AB500, s. 36 20Section 36. 49.45 (37) (intro.) of the statutes is amended to read:
AB500,16,621 49.45 (37) Plans of care. (intro.) The department may seek a waiver of the
22requirement under 42 USC 1396n (c) (1) that the department review and approve
23every written plan of care developed for each individual who receives, under 42 USC
241396n
(c) (1), home or community-based services under ss. 49.46 (2) (b) 8. and 49.47
25(6) (a) 1. The waiver of the requirement, if granted, shall apply to those county

1departments or private nonprofit agencies that administer the services and that the
2department finds and certifies have implemented effective quality assurance
3systems for service plan development and implementation. If the federal health care
4financing administration approves the department's request for waiver of the
5requirement, the department shall, in evaluating a quality assurance system for
6certification, consider all of the following:
AB500, s. 37 7Section 37. 49.45 (50) of the statutes is created to read:
AB500,16,138 49.45 (50) Applicability. Beginning on the first day of the 12th month
9beginning after the date on which the department makes a certification under s.
1049.44 (5), subs. (2) (a) 9. to 14. and (b), (3) (b) to (k), (6b) to (9s), (13) to (16), (18), (20)
11to (22), (24) to (26), (29) to (32) and (35) to (37) do not apply with respect to persons
12eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr)
13or (cs) or 49.47 (4) (a) 1. or 2.
AB500, s. 38 14Section 38. 49.46 (2) (a) (intro.) of the statutes is amended to read:
AB500,16,1715 49.46 (2) (a) (intro.) Except as provided in par. pars. (be) and (bm), the
16department shall audit and pay allowable charges to certified providers for medical
17assistance on behalf of recipients for the following federally mandated benefits:
AB500, s. 39 18Section 39. 49.46 (2) (b) (intro.) of the statutes is amended to read:
AB500,16,2119 49.46 (2) (b) (intro.) Except as provided in par. pars. (be) and (bm), the
20department shall audit and pay allowable charges to certified providers for medical
21assistance on behalf of recipients for the following services:
AB500, s. 40 22Section 40. 49.46 (2) (bm) of the statutes is created to read:
AB500,17,323 49.46 (2) (bm) Beginning on the first day of the 12th month beginning after the
24date on which the department makes a certification under s. 49.44 (5), benefits for
25an individual who is eligible for medical assistance under sub. (1) (a) 1., 1m., 6. or 12.,

