AB1140,15,1010 (j) The limited dental care specified in sub. (4).
AB1140,15,1311 (k) Other preventive services or procedures, as determined by the corporation,
12for which there is scientific evidence that exemption from cost sharing is likely to
13reduce health care costs or avoid health risks.
AB1140,15,17 14(3) Pharmacy benefit. (a) Except as provided in par. (b), the corporation shall
15assume the risk for, and pay for, prescription drugs provided to eligible residents.
16For this purpose, the corporation shall retain the portion of the amount credited
17under s. 260.10 (1) (a) that is actuarially allocated for prescription drug coverage.
AB1140,15,2218 (b) If the corporation determines that the method of providing prescription
19drug coverage under par. (a) is not cost-effective, the corporation may require the
20health care plans to provide prescription drug coverage to eligible residents and shall
21pay the portion of the amount credited under s. 260.10 (1) (a) that is actuarially
22allocated for prescription drug coverage to the eligible residents' health care plans.
AB1140,16,2 23(4) Dental benefit. Every health care plan shall provide coverage of dental
24examinations and the application of varnishes and sealants, as determined by the

1corporation, for eligible residents who are at least 2 years of age but not more than
216 years of age.
AB1140,16,7 3(5) Benefit and health savings account deposit reductions. (a) If the
4corporation determines, based on information and recommendations received from
5its actuaries, that the cash balance in the health insurance purchasing trust fund is
6likely to be insufficient for providing the health care benefits under subs. (1) to (4),
7the corporation shall inform the governor and the legislature of all of the following:
AB1140,16,88 1. That expenses will exceed revenues for one or more specified years.
AB1140,16,119 2. What increase in revenues would be required to maintain the current health
10savings account and benefit levels and bring revenues and expenses into balance for
11the year or years specified in subd. 1.
AB1140,16,1512 3. Alternative reductions in the amount deposited into health savings accounts
13under s. 260.10 (1) (b) 2. or in the benefits under this section that would be
14appropriate to bring revenues and expenses into balance for the year or years
15specified in subd. 1.
AB1140,16,1916 4. The revenue increase, health savings account deposit reduction, or benefit
17reductions, or the combination of increase and reductions, that the corporation
18recommends to bring revenues and expenses into balance for the year or years
19specified in subd. 1.
AB1140,16,2420 5. The health savings account deposit reduction or benefit reductions that the
21corporation prefers to bring revenues and expenses into balance for the year or years
22specified in subd. 1. if legislation that increases revenues, reduces the health savings
23account deposit under s. 260.10 (1) (b) 2., or reduces benefits provided under this
24section is not enacted before the beginning of the first year specified in subd. 1.
AB1140,17,4
1(b) If legislation to bring revenues and expenses into balance for the year or
2years specified in par. (a) 1. is not enacted before the beginning of the first year
3specified, the corporation shall implement the health savings account deposit
4reduction or benefit reductions specified in par. (a) 5.
AB1140,17,8 5260.25 Cost sharing. (1) Premiums. (a) An eligible resident who selects or
6is assigned to coverage under a Tier 1 health care plan shall pay no premium in
7addition to the amount paid by the corporation under s. 260.10 (1) (a) to the eligible
8resident's health care plan.
AB1140,17,129 (b) An eligible resident who selects coverage under a Tier 2 or Tier 3 health care
10plan shall be required to pay to the selected Tier 2 or Tier 3 health care plan, as a
11condition of enrollment, the out-of-pocket monthly premium determined by the
12corporation under s. 260.15 (2) (b).
AB1140,17,14 13(2) Deductibles. Except as provided in s. 260.20 (2) and subject to sub. (4), in
14a year, an eligible resident shall pay the following annual deductible amount:
AB1140,17,1615 (a) For an eligible resident who is 18 years of age or older on January 1 of that
16year, $1,200.
AB1140,17,1817 (b) For an eligible resident who is under 18 years of age on January 1 of that
18year, $100.
