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)
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