AB100: Bill Text

AB100,1810,9 149.13 (1) (d) 2. If the department or the commissioner finds that the commissioner's authority to require insurers to report under chs. 600 to 646 and 655 is not adequate to permit the department, the commissioner or the board to carry out the department's, commissioner's or the board's responsibilities under this subchapter chapter, the commissioner may shall promulgate rules requiring insurers to report the information necessary for the department, commissioner and the board to make the determinations required under this subchapter chapter.

AB100, s. 4839 Section 4839. 619.13 (2) of the statutes is renumbered 149.13 (2).

AB100, s. 4840 Section 4840. 619.135 (title) of the statutes is renumbered 149.135 (title).

AB100, s. 4841 Section 4841. 619.135 (1) (a) of the statutes is renumbered 149.135 (1) (a) and amended to read:

AB100,1810,21 149.135 (1) (a) Whenever a person becomes eligible for and obtains coverage under the plan as a result of receiving a notice under s. 619.12 149.12 (1) (am), (b) or (c), the commissioner shall levy an assessment of $1,750 against the insurer that issued the notice, except that the commissioner may not levy an assessment if the notice of cancellation under s. 619.12 149.12 (1) (am) was issued on one of the permissible grounds under s. 631.36 (2) (a). The commissioner shall notify the department if an assessment is not levied under this paragraph because a notice of cancellation was issued on permissible grounds.

AB100, s. 4842 Section 4842. 619.135 (1) (b) of the statutes is renumbered 149.135 (1) (b).

AB100, s. 4843 Section 4843. 619.135 (1) (c) of the statutes is renumbered 149.135 (1) (c) and amended to read:

AB100,1811,4 149.135 (1) (c) If an assessment levied under par. (a) is not paid within the time prescribed, the commissioner shall impose a penalty against the insurer in an amount established by the commissioner by rule, in consultation with the department.

AB100, s. 4844 Section 4844. 619.135 (1) (d) of the statutes is renumbered 149.135 (1) (d) and amended to read:

AB100,1811,8 149.135 (1) (d) All assessments and penalties collected under this subsection shall be credited to the appropriation under s. 20.145 (7) (g) 20.435 (5) (hp).

AB100, s. 4845 Section 4845. 619.135 (2) of the statutes is renumbered 149.135 (2) and amended to read:

AB100,1811,21 149.135 (2) If the moneys under s. 20.145 (7) (a) and (g) 20.435 (5) (ah), (g) and (hp) are insufficient to reimburse the plan for premium reductions under s. 619.165 149.165 and deductible reductions under s. 619.14 149.14 (5) (a), or the commissioner department determines that the moneys under s. 20.145 (7) (a) and (g) 20.435 (5) (ah), (g) and (hp) will be insufficient to reimburse the plan for premium reductions under s. 619.165 149.165 and deductible reductions under s. 619.14 149.14 (5) (a), the department shall notify the commissioner. In consultation with the department, the commissioner shall, by rule, increase the amount of the assessment under sub. (1) (a) or levy an assessment against every insurer, or a combination of both, sufficient to reimburse the plan for premium reductions under s. 619.165 149.165 and deductible reductions under s. 619.14 149.14 (5) (a).

AB100, s. 4846 Section 4846. 619.135 (3) of the statutes is renumbered 149.135 (3) and amended to read:

AB100,1812,5 149.135 (3) In addition to the assessments under subs. (1) (a) and (2), in consultation with the department the commissioner may, by rule, establish an assessment to be levied against each insurer that issues a notice of rejection under s. 619.12 149.12 (1) (a) to a person who becomes eligible for and obtains coverage under the plan as a result of receiving the notice. Any assessments levied and collected under this subsection shall be credited to the appropriation under s. 20.145 (7) (g) 20.435 (5) (hp).

AB100, s. 4847 Section 4847. 619.14 (title) of the statutes is renumbered 149.14 (title).

AB100, s. 4848 Section 4848. 619.14 (1) of the statutes is renumbered 149.14 (1), and 149.14 (1) (b), as renumbered, is amended to read:

AB100,1812,13 149.14 (1) (b) If an individual terminates medical assistance coverage and applies for coverage under the plan within 45 days after the termination and is subsequently found to be eligible under s. 619.12 149.12, the effective date of coverage for the eligible person under the plan shall be the date of termination of medical assistance coverage.

