AB100,1810,93
149.13
(1) (d) 2. If the
department or the commissioner finds that the
4commissioner's authority to require insurers to report under chs. 600 to 646 and 655
5is not adequate to permit the
department, the commissioner or the board to carry out
6the
department's, commissioner's or
the board's responsibilities under this
7subchapter chapter, the commissioner
may shall promulgate rules requiring
8insurers to report the information necessary for the
department, commissioner and
9the board to make the determinations required under this
subchapter chapter.
AB100, s. 4839
10Section
4839. 619.13 (2) of the statutes is renumbered 149.13 (2).
AB100, s. 4840
11Section
4840. 619.135 (title) of the statutes is renumbered 149.135 (title).
AB100, s. 4841
12Section
4841. 619.135 (1) (a) of the statutes is renumbered 149.135 (1) (a) and
13amended to read:
AB100,1810,2114
149.135
(1) (a) Whenever a person becomes eligible for and obtains coverage
15under the plan as a result of receiving a notice under s.
619.12 149.12 (1) (am), (b)
16or (c), the commissioner shall levy an assessment of $1,750 against the insurer that
17issued the notice, except that the commissioner may not levy an assessment if the
18notice of cancellation under s.
619.12 149.12 (1) (am) was issued on one of the
19permissible grounds under s. 631.36 (2) (a).
The commissioner shall notify the
20department if an assessment is not levied under this paragraph because a notice of
21cancellation was issued on permissible grounds.
AB100, s. 4842
22Section
4842. 619.135 (1) (b) of the statutes is renumbered 149.135 (1) (b).
AB100, s. 4843
23Section
4843. 619.135 (1) (c) of the statutes is renumbered 149.135 (1) (c) and
24amended to read:
AB100,1811,4
1149.135
(1) (c) If an assessment levied under par. (a) is not paid within the time
2prescribed, the commissioner shall impose a penalty against the insurer in an
3amount established by the commissioner by rule
, in consultation with the
4department.
AB100, s. 4844
5Section
4844. 619.135 (1) (d) of the statutes is renumbered 149.135 (1) (d) and
6amended to read:
AB100,1811,87
149.135
(1) (d) All assessments and penalties collected under this subsection
8shall be credited to the appropriation under s.
20.145 (7) (g) 20.435 (5) (hp).
AB100, s. 4845
9Section
4845. 619.135 (2) of the statutes is renumbered 149.135 (2) and
10amended to read:
AB100,1811,2111
149.135
(2) If the moneys under s.
20.145 (7) (a) and (g) 20.435 (5) (ah), (g) and
12(hp) are insufficient to reimburse the plan for premium reductions under s.
619.165 13149.165 and deductible reductions under s.
619.14 149.14 (5) (a), or the
commissioner 14department determines that the moneys under s.
20.145 (7) (a) and (g) 20.435 (5)
15(ah), (g) and (hp) will be insufficient to reimburse the plan for premium reductions
16under s.
619.165 149.165 and deductible reductions under s.
619.14 149.14 (5) (a),
17the
department shall notify the commissioner. In consultation with the department,
18the commissioner shall, by rule, increase the amount of the assessment under sub.
19(1) (a) or levy an assessment against every insurer, or a combination of both,
20sufficient to reimburse the plan for premium reductions under s.
619.165 149.165 21and deductible reductions under s.
619.14 149.14 (5) (a).
AB100, s. 4846
22Section
4846. 619.135 (3) of the statutes is renumbered 149.135 (3) and
23amended to read:
AB100,1812,524
149.135
(3) In addition to the assessments under subs. (1) (a) and (2),
in
25consultation with the department the commissioner may, by rule, establish an
1assessment to be levied against each insurer that issues a notice of rejection under
2s.
619.12 149.12 (1) (a) to a person who becomes eligible for and obtains coverage
3under the plan as a result of receiving the notice. Any assessments levied and
4collected under this subsection shall be credited to the appropriation under s.
20.145
5(7) (g) 20.435 (5) (hp).
AB100, s. 4847
6Section
4847. 619.14 (title) of the statutes is renumbered 149.14 (title).
AB100, s. 4848
7Section
4848. 619.14 (1) of the statutes is renumbered 149.14 (1), and 149.14
8(1) (b), as renumbered, is amended to read:
AB100,1812,139
149.14
(1) (b) If an individual terminates medical assistance coverage and
10applies for coverage under the plan within 45 days after the termination and is
11subsequently found to be eligible under s.
619.12
149.12, the effective date of
12coverage for the eligible person under the plan shall be the date of termination of
13medical assistance coverage.
AB100, s. 4849
14Section
4849. 619.14 (2) of the statutes is renumbered 149.14 (2).
