SB1,2,2 1An Act to repeal 49.471 (4m) and 49.67 (9m); to amend 20.145 (5) (k), 71.07 (5g)
2(b), 71.07 (5g) (c) 1., 71.07 (5g) (d) 2., 71.28 (5g) (b), 71.28 (5g) (c) 1., 71.28 (5g)
3(d) 2., 71.47 (5g) (b), 71.47 (5g) (c) 1., 71.47 (5g) (d) 2., 76.655 (2), 76.655 (3) (a),
476.655 (5), 177.075 (3), 895.514 (2), 895.514 (3) (a) and 895.514 (3) (b); to repeal
5and recreate
49.45 (23) (a), 49.45 (23) (a) and 49.471 (4) (a) 4. b. of the statutes;
6and to affect 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b., 2013 Wisconsin
7Act 20
, section 9122 (1L) (b) 1. c., 2013 Wisconsin Act 20, section 9122 (1L) (b)
82. and 3. a. and c., 2013 Wisconsin Act 20, section 9122 (1L) (b) 4., 2013
9Wisconsin Act 20
, section 9122 (1L) (b) 8. (intro.), 2013 Wisconsin Act 20, section
109122 (1L) (b) 8. a., 9. a., 10. a. and b. and 11. b., 2013 Wisconsin Act 20, section
119418 (7), 2013 Wisconsin Act 20, section 9418 (7m) and 2013 Wisconsin Act 20,
12section 9418 (9); relating to: delaying eligibility changes to BadgerCare Plus
13and BadgerCare Plus Core and delaying other changes to the Medical

1Assistance program; and extending coverage under, and the deadline for the
2dissolution of, the Health Insurance Risk-Sharing Plan.
Analysis by the Legislative Reference Bureau
Medical Assistance
Currently, the Department of Health Services (DHS) administers the Medical
Assistance (MA) program, which is a joint federal and state program that provides
health services to individuals who have limited resources. Some services are
provided through programs that operate under a waiver of federal Medicaid laws,
including services provided through the BadgerCare Plus (BC+) and BadgerCare
Plus Core (BC+ Core) programs. Under current law, BC+ provides health and
medical services to eligible recipients and has a standard plan with a larger set of
benefits and a Benchmark plan with fewer benefits. The 2013-2015 biennial budget
act, 2013 Wisconsin Act 20 (Act 20), makes changes to BC+, BC+ Core, and MA, and
some of those changes are not in effect until January 1, 2014.
Under current law, unless DHS has a policy that conflicts with current state law
eligibility requirements, certain individuals are eligible for benefits under the BC+
standard plan. Beginning on January 1, 2014, Act 20 reduces the income eligibility
level for the BC+ standard plan for parents and caretaker relatives from not more
than 200 percent of the federal poverty line (FPL) to not more than 100 percent of
the FPL before a 5 percent income disregard is applied. Act 20 also defines,
beginning on January 1, 2014, for purposes of eligibility of a parent or caretaker
relative, a "dependent child." In addition, Act 20 eliminates the distinction between
self-employment income and other income. This bill delays the effective date of
these changes enacted in Act 20 from January 1, 2014, to April 1, 2014.
Under current law, certain individuals are eligible for benefits under the BC+
Benchmark plan including pregnant women whose family income exceeds 200
percent but does not exceed 300 percent of the FPL and children under one year of
age of those women; certain other pregnant women; children whose family income
exceeds 200 percent but does not exceed 300 percent of the FPL; and parents or
caretaker relatives whose family income includes self-employment income and does
not exceed 200 percent of the FPL under a certain calculation. Act 20, beginning on
January 1, 2014, provides benefits under the standard plan to the pregnant women
and children who are currently eligible for the BC+ Benchmark plan. Under Act 20,
parents and caretaker relatives are covered only under the standard plan. Certain
individuals, under current law, may pay the full member per month cost of coverage
to receive benefits under the Benchmark plan. On January 1, 2014, Act 20
eliminates the ability of children whose family incomes exceed 300 percent of the
FPL to receive Benchmark plan benefits. This bill delays the effective date of these
changes enacted in Act 20 from January 1, 2014, to April 1, 2014.
