SB466, s. 53 14Section 53 . 149.143 (5) (a) of the statutes, as affected by 2003 Wisconsin Act
15.... (this act), is amended to read:
SB466,19,2416 149.143 (5) (a) Annually, no later than April 30, the board shall perform a
17reconciliation with respect to plan costs, premiums, insurer assessments,
18manufacturer and labeler assessments, and provider payment rate adjustments
19based on data from the previous calendar year. On the basis of the reconciliation, the
20board shall make any necessary adjustments in premiums, insurer assessments, or
21provider payment rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on
22the first July 1 after the reconciliation, as provided in sub. (2) (b). The board shall
23consult with the department as necessary in performing the reconciliation and in
24making the adjustments under this paragraph.
SB466, s. 54 25Section 54. 149.143 (5) (b) of the statutes is amended to read:
SB466,20,6
1149.143 (5) (b) Except as provided in sub. (3) and s. 149.144, the department
2board shall adjust the provider payment rates to meet the providers' specified portion
3of the plan costs no more than once annually, subject to s. 149.142 (1) (b). The
4department board may not determine the adjustment on an individual provider basis
5or on the basis of provider type, but shall determine the adjustment for all providers
6in the aggregate, subject to s. 149.142 (1) (b).
SB466, s. 55 7Section 55. 149.144 of the statutes, as affected by 2003 Wisconsin Act 33, is
8amended to read:
SB466,20,18 9149.144 Adjustments to insurer assessments and provider payment
10rates for premium, deductible, and prescription drug copayment
11reductions.
The department board shall, by rule, adjust in equal proportions the
12amount of the assessment assessments set under s. 149.143 (2) (a) 3. and the provider
13payment rate set under s. 149.143 (2) (a) 4., subject to ss. 149.142 (1) (b) and 149.143
14(1) (am), sufficient to reimburse the plan for premium reductions under s. 149.165
15(2) and (3), deductible reductions under s. 149.14 (5) (a), and any prescription drug
16copayment reductions under s. 149.14 (5) (e). The department board shall notify the
17commissioner so that the commissioner may levy any increase in insurer
18assessments.
SB466, s. 56 19Section 56. 149.145 of the statutes, as affected by 2003 Wisconsin Act 33, is
20amended to read:
SB466,21,8 21149.145 Program budget. The department, in consultation with the board,
22shall establish a program budget for each plan year. The program budget shall be
23based on the provider payment rates specified in s. 149.142 and in the most recent
24provider contracts that are in effect and on the funding sources specified in ss.
25149.143 (1) and 149.144, including the methodologies specified in ss. 149.143,

1149.144, and 149.146 for determining premium rates, insurer assessments, and
2provider payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b)
3and subject to s. 149.142 (1) (b), from the program budget the department board shall
4derive the actual provider payment rate for a plan year that reflects the providers'
5proportional share of the plan costs, consistent with ss. 149.143 and 149.144. The
6department may not implement a program budget established under this section
7unless it is approved by the
board shall consult with the department as necessary in
8deriving the actual provider payment rate
.
SB466, s. 57 9Section 57 . 149.145 of the statutes, as affected by 2003 Wisconsin Act .... (this
10act), is amended to read:
SB466,21,21 11149.145 Program budget. The board shall establish a program budget for
12each plan year. The program budget shall be based on the provider payment rates
13specified in s. 149.142 and in the most recent provider contracts that are in effect and
14on the funding sources specified in ss. 149.143 (1) and 149.144, including the
15methodologies specified in ss. 149.143, 149.144, and 149.146 for determining
16premium rates, insurer and manufacturer and labeler assessments, and provider
17payment rates. Except as otherwise provided in s. 149.143 (3) (a) and (b) and subject
18to s. 149.142 (1) (b), from the program budget the board shall derive the actual
19provider payment rate for a plan year that reflects the providers' proportional share
20of the plan costs, consistent with ss. 149.143 and 149.144. The board shall consult
21with the department as necessary in deriving the actual provider payment rate.