AB100, s. 4849 Section 4849. 619.14 (2) of the statutes is renumbered 149.14 (2).

AB100, s. 4850 Section 4850. 619.14 (3) of the statutes is renumbered 149.14 (3), and 149.14 (3) (intro.) and (c) 1. and 3., as renumbered, are amended to read:

AB100,1813,3 149.14 (3) Covered expenses. (intro.) Except as restricted by cost containment provisions under s. 619.17 149.17 (4) and except as reduced by the board under s. 619.15 (3) (e), covered expenses shall be the usual and customary allowable charges paid under the medical assistance program under ss. 49.45 to 49.47 for the services provided by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Except as restricted by cost containment provisions under s. 619.17 149.17 (4) and except as reduced by the board under s. 619.15 (3) (e), covered expenses shall also be the usual and customary allowable charges paid under the medical assistance program under ss. 49.45 to 49.47 for the following services and articles when if the service or article is prescribed by a physician who is licensed under ch. 448 or in another state and who is certified under s. 49.45 (2) (a) 11. and if the service or article is provided by a provider certified under s. 49.45 (2) (a) 11.:

AB100,1813,7 (c) 1. Inpatient treatment in a hospital as defined in s. 632.89 (1) (c) or in a medical facility in another state approved by the board, licensed under s. 50.35 for up to 30 days' confinement per calendar year due to alcoholism or drug abuse and up to 60 days' confinement per calendar year for nervous and mental disorders.

AB100,1813,10 3. Subject to the limits under subd. 2. and to rules promulgated by the commissioner department, services for the chronically mentally ill in community support programs operated under s. 51.421.

AB100, s. 4851 Section 4851. 619.14 (4) of the statutes is renumbered 149.14 (4), and 149.14 (4) (d) and (m), as renumbered, are amended to read:

AB100,1813,17 149.14 (4) (d) That part of any charge for services or articles rendered or prescribed by a physician, dentist or other health care personnel which exceeds the prevailing charge in the locality where the service is provided allowable charge paid under the medical assistance program under ss. 49.45 to 49.47 or any charge not medically necessary.

AB100,1813,19 (m) Experimental treatment, as determined by the board or its designee department.

AB100, s. 4852 Section 4852. 619.14 (5) (title) of the statutes is renumbered 149.14 (5) (title).

AB100, s. 4853 Section 4853. 619.14 (5) (a) of the statutes is renumbered 149.14 (5) (a) and amended to read:

AB100,1814,17 149.14 (5) (a) The plan shall offer a deductible in combination with appropriate premiums determined under this subchapter chapter for major medical expense coverage required under this section. For coverage offered to those persons eligible for medicare, the plan shall offer a deductible equal to the deductible charged by part A of title XVIII of the federal social security act, as amended. The deductible amounts for all other eligible persons shall be dependent upon household income as determined under s. 619.165 149.165. For eligible persons under s. 619.165 (1) (b) 1. 149.165 (2) (a), the deductible shall be $500. For eligible persons under s. 619.165 (1) (b) 2. 149.165 (2) (b), the deductible shall be $600. For eligible persons under s. 619.165 (1) (b) 3. 149.165 (2) (c), the deductible shall be $700. For eligible persons under s. 619.165 (1) (b) 4. 149.165 (2) (d), the deductible shall be $800. For all other eligible persons who are not eligible for medicare, the deductible shall be $1,000. With respect to all eligible persons, expenses used to satisfy the deductible during the last 90 days of a calendar year shall also be applied to satisfy the deductible for the following calendar year. The schedule of premiums shall be promulgated by rule by the commissioner department. The commissioner department shall set rates at 60% of the operating and administrative costs of the plan, except that a rate may not exceed 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan.

AB100, s. 4854 Section 4854. 619.14 (5) (b) of the statutes is renumbered 149.14 (5) (b) and amended to read:

AB100,1814,24 149.14 (5) (b) Except as provided in par. (c), if the covered costs incurred by the eligible person exceed the deductible for major medical expense coverage in a calendar year, the plan shall pay at least 80% of the allowable charges paid under the medical assistance program under ss. 49.45 to 49.47 for any additional covered costs incurred by the person during the calendar year.

