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Wisconsin Assembly Bill Implements Affordable Care Act Provisions

On Tuesday (October 18th), the Wisconsin Assembly passed 2011 Assembly Bill 210, implementing provisions of the Affordable Care Act (ACA) that have gone—or soon will go—into effect. The bill includes the following ACA provisions dealing with health insurance plans:

  • Rate reporting requirements;
  • Internal grievance procedures and external review procedures;
  • Medical loss ratio reporting;
  • Standards for lifetime and annual limits;
  • Prohibition on rescissions;
  • Prohibition on pre-existing condition exclusions for minors;
  • Coverage of preventative health services;
  • Extension of dependent coverage to age 26; and
  • Choice of health care provider.

The bill does not provide for implementation or establishment of a health benefit exchange in Wisconsin.

The bill grandfathers health plans that were in effect when the ACA was enacted.  This delays the timeline for when these plans must begin to comply with some of the specified provisions of the ACA provisions until such time that the health plans are renewed.  The bill requires grandfathered health plans to comply with the ACA provisions for non-grandfathered plans relating to reporting requirements ensuring the quality of care and requirements for coverage of dependent students on a medically necessary leave of absence, coverage of emergency services, and others.

Assembly Bill 210 provides the Commissioner of Insurance the authority to promulgate emergency rules to adopt certain ACA provisions.

According to the amended bill, if the ACA is found unconstitutional or unenforceable in Wisconsin, whether in its entirety or in part, then insurers and self-insured governmental health plans are exempt from the specified or affected corresponding provision(s).  Further, any rules or requirements established by the commissioner with respect to such provision(s) would be void and unenforceable.

Assembly Bill 210 was introduced in July and was referred to the Assembly Committee on Insurance. The bill passed the Assembly 57 to 39 and was referred to the Senate Committee on Insurance and Housing. The Health Law team at von Briesen will monitor the progress of Assembly Bill 210, including the bill’s progress in the Senate.

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About this Author

von Briesen & Roper’s Health Law Section provides comprehensive legal services to the health care industry nationwide as both general counsel and special project counsel. Our clients include integrated delivery systems, academic medical centers, community hospitals, Catholic-sponsored hospitals, rural and critical access hospitals, imaging centers, physicians and multi-specialty clinics, specialty hospitals, ancillary suppliers, home health agencies, nursing homes, hospices, assisted living facilities, mental health and AODA facilities, DME suppliers, laboratories,...