1(c), (cg), (co), (cr) or (cs) are limited to coverage under the basic plan under s. 637.05
2or to the payment of medicare premiums, coinsurance and deductibles to the extent
3provided in pars. (c) and (cm).
AB500, s. 41 4Section 41. 49.465 (10) of the statutes is created to read:
AB500,17,85 49.465 (10) This section does not apply on or after the first day of the 12th
6month beginning after the date on which the department makes a certification under
7s. 49.44 (5) with respect to persons eligible for medical assistance under s. 49.46 (1)
8(a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.
AB500, s. 42 9Section 42. 49.47 (6) (a) (intro.) of the statutes is renumbered 49.47 (6) (a) and
10amended to read:
AB500,17,1411 49.47 (6) (a) The Except as provided in pars. (ag), (ar) and (as), the department
12shall audit and pay charges to certified providers for medical assistance services
13under s. 49.46 (2) (a) and (b)
on behalf of the following: all medical assistance
14recipients eligible under sub. (4).
AB500, s. 43 15Section 43. 49.47 (6) (a) 1. of the statutes is repealed.
AB500, s. 44 16Section 44. 49.47 (6) (a) 6. of the statutes is renumbered 49.47 (6) (ag) and
17amended to read:
AB500,17,1818 49.47 (6) (ag) 1. In this subdivision: 1) "entitled paragraph:
AB500,17,20 19a. "Entitled to coverage under part A of medicare" means eligible for and
20enrolled in part A of medicare under 42 USC 1395c to 1395f; 2) "entitled.
AB500,17,22 21b. "Entitled to coverage under part B of medicare" means eligible for and
22enrolled in part B of medicare under 42 USC 1395j to 1395L; and 3) "income.
AB500,17,24 23c. "Income limitation" means income that is equal to or less than 100% of the
24poverty line, as established under 42 USC 9902 (2).
AB500,18,11
12. An For an individual who is entitled to coverage under part A of medicare,
2entitled to coverage under part B of medicare, meets the eligibility criteria under sub.
3(4) (a) and meets the income limitation, medical assistance shall pay the deductible
4and coinsurance portions of medicare services under 42 USC 1395 to 1395zz which
5that are not paid under 42 USC 1395 to 1395zz, including those medicare services
6that are not included in the approved state plan for services under 42 USC 1396; the
7monthly premiums payable under 42 USC 1395v; the monthly premiums, if
8applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
9for premiums under part A of medicare. Payment of coinsurance for a service under
10part B of medicare under 42 USC 1395j to 1395w may not exceed the allowable
11charge for the service under medical assistance minus the medicare payment.
AB500,18,1912 3. An For an individual who is only entitled to coverage under part A of
13medicare, meets the eligibility criteria under sub. (4) (a) and meets the income
14limitation, medical assistance shall pay the deductible and coinsurance portions of
15medicare services under 42 USC 1395 to 1395i which that are not paid under 42 USC
161395
to 1395i, including those medicare services that are not included in the
17approved state plan for services under 42 USC 1396; the monthly premiums, if
18applicable, under 42 USC 1395i-2 (d); and the late enrollment penalty, if applicable,
19for premiums under part A of medicare.
AB500,19,320 4. An For an individual who is entitled to coverage under part A of medicare,
21entitled to coverage under part B of medicare and meets the eligibility criteria for
22medical assistance under sub. (4) (a) but does not meet the income limitation,
23medical assistance shall pay the deductible and coinsurance portions of medicare
24services under 42 USC 1395 to 1395zz which that are not paid under 42 USC 1395
25to 1395zz, including those medicare services that are not included in the approved

1state plan for services under 42 USC 1396. Payment of coinsurance for a service
2under part B of medicare under 42 USC 1395j to 1395w may not exceed the allowable
3charge for the service under medical assistance minus the medicare payment.
AB500,19,94 5. An For an individual who is only entitled to coverage under part A of
5medicare and meets the eligibility criteria for medical assistance under sub. (4) (a),
6but does not meet the income limitation, medical assistance shall pay the deductible
7and coinsurance portions of medicare services under 42 USC 1395 to 1395i, including
8those services that are not included in the approved state plan for services under 42
9USC 1396
.
AB500,19,1710 6. For an individual who is only entitled to coverage under part B of medicare
11and meets the eligibility criteria under sub. (4), but does not meet the income
12limitation, medical assistance shall include payment of pay the deductible and
13coinsurance portions of medicare services under 42 USC 1395j to 1395w, including
14those medicare services that are not included in the approved state plan for services
15under 42 USC 1396. Payment of coinsurance for a service under part B of medicare
16may not exceed the allowable charge for the service under medical assistance minus
17the medicare payment.
AB500, s. 45 18Section 45. 49.47 (6) (a) 6m. of the statutes is repealed.
AB500, s. 46 19Section 46. 49.47 (6) (a) 7. of the statutes is renumbered 49.47 (6) (ar) and
20amended to read:
AB500,19,2421 49.47 (6) (ar) Beneficiaries For medical assistance recipients who are eligible
22under sub. (4) (a) 2. or (am) 1., medical assistance shall pay for services under s. 49.46
23(2) (a) and (b) that are related to pregnancy, including postpartum and family
24planning services, or related to other conditions which may complicate pregnancy.
AB500, s. 47 25Section 47. 49.47 (6) (ag) 7. of the statutes is created to read:
AB500,20,5
149.47 (6) (ag) 7. For an individual who is entitled to coverage under part A of
2medicare, is entitled to coverage under part B of medicare and meets the eligibility
3criteria under sub. (4) (a) and whose income is greater than 100% of the poverty line
4but less than 120% of the poverty line, medical assistance shall pay the monthly
5premiums under 42 USC 1395r.
AB500, s. 48 6Section 48. 49.47 (6) (as) of the statutes is created to read:
AB500,20,127 49.47 (6) (as) Beginning on the first day of the 12th month beginning after the
8date on which the department makes a certification under s. 49.44 (5), benefits for
9an individual who is eligible for medical assistance under sub. (4) (a) 1. or 2. are
10limited to coverage under the basic plan under s. 637.05 or to the payment of
11medicare premiums, coinsurance and deductibles to the extent provided in pars. (ag)
12and (ar).
AB500, s. 49 13Section 49. 49.47 (15) of the statutes is created to read:
AB500,20,1814 49.47 (15) Applicability. Beginning on the first day of the 12th month
15beginning after the date on which the department makes a certification under s.
1649.44 (5), subs. (7) and (8) do not apply with respect to persons eligible for medical
17assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or sub. (4)
18(a) 1. or 2.
AB500, s. 50 19Section 50. 49.475 (1) (a) of the statutes is amended to read:
AB500,20,2220 49.475 (1) (a) "Disability insurance policy" has the meaning given in s. 632.895
21(1) (a), except that "disability insurance policy" does not include coverage under the
22basic plan under ch. 637
.
AB500, s. 51 23Section 51. 49.49 (7) of the statutes is created to read:
AB500,21,324 49.49 (7) Applicability. Subsections (3) to (4) do not apply with respect to
25offenses occurring on or after the first day of the 12th month beginning after the date