Under current law, BC+ Core provides basic primary and preventive care to
eligible individuals. Adults who are under age 65, who have family incomes that do
not exceed 200 percent of the FPL, and who are not otherwise eligible for MA,

including BC+, are eligible for benefits under BC+ Core. Beginning January 1, 2014,
Act 20 allows only those individuals whose family incomes do not exceed 100 percent
of the FPL, before a 5 percent income disregard is applied, to be eligible for BC+ Core.
Act 20 removes limitations on the benefits provided to individuals in BC+ Core and,
thus, allows DHS to provide standard plan benefits to these individuals. This bill
delays the effective date of these changes enacted in Act 20 from January 1, 2014,
to April 1, 2014.
Under current law, family income is the total gross earned and unearned
income received by all members of a family. Beginning on January 1, 2014, under
Act 20, for purposes of determining eligibility for BC+ and BC+ Core, family income
has the meaning given for household income under a federal regulation, which uses
an income calculation based on modified adjusted gross income. Act 20 also requires
DHS, beginning on January 1, 2014, to apply the definition of household in federal
regulations to determinations of income. Act 20 also makes other changes to the
calculation of income and family size for BC+ and BC+ Core on January 1, 2014. This
bill delays the effective date of these changes enacted in Act 20 from January 1, 2014,
to April 1, 2014.
DHS also currently administers the BadgerCare Plus Basic (BC+ Basic) plan,
which is not an MA program but is funded by premiums paid by plan participants.
To be eligible for the BC+ Basic plan, an individual must be on the waiting list for
BC+ Core. BC+ Basic provides health care benefits that do not exceed those benefits
provided by BC+ Core. Under current law, BC+ Basic terminates on January 1, 2014,
and Act 20 repeals the BC+ Basic statutory language on that same date. The bill
eliminates the statutory termination date and delays the repeal of BC+ Basic
enacted in Act 20 until April 1, 2014.
Under current law, DHS is required to develop a purchasing pool, known as
Badger Rx Gold, for pharmacy benefits and set eligibility requirements to obtain
prescription drug coverage through the purchasing pool. Current law allows DHS
to contract with an entity to operate the purchasing pool, which is not an MA
program. Act 20 eliminates the purchasing pool, Badger Rx Gold, on January 1,
2014. The bill delays the elimination of Badger Rx Gold until April 1, 2014.
Dissolution of the Health Insurance Risk-Sharing Plan
The Health Insurance Risk-Sharing Plan (HIRSP), which is administered by
the Health Insurance Risk-Sharing Plan Authority (authority), provides health
insurance coverage in individual policies for persons who are covered under
Medicare because they are disabled, persons who have tested positive for human
immunodeficiency virus (HIV), persons who have been refused coverage, or coverage
at an affordable price, in the private health insurance market because of their mental
or physical health condition, and persons (called "eligible individuals" in the
statutes) who do not currently have health insurance coverage, but who were covered
under certain types of health insurance coverage (creditable coverage) for at least 18
months in the past. HIRSP is funded by premiums paid by covered persons, insurer
assessments, and provider payment discounts.
Current law provides for the dissolution of HIRSP and the authority. Generally,
coverage under HIRSP may not be issued to any person after December 1, 2013,

existing coverage under HIRSP will end on January 1, 2014, or on the date that any
health insurance coverage that is accessed through an American health benefit
exchange in this state is effective, if that is later than January 1, 2014, and the
authority must pay the costs of HIRSP that are incurred before administrative
responsibility for HIRSP and HIRSP's remaining cash assets, tangible personal
property, contracts and agreements, and all other matters, including grievances and
independent reviews, are transferred to the Office of the Commissioner of Insurance
(OCI). Thereafter, OCI must take any action necessary or advisable to wind up the
affairs of HIRSP.