AB100, s. 4850
15Section
4850. 619.14 (3) of the statutes is renumbered 149.14 (3), and 149.14
16(3) (intro.) and (c) 1. and 3., as renumbered, are amended to read:
AB100,1813,317
149.14
(3) Covered expenses. (intro.) Except as restricted by cost containment
18provisions under s.
619.17 149.17 (4)
and except as reduced by the board under s.
19619.15 (3) (e), covered expenses shall be the
usual and customary allowable charges
20paid under the medical assistance program under ss. 49.45 to 49.47 for the services
21provided by persons licensed under ch. 446
and certified under s. 49.45 (2) (a) 11.
22Except as restricted by cost containment provisions under s.
619.17 149.17 (4)
and
23except as reduced by the board under s. 619.15 (3) (e), covered expenses shall also be
24the
usual and customary allowable charges
paid under the medical assistance
25program under ss. 49.45 to 49.47 for the following services and articles
when if the
1service or article is prescribed by a physician
who is licensed under ch. 448 or in
2another state
and who is certified under s. 49.45 (2) (a) 11. and if the service or article
3is provided by a provider certified under s. 49.45 (2) (a) 11.:
AB100,1813,74
(c) 1. Inpatient treatment in a hospital
as defined in s. 632.89 (1) (c) or in a
5medical facility in another state approved by the board, licensed under s. 50.35 for
6up to 30 days' confinement per calendar year due to alcoholism or drug abuse and up
7to 60 days' confinement per calendar year for nervous and mental disorders.
AB100,1813,108
3. Subject to the limits under subd. 2. and to rules promulgated by the
9commissioner department, services for the chronically mentally ill in community
10support programs operated under s. 51.421.
AB100, s. 4851
11Section
4851. 619.14 (4) of the statutes is renumbered 149.14 (4), and 149.14
12(4) (d) and (m), as renumbered, are amended to read:
AB100,1813,1713
149.14
(4) (d) That part of any charge for services or articles rendered or
14prescribed by a physician, dentist or other health care personnel which exceeds the
15prevailing charge in the locality where the service is provided allowable charge paid
16under the medical assistance program under ss. 49.45 to 49.47 or any charge not
17medically necessary.
AB100,1813,1918
(m) Experimental treatment, as determined by the
board or its designee 19department.
AB100, s. 4852
20Section
4852. 619.14 (5) (title) of the statutes is renumbered 149.14 (5) (title).
AB100, s. 4853
21Section
4853. 619.14 (5) (a) of the statutes is renumbered 149.14 (5) (a) and
22amended to read:
AB100,1814,1723
149.14
(5) (a) The plan shall offer a deductible in combination with appropriate
24premiums determined under this
subchapter chapter for major medical expense
25coverage required under this section. For coverage offered to those persons eligible
1for medicare, the plan shall offer a deductible equal to the deductible charged by part
2A of title XVIII of the federal social security act, as amended. The deductible
3amounts for all other eligible persons shall be dependent upon household income as
4determined under s.
619.165 149.165. For eligible persons under s.
619.165 (1) (b)
51. 149.165 (2) (a), the deductible shall be $500. For eligible persons under s.
619.165
6(1) (b) 2. 149.165 (2) (b), the deductible shall be $600. For eligible persons under s.
7619.165 (1) (b) 3. 149.165 (2) (c), the deductible shall be $700. For eligible persons
8under s.
619.165 (1) (b) 4. 149.165 (2) (d), the deductible shall be $800. For all other
9eligible persons who are not eligible for medicare, the deductible shall be $1,000.
10With respect to all eligible persons, expenses used to satisfy the deductible during
11the last 90 days of a calendar year shall also be applied to satisfy the deductible for
12the following calendar year. The schedule of premiums shall be promulgated by rule
13by the
commissioner department. The
commissioner department shall set rates at
1460% of the operating and administrative costs of the plan
, except that a rate may not
15exceed 200% of the rate that a standard risk would be charged under an individual
16policy providing substantially the same coverage and deductibles as are provided
17under the plan.
AB100, s. 4854
18Section
4854. 619.14 (5) (b) of the statutes is renumbered 149.14 (5) (b) and
19amended to read:
AB100,1814,2420
149.14
(5) (b) Except as provided in par. (c), if the covered costs incurred by the
21eligible person exceed the deductible for major medical expense coverage in a
22calendar year, the plan shall pay at least 80% of
the allowable charges paid under
23the medical assistance program under ss. 49.45 to 49.47 for any additional covered
24costs incurred by the person during the calendar year.