1on which the department makes a certification under s. 49.44 (5) with respect to
2persons eligible for medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg),
3(co), (cr) or (cs) or 49.47 (4) (a) 1. or 2.
AB500, s. 52 4Section 52. 613.03 (3) of the statutes is amended to read:
AB500,21,95 613.03 (3) Applicability of insurance laws. Except as otherwise specifically
6provided, service insurance corporations organized or operating under this chapter
7are subject to subch. II of ch. 619 and ss. 610.01, 610.11, 610.21, 610.23 and 610.24
8and chs. 600, 601, 609, 617, 620, 623, 625, 627, 628, 631, 632, 635 , 637 and 645 and
9to no other insurance laws.
AB500, s. 53 10Section 53. 625.12 (2) of the statutes is amended to read:
AB500,21,1911 625.12 (2) Classification. Risks Subject to s. 637.25, risks may be classified
12in any reasonable way for the establishment of rates and minimum premiums,
13except that no classifications may be based on race, color, creed or national origin,
14and classifications in automobile insurance may not be based on physical condition
15or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and
16637.25
, rates thus produced may be modified for individual risks in accordance with
17rating plans or schedules that establish reasonable standards for measuring
18probable variations in hazards, expenses, or both. Rates may also be modified for
19individual risks under s. 625.13 (2).
AB500, s. 54 20Section 54. 625.15 (1) of the statutes is amended to read:
AB500,22,421 625.15 (1) Rate making. An insurer may itself establish rates and
22supplementary rate information for one or more market segments based on the
23factors in s. 625.12 and, subject to s. 632.365 if the rates are for motor vehicle liability
24insurance, subject to s. 632.365, or s. 637.25 if the rates are for coverage under the
25basic plan under ch. 637. In the alternative,
the insurer may use rates and