SB466, s. 58 22Section 58. 149.146 (1) (b) of the statutes is amended to read:
SB466,22,623 149.146 (1) (b) An eligible person under par. (a) may elect once each year, at
24the time and according to procedures established by the department board, among
25the coverages offered under this section and s. 149.14. If an eligible person elects new

1coverage, any preexisting condition exclusion imposed under the new coverage is met
2to the extent that the eligible person has been previously and continuously covered
3under this chapter. No preexisting condition exclusion may be imposed on an eligible
4person who elects new coverage if the person was an eligible individual when first
5covered under this chapter and the person remained continuously covered under this
6chapter up to the time of electing the new coverage.
SB466, s. 59 7Section 59. 149.146 (2) (a) of the statutes, as affected by 2003 Wisconsin Act
833
, is amended to read:
SB466,22,139 149.146 (2) (a) Except as specified by the department board, the terms of
10coverage under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and
11prescription drug copayment reductions under s. 149.14 (5) (e), do not apply to the
12coverage offered under this section. Premium reductions under s. 149.165 do not
13apply to the coverage offered under this section.
SB466, s. 60 14Section 60. 149.146 (2) (am) 4. of the statutes is amended to read:
SB466,22,1915 149.146 (2) (am) 4. Notwithstanding subds. 1. to 3., the department board may
16establish different deductible amounts, a different coinsurance percentage, and
17different covered costs and deductible aggregate amounts from those specified in
18subds. 1. to 3. in accordance with cost containment provisions established by the
19department board under s. 149.17 (4).
SB466, s. 61 20Section 61. 149.146 (2) (am) 5. of the statutes is amended to read:
SB466,23,421 149.146 (2) (am) 5. Subject to s. 149.14 (8) (b), the department board may, by
22rule under s. 149.17 (4), establish for prescription drug coverage under this section
23copayment amounts, coinsurance rates, and copayment and coinsurance
24out-of-pocket limits over which the plan will pay 100% 100 percent of covered costs
25for prescription drugs. Any copayment amount, coinsurance rate, or out-of-pocket

1limit established under this subdivision is subject to the approval of the board.

2Copayments and coinsurance paid by an eligible person under this subdivision are
3separate from and do not count toward the deductible and covered costs not paid by
4the plan under subds. 1. to 3.
SB466, s. 62 5Section 62. 149.146 (2) (b) (intro.) of the statutes is amended to read:
SB466,23,106 149.146 (2) (b) (intro.) The schedule of premiums for coverage under this
7section shall be promulgated by rule by the department board, as provided in s.
8149.143. The rates for coverage under this section shall be set such that they differ
9from the rates for coverage under s. 149.14 (2) (a) by the same percentage as the
10percentage difference between the following:
SB466, s. 63 11Section 63. 149.146 (2) (b) 1. of the statutes is amended to read:
SB466,23,1412 149.146 (2) (b) 1. The rate that a standard risk would be charged under an
13individual policy providing substantially the same coverage and deductibles
14cost-sharing provisions as provided under s. 149.14 (2) (a) and (5) (a).
SB466, s. 64 15Section 64. 149.146 (2) (b) 2. of the statutes is amended to read:
SB466,23,1816 149.146 (2) (b) 2. The rate that a standard risk would be charged under an
17individual policy providing substantially the same coverage and deductibles
18cost-sharing provisions as the coverage offered under this section.
SB466, s. 65 19Section 65. 149.15 (1) of the statutes is amended to read:
SB466,24,1320 149.15 (1) The plan shall have operate under the direction of a board of
21governors consisting of representatives of 2 participating insurers that are nonprofit
22corporations, representatives of 2 other participating insurers, 3 4 health care
23provider industry representatives, including one representative of the State
24Wisconsin Medical Society of Wisconsin, one representative of the Wisconsin Health
25and Hospital Association, one representative of Pharmaceutical Research and

1Manufacturers of America,
and one representative of an integrated
2multidisciplinary health system, and 4 public members, including one
3representative of small businesses in the state, appointed by the secretary for
4staggered 3-year terms. In addition, the commissioner, or a designated
5representative from the office of the commissioner, and the secretary, or a designated
6representative from the department, shall be members of the board. The public
7members shall not be professionally affiliated with the practice of medicine, a
8hospital, or an insurer. At least one of the public members shall be an individual who
9has coverage under the plan. The secretary or the secretary's representative shall
10be
board annually shall select the chairperson of the board. Board members, except
11the commissioner or the commissioner's representative and the secretary or the
12secretary's representative, shall be compensated at the rate of $50 per diem plus
13actual and necessary expenses.
