SB226-SSA1,3,73 20.435 (4) (jz) Badger Care cost sharing , and employer penalty assessments ,
4and premium subsidies. All moneys received from payments under s. 49.665 (5), all
5moneys transferred under s. 149.165 (4), and all moneys received from penalty
6assessments under s. 49.665 (7) (b) 2. to be used for the Badger Care health care
7program under s. 49.665 and for the demonstration project under s. 49.45 (23).

SB226-SSA1,3,1610 20.435 (4) (jz) Medical Assistance and Badger Care cost sharing and employer
11penalty assessments. All moneys received from in cost sharing from medical
12assistance recipients, including payments under s. 49.665 (5) and, all moneys
13received from penalty assessments under s. 49.665 (7) (b) 2., and 90 percent of all
14moneys received from penalty assessments under s. 49.471 (9) (c) to be used for the
15Badger Care health care program under s. 49.665 and for the Medical Assistance
16program under subch. IV of ch. 49.

SB226-SSA1,3,2219 149.12 (2) (e) 1. No Subject to subd. 2., no person who is eligible for creditable
20coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that is
21provided by an employer on a self-insured basis or through health insurance is
22eligible for coverage under the plan.

SB226-SSA1,4,3

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1149.12 (2) (e) 2. The board may specify, subject to the approval of the
2commissioner, other types of coverage provided by an employer that do not render
3a person ineligible for coverage under the plan.

SB226-SSA1,4,157 149.14 (3) Covered expenses. (intro.) Covered expenses for coverage under the
8plan shall be the payment rates established by the authority for services provided
9by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Covered
10expenses for coverage under the plan shall also be the payment rates established by
11the authority for, at a minimum, the following services and articles if the service or
12article is prescribed by a physician who is licensed under ch. 448 or in another state
13and who is certified under s. 49.45 (2) (a) 11. and if the service or article, except for
14prescription drugs that are provided by a network of pharmacies approved by the
15board, is provided by a provider certified under s. 49.45 (2) (a) 11.:

SB226-SSA1,4,2317 149.14 (3c) Temporary provider certification. Notwithstanding the provider
18licensing and certification requirements under sub. (3) (intro.), for coverage of
19services or articles provided to an eligible person the authority may certify on a
20temporary basis a provider that is not licensed under ch. 446 or 448 but that is
21licensed in another state to provide the service or article, or a provider that is not
22certified under s. 49.45 (2) (a) 11. The certification under this subsection may be
23retroactive.

SB226-SSA1,5,3

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1149.14 (5) (a) The authority shall establish and provide subsidies for
2deductibles paid by eligible persons with coverage under s. 149.14 (2) (a) and
3household incomes specified in s. 149.165 (2) (a) 1. to 5 to (e).

SB226-SSA1,5,155 149.142 (1) Establishment of rates. The authority shall establish provider
6payment rates for covered expenses that consist of the allowable charges paid under
7s. 49.46 (2) usual and customary payment rates, as determined by the authority, for
8the services and articles provided plus an enhancement adjustment determined by
9the authority. The rates shall be based on the allowable charges paid under s. 49.46
10(2), projected plan costs, and trend factors. Using the same methodology that applies
11to medical assistance under subch. IV of ch. 49, the authority shall establish hospital
12outpatient per visit reimbursement rates and hospital inpatient reimbursement
13rates that are specific to diagnostically related groups of eligible persons. The
14adjustments to the usual and customary rates shall be sufficient to cover the portion
15of plan costs specified in s. 149.143 (1) (c) and (2) (b).

SB226-SSA1,5,2318 149.165 (2) Subject to sub. (3m), if the household income, as defined in s. 71.52
19(5) and as determined under sub. (3), of an eligible person with coverage under s.
20149.14 (2) (a) is equal to or greater than the first amount and less than the 2nd
21amount listed in any of the following, the authority shall reduce the premium for the
22eligible person to the rate by the percentage of the premium shown after the
23amounts:

SB226-SSA1,6,224 (a) If equal to or greater than $0 and less than $10,000, to 100% of the rate that
25a standard risk would be charged under an individual policy providing substantially

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1the same coverage and deductibles as provided under s. 149.14 (2) (a) and (5) (a) by
2at least 30 percent.

SB226-SSA1,6,63 (b) If equal to or greater than $10,000 and less than $14,000, to 106.5% of the
4rate that a standard risk would be charged under an individual policy providing
5substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
6and (5) (a) by at least 25 percent.

SB226-SSA1,6,107 (c) If equal to or greater than $14,000 and less than $17,000, to 115.5% of the
8rate that a standard risk would be charged under an individual policy providing
9substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
10and (5) (a) by at least 20 percent.

SB226-SSA1,6,1411 (d) If equal to or greater than $17,000 and less than $20,000, to 124.5% of the
12rate that a standard risk would be charged under an individual policy providing
13substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
14and (5) (a) by at least 15 percent.

SB226-SSA1,6,1815 (e) If equal to or greater than $20,000 and less than $25,000, to 130% of the rate
16that a standard risk would be charged under an individual policy providing
17substantially the same coverage and deductibles as provided under s. 149.14 (2) (a)
18and (5) (a) by at least 10 percent.

SB226-SSA1,6,2421 149.165 (3m) The authority may approve adjustment of the household income
22dollar amounts listed in sub. (2) (a) 1. to 5. to (e), except for the first dollar amount
23listed in sub. (2) (a) 1., to reflect changes in the consumer price index for all urban
24consumers, U.S. city average, as determined by the U.S. department of labor.