1supplementary rate information prepared by a rate service organization, with
2average expense factors determined by the rate service organization or with such
3modification for its own expense and loss experience as the credibility of that
4experience allows.
AB500, s. 55 5Section 55. 625.22 (1) of the statutes is amended to read:
AB500,22,96 625.22 (1) Order in event of violation. If the commissioner finds after a
7hearing that a rate is not in compliance with s. 625.11 or 637.25, the commissioner
8shall order that its use be discontinued for any policy issued or renewed after a date
9specified in the order.
AB500, s. 56 10Section 56. 628.34 (3) of the statutes is amended to read:
AB500,22,1811 628.34 (3) Unfair discrimination. (a) No insurer may unfairly discriminate
12among policyholders by charging different premiums or by offering different terms
13of coverage except on the basis of classifications related to the nature and the degree
14of the risk covered or the expenses involved, subject to s. ss. 632.365 and 637.25.
15Rates are not unfairly discriminatory if they are averaged broadly among persons
16insured under a group, blanket or franchise policy, and terms are not unfairly
17discriminatory merely because they are more favorable than in a similar individual
18policy.
AB500,22,2419 (b) No insurer may refuse to insure or refuse to continue to insure, or limit the
20amount, extent or kind of coverage available to an individual, or charge an individual
21a different rate for the same coverage because of a mental or physical disability
22except when the refusal, limitation or rate differential is based on either sound
23actuarial principles supported by reliable data or actual or reasonably anticipated
24experience, subject to ss. 637.20, 637.23 and 637.25.
AB500, s. 57 25Section 57. 628.36 (2) (b) 5. of the statutes is amended to read:
AB500,23,6
1628.36 (2) (b) 5. Except for the small employer health insurance plan under
2subch. II of ch. 635 to the extent determined by the small employer insurance board
3under s. 635.23 (1) (b), and the basic plan under ch. 637 as determined by the
4commissioner under s. 637.05 (1)
, all health care plans, including health
5maintenance organizations, limited service health organizations and preferred
6provider plans are subject to s. 632.87 (3).
AB500, s. 58 7Section 58. 632.70 of the statutes is amended to read:
AB500,23,13 8632.70 (title) Exemption for plan under ch. 635 or 637. The health
9insurance mandates, as defined in s. 601.423 (1), that are provided under this
10subchapter apply to the small employer health insurance plan under subch. II of ch.
11635 only to the extent determined by the small employer insurance board under s.
12635.23 (1) (b), and to the basic plan under ch. 637 only as determined by the
13commissioner under s. 637.05 (1)
.
AB500, s. 59 14Section 59. 632.72 (1) of the statutes is renumbered 632.72 (1m).
AB500, s. 60 15Section 60. 632.72 (1c) of the statutes is created to read:
AB500,23,1716 632.72 (1c) In this section, "policy of health and disability insurance" does not
17include a policy issued under the basic plan under ch. 637.
AB500, s. 61 18Section 61. 632.755 (2) of the statutes is renumbered 632.755 (2) (b).
AB500, s. 62 19Section 62. 632.755 (2) (a) of the statutes is created to read:
AB500,23,2120 632.755 (2) (a) In this subsection, "disability insurance policy" does not include
21coverage under the basic plan under ch. 637.
AB500, s. 63 22Section 63. 635.01 of the statutes is renumbered 635.01 (1) and amended to
23read:
AB500,24,524 635.01 (1) This Except as provided in sub. (2), this subchapter applies to all
25group health insurance plans, policies or certificates, written on risks or operations

1in this state, providing coverage for employes of a small employer, or employes of a
2small employer and the employer, and to individual health insurance policies,
3written on risks or operations in this state, providing coverage for employes of a small
4employer, or employes of a small employer and the employer when 3 or more are sold
5to a small employer.
AB500, s. 64 6Section 64. 635.01 (2) of the statutes is created to read:
AB500,24,77 635.01 (2) This subchapter does not apply to the basic plan under ch. 637.
AB500, s. 65 8Section 65. Chapter 637 of the statutes is created to read:
AB500,24,109 Chapter 637
10 Basic health insurance plan
AB500,24,12 11637.01 Application. This chapter applies only if the department of health and
12social services makes a certification under s. 49.44 (5).
AB500,24,13 13637.02 Definitions. In this chapter:
AB500,24,18 14(1) "Abortion" means the use of any instrument, medicine, drug or any other
15substance or device with intent to terminate a pregnancy after implantation of a
16fertilized human ovum and with intent other than to increase the probability of a live
17birth, to preserve the life or health of the infant after live birth or to remove a dead
18fetus.
AB500,24,23 19(2) "Community rate" means a uniform rate determined in such a manner that
20all insured individuals with the same level of coverage and plan design pay the same
21rate for that coverage, without regard to case characteristics or to loss or claim
22history, health condition, duration of coverage or other factors related to claims
23experience.
AB500,25,2 24(3) "Dependent" means a spouse, an unmarried child under the age of 19 years,
25an unmarried child who is a full-time student under the age of 21 years and who is

