SB466, s. 31 22Section 31. 149.143 (1) (bm) (intro.) of the statutes, as affected by 2003
23Wisconsin Act 33
, is amended to read:
SB466,13,2424 149.143 (1) (bm) (intro.) A total of 40% 40 percent as follows:
SB466, s. 32
1Section 32. 149.143 (1) (bm) 1. of the statutes, as affected by 2003 Wisconsin
2Act 33
, is renumbered 149.143 (1) (bm) 2m. a.
SB466, s. 33 3Section 33. 149.143 (1) (bm) 1m. of the statutes is created to read:
SB466,14,54 149.143 (1) (bm) 1m. First, from manufacturer and labeler assessments under
5s. 149.132.
SB466, s. 34 6Section 34. 149.143 (1) (bm) 2. of the statutes, as affected by 2003 Wisconsin
7Act 33
, is renumbered 149.143 (1) (bm) 2m. b.
SB466, s. 35 8Section 35. 149.143 (1) (bm) 2m. (intro.) of the statutes is created to read:
SB466,14,99 149.143 (1) (bm) 2m. (intro.) The remainder as follows:
SB466, s. 36 10Section 36. 149.143 (2) (a) (intro.) of the statutes, as affected by 2003
11Wisconsin Act 33
, is amended to read:
SB466,14,1612 149.143 (2) (a) (intro.) Prior to each plan year, the department board shall
13estimate the operating and administrative costs of the plan and the costs of the
14premium reductions under s. 149.165 (2) and (3), the deductible reductions under s.
15149.14 (5) (a), and any prescription drug copayment reductions under s. 149.14 (5)
16(e) for the new plan year and do all of the following:
SB466, s. 37 17Section 37. 149.143 (2) (a) 1. a. of the statutes, as affected by 2003 Wisconsin
18Act 33
, is amended to read:
SB466,14,2419 149.143 (2) (a) 1. a. Estimate the amount of enrollee premiums that would be
20received in the new plan year if the enrollee premiums were set at a level sufficient,
21when including amounts received for premium, deductible, and prescription drug
22copayment subsidies under s. 149.144 and from premiums collected from eligible
23persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b), to
24cover 60% 60 percent of the estimated plan costs for the new plan year.
SB466, s. 38
1Section 38. 149.143 (2) (a) 2. of the statutes, as affected by 2003 Wisconsin Act
233
, is amended to read:
SB466,15,93 149.143 (2) (a) 2. After making the determinations under subd. 1., by rule set
4premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in
5the manner specified in sub. (1) (am) 1. and 3. and such that a rate for coverage under
6s. 149.14 (2) (a) is approved by the board and is not less than 140% 140 percent nor
7more than 200% 200 percent of the rate that a standard risk would be charged under
8an individual policy providing substantially the same coverage and deductibles
9cost-sharing provisions as are provided under the plan.
SB466, s. 39 10Section 39. 149.143 (2) (a) 3. of the statutes, as affected by 2003 Wisconsin Act
1133
, is amended to read:
SB466,15,1612 149.143 (2) (a) 3. By rule, after estimating the amount of manufacturer and
13labeler assessments that will be received under sub. (1) (bm) 1m.,
set the total
14insurer assessments under s. 149.13 for the new plan year by estimating and setting
15the assessments at the amount necessary to equal the amounts specified in sub. (1)
16(am) 4. and (bm) 1. 2m. a. and notify the commissioner of the amount.
SB466, s. 40 17Section 40. 149.143 (2) (a) 4. of the statutes, as affected by 2003 Wisconsin Act
1833
, is amended to read:
SB466,15,2419 149.143 (2) (a) 4. By the same rule as under subd. 3., after estimating the
20amount of the manufacturer and labeler assessments that will be received under
21sub. (1) (bm) 1m.,
adjust the provider payment rate for the new plan year, subject to
22s. 149.142 (1) (b), by estimating and setting the rate at the level necessary to equal
23the amounts specified in sub. (1) (am) 4. and (bm) 2. 2m. b. and as provided in s.
24149.145.
SB466, s. 41
1Section 41. 149.143 (2) (b) of the statutes, as affected by 2003 Wisconsin Act
233
, is amended to read:
SB466,16,83 149.143 (2) (b) In setting the premium rates under par. (a) 2., the insurer
4assessment amount under par. (a) 3., and the provider payment rate under par. (a)
54. for the new plan year, the department board shall include any increase or decrease
6necessary to reflect the amount, if any, by which the rates and amount set under par.
7(a) for the current plan year differed from the rates and amount which would have
8equaled the amounts specified in sub. (1) (am) and (bm) in the current plan year.
SB466, s. 42 9Section 42. 149.143 (2m) (a) (intro.) of the statutes is amended to read:
SB466,16,1110 149.143 (2m) (a) (intro.) The department board shall keep a separate
11accounting of the difference between the following:
SB466, s. 43 12Section 43. 149.143 (2m) (a) 2. of the statutes, as affected by 2003 Wisconsin
13Act 33
, is amended to read:
SB466,16,1614 149.143 (2m) (a) 2. The amount of premiums, including amounts received for
15premium, deductible, and prescription drug copayment subsidies, necessary to cover
1660% 60 percent of the plan costs for the plan year.
