Under current law, the Health Insurance Risk-Sharing Plan (HIRSP)
Authority administers HIRSP, which provides health insurance coverage 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 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.

This substitute amendment makes the following changes to HIRSP and the
HIRSP Authority:

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1. Currently, to receive payment under HIRSP, all providers of services and
articles must be certified to provide those services and articles under the Medical
Assistance (MA) program. The substitute amendment makes an exception from this
requirement for prescription drugs that are provided by a network of pharmacies
that are approved by the HIRSP Authority Board of Directors. In addition, the
substitute amendment authorizes the HIRSP Authority to certify providers on a
temporary basis to provide services or articles to HIRSP enrollees. These providers
would not be certified to provide services and articles under MA; they would have to
be licensed to provide the services or articles that they are providing to HIRSP
enrollees but not necessarily licensed in this state; and the certification could be done
retroactively after the services or articles were provided.

2. Currently, payments to providers must consist of the allowable charges for
services and articles under MA with an enhancement determined by the HIRSP
Authority. The adjustments must take into account provider discounts. The
substitute amendment requires payments to providers to consist of usual and
customary payment rates, determined by the HIRSP Authority, with adjustments
that take into account provider discounts.

3. Under current law, HIRSP enrollees with incomes below a specified level who
are covered under certain HIRSP coverage options are eligible for premium and
deductible subsidies. The substitute amendment makes all persons with coverage
under HIRSP with incomes below that specified level eligible for the premium and
deductible subsidies.

4. For HIRSP enrollees who receive premium subsidies, current law describes
the amount of the reduction in an enrollee's premium in terms of requiring an
enrollee's regular HIRSP premium to be reduced to a specified percentage of the rate
that a standard risk would be charged under an individual policy providing
substantially the same coverage and deductibles as HIRSP. The substitute
amendment changes the way the premium reduction is described by establishing
discounts, so that an enrollee's regular premium is reduced by a specified percentage
of the premium, such as 30 percent or 20 percent.

5. Under current law, with certain exceptions, anyone who is eligible for certain
types of health care coverage provided by an employer is ineligible for coverage under
HIRSP. The substitute amendment authorizes the HIRSP Authority Board to
specify other exceptions, subject to the approval of the Commissioner of Insurance.

6. Under current law, as enacted by the budget bill, 2007 Wisconsin Act 20, the
amount of any premium subsidy that would have been paid under HIRSP on behalf
of an enrollee who terminates coverage under HIRSP and obtains coverage under an
MA demonstration project providing health care benefits for low-income childless
adults must be transferred to the department of health and family services (DHFS)
for use for that demonstration project. The bill removes the requirement that any
moneys be transferred from HIRSP to DHFS for the MA demonstration project.