AB100, s. 4855 Section 4855. 619.14 (5) (c) of the statutes is renumbered 149.14 (5) (c) and amended to read:

AB100,1815,9 149.14 (5) (c) If the aggregate of the covered costs not paid by the plan under par. (b) and the deductible exceeds $500 for an eligible person receiving medicare, $2,000 for any other eligible person during a calendar year or $4,000 for all eligible persons in a family, the plan shall pay 100% of the allowable charges paid under the medical assistance program under ss. 49.45 to 49.47 for all covered costs incurred by the eligible person during the calendar year after the payment ceilings under this paragraph are exceeded.

AB100, s. 4856 Section 4856. 619.14 (5) (d) of the statutes is renumbered 149.14 (5) (d) and amended to read:

AB100,1815,17 149.14 (5) (d) Notwithstanding pars. (a) to (c), the board department may establish different deductible amounts, a different coinsurance percentage and different covered costs and deductible aggregate amounts from those specified in pars. (a) to (c) in accordance with cost containment provisions established by the commissioner department under s. 619.17 (4) (a) and for individuals who enroll in an alternative plan under s. 619.145 149.17 (4).

AB100, s. 4857 Section 4857. 619.14 (5) (e) of the statutes is renumbered 149.14 (5) (e) and amended to read:

AB100,1815,25 149.14 (5) (e) Using the procedure under s. 227.24, the commissioner department may promulgate rules under par. (a) for the schedule of premiums for the period before the effective date of any permanent rules promulgated under par. (a) for the schedule of premiums, but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the commissioner department is not required to make a finding of emergency.

AB100, s. 4858 Section 4858. 619.14 (6) of the statutes is repealed.

AB100, s. 4859 Section 4859. 619.14 (7) of the statutes is renumbered 149.14 (7), and 149.14 (7) (b) and (c), as renumbered, are amended to read:

AB100,1816,7 149.14 (7) (b) The board department has a cause of action against an eligible participant for the recovery of the amount of benefits paid which are not for covered expenses under the plan. Benefits under the plan may be reduced or refused as a setoff against any amount recoverable under this paragraph.

AB100,1816,11 (c) The board department is subrogated to the rights of an eligible person to recover special damages for illness or injury to the person caused by the act of a 3rd person to the extent that benefits are provided under the plan. Section 814.03 (3) applies to the department under this paragraph.

AB100, s. 4860 Section 4860. 619.145 of the statutes is repealed.

AB100, s. 4861 Section 4861. 619.15 (title) of the statutes is renumbered 149.15 (title).

AB100, s. 4862 Section 4862. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended to read:

AB100,1817,4 149.15 (1) The plan shall operate subject to the supervision and approval of a have a board of governors consisting of representatives of 2 participating insurers which are nonprofit corporations, 2 other participating insurers, and 3 public members, appointed by the commissioner secretary for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the secretary, or a designated representative from the department, shall be a member members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital or an insurer. At least 2 of the public members shall be individuals reasonably expected to qualify for coverage under the plan or the parent or spouse of such an individual. The commissioner secretary or the commissioner's secretary's representative shall be the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the secretary or the secretary's representative, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.

AB100, s. 4863 Section 4863. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended to read:

AB100,1817,12 149.15 (2) Annually, the board shall make a report to the members of the plan and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3), and to the members of the plan summarizing the activities of the plan in the preceding calendar year. The annual report shall define the cost burden imposed by the plan on all policyholders in this state.

AB100, s. 4864 Section 4864. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3) (intro.) and amended to read:

AB100,1817,15 149.15 (3) (intro.) The board shall do all of the following:

AB100, s. 4865 Section 4865. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).

AB100, s. 4866 Section 4866. 619.15 (3) (b) of the statutes is repealed.

AB100, s. 4867 Section 4867. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c).

AB100, s. 4868 Section 4868. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).

AB100, s. 4869 Section 4869. 619.15 (3) (e) of the statutes is repealed.

AB100, s. 4870 Section 4870. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4) (intro.) and amended to read:

AB100,1817,23 149.15 (4) (intro.) The board may do any of the following:

AB100, s. 4871 Section 4871. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).

AB100, s. 4872 Section 4872. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).

