinsurance payments from the commissioner when the eligible health carrier meets
20the requirements of this subsection and sub. (4).
SB770-SSA1,11,2221 (b) An eligible health carrier shall make any requests for a reinsurance
22payment in accordance with any requirements established by the commissioner.
SB770-SSA1,12,323 (c) Each eligible health carrier shall provide the commissioner with access to
24the data within the dedicated data environment established by the eligible health
25carrier under the federal risk adjustment program under 42 USC 18063. Each

1eligible health carrier shall submit to the commissioner attesting to compliance with
2the dedicated data environments, data requirements, establishment and usage of
3masked enrollee identification numbers, and data submission deadlines.
SB770-SSA1,12,64 (d) Each eligible health carrier shall provide the access under par. (c) for each
5applicable benefit year by April 30 of the calendar year following the end of the
6applicable benefit year.
SB770-SSA1,12,127 (e) Each eligible health carrier shall maintain for at least 6 years documents
8and records, by paper, electronic, or other media, sufficient to substantiate a request
9for a reinsurance payment made under this section. An eligible health carrier shall
10make the documents and records available to the commissioner, upon request, for
11purposes of verification, investigation, audit, or other review of a reinsurance
12payment request.
SB770-SSA1,12,2113 (f) The commissioner may have an eligible health carrier audited to assess the
14health carrier's compliance with the requirements of this section. The eligible health
15carrier shall ensure that its contractors, subcontractors, or agents cooperate with
16any audit under this paragraph. Within 30 days of receiving notice that an audit
17results in a proposed finding of material weakness or significant deficiency with
18respect to compliance with any requirement of this section, the eligible health carrier
19may provide a response to the proposed finding. Within 60 days of the issuance of
20a final audit report that includes a finding of material weakness or significant
21deficiency, the eligible health carrier shall do all of the following:
SB770-SSA1,12,2222 1. Provide a written corrective action plan to the commissioner for approval.
SB770-SSA1,12,2423 2. Implement the corrective action plan under subd. 1. as approved by the
24commissioner.
SB770-SSA1,13,2
13. Provide the commissioner with written documentation of the corrective
2action after implementation.
SB770-SSA1,13,43 (g) The commissioner may recover from an eligible health carrier any
4overpayment of reinsurance payments as determined under the audit under par. (f).
SB770-SSA1,13,85 (h) A health carrier is not eligible to receive a reinsurance payment unless the
6health carrier agrees not to bring a lawsuit against the commissioner or a state
7agency or employee over any delay in reinsurance payments or any reduction in
8reinsurance payments in accordance with sub. (3) (c).
SB770-SSA1,13,12 9(6) Access to information. Information submitted by an eligible health carrier
10or obtained by the commissioner for purposes of the healthcare stability plan shall
11be used only for purposes of this subchapter and is proprietary and confidential
12under s. 601.465.
SB770-SSA1,8 13Section 8. 601.85 of the statutes is created to read:
SB770-SSA1,13,15 14601.85 Accounting, reports, and audits. (1) Accounting. The
15commissioner shall keep an accounting for each benefit year of all of the following:
SB770-SSA1,13,1716 (a) Funds appropriated for reinsurance payments and administrative and
17operational expenses.
SB770-SSA1,13,1818 (b) Requests for reinsurance payments received from eligible health carriers.
SB770-SSA1,13,1919 (c) Reinsurance payments made to eligible health carriers.
SB770-SSA1,13,2120 (d) Administrative and operational expenses incurred for the healthcare
21stability plan.
SB770-SSA1,14,2 22(2) Reports. By November 1 of the calendar year following the applicable
23benefit year or by 60 days following the final disbursement of reinsurance payments
24for the applicable benefit year, whichever is later, the commissioner shall make

1available to the public a report summarizing the healthcare stability plan's
2operations for each benefit year by posting the summary on the office's Internet site.
SB770-SSA1,14,6 3(3) Legislative auditor. The healthcare stability plan is subject to audit by the
4legislative audit bureau. The commissioner shall ensure that its contractors,
5subcontractors, or agents cooperate with any audit of the healthcare stability plan
6performed by the legislative audit bureau.
SB770-SSA1,14,16 7(4) Required recommendation report. By December 31, 2018, the
8commissioner shall submit to the governor recommendations on implementing a
9waiver under s. 601.83 (1) (b), any possible additional waivers to be requested, and
10any other options to stabilize the individual health care market in this state. In
11developing the recommendations, the commissioner shall consider and include in the
12report the impacts of creating a high-risk pool or an invisible high-risk pool; funding
13of consumer health savings accounts; expanding consumer plan choices, including
14catastrophic plans or coverage and new low-cost plan options; and implementing
15any other approach that will lower consumer costs, stabilize the insurance market,
16or expand the availability of private insurance coverage.
SB770-SSA1,9 17Section 9 . Subchapter VIII (title) of chapter 601 [precedes 601.93] of the
18statutes is created to read:
SB770-SSA1,14,1919 Chapter 601
SB770-SSA1,14,2020 Subchapter VIII
SB770-SSA1,14,2121 FIRE DEPARTMENT DUES
SB770-SSA1,10 22Section 10 . Subchapter VI (title) of chapter 601 [precedes 601.93] of the
23statutes is repealed.
SB770-SSA1,11 24Section 11 . Nonstatutory provisions.
SB770-SSA1,15,8
1(1) Payment parameters. For the 2019 benefit year, the commissioner of
2insurance shall set as payment parameters for the healthcare stability plan under
3subchapter VII of chapter 601 an attachment point of $50,000, a coinsurance rate of
4between 50 and 80 percent, and a reinsurance cap of $250,000. The commissioner
5of insurance may adjust the payment parameters to the extent necessary to secure
6federal approval of the waiver request under section 601.83 (1) (b) of the statutes. For
7subsequent benefit years, the commissioner of insurance may adjust the payment
8parameters in accordance with section 601.83 (2) of the statutes.
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