AB840,15,2120 149.143 (2m) (a) (intro.) The department board shall keep a separate
21accounting of the difference between the following:
AB840, s. 43 22Section 43. 149.143 (2m) (a) 2. of the statutes, as affected by 2003 Wisconsin
23Act 33
, is amended to read:
AB840,16,3
1149.143 (2m) (a) 2. The amount of premiums, including amounts received for
2premium, deductible, and prescription drug copayment subsidies, necessary to cover
360% 60 percent of the plan costs for the plan year.
AB840, s. 44 4Section 44. 149.143 (2m) (b) 1. of the statutes, as affected by 2003 Wisconsin
5Act 33
, is amended to read:
AB840,16,106 149.143 (2m) (b) 1. To reduce premiums in succeeding plan years as provided
7in sub. (1) (am) 2. For eligible persons with coverage under s. 149.14 (2) (a),
8premiums may not be reduced below 140% 140 percent of the rate that a standard
9risk would be charged under an individual policy providing substantially the same
10coverage and deductibles cost-sharing provisions as are provided under the plan.
AB840, s. 45 11Section 45. 149.143 (2m) (b) 2. of the statutes is amended to read:
AB840,16,1312 149.143 (2m) (b) 2. For other needs of eligible persons, with the approval of the
13board
including the purpose specified in s. 149.15 (4) (d).
AB840, s. 46 14Section 46. 149.143 (2m) (b) 3. of the statutes is amended to read:
AB840,16,1915 149.143 (2m) (b) 3. For distribution to eligible persons, notwithstanding any
16requirements in this chapter related to setting premium amounts. The department
17board, with the approval of the board and the concurrence of the plan actuary, shall
18determine the policies, eligibility criteria, methodology, and other factors to be used
19in making any distribution under this subdivision.
AB840, s. 47 20Section 47. 149.143 (2m) (c) of the statutes is created to read:
AB840,16,2221 149.143 (2m) (c) The board shall consult with the department as necessary for
22the accounting under par. (a).
AB840, s. 48 23Section 48. 149.143 (3) (a) of the statutes, as affected by 2003 Wisconsin Act
2433
, is amended to read:
AB840,17,11
1149.143 (3) (a) If, during a plan year, the department board determines that
2the amounts estimated to be received as a result of the rates and amount set under
3sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider
4payment rate under s. 149.144 will not be sufficient to cover plan costs, the
5department board may by rule increase the premium rates set under sub. (2) (a) 2.
6for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum
7specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3.
8for the remainder of the plan year, subject to sub. (1) (bm) 1., and by the same rule
9under which assessments are increased adjust the provider payment rate set under
10sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (bm) 2. and s.
11149.142 (1) (b).
AB840, s. 49 12Section 49 . 149.143 (3) (a) of the statutes, as affected by 2003 Wisconsin Act
13.... (this act), is amended to read:
AB840,17,2414 149.143 (3) (a) If, during a plan year, the board determines that the amounts
15estimated to be received in manufacturer and labeler assessments and as a result of
16the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer
17assessments and the provider payment rate under s. 149.144 will not be sufficient
18to cover plan costs, the board may by rule increase the premium rates set under sub.
19(2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the
20maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub.
21(2) (a) 3. for the remainder of the plan year, subject to sub. (1) (bm) 1. 2m. a., and by
22the same rule under which assessments are increased adjust the provider payment
23rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (bm)
242. 2m. b. and s. 149.142 (1) (b).
AB840, s. 50
1Section 50. 149.143 (3) (b) of the statutes, as affected by 2003 Wisconsin Act
233
, is amended to read:
AB840,18,93 149.143 (3) (b) If the department board increases premium rates and insurer
4assessments and adjusts the provider payment rate under par. (a) and determines
5that there will still be a deficit and that premium rates have been increased to the
6maximum extent allowable under par. (a), the department board may further adjust,
7in equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
8rate set under sub. (2) (a) 4., without regard to sub. (1) (bm) but subject to s. 149.142
9(1) (b).
AB840, s. 51 10Section 51. 149.143 (4) of the statutes is amended to read:
AB840,18,1511 149.143 (4) Using the procedure under s. 227.24, the department board may
12promulgate rules under sub. (2) or (3) for the period before the effective date of any
13permanent rules promulgated under sub. (2) or (3), but not to exceed the period
14authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the
15department board is not required to make a finding of emergency.