AB1140,17,21 19(3) Coinsurance and copayments. Except as provided in s. 260.20 (2) and
20subject to sub. (4), in a year, after the deductible under sub. (2) has been satisfied,
21an eligible resident shall pay all of the following:
AB1140,17,2422 (a) Coinsurance that is equal to at least 10 percent but not more than 20 percent
23of medical, hospital, related health care services, and prescription drug costs, as
24determined by the corporation.
AB1140,18,5
1(b) For each prescription of a brand-name drug that is on the preferred list
2determined by the corporation under s. 260.20 (3) (a) or by the eligible resident's
3health care plan under s. 260.20 (3) (b), in addition to the coinsurance required under
4par. (a), either coinsurance of at least 10 percent but not more than 20 percent or a
5copayment, as determined by the corporation.
AB1140,18,106 (c) For each prescription of a brand-name drug that is not on the preferred list
7determined by the corporation under s. 260.20 (3) (a) or by the eligible resident's
8health care plan under s. 260.20 (3) (b), in addition to the coinsurance required under
9par. (a), either coinsurance of at least 20 percent but not more than 40 percent or a
10copayment, as determined by the corporation.
AB1140,18,13 11(4) Maximum amounts. (a) Subject to par. (c), an eligible resident under sub.
12(2) (a) may not be required to pay more than $2,000 per year in total cost sharing
13under subs. (2) and (3).
AB1140,18,1514 (b) Subject to par. (c), an eligible resident under sub. (2) (b) may not be required
15to pay more than $500 per year in total cost sharing under subs. (2) and (3).
AB1140,18,1716 (c) A family consisting of 2 or more eligible residents may not be required to pay
17more than $3,000 per year in total cost sharing under subs. (2) and (3).
AB1140,18,23 18(5) Adjustments. (a) Notwithstanding subs. (2) to (4), the corporation shall
19reduce the deductible, coinsurance, copayment, or maximum cost-sharing amounts,
20or any combination of those amounts, for low-income eligible residents, as
21determined by the corporation, to ensure that the cost sharing required does not
22deter low-income eligible residents from seeking and using appropriate health care
23services.
AB1140,19,324 (b) Notwithstanding subs. (2) to (4), beginning in 2010, the corporation
25annually shall adjust the deductible and maximum cost-sharing amounts to reflect

1the annual percentage change in the U.S. consumer price index for all urban
2consumers, U.S. city average, as determined by the U.S. department of labor, for the
312-month period ending on December 31 of the preceding year.
AB1140,19,9 4260.30 Preexisting condition exclusion. (1) To whom applicable. Subject
5to sub. (2), a health care plan may not provide coverage for any preexisting condition,
6as defined by the corporation, of an eligible resident who, at any time during the
718-month period before becoming an eligible resident, resided outside of Wisconsin
8and did not have health insurance coverage that was substantially similar to the
9coverage provided under this chapter, as determined by the corporation.
AB1140,19,12 10(2) Length of exclusion. A preexisting condition exclusion under sub. (1) may
11not extend beyond the date on which the eligible resident has been continuously
12covered under this chapter for a total of 18 months.
AB1140,19,21 13260.40 Health care advisory committee; health care policies. (1)
14Establishment of committee. (a) The corporation shall establish a health care
15advisory committee to advise it on all matters related to promoting healthier
16lifestyles; promoting health care quality; increasing the transparency of health care
17cost and quality information; preventive care; disease management; the appropriate
18use of primary care, medical specialists, prescription drugs, and hospital emergency
19rooms; confidentiality of medical information; the appropriate use of technology;
20benefit design; the availability of physicians, hospitals, and other providers; and
21reducing health care costs.
AB1140,19,2222 (b) The committee shall consist of the following:
AB1140,19,2323 1. Three members designated by the Wisconsin Medical Society.
AB1140,19,2424 2. Three members designated by the Wisconsin Hospital Association.
AB1140,20,2
13. One member designated by the dean of the University of Wisconsin School
2of Medicine and Public Health.
AB1140,20,43 4. One member designated by the president of the Medical College of
4Wisconsin.
AB1140,20,55 5. One member designated by the Wisconsin Nurses Association.
AB1140,20,76 6. One member designated by the Wisconsin Federation of Nurses and Health
7Professionals.
