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LRB-3762/1
TJD:amn
2017 Special Session
2017 - 2018 LEGISLATURE
Badger Health Benefit Authority; health benefit exchange operation
Preliminary Draft - Not Ready For Introduction
July 19, 2017 - Introduced by Representatives Sargent, Anderson, Berceau,
Brostoff, Considine, Crowley, Hebl, Kessler, Kolste, Ohnstad, Pope,
Shankland, Sinicki, Subeck, C. Taylor and Zamarripa, cosponsored by
Senators Larson, Carpenter, Hansen, Johnson, Miller and Vinehout.
Referred to Committee on Insurance.
AB445,2,2 1An Act to amend 1.12 (1) (b), 13.172 (1), 13.62 (2), 13.95 (intro.), 16.002 (2),
216.004 (4), 16.004 (5), 16.004 (12) (a), 16.045 (1) (a), 16.15 (1) (ab), 16.41 (4),
316.417 (1) (a), 16.52 (7), 16.528 (1) (a), 16.53 (2), 16.54 (9) (a) 1., 16.70 (2), 16.72
4(2) (e) (intro.), 16.72 (2) (f), 16.75 (1m), 16.75 (8) (am), 16.75 (8) (bm), 16.75 (9),
516.765 (1), 16.765 (2), 16.765 (4), 16.765 (5), 16.765 (6), 16.765 (7) (intro.),
616.765 (7) (d), 16.765 (8), 16.85 (2), 16.865 (8), 25.50 (1) (d), 49.45 (2) (a) 3., 71.26
7(1) (be), 77.54 (9a) (a), 101.055 (2) (a), 230.03 (3), 230.80 (4), 230.90 (1) (c) and
8635.18 (1); and to create 13.94 (1) (dj), 13.94 (1s) (c) 9., 40.02 (54) (n), 70.11 (41c)
9and chapter 636 of the statutes; relating to: the Badger Health Benefit

1Authority, health benefit exchange operation, granting rule-making authority,
2and providing a criminal penalty.
Analysis by the Legislative Reference Bureau
This bill requires the establishment and operation of a Wisconsin Health
Benefit Exchange, which is administered by the Badger Health Benefit Authority
that is also created in the bill.
Badger Health Benefit Authority
This bill creates the Badger Health Benefit Authority (authority) that is a
public body corporate and politic that is created by state law but that is not a state
agency. The authority is governed by a board of directors consisting of the
commissioner of insurance, the secretary of employee trust funds, the director of the
state Medical Assistance program, the executive directors of the Wisconsin
Collaborative for Healthcare Quality and the Wisconsin Health Information
Organization, and the following members who are nominated by the governor and,
with the advice and consent of the senate, appointed for three-year terms: a member
in good-standing of the American Academy of Actuaries, a health economist, an
employee benefits specialist, a representative of small employers, a representative
of an organization that represents consumer interests, a representative of organized
labor, and an individual with experience in health care administration. The
chairperson of the board is the commissioner. The board must appoint an executive
director of the authority. The executive director must, among other duties, supervise
the administrative affairs and general management and operation of the authority,
employ professional and clerical staff, as necessary, and prepare the authority's
annual budget.
The authority is not a state agency, so numerous laws that apply to state
agencies do not apply to the authority. However, the authority is treated like a state
agency in the following ways, among others: it is subject to auditing by the
Legislative Audit Bureau; it is subject to open meeting and open records laws; and
it is exempt from property tax, income tax, and sales and uses taxes. The authority
has powers, including adopting bylaws and policies and procedures for the
regulation of its affairs and conduct of its business; hiring employees; incurring debt;
suing and being sued in its own name; and executing contracts. The bill establishes
a process that the authority must use when it contracts for professional services.
Under the bill, the authority is subject to civil liability for its acts or omissions except
that the maximum amount recoverable in a civil action against the authority is
$100,000. However, a member of the authority's board of directors, the authority's
executive director, or an authority employee is exempt from civil liability unless the
member, director, or employee acted with willful misconduct or in intentional
violation of the law. The bill also imposes restrictions on board members and the
authority's executive director pertaining to conflicts of interest and requires board
members and the executive director to file financial disclosures.