Extension of coverage under the Health Insurance Risk-Sharing Plan
The bill makes various modifications to the timetable for the dissolution of
HIRSP, including the following:
1. Under the bill, all coverage under HIRSP terminates at 11:59 p.m. on
December 31, 2013, but an individual who has coverage on December 1, 2013, and
who has paid the December premium may elect to obtain a policy under HIRSP by
making a timely payment of the January 2014 premium. Any such new policy must
have the same benefits, including the deductible amount, that were in effect on
December 1, 2013, and may not extend beyond March 31, 2014. An individual who
is eligible for Medicare has the same option to extend coverage under a HIRSP policy
until March 31, 2014, if the individual was covered under HIRSP on December 1,
2013, has paid the December premium, did not enroll in Medicare Advantage during
the federal open enrollment period in 2013, and, for individuals whose coverage is
funded under a contract with the federal Department of Health and Human Services,
the federal Department of Health and Human Services takes certain actions.
2. Under current law, provider claims for payment for medical services
provided to individuals with coverage under HIRSP must be filed no later than 90
days after coverage terminates or they will not be paid. Under the bill, all provider
claims for services provided to HIRSP enrollees must be filed no later than June 1,
2014, or they will not be paid. All provider claims must be adjudicated by September
30, 2014.
3. Under current law, a grievance must be submitted no later than 180 days
after coverage terminates or be barred, and an independent review must be
requested no later than 60 days after the individual receives notice of the disposition
of his or her grievance. The bill provides that a grievance must be received no later
than July 1, 2014, or be barred, and that an individual who submits a grievance after
March 31, 2014, must request an independent review with respect to the grievance
no later than August 1, 2014, or be barred from requesting an independent review.
4. Under current law, the transfer from the authority to OCI of administrative
responsibility for HIRSP and HIRSP's remaining cash assets, tangible personal
property, contracts and agreements, and all other matters takes place 60 days after
coverage under HIRSP terminates. Under the bill, the transfer takes place on
February 28, 2014.
5. Under current law, the authority must pay HIRSP's costs incurred in 2013
and those that are incurred before the transfer to OCI. The authority must make
every effort to pay costs in accordance with the manner provided in the statutes,

which is that costs are to be paid 60 percent from premiums, 20 percent from insurer
assessments, and 20 percent from adjustments to provider payments. Under the bill,
the authority before March 1, 2014, and OCI on and after March 1, 2014, must pay
all of HIRSP's costs in accordance with the manner provided in the statutes, except
that any available surplus may be used before an assessment is imposed against
insurers. OCI must determine no later than July 1, 2014, whether an insurer
assessment is necessary.
Time-limited guaranteed issue under Medicare supplement and
replacement policies
Under current law, an insurer that offers a Medicare supplement or
replacement policy must provide coverage to any individual who is eligible for
Medicare, who had coverage under HIRSP, whose coverage terminates on January
1, 2014, or on the date that any health insurance coverage that is accessed through
an American health benefit exchange in this state is effective, if that is later than
January 1, 2014, who applies for coverage before 63 days after their coverage
terminated, and who pays the premium. Coverage may not be denied on the basis
of health status, receipt of health care, claims experience, or medical condition.
Under the bill, the requirement to provide coverage applies if the individual's
coverage under HIRSP terminated on December 31, 2014, which is the new date for
coverage termination under the bill. In addition, the bill imposes the same
requirement on an insurer that offers a Medicare supplement or replacement policy
to provide coverage under such a policy to an individual who is eligible for Medicare,
whose coverage under HIRSP terminates on March 31, 2014, who applies for
coverage under the Medicare supplement or replacement policy before 63 days after
their coverage terminated, and who pays the premium.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB1,1 1Section 1. 20.145 (5) (k) of the statutes, as created by 2013 Wisconsin Act 20,
2is amended to read:
SB1,5,63 20.145 (5) (k) Operational expenses. All moneys transferred from the
4appropriation account under par. (g) for operational expenses related to winding up
5the affairs of the Health Insurance Risk-Sharing Plan, including hiring consultants,
6limited-term employees, and experts.