SB466, s. 66 14Section 66. 149.15 (3) (b) of the statutes is created to read:
SB466,24,2215 149.15 (3) (b) Establish by rule the plan design, including covered benefits and
16exclusions. At least every 3 years, the board shall conduct a survey of health care
17plans available in the private market and make any adjustments to the plan that the
18board determines are advisable on the basis of the survey. Using the procedure under
19s. 227.24, the board may promulgate rules under this paragraph for the period before
20the effective date of any permanent rules promulgated under this paragraph, but not
21to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s.
22227.24 (1) and (3), the board is not required to make a finding of emergency.
SB466, s. 67 23Section 67. 149.15 (3) (c) of the statutes is repealed.
SB466, s. 68 24Section 68. 149.15 (3) (e) of the statutes is created to read:
SB466,25,2
1149.15 (3) (e) Select a plan administrator in a competitive,
2request-for-proposals process and enter into a contract with the person selected.
SB466, s. 69 3Section 69. 149.15 (3) (f) of the statutes is repealed.
SB466, s. 70 4Section 70. 149.15 (4) (c) of the statutes is created to read:
SB466,25,65 149.15 (4) (c) Contract with persons to provide professional services to the
6board and the plan.
SB466, s. 71 7Section 71. 149.15 (4) (d) of the statutes is created to read:
SB466,25,198 149.15 (4) (d) Notwithstanding ss. 625.11 (4) and 628.34 (3) (a) and any
9requirements in this chapter related to setting premium rates or amounts, establish
10for eligible persons with household incomes that exceed $100,000 a separate
11schedule of premium rates that are higher than the rates set for other eligible
12persons. Premium rates established under this paragraph may not exceed 200
13percent of the rate that a standard risk would be charged under an individual policy
14providing substantially the same coverage and cost-sharing provisions that are
15provided under the plan. The board shall use excess premiums collected under a
16schedule established under this paragraph to reduce premiums for eligible persons
17with low household incomes, as determined by the board. Household income under
18this paragraph shall be determined in the same manner as household income is
19determined under s. 149.165 (2) and (3).
SB466, s. 72 20Section 72. 149.15 (5) of the statutes is repealed.
SB466, s. 73 21Section 73. 149.16 of the statutes, as affected by 2003 Wisconsin Act 33, is
22repealed.
SB466, s. 74 23Section 74. 149.165 (1) of the statutes is amended to read:
SB466,26,224 149.165 (1) Except as provided in s. 149.146 (2) (a), the department board shall
25reduce the premiums established under s. 149.11 in conformity with ss. 149.14 (5m),

1149.143, and 149.17 for the eligible persons and in the manner set forth in subs. (2)
2and (3).
SB466, s. 75 3Section 75. 149.165 (2) of the statutes is amended to read:
SB466,26,84 149.165 (2) (a) Subject to sub. subs. (3m) and (3r), if the household income, as
5defined in s. 71.52 (5) and as determined under sub. (3), of an eligible person with
6coverage under s. 149.14 (2) (a) is equal to or greater than the first amount and less
7than the 2nd amount listed in any of the following, the department board shall
8reduce the premium for the eligible person to the rate shown after the amounts:
SB466,26,129 1. If equal to or greater than $0 and less than $10,000, to 100% 100 percent of
10the rate that a standard risk would be charged under an individual policy providing
11substantially the same coverage and deductibles cost-sharing provisions as
12provided under s. 149.14 (2) (a) and (5) (a).
SB466,26,1613 2. If equal to or greater than $10,000 and less than $14,000, to 106.5% 106.5
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).