Health benefit exchange
Under the bill, the authority must establish and operate a Wisconsin Health
Benefit Exchange in this state, must make qualified health plans, with effective
dates on or before January 1, 2018, available to qualified individuals and qualified
employers, and must seek federal grants and other funding for the purpose of the
exchange. A qualified health plan is defined in the bill, generally, as a health benefit
plan that covers the costs of health care services and that meets the certification
criteria described in the federal Patient Protection and Affordable Care Act
(PPACA). A qualified individual is defined in the bill, generally, as a citizen or
national of the United States, or an alien lawfully present in the United States, who
is not imprisoned in a correctional facility and who resides in this state. A qualified
employer is defined in the bill, generally, as a small employer with not more than 100
employees that either 1) has its principal place of business in this state and elects
to provide coverage to all of its eligible employees, wherever employed, through the
small business health options program component of the exchange (SHOP
Exchange) established by the authority; or 2) elects to provide coverage through the
SHOP Exchange to all of its eligible employees who are principally employed in this
state.
Only health benefit plans that are certified by the authority as qualified health
plans may be offered through the exchange. To be certified as a qualified health plan,
a health benefit plan must provide the essential health benefits package described
in PPACA, its premium rates and contract language must have been filed with and
not disapproved by the commissioner, it must provide at least a bronze level of
coverage, as determined by the authority in accordance with criteria developed by
the secretary of the federal Department of Health and Human Services, its cost
sharing must not exceed limits established in PPACA, the insurer offering it must
meet specified criteria, and the authority must determine that making the plan
available through the exchange is in the interest of qualified individuals and
qualified employers in this state.
The authority must assign a rating to, and determine the level of coverage of,
each qualified health plan offered through the exchange. The levels of coverage
under PPACA are bronze, silver, gold, and platinum, and are based on what
percentage of the full actuarial value of the benefits provided under the plan the
benefits under the plan provides. An eligible employee of a qualified employer that
provides coverage through the SHOP Exchange may enroll in any qualified health
plan offered through the SHOP Exchange at the level of coverage specified by his or
her employer.
After the exchange begins operating, no insurer may offer or issue health
benefit plan coverage in this state to an individual or a small employer except
through the exchange. Although any insurer that is authorized to do business in this
state in one or more lines of insurance that includes health insurance may offer
qualified health plans through the exchange, a health benefit plan may not be
certified as a qualified health plan unless the insurer that offers it, among other
things, is in good standing, charges the same premium for the plan regardless of
whether it is offered directly by the insurer or through an insurance intermediary,

offers through the exchange at least one qualified health plan in each of the silver
and gold levels of coverage, and complies with regulations of the federal DHHS and
any other requirements established by the authority. In addition, any insurer that
seeks certification of a health benefit plan as a qualified health plan must provide
a justification for any premium increase; must make specified information available
to the public, such as data on enrollment and on the number of claims denied, claims
payment policies and practices, and financial disclosures; and must permit
individuals enrolled in the plan to learn the amount that an individual would be
responsible for paying toward the cost of a specific item or service.
An insurer that offers coverage through the exchange must establish a toll-free
hotline for providing information to enrollees and must pay a commission,
determined by the authority, to an insurance intermediary who enrolls a qualified
individual or employees of a qualified employer in a qualified health plan offered by
the insurer through the exchange. For determining premiums, an insurer that offers
coverage through the exchange may pool together all individuals and employees with
coverage under all of the plans issued by the insurer through the exchange. To pay
administrative expenses of the exchange, the authority may impose on each insurer
offering plans through the exchange a surcharge that is based on the insurer's total
premium or flat dollar amount per enrollee collected through the exchange.
The bill sets out numerous responsibilities for the authority with respect to the
exchange. In addition to the administrative duties related to certifying and rating
health benefit plans and enrolling qualified individuals and qualified employers, the
authority must provide for the operation of a toll-free telephone hotline to respond
to requests for assistance; establish an appeals process; establish and operate a
service center to provide information; publicize the exchange; maintain an Internet
site with comparative information about qualified health plans; screen applicants for
eligibility for Medical Assistance and, if eligible, assist them to enroll in Medical
Assistance; select, and award grants to, entities to serve as navigators for conducting
public education activities and distributing information about, and facilitating
enrollment in, qualified health plans; review the rate of premium growth within the
exchange and outside of the exchange; and develop recommendations on whether
qualified employers should be limited to small employers. The authority may
establish risk adjustment mechanisms for the exchange, contract with a third-party
administrator for services on behalf of the exchange, and establish sub-exchanges
or other exchanges provided for under federal law. The authority must keep an
accounting of all exchange-related activities and receipts and expenditures and
annually submit a report of the accounting to the federal DHHS, the governor, the
commissioner, and the legislature.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.

