SB707: Bill Text

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.

SB707,28,24 (b) A health economist.

SB707,28,25 (c) An employee benefits specialist.

SB707,29,1 (d) A representative of small employers.

SB707,29,2 (e) A representative of an organization that represents consumer interests.

SB707,29,3 (f) A representative of organized labor.

SB707,29,5 (2) A vacancy on the board shall be filled in the same manner as the original appointment to the board for the remainder of the unexpired term, if any.

SB707,29,8 (3) A member of the board shall receive no compensation for services under this chapter but shall be reimbursed for actual and necessary expenses, including travel expenses, incurred in the discharge of the member's duties under this chapter.

SB707,29,13 (4) The commissioner or the commissioner's designee shall be the chairperson of the board. Five members of the board constitute a quorum for the purpose of conducting the business and exercising the powers of the authority, notwithstanding the existence of any vacancy. The board may take action upon a vote of a majority of the members present, unless the bylaws of the authority require a larger number.

SB707,29,25 (5) The chairperson shall appoint an executive director who shall not be a member of the board and who shall serve at the pleasure of the board. The executive director shall receive compensation commensurate with the duties of the office, as determined by the board. The executive director shall serve as secretary of the authority and shall keep a record of the proceedings of the authority and shall be custodian of all books, documents, and papers filed with the authority, the minute book or journal of the authority, and its official seal. The executive director or other person may cause copies to be made of all minutes and other records and documents of the authority and may give certificates under the official seal of the authority to the effect that such copies are true copies, and all persons dealing with the authority may rely upon such certificates. The executive director shall have all of the following duties:

SB707,30,2 (a) Supervising the administrative affairs and the general management and operation of the authority.

SB707,30,4 (b) Planning, directing, coordinating, and executing administrative functions in conformity with the policies and directives of the board.

SB707,30,5 (c) Employing professional and clerical staff, as necessary.

SB707,30,7 (d) Reporting to the board on all operations under his or her control and supervision.

SB707,30,9 (e) Preparing an annual budget and managing the administrative expenses of the authority.

SB707,30,11 (f) Undertaking any activities necessary to implement the powers and duties set forth in this chapter.

SB707,30,13 635.72 Duties. In addition to all other duties imposed under this chapter, the authority shall do all of the following:

SB707,30,14 (1) Establish its annual budget and monitor its fiscal management.

SB707,30,18 (2) No later than two years after the exchange under subch. II begins operation, and annually thereafter, submit a report to the legislature under s. 13.172 (2) and to the governor on the operation of the exchange under subch. II, including a review of all of the following:

SB707,30,19 (a) Progress toward the goals of the exchange.

SB707,30,20 (b) The operations and administration of the exchange.

SB707,30,22 (c) The types of health insurance plans available to eligible individuals and groups and the percentage of the total exchange enrollees served by each plan.

SB707,30,25 (d) Surveys and reports on the insurers' experiences with different plans, including aggregated data on enrollees, claims, statistics, complaint data, and enrollee satisfaction data.

SB707,31,2 (e) Significant observations regarding utilization and adoption of the exchange.

SB707,31,4 (3) Annually submit to the governor and the legislative audit bureau a statement of its activities and financial condition.

SB707,31,6 (4) Approve the use of any trademarks, seals, or logos by participating insurers and small employers.

SB707,31,9 635.74 Powers. The authority has all of the powers necessary or convenient to carry out its duties under this chapter, except that it may not acquire or hold title to real estate or issue bonds. In addition, the authority may do any of the following:

SB707,31,11 (1) Adopt bylaws and policies and procedures for the regulation of its affairs and the conduct of its business.

SB707,31,13 (2) Have a seal and alter the seal at pleasure; have perpetual existence; and maintain an office.

SB707,31,14 (3) Hire employees, define their duties, and fix their rate of compensation.

SB707,31,16 (4) Delegate by resolution to one or more of its members any powers and duties that it considers proper.

SB707,31,17 (5) Incur debt.

SB707,31,21 (6) Appoint any technical or professional advisory committee that the authority finds necessary to assist the authority in exercising its duties and powers. If the authority appoints a committee, the authority shall define the duties of the committee and provide reimbursement for the expenses of the committee.

SB707,31,23 (7) Accept gifts, grants, loans, or other contributions from private or public sources.

SB707,31,24 (8) Procure liability insurance.

SB707,31,25 (9) Sue and be sued in its own name and plead and be impleaded.

SB707,32,3 (10) Execute contracts and other instruments, including contracts for professional or technical services required for the authority or the operation of the exchange under subch. II.