SB1,2
1Section 2 . 49.45 (23) (a) of the statutes, as affected by 2013 Wisconsin Act 20,
2section 1046, is repealed and recreated to read:
SB1,6,113 49.45 (23) (a) The department shall request a waiver from the secretary of the
4federal department of health and human services to permit the department to
5conduct a demonstration project to provide health care coverage to adults who are
6under the age of 65, who have family incomes not to exceed 100 percent of the poverty
7line before application of the 5 percent income disregard under 42 CFR 435.603 (d),
8and who are not otherwise eligible for medical assistance under this subchapter, the
9Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395
10et seq. If the department creates a policy under sub. (2m) (c) 10., this paragraph does
11not apply to the extent that it conflicts with the policy.
SB1,3 12Section 3 . 49.45 (23) (a) of the statutes, as affected by 2013 Wisconsin Act 20,
13section 1047, and 2013 Wisconsin Act .... (this act), is repealed and recreated to read:
SB1,6,2114 49.45 (23) (a) The department shall request a waiver from the secretary of the
15federal department of health and human services to permit the department to
16conduct a demonstration project to provide health care coverage to adults who are
17under the age of 65, who have family incomes not to exceed 100 percent of the poverty
18line before application of the 5 percent income disregard under 42 CFR 435.603 (d),
19and who are not otherwise eligible for medical assistance under this subchapter, the
20Badger Care health care program under s. 49.665, or Medicare under 42 USC 1395
21et seq.
SB1,4 22Section 4. 49.471 (4) (a) 4. b. of the statutes, as affected by 2013 Wisconsin Act
2320
, is repealed and recreated to read:
SB1,7,3
149.471 (4) (a) 4. b. The individual's family income does not exceed 100 percent
2of the poverty line before application of the 5 percent income disregard under 42 CFR
3435.603
(d).
SB1,5 4Section 5. 49.471 (4m) of the statutes, as created by 2013 Wisconsin Act 20,
5is repealed.
SB1,6 6Section 6. 49.67 (9m) of the statutes is repealed.
SB1,7 7Section 7. 71.07 (5g) (b) of the statutes, as affected by 2013 Wisconsin Act 20,
8is amended to read:
SB1,7,149 71.07 (5g) (b) Filing claims. Subject to the limitations provided under this
10subsection, for taxable years beginning after December 31, 2005, and before January
111, 2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1271.02 an amount that is equal to the amount of the assessment under s. 149.13, 2011
13stats., that the claimant paid in the claimant's taxable year, multiplied by the
14percentage determined under par. (c) 1.
SB1,8 15Section 8. 71.07 (5g) (c) 1. of the statutes, as affected by 2013 Wisconsin Act
1620
, is amended to read:
SB1,8,417 71.07 (5g) (c) 1. The department of revenue, in consultation with the office of
18the commissioner of insurance, shall determine the percentage under par. (b) for
19each claimant for each taxable year. The percentage shall be equal to $5,000,000
20divided by the aggregate assessment under s. 149.13, 2011 stats., except that for
21taxable years beginning after December 31, 2013, and before January 1, 2015, the
22percentage shall be equal to $1,250,000 divided by the aggregate assessment under
23s. 149.13, 2011 stats., and shall not exceed 100 percent.
The office of the
24commissioner of insurance shall provide to each claimant that participates in the
25cost of administering the plan the aggregate assessment at the time that it notifies

1the claimant of the claimant's assessment. The aggregate amount of the credit under
2this subsection and ss. 71.28 (5g), 71.47 (5g), and 76.655 for all claimants
3participating in the cost of administering the plan under ch. 149, 2011 stats., shall
4not exceed $5,000,000 in each fiscal year.
