601.83 Healthcare stability plan; administration.

791 words·~4 min read·/wi/chapter-601/601-83

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(1)Plan established; general administration.

(a)The commissioner shall administer a state-based reinsurance program known as the healthcare stability plan in accordance with the specific terms and conditions approved by the federal department of health and human services dated July 29, 2018. The commissioner may not request from the federal department of health and human services a modification, suspension, withdrawal, or termination of the waiver under 42 USC 18052 under which the healthcare stability plan under this subchapter operates unless legislation has been enacted specifically directing the modification, suspension, withdrawal, or termination. The commissioner may request renewal, without substantive change, of the waiver under 42 USC 18052 under which the health care stability plan operates in accordance with s. 20.940

(4)unless legislation has been enacted that is contrary to such a renewal request. The commissioner shall comply with applicable timing in and requirements of s. 20.940 .

(c)If the federal government enacts into law Senate Bill 1835 of the 115th Congress or a similar bill providing support to states to establish reinsurance programs, the commissioner shall seek, if necessary, and receive federal moneys for the purpose of reinsurance programs that result from that enacted law to expend for the purposes of this subchapter.

(d)In accordance with sub.

(c), the commissioner shall collect the data from an eligible health carrier as necessary to determine reinsurance payments.

(e)Beginning on a date determined by the commissioner, the commissioner shall require each eligible health carrier to calculate the rates the eligible health carrier would have charged for a benefit year if the healthcare stability plan had not been established and submit the calculated rates as part of its rate filing submitted to the commissioner. The commissioner shall consider the calculated rate information provided under this paragraph as part of the rate filing review.

1. For each applicable benefit year, the commissioner shall notify eligible health carriers of reinsurance payments to be made for the applicable benefit year no later than June 30 of the calendar year following the applicable benefit year.

2. Quarterly during the applicable benefit year, the commissioner shall provide each eligible health carrier with the calculation of total amounts of reinsurance payment requests.

3. By August 15 of the calendar year following the applicable benefit year, the commissioner shall disburse all applicable reinsurance payments to an eligible health carrier.

(g)The commissioner may promulgate any rules necessary to implement the healthcare stability plan under this section, except that any rules promulgated under this paragraph shall seek to maximize federal funding for the healthcare stability plan and shall comply with this section and with the approval by the federal department of health and human services dated July 29, 2018. The commissioner may promulgate rules necessary to implement this section as emergency rules under s. 227.24 . Notwithstanding s. 227.24

(a)and

(3), the commissioner is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph. An emergency rule promulgated by the commissioner under this paragraph before January 1, 2019, remains in effect until it is superseded by a subsequent permanent rule.

(h)In 2019 and in each subsequent year, the commissioner may expend no more than $200,000,000 from all revenue sources for the healthcare stability plan under this section, unless the joint committee on finance under s. 13.10 has increased this amount upon request by the commissioner. The commissioner shall ensure that sufficient funds are available for the healthcare stability plan under this section to operate as described in the approval of the federal department of health and human services dated July 29, 2018.

(hm)Notwithstanding par.

(h), in 2022 and in each year thereafter, the commissioner may expend from all revenue sources $230,000,000 or less for the healthcare stability plan under this section.

(hp)Notwithstanding pars.

(h)and

(hm), in 2026 and in each year thereafter, the commissioner may expend from all revenue sources $265,000,000 or less for the healthcare stability plan under this section.

(i)The commissioner shall complete and submit any reports, provide any information, and participate in any oversight activities required by the federal department of health and human services to implement and maintain the healthcare stability plan under this subchapter.

(2)Payment parameters. The commissioner, after consulting with an actuarial firm, shall design and adjust payment parameters with the goal to do all of the following:

(a)Stabilize or reduce premium rates in the individual market.

(b)Increase participation by health carriers in the individual market.