AB840, s. 52 16Section 52. 149.143 (5) (a) of the statutes is amended to read:
AB840,18,2517 149.143 (5) (a) Annually, no later than April 30, the department board shall
18perform a reconciliation with respect to plan costs, premiums, insurer assessments,
19and provider payment rate adjustments based on data from the previous calendar
20year. On the basis of the reconciliation, the department board shall make any
21necessary adjustments in premiums, insurer assessments, or provider payment
22rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on the first July 1 after
23the reconciliation, as provided in sub. (2) (b). The board shall consult with the
24department as necessary in performing the reconciliation and in making the
25adjustments under this paragraph.
AB840, s. 53
1Section 53 . 149.143 (5) (a) of the statutes, as affected by 2003 Wisconsin Act
2.... (this act), is amended to read:
AB840,19,113 149.143 (5) (a) Annually, no later than April 30, the board shall perform a
4reconciliation with respect to plan costs, premiums, insurer assessments,
5manufacturer and labeler assessments, and provider payment rate adjustments
6based on data from the previous calendar year. On the basis of the reconciliation, the
7board shall make any necessary adjustments in premiums, insurer assessments, or
8provider payment rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on
9the first July 1 after the reconciliation, as provided in sub. (2) (b). The board shall
10consult with the department as necessary in performing the reconciliation and in
11making the adjustments under this paragraph.
AB840, s. 54 12Section 54. 149.143 (5) (b) of the statutes is amended to read:
AB840,19,1813 149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department
14board shall adjust the provider payment rates to meet the providers' specified portion
15of the plan costs no more than once annually, subject to s. 149.142 (1) (b). The
16department board may not determine the adjustment on an individual provider basis
17or on the basis of provider type, but shall determine the adjustment for all providers
18in the aggregate, subject to s. 149.142 (1) (b).
AB840, s. 55 19Section 55. 149.144 of the statutes, as affected by 2003 Wisconsin Act 33, is
20amended to read:
AB840,20,5 21149.144 Adjustments to insurer assessments and provider payment
22rates for premium, deductible, and prescription drug copayment
23reductions.
The department board shall, by rule, adjust in equal proportions the
24amount of the assessment assessments set under s. 149.143 (2) (a) 3. and the provider
25payment rate set under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143

1(1) (am), sufficient to reimburse the plan for premium reductions under s. 149.165
2(2) and (3), deductible reductions under s. 149.14 (5) (a), and any prescription drug
3copayment reductions under s. 149.14 (5) (e). The department board shall notify the
4commissioner so that the commissioner may levy any increase in insurer
5assessments.
AB840, s. 56 6Section 56. 149.145 of the statutes, as affected by 2003 Wisconsin Act 33, is
7amended to read:
AB840,20,20 8149.145 Program budget. The department, in consultation with the board,
9shall establish a program budget for each plan year. The program budget shall be
10based on the provider payment rates specified in s. 149.142 and in the most recent
11provider contracts that are in effect and on the funding sources specified in ss.
12149.143 (1) and 149.144, including the methodologies specified in ss. 149.143,
13149.144, and 149.146 for determining premium rates, insurer assessments, and
14provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b)
15and subject to s. 149.142 (1) (b), from the program budget the department board shall
16derive the actual provider payment rate for a plan year that reflects the providers'
17proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The
18department may not implement a program budget established under this section
19unless it is approved by the
board shall consult with the department as necessary in
20deriving the actual provider payment rate
.
AB840, s. 57 21Section 57 . 149.145 of the statutes, as affected by 2003 Wisconsin Act .... (this
22act), is amended to read:
AB840,21,8 23149.145 Program budget. The board shall establish a program budget for
24each plan year. The program budget shall be based on the provider payment rates
25specified in s. 149.142 and in the most recent provider contracts that are in effect and

1on the funding sources specified in ss. 149.143 (1) and 149.144, including the
2methodologies specified in ss. 149.143, 149.144, and 149.146 for determining
3premium rates, insurer and manufacturer and labeler assessments, and provider
4payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b) and subject
5to s. 149.142 (1) (b), from the program budget the board shall derive the actual
6provider payment rate for a plan year that reflects the providers' proportional share
7of the plan costs, consistent with ss. 149.143 and 149.144. The board shall consult
8with the department as necessary in deriving the actual provider payment rate.