SB1,9 5Section 9. 71.07 (5g) (d) 2. of the statutes, as created by 2013 Wisconsin Act
620
, is amended to read:
SB1,8,107 71.07 (5g) (d) 2. No credit may be claimed under this subsection for taxable
8years beginning after December 31, 2013 2014. Credits under this subsection for
9taxable years that begin before January 1, 2014 2015, may be carried forward to
10taxable years that begin after December 31, 2013 2014.
SB1,10 11Section 10. 71.28 (5g) (b) of the statutes, as affected by 2013 Wisconsin Act 20,
12is amended to read:
SB1,8,1813 71.28 (5g) (b) Filing claims. Subject to the limitations provided under this
14subsection, for taxable years beginning after December 31, 2005, and before January
151, 2014 2015, a claimant may claim as a credit against the taxes imposed under s.
1671.23 an amount that is equal to the amount of assessment under s. 149.13, 2011
17stats., that the claimant paid in the claimant's taxable year, multiplied by the
18percentage determined under par. (c) 1.
SB1,11 19Section 11. 71.28 (5g) (c) 1. of the statutes, as affected by 2013 Wisconsin Act
2020
, is amended to read:
SB1,9,821 71.28 (5g) (c) 1. The department of revenue, in consultation with the office of
22the commissioner of insurance, shall determine the percentage under par. (b) for
23each claimant for each taxable year. The percentage shall be equal to $5,000,000
24divided by the aggregate assessment under s. 149.13, 2011 stats., except that for
25taxable years beginning after December 31, 2013, and before January 1, 2015, the

1percentage shall be equal to $1,250,000 divided by the aggregate assessment under
2s. 149.13, 2011 stats., and shall not exceed 100 percent.
The office of the
3commissioner of insurance shall provide to each claimant that participates in the
4cost of administering the plan the aggregate assessment at the time that it notifies
5the claimant of the claimant's assessment. The aggregate amount of the credit under
6this subsection and ss. 71.07 (5g), 71.47 (5g), and 76.655 for all claimants
7participating in the cost of administering the plan under ch. 149, 2011 stats., shall
8not exceed $5,000,000 in each fiscal year.
SB1,12 9Section 12. 71.28 (5g) (d) 2. of the statutes, as created by 2013 Wisconsin Act
1020
, is amended to read:
SB1,9,1411 71.28 (5g) (d) 2. No credit may be claimed under this subsection for taxable
12years beginning after December 31, 2013 2014. Credits under this subsection for
13taxable years that begin before January 1, 2014 2015, may be carried forward to
14taxable years that begin after December 31, 2013 2014.
SB1,13 15Section 13. 71.47 (5g) (b) of the statutes, as affected by 2013 Wisconsin Act 20,
16is amended to read:
SB1,9,2217 71.47 (5g) (b) Filing claims. Subject to the limitations provided under this
18subsection, for taxable years beginning after December 31, 2005, and before January
191, 2014 2015, a claimant may claim as a credit against the taxes imposed under s.
2071.43 an amount that is equal to the amount of assessment under s. 149.13, 2011
21stats., that the claimant paid in the claimant's taxable year, multiplied by the
22percentage determined under par. (c) 1.
SB1,14 23Section 14. 71.47 (5g) (c) 1. of the statutes, as affected by 2013 Wisconsin Act
2420
, is amended to read:
SB1,10,13
171.47 (5g) (c) 1. The department of revenue, in consultation with the office of
2the commissioner of insurance, shall determine the percentage under par. (b) for
3each claimant for each taxable year. The percentage shall be equal to $5,000,000
4divided by the aggregate assessment under s. 149.13, 2011 stats., except that for
5taxable years beginning after December 31, 2013, and before January 1, 2015, the
6percentage shall be equal to $1,250,000 divided by the aggregate assessment under
7s. 149.13, 2011 stats., and shall not exceed 100 percent.
The office of the
8commissioner of insurance shall provide to each claimant that participates in the
9cost of administering the plan the aggregate assessment at the time that it notifies
10the claimant of the claimant's assessment. The aggregate amount of the credit under
11this subsection and ss. 71.07 (5g), 71.28 (5g), and 76.655 for all claimants
12participating in the cost of administering the plan under ch. 149, 2011 stats., shall
13not exceed $5,000,000 in each fiscal year.
