SB707: Bill Text

SB707,16,18 16.765 (7) (d) Direct the violating party to take immediate steps to prevent further violations of this section and to report its corrective action to the contracting agency, the University of Wisconsin Hospitals and Clinics Authority, the Fox River Navigational System Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, the Lower Fox River Remediation Authority, the Wisconsin Quality Home Care Authority, or the Bradley Center Sports and Entertainment Corporation.

SB707, s. 33 Section 33. 16.765 (8) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,17,15 16.765 (8) If further violations of this section are committed during the term of the contract, the contracting agency, the Fox River Navigational System Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, the Lower Fox River Remediation Authority, the Wisconsin Quality Home Care Authority, or the Bradley Center Sports and Entertainment Corporation may permit the violating party to complete the contract, after complying with this section, but thereafter the contracting agency, the Fox River Navigational System Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, the Lower Fox River Remediation Authority, the Wisconsin Quality Home Care Authority, or the Bradley Center Sports and Entertainment Corporation shall request the department to place the name of the party on the ineligible list for state contracts, or the contracting agency, the Fox River Navigational System Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, the Lower Fox River Remediation Authority, the Wisconsin Quality Home Care Authority, or the Bradley Center Sports and Entertainment Corporation may terminate the contract without liability for the uncompleted portion or any materials or services purchased or paid for by the contracting party for use in completing the contract.

SB707, s. 34 Section 34. 16.85 (2) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,18,3 16.85 (2) To furnish engineering, architectural, project management, and other building construction services whenever requisitions therefor are presented to the department by any agency. The department may deposit moneys received from the provision of these services in the account under s. 20.505 (1) (kc) or in the general fund as general purpose revenue — earned. In this subsection, "agency" means an office, department, independent agency, institution of higher education, association, society, or other body in state government created or authorized to be created by the constitution or any law, which is entitled to expend moneys appropriated by law, including the legislature and the courts, but not including an authority created in subch. II of ch. 114 or, subch. III of ch. 149, or subch. III of ch. 635 or in ch. 52, 231, 233, 234, 237, or 279.

SB707, s. 35 Section 35. 16.865 (8) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,18,20 16.865 (8) Annually in each fiscal year, allocate as a charge to each agency a proportionate share of the estimated costs attributable to programs administered by the agency to be paid from the appropriation under s. 20.505 (2) (k). The department may charge premiums to agencies to finance costs under this subsection and pay the costs from the appropriation on an actual basis. The department shall deposit all collections under this subsection in the appropriation account under s. 20.505 (2) (k). Costs assessed under this subsection may include judgments, investigative and adjustment fees, data processing and staff support costs, program administration costs, litigation costs, and the cost of insurance contracts under sub. (5). In this subsection, "agency" means an office, department, independent agency, institution of higher education, association, society, or other body in state government created or authorized to be created by the constitution or any law, that is entitled to expend moneys appropriated by law, including the legislature and the courts, but not including an authority created in subch. II of ch. 114 or , subch. III of ch. 149, or subch. III of ch. 635 or in ch. 52, 231, 232, 233, 234, 235, 237, or 279.

SB707, s. 36 Section 36. 25.50 (1) (d) of the statutes is amended to read:

SB707,19,6 25.50 (1) (d) "Local government" means any county, town, village, city, power district, sewerage district, drainage district, town sanitary district, public inland lake protection and rehabilitation district, local professional baseball park district created under subch. III of ch. 229, long-term care district under s. 46.2895, local professional football stadium district created under subch. IV of ch. 229, local cultural arts district created under subch. V of ch. 229, public library system, school district or technical college district in this state, any commission, committee, board or officer of any governmental subdivision of this state, any court of this state, other than the court of appeals or the supreme court, or any authority created under s. 114.61, 149.41, 231.02, 233.02 or, 234.02 , or 635.70.

SB707, s. 37 Section 37. 40.02 (54) (m) of the statutes is created to read:

SB707,19,8 40.02 (54) (m) The Small Business Health Options Program Authority.

SB707, s. 38 Section 38. 70.11 (41c) of the statutes is created to read:

SB707,19,12 70.11 (41c) Small Business Health Options Program Authority. All property owned by the Small Business Health Options Program Authority, provided that the use of the property is primarily related to the purposes of the authority.