1financially dependent upon the parent, or an unmarried child of any age who is
2medically certified as disabled and who is dependent upon the parent.
AB500,25,7 3(4) "Employe" includes a sole proprietor, a business owner, including the owner
4of a farm business, a partner of a partnership, a member of a limited liability
5company and an independent contractor if the sole proprietor, business owner,
6partner, member or independent contractor is included as an employe under a health
7benefit plan of an employer.
AB500,25,8 8(5) "Employer" means any of the following:
AB500,25,119 (a) An individual, firm, corporation, partnership, limited liability company or
10association that is actively engaged in a business enterprise in this state, including
11a farm business.
AB500,25,1212 (b) The state.
AB500,25,1313 (c) A municipality, as defined in s. 16.70 (8).
AB500,25,15 14(6) "Medical assistance recipient" means a person entitled, under s. 49.44 (6),
15to coverage under the basic plan under s. 637.05.
AB500,25,17 16(7) "Poverty line" means the poverty line as defined and revised annually under
1742 USC 9902 (2).
AB500,25,19 18(8) "Qualifying coverage" means benefits or coverage provided under any of the
19following:
AB500,25,2020 (a) Medicare or medicaid.
AB500,25,2221 (b) An employer-based health insurance or health benefit arrangement that
22provides benefits similar to or exceeding benefits provided under the basic plan.
AB500,26,223 (c) Except for a policy under the health insurance risk-sharing plan or an
24alternative plan under subch. II of ch. 619, an individual health insurance policy that

1provides benefits similar to or exceeding benefits provided under the basic plan if the
2policy has been in effect for at least one year.
AB500,26,8 3637.05 Basic plan. (1) The commissioner shall by rule design a health care
4plan that provides basic coverage of hospital, surgical and medical services and
5items. The basic plan shall provide both single and family coverage. The
6commissioner shall require a copayment of at least $2 for every service or item
7covered under the basic plan. The commissioner may by rule exempt the basic plan
8from any health insurance mandate, as defined in s. 601.423 (1).
AB500,26,12 9(2) The commissioner shall administer the basic plan under this chapter and
10may promulgate rules relating to the operation and administration of the basic plan,
11including rules that are designed to reduce adverse selection, or the effects of adverse
12selection, in relation to the basic plan.
AB500,26,16 13(3) The commissioner shall ensure that individuals and employers may obtain,
14and that medical assistance recipients shall receive, coverage under the basic plan
15no later than the first day of the 12th month beginning after the date on which the
16department of health and social services makes a certification under s. 49.44 (5).
AB500,27,2 17637.10 Designating regions; selecting insurers. (1) The commissioner
18may divide the state into regions for the purpose of pooling individuals and employes
19with coverage under the basic plan if the commissioner determines that regional
20pools will result in more efficient and cost-effective delivery of health care coverage
21or services. The commissioner shall select insurers to provide coverage under the
22basic plan using a competitive sealed proposal process. Any insurer authorized to
23do a health insurance business in this state may submit a proposal to provide
24coverage under a basic health insurance plan that complies with this chapter, any

1rules promulgated under this chapter and the terms of any waiver under s. 49.44 (2)
2or any legislation under s. 49.44 (3).
AB500,27,5 3(2) An insurer selected by the commissioner shall comply with any
4requirements imposed by the commissioner related to the insurer's provision of
5coverage under the basic plan.
AB500,27,10 6637.15 Coverage eligibility and entitlement. (1) Beginning on the first
7day of the 12th month beginning after the date on which the department of health
8and social services makes a certification under s. 49.44 (5), persons eligible for
9medical assistance under s. 49.46 (1) (a) 1., 1m., 6. or 12., (c), (cg), (co), (cr) or (cs) or
1049.47 (4) (a) 1. or 2. shall receive coverage, under s. 49.44 (6), under the basic plan.
AB500,27,14 11(2) Beginning on the first day of the 12th month beginning after the date on
12which the department of health and social services makes a certification under s.
1349.44 (5), all of the following are eligible to purchase coverage under the basic plan,
14subject to sub. (4):
AB500,27,1515 (a) Any employer.
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