SB1,15 14Section 15. 71.47 (5g) (d) 2. of the statutes, as created by 2013 Wisconsin Act
1520
, is amended to read:
SB1,10,1916 71.47 (5g) (d) 2. No credit may be claimed under this subsection for taxable
17years beginning after December 31, 2013 2014. Credits under this subsection for
18taxable years that begin before January 1, 2014 2015, may be carried forward to
19taxable years that begin after December 31, 2013 2014.
SB1,16 20Section 16. 76.655 (2) of the statutes, as affected by 2013 Wisconsin Act 20,
21is amended to read:
SB1,11,222 76.655 (2) Filing claims. Subject to the limitations provided under this section,
23for taxable years beginning after December 31, 2005, and before January 1, 2014
242015, a claimant may claim as a credit against the fees imposed under ss. 76.60,
2576.63, 76.65, 76.66 or 76.67 an amount that is equal to the amount of assessment

1under s. 149.13, 2011 stats., that the claimant paid in the claimant's taxable year,
2multiplied by the percentage determined under sub. (3).
SB1,17 3Section 17. 76.655 (3) (a) of the statutes, as affected by 2013 Wisconsin Act 20,
4is amended to read:
SB1,11,175 76.655 (3) (a) The department of revenue, in consultation with the office of the
6commissioner of insurance, shall determine the percentage under sub. (2) for each
7claimant for each taxable year. The percentage shall be equal to $5,000,000 divided
8by the aggregate assessment under s. 149.13, 2011 stats., except that for taxable
9years beginning after December 31, 2013, and before January 1, 2015, the
10percentage shall be equal to $1,250,000 divided by the aggregate assessment under
11s. 149.13, 2011 stats., and shall not exceed 100 percent.
The office of the
12commissioner of insurance shall provide to each claimant that participates in the
13cost of administering the plan the aggregate assessment at the time that it notifies
14the claimant of the claimant's assessment. The aggregate amount of the credit under
15this subsection and ss. 71.07 (5g), 71.28 (5g), and 71.47 (5g) for all claimants
16participating in the cost of administering the plan under ch. 149, 2011 stats., shall
17not exceed $5,000,000 in each fiscal year.
SB1,18 18Section 18. 76.655 (5) of the statutes, as created by 2013 Wisconsin Act 20, is
19amended to read:
SB1,11,2320 76.655 (5) Sunset. No credit may be claimed under this section for taxable
21years beginning after December 31, 2013 2014. Credits under this section for taxable
22years that begin before January 1, 2014 2015, may be carried forward to taxable
23years that begin after December 31, 2013 2014.
SB1,19 24Section 19. 177.075 (3) of the statutes, as created by 2013 Wisconsin Act 20,
25is amended to read:
SB1,12,5
1177.075 (3) Any intangible property distributable in the course of the
2dissolution of the Health Insurance Risk-Sharing Plan under 2013 Wisconsin Act
320
, section 9122 (1L), and 2013 Wisconsin Act .... (this act), section 32 (1) (b ), is
4presumed abandoned as otherwise provided under this chapter if sub. (1) (a), (b), or
5(c) does not apply with respect to the distribution.
SB1,20 6Section 20. 895.514 (2) of the statutes, as created by 2013 Wisconsin Act 20,
7is amended to read:
SB1,12,158 895.514 (2) No cause of action of any nature may arise against, and no liability
9may be imposed upon, the authority, plan, or board; or any agent, employee, or
10director of any of them; or insurers participating in the plan; or the commissioner;
11or any agent, employee, or representative of the commissioner, for any act or
12omission by any of them in the performance of their powers and duties under ch. 149,
132011 stats., or under 2013 Wisconsin Act 20, section 9122 (1L), or under 2013
14Wisconsin Act .... (this act), section 32 (1) (b ),
unless the person asserting liability
15proves that the act or omission constitutes willful misconduct.