SB707, s. 39 Section 39. 71.26 (1) (be) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,19,19 71.26 (1) (be) Certain authorities. Income of the University of Wisconsin Hospitals and Clinics Authority, of the Health Insurance Risk-Sharing Plan Authority, of the Small Business Health Options Program Authority, of the Wisconsin Quality Home Care Authority, of the Fox River Navigational System Authority, and of the Wisconsin Aerospace Authority.

SB707, s. 40 Section 40. 77.54 (9a) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,20,2 77.54 (9a) (a) This state or any agency thereof, the University of Wisconsin Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, the Wisconsin Quality Home Care Authority, and the Fox River Navigational System Authority.

SB707, s. 41 Section 41. 101.055 (2) (a) of the statutes is amended to read:

SB707,20,8 101.055 (2) (a) "Agency" means an office, department, independent agency, authority, institution, association, society, or other body in state government created or authorized to be created by the constitution or any law, and includes the legislature and the courts, but excludes the Health Insurance Risk-Sharing Plan Authority and the Small Business Health Options Program Authority.

SB707, s. 42 Section 42. 101.177 (1) (d) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,20,21 101.177 (1) (d) "State agency" means any office, department, agency, institution of higher education, association, society, or other body in state government created or authorized to be created by the constitution or any law, that is entitled to expend moneys appropriated by law, including the legislature and the courts, the Wisconsin Housing and Economic Development Authority, the Bradley Center Sports and Entertainment Corporation, the University of Wisconsin Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Wisconsin Quality Home Care Authority, and the Wisconsin Health and Educational Facilities Authority, but excluding the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, and the Lower Fox River Remediation Authority.

SB707, s. 43 Section 43. 230.03 (3) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB707,21,8 230.03 (3) "Agency" means any board, commission, committee, council, or department in state government or a unit thereof created by the constitution or statutes if such board, commission, committee, council, department, unit, or the head thereof, is authorized to appoint subordinate staff by the constitution or statute, except a legislative or judicial board, commission, committee, council, department, or unit thereof or an authority created under subch. II of ch. 114 or, subch. III of ch. 149, or subch. III of ch. 635 or under ch. 52, 231, 232, 233, 234, 235, 237, or 279. "Agency" does not mean any local unit of government or body within one or more local units of government that is created by law or by action of one or more local units of government.

SB707, s. 44 Section 44. 230.80 (4) of the statutes is amended to read:

SB707,21,17 230.80 (4) "Governmental unit" means any association, authority, board, commission, department, independent agency, institution, office, society, or other body in state government created or authorized to be created by the constitution or any law, including the legislature, the office of the governor, and the courts, but excluding the Health Insurance Risk-Sharing Plan Authority and the Small Business Health Options Program Authority. "Governmental unit" does not mean any political subdivision of the state or body within one or more political subdivisions that is created by law or by action of one or more political subdivisions.

SB707, s. 45 Section 45. 230.90 (1) (c) of the statutes is amended to read:

SB707,22,2 230.90 (1) (c) "Governmental unit" means any association, authority, board, commission, department, independent agency, institution, office, society or other body in state government created or authorized to be created by the constitution or any law, including the legislature, the office of the governor and the courts. "Governmental unit" does not mean the University of Wisconsin Hospitals and Clinics Authority, the Health Insurance Risk-Sharing Plan Authority, the Small Business Health Options Program Authority, or any political subdivision of the state or body within one or more political subdivisions which is created by law or by action of one or more political subdivisions.

SB707, s. 46 Section 46. Subchapter I (title) of chapter 635 [precedes 635.01] of the statutes is created to read:

SB707,22,5 CHAPTER 635

SB707,22,7 Subchapter i General Provisions

SB707, s. 47 Section 47. 635.02 (1) of the statutes is renumbered 635.02 (1g).

SB707, s. 48 Section 48. 635.02 (1c) of the statutes is created to read:

SB707,22,11 635.02 (1c) "Authority" means the Small Business Health Options Program Authority.

SB707, s. 49 Section 49. 635.02 (1o) of the statutes is created to read:

SB707,22,13 635.02 (1o) "Board" means the board of directors of the authority.

SB707, s. 50 Section 50. 635.18 (1) of the statutes is amended to read:

SB707,22,16 635.18 (1) Every Any small employer insurer shall may actively market health benefit plan coverage to small employers in the state.