SB466,26,2017 3. If equal to or greater than $14,000 and less than $17,000, to 115.5% 115.5
18percent
of the rate that a standard risk would be charged under an individual policy
19providing substantially the same coverage and deductibles cost-sharing provisions
20as provided under s. 149.14 (2) (a) and (5) (a).
SB466,26,2421 4. If equal to or greater than $17,000 and less than $20,000, to 124.5% 124.5
22percent
of the rate that a standard risk would be charged under an individual policy
23providing substantially the same coverage and deductibles cost-sharing provisions
24as provided under s. 149.14 (2) (a) and (5) (a).
SB466,27,4
15. If equal to or greater than $20,000 and less than $25,000, to 130% 130
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).
SB466,27,135 (bc) Subject to sub. subs. (3m) and (3r), if the household income, as defined in
6s. 71.52 (5) and as determined under sub. (3), of an eligible person with coverage
7under s. 149.14 (2) (b) is equal to or greater than the first amount and less than the
82nd amount listed in par. (a) 1., 2., 3., 4., or 5., the department board shall reduce the
9premium established for the eligible person by the same percentage as the
10department board reduces, under par. (a), the premium established for an eligible
11person with coverage under s. 149.14 (2) (a) who has a household income specified
12in the same subdivision under par. (a) as the household income of the eligible person
13with coverage under s. 149.14 (2) (b).
SB466, s. 76 14Section 76. 149.165 (3) (a) of the statutes is amended to read:
SB466,27,1715 149.165 (3) (a) Subject to par. (b), the department board shall establish and
16implement the method for determining the household income of an eligible person
17under sub. (2).
SB466, s. 77 18Section 77. 149.165 (3) (b) (intro.) of the statutes is amended to read:
SB466,27,2219 149.165 (3) (b) (intro.) In determining household income under sub. (2), the
20department board shall consider information submitted by an eligible person on a
21completed federal profit or loss from farming form, schedule F, if all of the following
22apply:
SB466, s. 78 23Section 78. 149.165 (3r) of the statutes is created to read:
SB466,28,3
1149.165 (3r) The board shall use any excess premiums collected under a
2schedule established under s. 149.15 (4) (d) to further reduce the premium rates
3under sub. (2) (a) 1. to 5. and (bc).
SB466, s. 79 4Section 79. 149.17 (4) of the statutes is amended to read:
SB466,28,65 149.17 (4) Cost containment provisions established by the department board
6by rule, including managed care requirements.
SB466, s. 80 7Section 80. 149.175 of the statutes is amended to read:
SB466,28,12 8149.175 Waiver or exemption from provisions prohibited. Except as
9provided in s. ss. 149.13 (1) and 149.132 (1) (b), the department or the board may not
10waive, or authorize the board to waive, any of the requirements of this chapter or
11exempt, or authorize the board to exempt, an individual or a class of individuals from
12any of the requirements of this chapter.
SB466, s. 81 13Section 81. 149.20 of the statutes is amended to read:
SB466,28,17 14149.20 Rule-making in consultation with Rules to be approved by
15board.
In promulgating any Any rules proposed by the department under this
16chapter, the department shall consult with may not be promulgated without the
17approval of
the board.
SB466, s. 82 18Section 82. 149.25 (2) (a) of the statutes is amended to read:
SB466,28,2219 149.25 (2) (a) The department shall conduct a 3-year pilot program, beginning
20on July 1, 2002, under which eligible persons who qualify under par. (b) are provided
21community-based case management services. The department shall consult with
22the board as necessary in conducting the pilot program.
SB466, s. 83 23Section 83. 149.25 (4) of the statutes is amended to read:
SB466,29,724 149.25 (4) Evaluation study. The department, in consultation with the board,
25shall conduct a study that evaluates the pilot program in terms of health care

1outcomes and cost avoidance. In the study, the department shall measure and
2compare, for pilot program participants and similarly situated eligible persons not
3participating in the pilot program, plan costs and utilization of services, including
4inpatient hospital days, rates of hospital readmission within 30 days for the same
5diagnosis, and prescription drug utilization. The department shall submit a report
6on the results of the study, including the department's conclusions and
7recommendations, to the legislature under s. 13.172 (2) and to the governor.