SB1,21 16Section 21. 895.514 (3) (a) of the statutes, as created by 2013 Wisconsin Act
1720
, is amended to read:
SB1,12,2218 895.514 (3) (a) Except as provided in 2013 Wisconsin Act 20, section 9122 (1L),
19and 2013 Wisconsin Act .... (this act), section 32 (1 ) (b), neither the state nor any
20political subdivision of the state nor any officer, employee, or agent of the state or a
21political subdivision acting within the scope of employment or agency is liable for any
22debt, obligation, act, or omission of the authority.
SB1,22 23Section 22. 895.514 (3) (b) of the statutes, as created by 2013 Wisconsin Act
2420
, is amended to read:
SB1,13,6
1895.514 (3) (b) All of the expenses incurred by the authority, or the
2commissioner, or any agent, employee, or representative of the commissioner, in
3exercising its duties and powers under ch. 149, 2011 stats., or under 2013 Wisconsin
4Act 20
, section 9122 (1L), or under 2013 Wisconsin Act .... (this act), section 32 (1) (b ),
5shall be payable only from funds of the authority or from the appropriation under s.
620.145 (5) (g) or (k), or from any combination of those payment sources.
SB1,23 7Section 23. 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b. is repealed and
8recreated to read:
SB1,13,169[2013 Wisconsin Act 20] Section 9122 (1L) (b) 1. b. Coverage under the policies
10issued under the plan, including to persons whose coverage under the plan is funded
11under a contract with the federal department of health and human services,
12terminates at 11:59 p.m. on December 31, 2013. At least 60 days before coverage
13terminates, the authority shall provide notice of the date on which coverage
14terminates to all covered persons, all insurers and providers that are affected by the
15termination of the coverage, the office, the legislative audit bureau, and the insurers
16described in subsection (1m) (b) 1.
SB1,24 17Section 24. 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. c. is repealed.
SB1,25 18Section 25. 2013 Wisconsin Act 20, section 9122 (1L) (b) 2. and 3. a. and c. are
19repealed and recreated to read:
SB1,14,320[2013 Wisconsin Act 20] Section 9122 (1L) (b) 2. `Provider claims.' Providers
21of medical services and devices and prescription drugs to covered persons must file
22claims for payment no later than June 1, 2014. Any claim filed after that date is not
23payable and may not be charged to the covered person who received the service,
24device, or drug. Except for copayments, coinsurance, or deductibles required under
25the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes, a

1provider may not bill a covered person who receives a covered service or article and
2shall accept as payment in full the payment rate determined under section 149.142
3(1) of the statutes.
SB1,14,64 3. a. Except for a grievance related to a prior authorization, any grievance by
5a covered person must be in writing and received no later than July 1, 2014, or be
6barred.
SB1,14,107 c. A covered person who submits a grievance after March 31, 2014, must
8request an independent review, if any, with respect to the grievance no later than
9August 1, 2014, or be barred from requesting an independent review with respect to
10the grievance.
SB1,26 11Section 26. 2013 Wisconsin Act 20, section 9122 (1L) (b) 4. is amended to read:
SB1,14,1812[2013 Wisconsin Act 20] Section 9122 (1L) (b) 4. `Payment of plan costs.' The
13To the extent possible, the authority shall pay plan costs incurred in 2013 and all
14other costs associated with dissolving the plan that are incurred before
15administrative responsibility for the dissolution of the plan is transferred to the
16office under subdivision 8. The authority and the office shall make every effort to pay
17plan costs in accordance with, or as closely as possible to, the manner provided in
18section 149.143 of the statutes.
SB1,27 19Section 27. 2013 Wisconsin Act 20, section 9122 (1L) (b) 8. (intro.) is repealed
20and recreated to read:
SB1,14,2221[2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. `Transfer to the office.' (intro.)