AB1140,20,88 7. One member designated by the Wisconsin Chiropractic Association.
AB1140,20,99 8. One member designated by the Wisconsin Dental Association.
AB1140,20,1610 (c) The committee members shall elect a chairperson from among the members.
11The chairperson, or his or her designee, shall attend every meeting of the board to
12communicate to the corporation the advice and recommendations of the committee.
13The chairperson, or his or her designee, shall communicate to the committee any
14questions on which the corporation is seeking the committee's advice or
15recommendations. The corporation shall vote on each recommendation submitted
16to it by the committee as to whether the recommendation should be implemented.
AB1140,20,2117 (d) Annually, on or before September 1, the committee shall submit to the
18corporation a summary of all of its recommendations during the previous 12 months
19for improving the health insurance purchasing arrangement under this chapter. The
20corporation shall include those recommendations and the votes taken by the
21corporation on them in its annual report under s. 260.05 (2) (f).
AB1140,20,23 22(2) Adoption of health care policies. The corporation shall do all of the
23following:
AB1140,21,324 (a) In consultation with the health care advisory committee and experts on
25creating effective incentives for individuals and employers relating to healthier

1lifestyles, adopt evidence-based policies that create incentives for eligible residents
2to adopt healthier lifestyles and for employers to institute work-based programs
3that have been shown to improve the health status of employees and their families.
AB1140,21,124 (b) In consultation with the health care advisory committee and experts on
5increasing the transparency of health care cost and quality information, and in
6collaboration with the health care advisory committee and health care plans and
7health care providers, adopt policies that provide eligible residents with current,
8comprehensive, easily accessible, and easily understandable information about the
9cost and quality of the care provided by Wisconsin health care providers and by any
10physicians, clinics, or hospitals outside of Wisconsin that are included in a network
11of a health care plan offered under the health insurance purchasing arrangement
12under this chapter.
AB1140,21,1613 (c) In consultation with the health care advisory committee, the Wisconsin
14Health Information Organization, the Wisconsin Collaborative for Health Care
15Quality, and other medical and nonmedical experts on health care quality, promote
16evidence-based improvements in the quality of health care delivery in Wisconsin.
AB1140,21,24 17260.60 Including certain residents who are eligible for Medical
18Assistance.
(1) Plan. The corporation and the department of health and family
19services shall jointly develop a plan for providing health care coverage under the
20health insurance purchasing arrangement established under this chapter to
21individuals who satisfy the criteria under s. 260.01 (3) (a) 1. to 4. and who are eligible
22for Medical Assistance under subch. IV of ch. 49 in the low-income families category,
23as determined under 2005 Wisconsin Act .... (this act), section 14 (1 ) (b), or for health
24care coverage under the Badger Care health care program under s. 49.665.
AB1140,22,5
1(2) Waiver request. The department of health and family services shall, no
2later than July 1, 2010, submit to the legislature under s. 13.172 (2) the plan
3developed under sub. (1), together with its recommendations concerning the
4desirability of requesting waivers from the secretary of the federal department of
5health and human services for all of the following purposes:
AB1140,22,66 (a) To implement the plan developed under sub. (1).
AB1140,22,97 (b) To allow the use of federal financial participation to fund, to the maximum
8extent possible, health care coverage under the arrangement established under this
9chapter for individuals specified in sub. (1).
AB1140,22,14 10(3) Proposed legislation. If the legislature authorizes or requires the
11department of health and family services to request the waivers specified in sub. (2)
12and if the waivers are granted, the department of health and family services shall
13submit to the appropriate standing committees under s. 13.172 (3) proposed
14legislation that will implement the provisions approved under the waivers.
AB1140, s. 12 15Section 12. 632.755 (1g) (a) of the statutes is amended to read:
AB1140,22,1916 632.755 (1g) (a) A Except as provided under ch. 260, a disability insurance
17policy may not exclude a person or a person's dependent from coverage because the
18person or the dependent is eligible for assistance under ch. 49 or because the
19dependent is eligible for early intervention services under s. 51.44.