AB100, s. 4855
1Section
4855. 619.14 (5) (c) of the statutes is renumbered 149.14 (5) (c) and
2amended to read:
AB100,1815,93
149.14
(5) (c) If the aggregate of the covered costs not paid by the plan under
4par. (b) and the deductible exceeds $500 for an eligible person receiving medicare,
5$2,000 for any other eligible person during a calendar year or $4,000 for all eligible
6persons in a family, the plan shall pay 100% of
the allowable charges paid under the
7medical assistance program under ss. 49.45 to 49.47 for all covered costs incurred by
8the eligible person during the calendar year after the payment ceilings under this
9paragraph are exceeded.
AB100, s. 4856
10Section
4856. 619.14 (5) (d) of the statutes is renumbered 149.14 (5) (d) and
11amended to read:
AB100,1815,1712
149.14
(5) (d) Notwithstanding pars. (a) to (c), the
board department may
13establish different deductible amounts, a different coinsurance percentage and
14different covered costs and deductible aggregate amounts from those specified in
15pars. (a) to (c) in accordance with cost containment provisions established by the
16commissioner department under s.
619.17 (4) (a) and for individuals who enroll in
17an alternative plan under s. 619.145 149.17 (4).
AB100, s. 4857
18Section
4857. 619.14 (5) (e) of the statutes is renumbered 149.14 (5) (e) and
19amended to read:
AB100,1815,2520
149.14
(5) (e) Using the procedure under s. 227.24, the
commissioner 21department may promulgate rules under par. (a) for the schedule of premiums for the
22period before the effective date of any permanent rules promulgated under par. (a)
23for the schedule of premiums, but not to exceed the period authorized under s. 227.24
24(1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the
commissioner department 25is not required to make a finding of emergency.
AB100, s. 4859
2Section
4859. 619.14 (7) of the statutes is renumbered 149.14 (7), and 149.14
3(7) (b) and (c), as renumbered, are amended to read:
AB100,1816,74
149.14
(7) (b) The
board department has a cause of action against an eligible
5participant for the recovery of the amount of benefits paid which are not for covered
6expenses under the plan. Benefits under the plan may be reduced or refused as a
7setoff against any amount recoverable under this paragraph.
AB100,1816,118
(c) The
board department is subrogated to the rights of an eligible person to
9recover special damages for illness or injury to the person caused by the act of a 3rd
10person to the extent that benefits are provided under the plan.
Section 814.03 (3)
11applies to the department under this paragraph.
AB100, s. 4861
13Section
4861. 619.15 (title) of the statutes is renumbered 149.15 (title).
AB100, s. 4862
14Section
4862. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended
15to read:
AB100,1817,416
149.15
(1) The plan shall
operate subject to the supervision and approval of a
17have a board
of governors consisting of representatives of 2 participating insurers
18which are nonprofit corporations, 2 other participating insurers, and 3 public
19members, appointed by the
commissioner secretary for staggered 3-year terms. In
20addition, the commissioner
, or a designated representative from the office of the
21commissioner
, and the secretary, or a designated representative from the
22department, shall be
a member members of the board. The public members shall not
23be professionally affiliated with the practice of medicine, a hospital or an insurer.
24At least 2 of the public members shall be individuals reasonably expected to qualify
25for coverage under the plan or the parent or spouse of such an individual. The
1commissioner secretary or the
commissioner's secretary's representative shall be the
2chairperson of the board. Board members, except the commissioner or the
3commissioner's representative
and the secretary or the secretary's representative,
4shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
AB100, s. 4863
5Section
4863. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended
6to read:
AB100,1817,127
149.15
(2) Annually, the board shall make a report to the
members of the plan
8and to the chief clerk of each house of the legislature, for distribution to the 9appropriate standing committees under s. 13.172 (3)
,
and to the members of the plan 10summarizing the activities of the plan in the preceding calendar year. The annual
11report shall define the cost burden imposed by the plan on all policyholders in this
12state.
AB100, s. 4864
13Section
4864. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3)
14(intro.) and amended to read:
AB100,1817,1515
149.15
(3) (intro.) The board shall
do all of the following:
AB100, s. 4865
16Section
4865. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).
AB100, s. 4866
17Section
4866. 619.15 (3) (b) of the statutes is repealed.
AB100, s. 4867
18Section
4867. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c).
AB100, s. 4868
19Section
4868. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).
AB100, s. 4869
20Section
4869. 619.15 (3) (e) of the statutes is repealed.
AB100, s. 4870
21Section
4870. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4)
22(intro.) and amended to read:
AB100,1817,2323
149.15
(4) (intro.) The board may
do any of the following:
AB100, s. 4871
24Section
4871. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).
AB100, s. 4872
25Section
4872. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).