AB840, s. 58 9Section 58. 149.146 (1) (b) of the statutes is amended to read:
AB840,21,1810 149.146 (1) (b) An eligible person under par. (a) may elect once each year, at
11the time and according to procedures established by the department board, among
12the coverages offered under this section and s. 149.14. If an eligible person elects new
13coverage, any preexisting condition exclusion imposed under the new coverage is met
14to the extent that the eligible person has been previously and continuously covered
15under this chapter. No preexisting condition exclusion may be imposed on an eligible
16person who elects new coverage if the person was an eligible individual when first
17covered under this chapter and the person remained continuously covered under this
18chapter up to the time of electing the new coverage.
AB840, s. 59 19Section 59. 149.146 (2) (a) of the statutes, as affected by 2003 Wisconsin Act
2033
, is amended to read:
AB840,21,2521 149.146 (2) (a) Except as specified by the department board, the terms of
22coverage under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and
23prescription drug copayment reductions under s. 149.14 (5) (e), do not apply to the
24coverage offered under this section. Premium reductions under s. 149.165 do not
25apply to the coverage offered under this section.
AB840, s. 60
1Section 60. 149.146 (2) (am) 4. of the statutes is amended to read:
AB840,22,62 149.146 (2) (am) 4. Notwithstanding subds. 1. to 3., the department board may
3establish different deductible amounts, a different coinsurance percentage, and
4different covered costs and deductible aggregate amounts from those specified in
5subds. 1. to 3. in accordance with cost containment provisions established by the
6department board under s. 149.17 (4).
AB840, s. 61 7Section 61. 149.146 (2) (am) 5. of the statutes is amended to read:
AB840,22,168 149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department board may, by
9rule under s. 149.17 (4), establish for prescription drug coverage under this section
10copayment amounts, coinsurance rates, and copayment and coinsurance
11out-of-pocket limits over which the plan will pay 100% 100 percent of covered costs
12for prescription drugs. Any copayment amount, coinsurance rate, or out-of-pocket
13limit established under this subdivision is subject to the approval of the board.

14Copayments and coinsurance paid by an eligible person under this subdivision are
15separate from and do not count toward the deductible and covered costs not paid by
16the plan under subds. 1. to 3.
AB840, s. 62 17Section 62. 149.146 (2) (b) (intro.) of the statutes is amended to read:
AB840,22,2218 149.146 (2) (b) (intro.) The schedule of premiums for coverage under this
19section shall be promulgated by rule by the department board, as provided in s.
20149.143. The rates for coverage under this section shall be set such that they differ
21from the rates for coverage under s. 149.14 (2) (a) by the same percentage as the
22percentage difference between the following:
AB840, s. 63 23Section 63. 149.146 (2) (b) 1. of the statutes is amended to read:
AB840,23,3
1149.146 (2) (b) 1. The rate that a standard risk would be charged under an
2individual policy providing substantially the same coverage and deductibles
3cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).
AB840, s. 64 4Section 64. 149.146 (2) (b) 2. of the statutes is amended to read:
AB840,23,75 149.146 (2) (b) 2. The rate that a standard risk would be charged under an
6individual policy providing substantially the same coverage and deductibles
7cost-sharing provisions as the coverage offered under this section.
AB840, s. 65 8Section 65. 149.15 (1) of the statutes is amended to read:
AB840,24,29 149.15 (1) The plan shall have operate under the direction of a board of
10governors consisting of representatives of 2 participating insurers that are nonprofit
11corporations, representatives of 2 other participating insurers, 3 4 health care
12provider industry representatives, including one representative of the State
13Wisconsin Medical Society of Wisconsin, one representative of the Wisconsin Health
14and Hospital Association, one representative of Pharmaceutical Research and
15Manufacturers of America,
and one representative of an integrated
16multidisciplinary health system, and 4 public members, including one
17representative of small businesses in the state, appointed by the secretary for
18staggered 3-year terms. In addition, the commissioner, or a designated
19representative from the office of the commissioner, and the secretary, or a designated
20representative from the department, shall be members of the board. The public
21members shall not be professionally affiliated with the practice of medicine, a
22hospital, or an insurer. At least one of the public members shall be an individual who
23has coverage under the plan. The secretary or the secretary's representative shall
24be
board annually shall select the chairperson of the board. Board members, except
25the commissioner or the commissioner's representative and the secretary or the

1secretary's representative, shall be compensated at the rate of $50 per diem plus
2actual and necessary expenses.