AB100, s. 4873 Section 4873. 619.15 (4) (c) of the statutes is renumbered 149.15 (4) (c) and amended to read:

AB100,1818,10 149.15 (4) (c) In addition to assessments imposed under sub. (3) (c), levy interim assessments, at the request of the department, to ensure the financial ability of the plan to cover claims expense and administrative expenses incurred or estimated to be incurred in the operation of the plan prior to the end of the calendar year end or other fiscal year end established by the board. Interim assessments shall be due and payable within 30 days of receipt by an insurer of an interim assessment notice. Interim assessments shall be credited against each insurer's annual assessment.

AB100, s. 4874 Section 4874. 619.15 (4) (d) of the statutes is repealed.

AB100, s. 4875 Section 4875. 619.15 (4) (e) of the statutes is repealed.

AB100, s. 4876 Section 4876. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended to read:

AB100,1818,16 149.15 (5) The commissioner department may, by rule, establish additional powers and duties of the board.

AB100, s. 4877 Section 4877. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended to read:

AB100,1818,20 149.15 (6) If any provision of this subchapter chapter conflicts with s. 625.11 or 625.12, this subchapter chapter prevails.

AB100, s. 4878 Section 4878. 619.15 (7) of the statutes is renumbered 149.15 (7).

AB100, s. 4879 Section 4879. 619.16 (title) of the statutes is repealed.

AB100, s. 4880 Section 4880. 619.16 (1) of the statutes is repealed.

AB100, s. 4881 Section 4881. 619.16 (2) of the statutes is repealed.

AB100, s. 4882 Section 4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and amended to read:

AB100,1819,4 149.16 (3) (a) The administering carrier plan administrator shall perform all eligibility and administrative claims payment functions relating to the plan.

AB100, s. 4883 Section 4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and amended to read:

AB100,1819,9 149.16 (3) (b) The administering carrier plan administrator shall establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the board department.

AB100, s. 4884 Section 4884. 619.16 (3) (c) of the statutes is repealed.

AB100, s. 4885 Section 4885. 619.16 (3) (d) of the statutes is repealed.

AB100, s. 4886 Section 4886. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and amended to read:

AB100,1819,21 149.16 (3) (e) The administering carrier plan administrator, under the direction of the department, shall pay claims expenses from the premium payments received from or on behalf of covered persons under the plan. If the administering carrier's plan administrator's payments for claims expenses exceed the portion of premiums allocated by the board for payment of claims expenses premium payments, the board shall forward to the department, and the department shall provide to the carrier plan administrator, additional funds for payment of claims expenses.

AB100, s. 4887 Section 4887. 619.16 (3) (em) of the statutes is repealed.

AB100, s. 4888 Section 4888. 619.16 (3) (f) of the statutes is repealed.

AB100, s. 4889 Section 4889. 619.165 (title) of the statutes is renumbered 149.165 (title).

AB100, s. 4890 Section 4890. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and amended to read:

AB100,1820,6 149.165 (1) The board department shall reduce the premiums established by the commissioner under s. 619.11 149.11 in conformity with ss. 619.14 149.14 (5) and 619.17 149.17, for the eligible persons and in the manner set forth in pars. (b) to (d) subs. (2) and (3).

AB100, s. 4891 Section 4891. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and 149.165 (2) (intro.), as renumbered, is amended to read:

AB100,1820,13 149.165 (2) (intro.) If the household income, as defined in s. 71.52 (5) and as determined under par. (d) sub. (3), of an eligible person is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the board department shall reduce the premium for the eligible person, as established by the commissioner, to the rate shown after the amounts:

AB100, s. 4892 Section 4892. 619.165 (1) (d) of the statutes is renumbered 149.165 (3) and amended to read:

AB100,1820,17 149.165 (3) The board department shall establish and implement the method for determining the household income of an eligible person under par. (b) sub. (2).

AB100, s. 4893 Section 4893. 619.165 (2) of the statutes is repealed.

AB100, s. 4894 Section 4894. 619.165 (3) of the statutes is renumbered 149.165 (4) and amended to read:

AB100,1820,25 149.165 (4) The commissioner shall forward to the board moneys received under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse the plan for premium reductions under sub. (1) (2) and deductible reductions under s. 619.14 149.14 (5) (a) with moneys from the appropriations under s. 20.435 (5) (ah), (g) and (hp).