SB466, s. 44 17Section 44. 149.143 (2m) (b) 1. of the statutes, as affected by 2003 Wisconsin
18Act 33
, is amended to read:
SB466,16,2319 149.143 (2m) (b) 1. To reduce premiums in succeeding plan years as provided
20in sub. (1) (am) 2. For eligible persons with coverage under s. 149.14 (2) (a),
21premiums may not be reduced below 140% 140 percent of the rate that a standard
22risk would be charged under an individual policy providing substantially the same
23coverage and deductibles cost-sharing provisions as are provided under the plan.
SB466, s. 45 24Section 45. 149.143 (2m) (b) 2. of the statutes is amended to read:
SB466,17,2
1149.143 (2m) (b) 2. For other needs of eligible persons, with the approval of the
2board
including the purpose specified in s. 149.15 (4) (d).
SB466, s. 46 3Section 46. 149.143 (2m) (b) 3. of the statutes is amended to read:
SB466,17,84 149.143 (2m) (b) 3. For distribution to eligible persons, notwithstanding any
5requirements in this chapter related to setting premium amounts. The department
6board, with the approval of the board and the concurrence of the plan actuary, shall
7determine the policies, eligibility criteria, methodology, and other factors to be used
8in making any distribution under this subdivision.
SB466, s. 47 9Section 47. 149.143 (2m) (c) of the statutes is created to read:
SB466,17,1110 149.143 (2m) (c) The board shall consult with the department as necessary for
11the accounting under par. (a).
SB466, s. 48 12Section 48. 149.143 (3) (a) of the statutes, as affected by 2003 Wisconsin Act
1333
, is amended to read:
SB466,17,2414 149.143 (3) (a) If, during a plan year, the department board determines that
15the amounts estimated to be received as a result of the rates and amount set under
16sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider
17payment rate under s. 149.144 will not be sufficient to cover plan costs, the
18department board may by rule increase the premium rates set under sub. (2) (a) 2.
19for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum
20specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3.
21for the remainder of the plan year, subject to sub. (1) (bm) 1., and by the same rule
22under which assessments are increased adjust the provider payment rate set under
23sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (bm) 2. and s.
24149.142 (1) (b).
SB466, s. 49
1Section 49 . 149.143 (3) (a) of the statutes, as affected by 2003 Wisconsin Act
2.... (this act), is amended to read:
SB466,18,133 149.143 (3) (a) If, during a plan year, the board determines that the amounts
4estimated to be received in manufacturer and labeler assessments and as a result of
5the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer
6assessments and the provider payment rate under s. 149.144 will not be sufficient
7to cover plan costs, the board may by rule increase the premium rates set under sub.
8(2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the
9maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub.
10(2) (a) 3. for the remainder of the plan year, subject to sub. (1) (bm) 1. 2m. a., and by
11the same rule under which assessments are increased adjust the provider payment
12rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (bm)
132. 2m. b. and s. 149.142 (1) (b).
SB466, s. 50 14Section 50. 149.143 (3) (b) of the statutes, as affected by 2003 Wisconsin Act
1533
, is amended to read:
SB466,18,2216 149.143 (3) (b) If the department board increases premium rates and insurer
17assessments and adjusts the provider payment rate under par. (a) and determines
18that there will still be a deficit and that premium rates have been increased to the
19maximum extent allowable under par. (a), the department board may further adjust,
20in equal proportions, assessments set under sub. (2) (a) 3. and the provider payment
21rate set under sub. (2) (a) 4., without regard to sub. (1) (bm) but subject to s. 149.142
22(1) (b).
SB466, s. 51 23Section 51. 149.143 (4) of the statutes is amended to read:
SB466,19,324 149.143 (4) Using the procedure under s. 227.24, the department board may
25promulgate rules under sub. (2) or (3) for the period before the effective date of any

1permanent rules promulgated under sub. (2) or (3), but not to exceed the period
2authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the
3department board is not required to make a finding of emergency.
SB466, s. 52 4Section 52. 149.143 (5) (a) of the statutes is amended to read:
SB466,19,135 149.143 (5) (a) Annually, no later than April 30, the department board shall
6perform a reconciliation with respect to plan costs, premiums, insurer assessments,
7and provider payment rate adjustments based on data from the previous calendar
8year. On the basis of the reconciliation, the department board shall make any
9necessary adjustments in premiums, insurer assessments, or provider payment
10rates, subject to s. 149.142 (1) (b), for the fiscal year beginning on the first July 1 after
11the reconciliation, as provided in sub. (2) (b). The board shall consult with the
12department as necessary in performing the reconciliation and in making the
13adjustments under this paragraph.
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).
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