AB1140, s. 13 20Section 13. 632.755 (1g) (b) of the statutes is amended to read:
AB1140,22,2421 632.755 (1g) (b) A Except as provided under ch. 260, a disability insurance
22policy may not terminate its coverage of a person or a person's dependent because the
23person or the dependent is eligible for assistance under ch. 49 or because the
24dependent is eligible for early intervention services under s. 51.44.
AB1140, s. 14 25Section 14 . Nonstatutory provisions.
AB1140,23,2
1(1) Proposed legislation on eligibility of and appropriations for Medical
2Assistance and Badger Care recipients.
AB1140,23,43 (a) Definition. In this subsection, "department" means the department of
4health and family services.
AB1140,23,55 (b) Eligibility categories for Medical Assistance.
AB1140,23,8 61. The department shall review the statutes and determine which statutory
7provisions specify eligibility criteria for Medical Assistance by each of the following
8categories of persons:
AB1140,23,9 9a. Low-income families.
AB1140,23,10 10b. Elderly or disabled persons.
AB1140,23,19 112. No later than April 1, 2008, the department shall submit the findings of its
12review under subdivision 1. to the appropriate standing committees of the
13legislature in the manner provided under section 13.172 (3) of the statutes. If the
14department determines that one or more statutory provisions provide eligibility
15criteria that apply to both categories of persons under subdivision 1., along with its
16findings the department shall submit proposed legislation specifying eligibility
17criteria for Medical Assistance that clearly separates the 2 categories of persons
18under subdivision 1. so that any single statutory unit applies to only one of the 2
19categories.
AB1140,23,2020 (c) Appropriations for Medical Assistance and Badger Care.
AB1140,24,2 211. The department and the legislative fiscal bureau shall review the following
22Medical Assistance and Badger Care health care program appropriations to
23determine what amount of each of the total amounts appropriated under each of the
24appropriations is attributable to benefits provided to, or the administrative costs of

1providing benefits to, Medical Assistance recipients in the category under paragraph
2(b) 1 . a. or Badger Care health care program recipients:
AB1140,24,3 3a. Section 20.435 (2) (gk) of the statutes.
AB1140,24,5 4b. Section 20.435 (4) (a), (b), (bc), (bm), (bn), (gp), (iL), (im), (in), (kt), (L), (vt),
5(w), (wm), (wp), and (x) of the statutes.
AB1140,24,6 6c. Section 20.435 (6) (ga) and (k) of the statutes.
AB1140,24,7 7d. Section 20.435 (7) (b) of the statutes.
AB1140,24,11 82. No later than April 1, 2008, the department and the legislative fiscal bureau
9shall submit the findings of the review under subdivision 1. to the appropriate
10standing committees of the legislature in the manner provided under section 13.172
11(3) of the statutes, along with proposed legislation that does all of the following:
AB1140,24,16 12a. Creates, effective January 1, 2009, separate Medical Assistance
13appropriations for the state's share of benefits and administrative costs for the
14category of persons under paragraph (b ) 1. a ., along with the appropriate amounts
15in the schedule, and funds those appropriations from the health insurance
16purchasing trust fund.
AB1140,24,20 17b. Creates, effective January 1, 2009, separate appropriations for the state's
18share of benefits and administrative costs for the Badger Care health care program,
19along with the appropriate amounts in the schedule, and funds those appropriations
20from the health insurance purchasing trust fund.
AB1140,25,2 21c. Modifies, effective January 1, 2009, the Medical Assistance and Badger Care
22health care program appropriations in current law that are affected by the creation
23of the appropriations under subdivision 2 . a. and b., along with the amounts in the
24schedule, to account for the creation of the appropriations under subdivision 2. a. and

1b., and funds the modified appropriations in the same manner as those
2appropriations are funded under current law.
AB1140, s. 15 3Section 15. Initial applicability.
AB1140,25,64 (1) Health savings accounts. The treatment of sections 71.83 (1) (ce) and
5subchapter XVI of chapter 71 of the statutes first applies to taxable years beginning
6on January 1, 2008.
AB1140,25,77 (End)
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