SB466, s. 84 8Section 84. 450.10 (2m) of the statutes is created to read:
SB466,29,119 450.10 (2m) If a manufacturer or labeler fails to pay an assessment levied
10under s. 149.132 within the time required for payment, the board may assess a
11forfeiture of not more than $1,000 for each day that the payment is past due.
SB466, s. 85 12Section 85. Nonstatutory provisions.
SB466,29,2013 (1) Federal grant funds. Notwithstanding section 149.143 (1) of the statutes,
14as affected by this act, any federal grant moneys received by the state under the
15Trade Adjustment Assistance Reform Act of 2002 and allocated to the Health
16Insurance Risk-Sharing Plan shall be used to pay plan costs before any moneys
17specified under section 149.143 (1) (am) and (bm) of the statutes, as affected by this
18act, are used. After the federal grant money has been used, plan costs shall be paid
19as provided under section 149.143 (1) (am) and (bm) of the statutes, as affected by
20this act.
SB466,29,2421 (2) Selection of plan administrator. The board of governors of the Health
22Insurance Risk-Sharing Plan shall, no later than July 1, 2004, issue a
23request-for-proposals under section 149.15 (3) (e) of the statutes, as created by this
24act, for administration of the Health Insurance Risk-Sharing Plan.
SB466,30,6
1(3) Drug manufacturer and labeler assessments. Notwithstanding section
2149.132 of the statutes, as created by this act, the first assessment under section
3149.132 of the statutes, as created by this act, that is payable by prescription drug
4manufacturers and labelers shall be calculated on prescription drug claims paid by
5the Health Insurance Risk-Sharing Plan from July 1, 2004, to December 31, 2004,
6rather than on total prescription drug claims paid in 2004.
SB466, s. 86 7Section 86 . Initial applicability.
SB466,30,128 (1) Design. With respect to changes in plan design, including covered expenses
9and exclusions, deductibles, copayments, coinsurance, and out-of-pocket limits, the
10treatment of sections 149.11, 149.14 (3) (intro.) and (a) to (r), (4), (5) (d) and (e), and
11(8), 149.146 (1) (b) and (2) (a), (am) 4. and 5., and (b) (intro.) and 1., 149.15 (3) (b), and
12149.17 (4) of the statutes first applies to the plan year beginning on January 1, 2005.
SB466,30,1513 (2) Eligibility. The treatment of section 149.12 (1) (a), (am), (b), and (c) of the
14statutes first applies to applications for coverage under the Health Insurance
15Risk-Sharing Plan that are received on the effective date of this subsection.
SB466,30,2016 (3) Drug manufacturer and labeler assessments. The treatment of sections
1725.55 (3), 149.10 (5f) and (5r), 149.132, 149.143 (1) (bm) 1., 1m., 2., and 2m. (intro.),
18(2) (a) 3. and 4., (3) (a) (by Section 49), and (5) (a) (by Section 53), 149.145 (by Section
1957), and 450.10 (2m) of the statutes first applies to drug manufacturer and labeler
20assessments that are payable with respect to claims paid on July 1, 2004.
SB466, s. 87 21Section 87. Effective dates. This act takes effect on the day after publication,
22except as follows:
SB466,30,2523 (1) Eligibility. The treatment of section 149.12 (1) (a), (am), (b), and (c) of the
24statutes and Section 86 (2) of this act take effect on the first day of the 4th month
25beginning after publication.
SB466,31,4
1(2) Drug manufacturer and labeler assessments. The treatment of sections
225.55 (3), 149.10 (5f) and (5r), 149.132, 149.143 (1) (bm) 1., 1m., 2., and 2m. (intro.),
3(2) (a) 3. and 4., (3) (a) (by Section 49), and (5) (a) (by Section 53), 149.145 (by Section
457), and 450.10 (2m) of the statutes takes effect on July 1, 2004.
SB466,31,55 (End)
Loading...
Loading...