SB707, s. 51 Section 51. Subchapter II of chapter 635 [precedes 635.30] of the statutes is created to read:

SB707,22,19 CHAPTER 635

SB707,22,21 Subchapter II HEALTH BENEFIT PLAN exchange

SB707,22,25 635.30 Establishment of exchange; plans. (1) Subject to s. 635.45 (4), the authority shall establish and, by January 1, 2011, begin operating a health benefit plan exchange under which the authority shall enroll eligible groups and individuals in health benefit plans offered through the exchange.

SB707,23,6 (2) (a) The commissioner shall determine the initial plan designs, including minimum benefit levels, for the health benefit plans that may be offered through the exchange. Thereafter, the authority may modify the plan designs as it determines necessary or appropriate. Both the commissioner and the authority, in specifying plan designs under this subsection, shall attempt to limit the degree of variation among plans and the number of different plan choices for exchange participants.

SB707,23,11 (b) Only health benefit plans that satisfy the requirements under par. (a) and that are approved by the authority may be offered by insurers through the exchange. Each plan offered through the exchange shall contain a detailed description of the benefits provided, including any maximum or minimum amounts, limitations, or exclusions.

SB707,23,14 (3) The authority shall rank the health benefit plans that are offered through the exchange according to the benefits provided and place each one into one of the following 3 tiers:

SB707,23,15 (a) A plan with full benefits shall be designated as a "gold" plan.

SB707,23,17 (b) A plan providing 75 percent of the actuarial value of a "gold" plan shall be designated as a "silver" plan.

SB707,23,19 (c) A plan providing 60 percent of the actuarial value of a "gold" plan shall be designated as a "bronze" plan.

SB707,23,21 (4) The authority may eliminate a plan from the exchange only after notice to the insurer offering the plan.

SB707,23,23 635.35 Participation in exchange. (1) All of the following shall be eligible to purchase coverage under a health benefit plan offered through the exchange:

SB707,23,24 (a) A small employer.

SB707,24,2 (b) A state employee who is a limited term employee and who is not eligible for coverage under a health care coverage plan under subch. IV of ch. 40.

SB707,24,5 (c) An individual who contracts with this state for the performance of services for the state and who is not eligible for coverage under a health care coverage plan under subch. IV of ch. 40.

SB707,24,12 (2) The authority shall accept for enrollment through the exchange any small employer under sub. (1) (a) and any individual under sub. (1) (b) or (c) who applies for enrollment. An individual under sub. (1) (b) or (c) and an employee of a small employer under sub. (1) (a) may select coverage under any health benefit plan offered through the exchange, except that all employees of a single small employer must select coverage under health benefit plans that have been placed in the same tier under s. 635.30 (3) (a), (b), or (c).

SB707,24,16 (3) The authority shall collect initial premiums for coverage under each health benefit plan from enrollees in the plan and disburse the initial premium collected to the insurer offering the plan, along with enrollment information about each individual or employee enrolled in the plan.

SB707,24,25 635.37 Insurer requirements. (1) (a) Any insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, may offer coverage through the exchange. No insurer may offer or issue a health benefit plan to a small employer except through the exchange. An insurer that offers coverage through the exchange may offer only health benefit plans that satisfy the requirements under s. 635.30 (2) (a) and that are approved for the exchange by the authority. An insurer that offers coverage through the exchange must offer at least one health benefit plan in each tier under s. 635.30 (3) (a), (b), and (c).

SB707,25,3 (b) Notwithstanding ss. 631.36 (4) and 632.749 (1) and (2), a health benefit plan issued to a small employer that is in effect on the day that the exchange begins operating may remain in effect until the end of its term but may not be renewed.

SB707,25,8 (2) Premiums for coverage through the exchange may be based only on age, sex, geographic location, whether coverage is single or family, and plan design. For the purpose of determining premiums, an insurer shall pool together all individuals and employees who have coverage under all of the plans issued by the insurer through the exchange.

SB707,25,16 (3) An insurer may not impose any annual or lifetime limits or any preexisting condition exclusions under any plan offered through the exchange. An insurer offering coverage through the exchange shall accept for enrollment any individual under s. 635.35 (1) (b) or (c) and any employee of a small employer under s. 635.35 (1) (a) who applies for enrollment in a health benefit plan offered by the insurer through the exchange. Section 632.7495 applies to the renewability of an individual's or employee's coverage under a health benefit plan offered through the exchange.

SB707,25,20 (4) An insurer that offers health benefit plans through the exchange shall establish a toll-free hotline for providing information to enrollees and other individuals and shall furnish such reasonable reports as the authority determines necessary for the administration of the exchange.