SB707,32,8 635.76 Contracting for professional services. (1) Whenever contracting for professional services, the authority shall solicit competitive sealed bids or competitive sealed proposals, whichever is appropriate. Each request for competitive sealed proposals shall state the relative importance of price and other evaluation factors.

SB707,32,16 (2) (a) When the estimated cost exceeds $25,000, the authority may invite competitive sealed bids or proposals by publishing a class 2 notice under ch. 985 or by posting notice on the Internet at a site determined or approved by the authority. The notice shall describe the contractual services to be purchased, the intent to make the procurement by solicitation of bids or proposals, any requirement for surety, and the date the bids or proposals will be opened, which shall be at least 7 days after the date of the last insertion of the notice or at least 7 days after the date of posting on the Internet.

SB707,32,19 (b) When the estimated cost is $25,000 or less, the authority may award the contract in accordance with simplified procedures established by the authority for such transactions.

SB707,32,23 (c) For purposes of clarification, the authority may discuss the requirements of the proposed contract with any person who submits a bid or proposal and shall permit any offerer to revise his or her bid or proposal to ensure its responsiveness to those requirements.

SB707,33,6 (3) (a) The authority shall determine which bids or proposals are reasonably likely to be awarded the contract and shall provide each offerer of such a bid or proposal a fair and equal opportunity to discuss the bid or proposal. The authority may negotiate with each offerer in order to obtain terms that are advantageous to the authority. Prior to the award of the contract, any offerer may revise his or her bid or proposal. The authority shall keep a written record of all meetings, conferences, oral presentations, discussions, negotiations, and evaluations of bids or proposals under this section.

SB707,33,9 (b) In opening, discussing, and negotiating bids or proposals, the authority may not disclose any information that would reveal the terms of a competing bid or proposal.

SB707,33,15 (4) (a) After receiving each offerer's best and final offer, the authority shall determine which proposal is most advantageous and shall award the contract to the person who offered it. The authority's determination shall be based only on price and the other evaluation factors specified in the request for bids or proposals. The authority shall state in writing the reason for the award and shall place the statement in the contract file.

SB707,33,17 (b) Following the award of the contract, the authority shall prepare a register of all bids or proposals.

SB707,34,2 635.78 Political activities. (1) No employee of the authority may directly or indirectly solicit or receive subscriptions or contributions for any partisan political party or any political purpose while engaged in his or her official duties as an employee. No employee of the authority may engage in any form of political activity calculated to favor or improve the chances of any political party or any person seeking or attempting to hold partisan political office while engaged in his or her official duties as an employee or engage in any political activity while not engaged in his or her official duties as an employee to such an extent that the person's efficiency during working hours will be impaired or that he or she will be tardy or absent from work. Any violation of this section is adequate grounds for dismissal.

SB707,34,6 (2) If an employee of the authority declares an intention to run for partisan political office, the employee shall be placed on a leave of absence for the duration of the election campaign and if elected shall no longer be employed by the authority on assuming the duties and responsibilities of such office.

SB707,34,8 (3) An employee of the authority may be granted, by the executive director, a leave of absence to participate in partisan political campaigning.

SB707,34,11 (4) Persons on leave of absence under sub. (2) or (3) shall not be subject to the restrictions of sub. (1), except as they apply to the solicitation of assistance, subscription, or support from any other employee in the authority.

SB707,34,15 635.80 Liability; expenses; limitations. (1) Neither the state, nor any political subdivision of the state, nor any officer, employee, or agent of the state or a political subdivision who is acting within the scope of employment or agency is liable for any debt, obligation, act, or omission of the authority.

SB707,34,17 (2) All of the expenses incurred by the authority in exercising its duties and powers under this chapter shall be payable only from funds of the authority.

SB707,34,21 (3) A cause of action may arise against and civil liability may be imposed on the authority for its acts or omissions or for any act or omission of a member of the board, the executive director, or an employee of the authority in the performance of his or her powers and duties under this chapter.

SB707,35,5 (4) A cause of action may not arise against and civil liability may not be imposed on a member of the board, the executive director, or an employee of the authority for any act or omission in the performance of his or her powers and duties under this chapter, unless the person asserting liability proves that the act or omission constitutes willful misconduct or intentional violation of the law. The member of the board, executive director, or employee who performed the act or omission that formed the basis of liability shall be jointly liable with the authority if that board member, executive director, or employee fails to cooperate with the authority in defense of the claim and if the failure to cooperate affects the defense of the action.

SB707,35,8 (5) The amount recoverable by any person for any damages, injuries, or death in any civil action or civil proceeding against the authority, including any such action or proceeding based on contribution or indemnification, shall not exceed $100,000.

SB707,35,9 (End)