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:
AB445,1 1Section 1. 1.12 (1) (b) of the statutes is amended to read:
AB445,5,72 1.12 (1) (b) “State agency" means an office, department, agency, institution of
3higher education, the legislature, a legislative service agency, the courts, a judicial
4branch agency, an association, society, or other body in state government that is
5created or authorized to be created by the constitution or by law, for which
6appropriations are made by law, excluding the Badger Health Benefit Authority and
7the Wisconsin Economic Development Corporation.
AB445,2 8Section 2. 13.172 (1) of the statutes is amended to read:
AB445,5,149 13.172 (1) In this section, “agency" means an office, department, agency,
10institution of higher education, association, society, or other body in state
11government created or authorized to be created by the constitution or any law, that
12is entitled to expend moneys appropriated by law, including the legislature and the
13courts, and any authority created in subch. II of ch. 114 or subch. III of ch. 636 or in
14ch. 231, 233, 234, 238, or 279.
AB445,3 15Section 3. 13.62 (2) of the statutes is amended to read:
AB445,5,2016 13.62 (2) “Agency" means any board, commission, department, office, society,
17institution of higher education, council, or committee in the state government, or any
18authority created in subch. II of ch. 114 or subch. III of ch. 636 or in ch. 231, 232, 233,
19234, 237, 238, or 279, except that the term does not include a council or committee
20of the legislature.
AB445,4 21Section 4. 13.94 (1) (dj) of the statutes is created to read:
AB445,6,5
113.94 (1) (dj) At least once every 2 years, perform a financial audit and
2performance evaluation audit of any health benefit plan exchange under subch. II
3of ch. 636 and an audit of the Badger Health Benefit Authority's policies and
4management practices and file copies of each audit report under this paragraph with
5the distributees specified in par. (b).
AB445,5 6Section 5. 13.94 (1s) (c) 9. of the statutes is created to read:
AB445,6,87 13.94 (1s) (c) 9. The Badger Health Benefit Authority for the cost of the audit
8under sub. (1) (dj).
AB445,6 9Section 6. 13.95 (intro.) of the statutes is amended to read:
AB445,6,22 1013.95 Legislative fiscal bureau. (intro.) There is created a bureau to be
11known as the “Legislative Fiscal Bureau" headed by a director. The fiscal bureau
12shall be strictly nonpartisan and shall at all times observe the confidential nature
13of the research requests received by it; however, with the prior approval of the
14requester in each instance, the bureau may duplicate the results of its research for
15distribution. Subject to s. 230.35 (4) (a) and (f), the director or the director's
16designated employees shall at all times, with or without notice, have access to all
17state agencies, the University of Wisconsin Hospitals and Clinics Authority, the
18Wisconsin Aerospace Authority, the Badger Health Benefit Authority, the Lower Fox
19River Remediation Authority, the Wisconsin Economic Development Corporation,
20and the Fox River Navigational System Authority, and to any books, records, or other
21documents maintained by such agencies or authorities and relating to their
22expenditures, revenues, operations, and structure.
AB445,7 23Section 7. 16.002 (2) of the statutes is amended to read:
AB445,7,324 16.002 (2) “Departments" means constitutional offices, departments, and
25independent agencies and includes all societies, associations, and other agencies of

1state government for which appropriations are made by law, but not including
2authorities created in subch. II of ch. 114 or subch. III of ch. 636 or in ch. 231, 232,
3233, 234, 237, 238, or 279.
AB445,8 4Section 8. 16.004 (4) of the statutes is amended to read:
AB445,7,105 16.004 (4) Freedom of access. The secretary and such employees of the
6department as the secretary designates may enter into the offices of state agencies
7and authorities created under subch. II of ch. 114 and subch. III of ch. 636 and under
8chs. 231, 233, 234, 237, 238, and 279, and may examine their books and accounts and
9any other matter that in the secretary's judgment should be examined and may
10interrogate the agency's employees publicly or privately relative thereto.
AB445,9 11Section 9. 16.004 (5) of the statutes is amended to read:
AB445,7,1612 16.004 (5) Agencies and employees to cooperate. All state agencies and
13authorities created under subch. II of ch. 114 and subch. III of ch. 636 and under chs.
14231, 233, 234, 237, 238, and 279, and their officers and employees, shall cooperate
15with the secretary and shall comply with every request of the secretary relating to
16his or her functions.
AB445,10 17Section 10. 16.004 (12) (a) of the statutes is amended to read:
AB445,7,2518 16.004 (12) (a) In this subsection, “state agency" means an association,
19authority, board, department, commission, independent agency, institution, office,
20society, or other body in state government created or authorized to be created by the
21constitution or any law, including the legislature, the office of the governor, and the
22courts, but excluding the University of Wisconsin Hospitals and Clinics Authority,
23the Wisconsin Aerospace Authority, the Lower Fox River Remediation Authority, the
24Wisconsin Economic Development Corporation, the Badger Health Benefit
25Authority,
and the Fox River Navigational System Authority.
AB445,11
1Section 11. 16.045 (1) (a) of the statutes is amended to read:
AB445,8,72 16.045 (1) (a) “Agency" means an office, department, independent agency,
3institution of higher education, association, society, or other body in state
4government created or authorized to be created by the constitution or any law, that
5is entitled to expend moneys appropriated by law, including the legislature and the
6courts, but not including an authority created in subch. II of ch. 114 or subch. III of
7ch. 636
or in ch. 231, 232, 233, 234, 237, 238, or 279.
AB445,12 8Section 12. 16.15 (1) (ab) of the statutes is amended to read:
AB445,8,129 16.15 (1) (ab) “Authority" has the meaning given under s. 16.70 (2), but
10excludes the University of Wisconsin Hospitals and Clinics Authority, the Lower Fox
11River Remediation Authority, and the Wisconsin Economic Development
12Corporation, and the Badger Health Benefit Authority.
AB445,13 13Section 13. 16.41 (4) of the statutes is amended to read:
AB445,8,1514 16.41 (4) In this section, “authority" means a body created under subch. II of
15ch. 114 or subch. III of ch. 636 or under ch. 231, 233, 234, 237, 238, or 279.
AB445,14 16Section 14. 16.417 (1) (a) of the statutes is amended to read:
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