SB707,25,24 (5) The authority may audit any insurer that provides coverage under a health benefit plan through the exchange for the purpose of ensuring that the insurer is providing covered individuals with the benefits provided for under this subchapter in a manner that does all of the following:

SB707,25,25 (a) Complies with the provisions of this chapter.

SB707,26,1 (b) Promotes positive health outcomes.

SB707,26,2 (c) Advances value-based and evidence-based medical practices.

SB707,26,5 (d) Avoids unnecessary operating and capital costs arising from inappropriate utilization or inefficient delivery of health care services, unwarranted duplication of services and infrastructure, or creation of excess care delivery capacity.

SB707,26,6 (e) Holds down the growth of health care costs.

SB707,26,15 635.40 Intermediaries. An insurance intermediary that enrolls an individual under s. 635.35 (1) (b) or (c) in a health benefit plan through the exchange shall be paid a commission by the insurer offering the health benefit plan. An insurance intermediary that enrolls the employees of a small employer under s. 635.35 (1) (a) in one or more health benefit plans through the exchange shall be paid a commission by each insurer offering a health benefit plan selected by an employee of the small employer. The authority shall determine the commission amounts that must be paid to intermediaries under this section after considering information provided to the commissioner under s. 628.81 with respect to health insurance.

SB707,26,19 635.45 Administration; rules. (1) For payment of administrative expenses, the authority may impose a surcharge on each insurer offering health benefit plans through the exchange. The surcharge shall be based on an insurer's total premium collected through the exchange.

SB707,26,20 (2) For administering the exchange the authority shall do all of the following:

SB707,26,24 (a) In consultation with the commissioner, establish procedures for approving plans that may be offered through the exchange, for ranking plans into the tiers under s. 635.30 (3), and for determining whether a plan should continue to be offered or should be eliminated from the exchange.

SB707,27,2 (b) Establish quality improvement standards for plans offered through the exchange.

SB707,27,4 (c) Establish a system for enrolling eligible groups and individuals, using a standard application form developed by the commissioner under sub. (5) (a).

SB707,27,6 (d) Establish procedures for collecting premiums and remitting premium payments and providing enrollment information to insurers.

SB707,27,9 (e) Establish, in consultation with the commissioner, the method for determining the amount of the surcharge under sub. (1) and establish the procedure for imposing and collecting the surcharge.

SB707,27,11 (f) Establish a plan for publicizing the exchange and the eligibility requirements and enrollment procedures.

SB707,27,13 (g) Establish and operate a service center to provide information to small employers, individuals, enrollees, and insurance intermediaries about the exchange.

SB707,27,15 (h) Establish a mechanism for regular communication and cooperation with insurance intermediaries.

SB707,27,17 (i) Establish an independent and binding appeals process for resolving disputes over eligibility and other determinations made by the authority.

SB707,27,18 (3) The authority may do all of the following:

SB707,27,20 (a) Contract with a 3rd-party administrator for the provision of services on behalf of the exchange.

SB707,27,21 (b) Establish risk adjustment mechanisms for the exchange.

SB707,27,22 (c) Enter into agreements with or establish sub-exchanges.

SB707,28,2 (4) The authority shall seek grants or other funding from the federal or state government for which it may be eligible and from private foundations. The authority may begin operating the exchange only if it receives federal grant moneys or other funds for that purpose.

SB707,28,4 (5) (a) The commissioner shall develop a standard application form for use in the exchange.

SB707,28,6 (b) The commissioner may promulgate rules, with the approval of the authority, for the administration of this subchapter.

SB707, s. 52 Section 52. Subchapter III of chapter 635 [precedes 635.70] of the statutes is created to read:

SB707,28,9 CHAPTER 635

SB707,28,12 Subchapter III Small Business Health Options Program authority

SB707,28,22 635.70 Creation and organization of authority. (1) There is created a public body corporate and politic to be known as the "Small Business Health Options Program Authority." The board of directors of the authority shall consist of the commissioner, or his or her designee; the secretary of employee trust funds, or his or her designee; the person who is appointed by the secretary of health services to be the director of the Medical Assistance program, or his or her designee; the executive director of the Health Insurance Risk-Sharing Plan Authority, or his or her designee; and all of the following members, who shall be nominated by the governor, and with the advice and consent of the senate appointed for 3-year terms, and none of whom shall be an employee of an insurer that is authorized to do business in the state:

SB707,28,23 (a) A member in good standing of the American Academy of Actuaries.