AB840, s. 66 3Section 66. 149.15 (3) (b) of the statutes is created to read:
AB840,24,114 149.15 (3) (b) Establish by rule the plan design, including covered benefits and
5exclusions. At least every 3 years, the board shall conduct a survey of health care
6plans available in the private market and make any adjustments to the plan that the
7board determines are advisable on the basis of the survey. Using the procedure under
8s. 227.24, the board may promulgate rules under this paragraph for the period before
9the effective date of any permanent rules promulgated under this paragraph, but not
10to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s.
11227.24 (1) and (3), the board is not required to make a finding of emergency.
AB840, s. 67 12Section 67. 149.15 (3) (c) of the statutes is repealed.
AB840, s. 68 13Section 68. 149.15 (3) (e) of the statutes is created to read:
AB840,24,1514 149.15 (3) (e) Select a plan administrator in a competitive,
15request-for-proposals process and enter into a contract with the person selected.
AB840, s. 69 16Section 69. 149.15 (3) (f) of the statutes is repealed.
AB840, s. 70 17Section 70. 149.15 (4) (c) of the statutes is created to read:
AB840,24,1918 149.15 (4) (c) Contract with persons to provide professional services to the
19board and the plan.
AB840, s. 71 20Section 71. 149.15 (4) (d) of the statutes is created to read:
AB840,25,721 149.15 (4) (d) Notwithstanding ss. 625.11 (4) and 628.34 (3) (a) and any
22requirements in this chapter related to setting premium rates or amounts, establish
23for eligible persons with household incomes that exceed $100,000 a separate
24schedule of premium rates that are higher than the rates set for other eligible
25persons. Premium rates established under this paragraph may not exceed 200

1percent of the rate that a standard risk would be charged under an individual policy
2providing substantially the same coverage and cost-sharing provisions that are
3provided under the plan. The board shall use excess premiums collected under a
4schedule established under this paragraph to reduce premiums for eligible persons
5with low household incomes, as determined by the board. Household income under
6this paragraph shall be determined in the same manner as household income is
7determined under s. 149.165 (2) and (3).
AB840, s. 72 8Section 72. 149.15 (5) of the statutes is repealed.
AB840, s. 73 9Section 73. 149.16 of the statutes, as affected by 2003 Wisconsin Act 33, is
10repealed.
AB840, s. 74 11Section 74. 149.165 (1) of the statutes is amended to read:
AB840,25,1512 149.165 (1) Except as provided in s. 149.146 (2) (a), the department board shall
13reduce the premiums established under s. 149.11 in conformity with ss. 149.14 (5m),
14149.143, and 149.17 for the eligible persons and in the manner set forth in subs. (2)
15and (3).
AB840, s. 75 16Section 75. 149.165 (2) of the statutes is amended to read:
AB840,25,2117 149.165 (2) (a) Subject to sub. subs. (3m) and (3r), if the household income, as
18defined in s. 71.52 (5) and as determined under sub. (3), of an eligible person with
19coverage under s. 149.14 (2) (a) is equal to or greater than the first amount and less
20than the 2nd amount listed in any of the following, the department board shall
21reduce the premium for the eligible person to the rate shown after the amounts:
AB840,25,2522 1. If equal to or greater than $0 and less than $10,000, to 100% 100 percent of
23the rate that a standard risk would be charged under an individual policy providing
24substantially the same coverage and deductibles cost-sharing provisions as
25provided under s. 149.14 (2) (a) and (5) (a).
AB840,26,4
12. If equal to or greater than $10,000 and less than $14,000, to 106.5% 106.5
2percent
of the rate that a standard risk would be charged under an individual policy
3providing substantially the same coverage and deductibles cost-sharing provisions
4as provided under s. 149.14 (2) (a) and (5) (a).
AB840,26,85 3. If equal to or greater than $14,000 and less than $17,000, to 115.5% 115.5
6percent
of the rate that a standard risk would be charged under an individual policy
7providing substantially the same coverage and deductibles cost-sharing provisions
8as provided under s. 149.14 (2) (a) and (5) (a).
AB840,26,129 4. If equal to or greater than $17,000 and less than $20,000, to 124.5% 124.5
10percent
of the rate that a standard risk would be charged under an individual policy
11providing substantially the same coverage and deductibles cost-sharing provisions
12as provided under s. 149.14 (2) (a) and (5) (a).
AB840,26,1613 5. If equal to or greater than $20,000 and less than $25,000, to 130% 130
14percent
of the rate that a standard risk would be charged under an individual policy
15providing substantially the same coverage and deductibles cost-sharing provisions
16as provided under s. 149.14 (2) (a) and (5) (a).
