In this email:

Provide Input: Proposed Legislation that would Require Self-funded Plans to Report to DHS Contact Your Legislator: Dental Contract Legislation [Jump to this]

Provide Input: Proposed Legislation that would Require Self-funded Plans to Report to DHS

Representative John Nygren is proposing legislation (.pdf) that would require self-insured health plans and their TPAs to provide enrollee coverage information to the state of Wisconsin.

The legislation was requested by the Wisconsin Department of Health Services (DHS), which would use the information to determine whether BadgerCare, Medicaid, SeniorCare and Family Care enrollees have employer-sponsored coverage that, by law, should pay claims before these Medical Assistance programs. Current law states that that when other coverage is available Medical Assistance is the payer of last resort.

The Alliance^®, along with representatives from member company Mead & Hunt, met with Rep. Nygren, Division of Health Care Access & Accountability Administrator Brett Davis and other staff last week to learn more about what data DHS would collect and how they would collect it if the bill passes. DHS has promised to provide this information as they finalize their plans for the proposed bill.

According to DHS, the proposed legislation is projected to save $3.6 million in Medical Assistance funding annually. The Medicaid program is currently under a directive to find $107 million in savings to avoid cuts in the Medicaid program.

The Alliance believes that if enacted this legislation could affect Wisconsin Alliance members in the following ways:

	There would be an administrative burden associated with reporting data to DHS, which we hope to minimize if the bill moves forward.
	The state of Wisconsin would for the first time have real data on self-funded health plans, which are otherwise regulated at the federal level. How this data would be used in the future is unknown.
	The $3.6 million in savings would result from employers paying claims before Medical Assistance, which they are legally obligated to do under current law.

We are interested in hearing from you to learn if this proposed legislation is of concern to you as a self-funded employer for the above reason, or others.

If you have thoughts on whether you would support or oppose this legislation, please email or call me at 800.223.4139 x 6621. As always, we will use information from members to develop our position on this proposed legislation and will report out to members as this issue progresses.

Contact Your Legislator: Dental Contract Legislation

A bill (AB 251) has been introduced at the request of the Wisconsin Dental Association (WDA) that would prohibit insurance companies, TPAs and networks from extending contracted rates to enrollees on non-covered services. Instead enrollees would pay full retail rates for non-covered services. The bill also defines "covered service" as one where the negotiated rate is 50% or more of the dentist's non-discounted fee.

The Alliance has the following concerns with AB 251 and for this reason, with health policy committee support, opposes it:

	The Alliance works on behalf of both employers and employees when negotiating discounts with health care providers. We believe that a fair rate is a fair rate, regardless of whether the employer, or the employee, is paying the bill.
	Contract disputes belong at the negotiating table or in the courts, not in the legislature.
	States have the authority to regulate insured plans, but ERISA precludes states from regulating most self-funded plans. By applying this bill to TPAs and networks, the WDA is in effect applying this prohibition to self-funded plans. At the national level, the American Dental Association is working to amend ERISA to apply this same prohibition to self-funded plans. We believe this could set a dangerous precedent.

In November, The Alliance provided testimony (.pdf) to the Insurance Committee on this bill. Unfortunately, the Committee approved the bill last Thursday. Next it will move on to the Assembly and possibly the Senate as it makes it way toward becoming law.

We encourage you to contact your legislator to oppose this bill. You can find your legislators at this Wisconsin State Legislature site. To help us track our members' efforts if you do contact your legislator, please let us know by emailing us to let us know how you reached out, or forwarding a copy of any correspondence you sent.

I look forward to hearing your thoughts. Please email me, or call me at 800.223.4139 x 6621, with any thoughts on this issue.

Kind regards,