22On February 28, 2014, all of the following shall occur:
SB1,28 23Section 28. 2013 Wisconsin Act 20, section 9122 (1L) (b) 8. a., 9. a., 10. a. and
24b. and 11. b. are amended to read:
SB1,15,9
1[2013 Wisconsin Act 20] Section 9122 (1L) (b) 8. a. Administrative
2responsibility for the operations and dissolution of the plan is transferred to the
3office. The commissioner shall take any action necessary or advisable to manage and
4wind up the affairs of the plan and shall notify the legislative audit bureau when the
5windup is completed and provide to the legislative audit bureau the final financial
6statements of the plan. For purposes of chapter 177 of the statutes, as affected by
7this act, the dissolution, and winding up of the affairs, of the plan shall be considered
8a dissolution of an insurer in accordance with section 645.44 of the statutes, except
9that a court order of dissolution is not required to effect the dissolution of the plan.
SB1,15,1410 9. a. There is created, 60 days after the date coverage under the plan terminates
11under subdivision 1. b.
on March 1, 2014, a Health Insurance Risk-Sharing Plan
12advisory committee consisting of the commissioner, or his or her designee, and the
13other 13 members of the board holding office on the date the advisory committee is
14created.
SB1,15,2515 10. a. On behalf of the commissioner, the authority shall provide notice of the
16plan's dissolution to all persons known, or reasonably expected from the plan's
17records, to have claims against the plan, including all covered persons. The notice
18shall be sent by first class mail to the last-known addresses at least 60 days before
19the date on which coverage terminates under subdivision 1. b. Notice to potential
20claimants of the plan shall require the claimants to file their claims, together with
21proofs of claims, within 90 days after the date on which coverage terminates under
22subdivision 1. b.
by June 1, 2014. The notice shall be consistent with any relevant
23terms of the policies under the plan and contracts and with section 645.47 (1) (a) of
24the statutes. The notice shall serve as final notice consistent with section 645.47 (3)
25of the statutes.
SB1,16,12
1b. Proofs of all claims must be filed with the office in the form provided by the
2office consistent with the proof of claim, as applicable, under section 645.62 of the
3statutes, on or before the last day for filing specified in the notice. For good cause
4shown, the office shall permit a claimant to make a late filing if the existence of the
5claim was not known to the claimant and the claimant files the claim within 30 days
6after learning of the claim, but not more than 210 days after the date on which
7coverage terminates under subdivision 1. b.
later than September 1, 2014. Any such
8late claim that would have been payable under the policy under the plan if it had been
9filed timely and that was not covered by a succeeding insurer shall be permitted
10unless the claimant had actual notice of the termination of the plan or the notice was
11mailed to the claimant by first class mail at least 10 days before the insured event
12occurred.
SB1,16,1513 11. b. Complete a final audit of the plan, after the termination of the plan in
142014, within 90 days after the office provides the final financial statements of the
15plan under subdivision 8. a.
by June 30, 2015.
SB1,29 16Section 29. 2013 Wisconsin Act 20, section 9418 (7) is amended to read:
SB1,16,2417[2013 Wisconsin Act 20] Section 9418 (7) Patient protection and affordable
18care act changes
. The treatment of sections 49.45 (23) (a) (by Section 1046), (b) (by
19Section 1048), and (e), 49.46 (1) (a) 15., 49.47 (4) (a) 1. and (c) 1. and 3., 49.471 (1)
20(f), (2), (3) (a) 1. and 3., (4) (a) 4. a., b., and c., and 5. and (b) (intro.), 1., 1m., 2., 3., and
214., (6) (d), (7) (a), (b) 1. and 2. and (e), (8) (d) 1. b., (9) (a) 2. b., and (10) (b) 1. (by Section
221143) and 4. b., 49.84 (6) (c) 1. d., and 66.0137 (3) of the statutes, the repeal of section
2349.471 (7) (c) of the statutes, and Section 9318 (14) of this act take effect on January
24April 1, 2014.
SB1,30 25Section 30. 2013 Wisconsin Act 20, section 9418 (7m) is created to read:
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