AB840,26,2517 (bc) Subject to sub. subs. (3m) and (3r), if the household income, as defined in
18s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage
19under s. 149.14 (2) (b) is equal to or greater than the first amount and less than the
202nd amount listed in par. (a) 1., 2., 3., 4., or 5., the department board shall reduce the
21premium established for the eligible person by the same percentage as the
22department board reduces, under par. (a), the premium established for an eligible
23person with coverage under s. 149.14 (2) (a) who has a household income specified
24in the same subdivision under par. (a) as the household income of the eligible person
25with coverage under s. 149.14 (2) (b).
AB840, s. 76
1Section 76. 149.165 (3) (a) of the statutes is amended to read:
AB840,27,42 149.165 (3) (a) Subject to par. (b), the department board shall establish and
3implement the method for determining the household income of an eligible person
4under sub. (2).
AB840, s. 77 5Section 77. 149.165 (3) (b) (intro.) of the statutes is amended to read:
AB840,27,96 149.165 (3) (b) (intro.) In determining household income under sub. (2), the
7department board shall consider information submitted by an eligible person on a
8completed federal profit or loss from farming form, schedule F, if all of the following
9apply:
AB840, s. 78 10Section 78. 149.165 (3r) of the statutes is created to read:
AB840,27,1311 149.165 (3r) The board shall use any excess premiums collected under a
12schedule established under s. 149.15 (4) (d) to further reduce the premium rates
13under sub. (2) (a) 1. to 5. and (bc).
AB840, s. 79 14Section 79. 149.17 (4) of the statutes is amended to read:
AB840,27,1615 149.17 (4) Cost containment provisions established by the department board
16by rule, including managed care requirements.
AB840, s. 80 17Section 80. 149.175 of the statutes is amended to read:
AB840,27,22 18149.175 Waiver or exemption from provisions prohibited. Except as
19provided in s. 149.13 (1), the department or the board may not waive, or authorize
20the board to waive,
any of the requirements of this chapter or exempt, or authorize
21the board to exempt,
an individual or a class of individuals from any of the
22requirements of this chapter.
AB840, s. 81 23Section 81. 149.20 of the statutes is amended to read:
AB840,28,2 24149.20 Rule-making in consultation with Rules to be approved by
25board.
In promulgating any Any rules proposed by the department under this

1chapter, the department shall consult with may not be promulgated without the
2approval of
the board.
AB840, s. 82 3Section 82. 149.25 (2) (a) of the statutes is amended to read:
AB840,28,74 149.25 (2) (a) The department shall conduct a 3-year pilot program, beginning
5on July 1, 2002, under which eligible persons who qualify under par. (b) are provided
6community-based case management services. The department shall consult with
7the board as necessary in conducting the pilot program.
AB840, s. 83 8Section 83. 149.25 (4) of the statutes is amended to read:
AB840,28,179 149.25 (4) Evaluation study. The department, in consultation with the board,
10shall conduct a study that evaluates the pilot program in terms of health care
11outcomes and cost avoidance. In the study, the department shall measure and
12compare, for pilot program participants and similarly situated eligible persons not
13participating in the pilot program, plan costs and utilization of services, including
14inpatient hospital days, rates of hospital readmission within 30 days for the same
15diagnosis, and prescription drug utilization. The department shall submit a report
16on the results of the study, including the department's conclusions and
17recommendations, to the legislature under s. 13.172 (2) and to the governor.
AB840, s. 84 18Section 84. 450.10 (2m) of the statutes is created to read:
AB840,28,2119 450.10 (2m) If a manufacturer or labeler fails to pay an assessment levied
20under s. 149.132 within the time required for payment, the board may assess a
21forfeiture of not more than $1,000 for each day that the payment is past due.
AB840, s. 85 22Section 85. Nonstatutory provisions.
AB840,29,523 (1) Federal grant funds. Notwithstanding section 149.143 (1) of the statutes,
24as affected by this act, any federal grant moneys received by the state under the
25Trade Adjustment Assistance Reform Act of 2002 and allocated to the Health

1Insurance Risk-Sharing Plan shall be used to pay plan costs before any moneys
2specified under section 149.143 (1) (am) and (bm) of the statutes, as affected by this
3act, are used. After the federal grant money has been used, plan costs shall be paid
4as provided under section 149.143 (1) (am) and (bm) of the statutes, as affected by
5this act.
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