AB100, s. 4873
1Section
4873. 619.15 (4) (c) of the statutes is renumbered 149.15 (4) (c) and
2amended to read:
AB100,1818,103
149.15
(4) (c) In addition to assessments imposed under sub. (3) (c), levy
4interim assessments
, at the request of the department, to ensure the financial ability
5of the plan to cover claims expense and administrative expenses incurred or
6estimated to be incurred in the operation of the plan prior to the end of the calendar
7year end or other fiscal year end established by the board. Interim assessments shall
8be due and payable within 30 days of receipt by an insurer of an interim assessment
9notice. Interim assessments shall be credited against each insurer's annual
10assessment.
AB100, s. 4874
11Section
4874. 619.15 (4) (d) of the statutes is repealed.
AB100, s. 4875
12Section
4875. 619.15 (4) (e) of the statutes is repealed.
AB100, s. 4876
13Section
4876. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended
14to read:
AB100,1818,1615
149.15
(5) The
commissioner department may, by rule, establish additional
16powers and duties of the board.
AB100, s. 4877
17Section
4877. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended
18to read:
AB100,1818,2019
149.15
(6) If any provision of this
subchapter chapter conflicts with s. 625.11
20or 625.12, this
subchapter chapter prevails.
AB100, s. 4878
21Section
4878. 619.15 (7) of the statutes is renumbered 149.15 (7).
AB100, s. 4879
22Section
4879. 619.16 (title) of the statutes is repealed.
AB100, s. 4880
23Section
4880. 619.16 (1) of the statutes is repealed.
AB100, s. 4881
24Section
4881. 619.16 (2) of the statutes is repealed.
AB100, s. 4882
1Section
4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
2amended to read:
AB100,1819,43
149.16
(3) (a) The
administering carrier plan administrator shall perform all
4eligibility and administrative claims payment functions relating to the plan.
AB100, s. 4883
5Section
4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and
6amended to read:
AB100,1819,97
149.16
(3) (b) The
administering carrier plan administrator shall establish a
8premium billing procedure for collection of premiums from insured persons. Billings
9shall be made on a periodic basis as determined by the
board department.
AB100, s. 4884
10Section
4884. 619.16 (3) (c) of the statutes is repealed.
AB100, s. 4885
11Section
4885. 619.16 (3) (d) of the statutes is repealed.
AB100, s. 4886
12Section
4886. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and
13amended to read:
AB100,1819,2114
149.16
(3) (e) The
administering carrier plan administrator, under the
15direction of the department, shall pay claims expenses from the premium payments
16received from or on behalf of covered persons under the plan. If the
administering
17carrier's plan administrator's payments for claims expenses exceed
the portion of
18premiums allocated by the board for payment of claims expenses
premium
19payments, the board
shall forward to the department, and the department shall
20provide to the
carrier plan administrator, additional funds for payment of claims
21expenses.
AB100, s. 4887
22Section
4887. 619.16 (3) (em) of the statutes is repealed.
AB100, s. 4888
23Section
4888. 619.16 (3) (f) of the statutes is repealed.
AB100, s. 4889
24Section
4889. 619.165 (title) of the statutes is renumbered 149.165 (title).
AB100, s. 4890
1Section
4890. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and
2amended to read:
AB100,1820,63
149.165
(1) The
board department shall reduce the premiums established
by
4the commissioner under s.
619.11 149.11 in conformity with ss.
619.14 149.14 (5) and
5619.17 149.17, for the eligible persons and in the manner set forth in
pars. (b) to (d) 6subs. (2) and (3).
AB100, s. 4891
7Section
4891. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and
8149.165 (2) (intro.), as renumbered, is amended to read:
AB100,1820,139
149.165
(2) (intro.) If the household income, as defined in s. 71.52 (5) and as
10determined under
par. (d) sub. (3), of an eligible person is equal to or greater than
11the first amount and less than the 2nd amount listed in any of the following, the
12board department shall reduce the premium for the eligible person
, as established
13by the commissioner, to the rate shown after the amounts:
AB100, s. 4892
14Section
4892. 619.165 (1) (d) of the statutes is renumbered 149.165 (3) and
15amended to read:
AB100,1820,1716
149.165
(3) The
board department shall establish and implement the method
17for determining the household income of an eligible person under
par. (b) sub. (2).
AB100, s. 4893
18Section
4893. 619.165 (2) of the statutes is repealed.
AB100, s. 4894
19Section
4894. 619.165 (3) of the statutes is renumbered 149.165 (4) and
20amended to read:
AB100,1820,2521
149.165
(4) The
commissioner shall forward to the board moneys received
22under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse
23the plan for premium reductions under sub.
(1) (2) and deductible reductions under
24s.
619.14 149.14 (5) (a)
with moneys from the appropriations under s. 20.435 (5) (ah),
25(g) and (hp).