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Legislature moves ahead on transitioning HIRSP patients to exchanges

The Wisconsin State Legislature’s Joint Committee on Finance (JCF) voted Wednesday to adopt a plan that would transition participants in the state’s high-risk insurance pool to the federal health insurance exchanges by January 1, 2014. Created by the Affordable Care Act, the federal exchanges are due to provide health insurance coverage on that date.

The action follows many of the recommendations from the state-run Health Insurance Risk-Sharing Pool (HIRSP) Board, which proposed the plan earlier this year. The nonpartisan Legislative Fiscal Bureau’s summary of the proposal and the potential JCF option are included in this paper.

HIRSP currently offers health insurance to roughly 22,000 Wisconsin residents who either are unable to find adequate health insurance coverage in the private market due to their medical conditions or who have lost their employer-sponsored group health insurance. The program was created in 1979.

The HIRSP Board originally planned to transition HIRSP participants into the federal exchanges more gradually, but a decision in March by the U.S. Department of Health and Human Services (HHS) to create national-level administration of these types of plans prompted HIRSP to propose a more rapid transition.

Included in the language JCF passed Wednesday is a proposal requiring physicians to file claims for HIRSP reimbursement no more than 90 days after termination of a participant’s HIRSP coverage, although there are some provisions allowing for later claims if just cause is shown.

The Society will continue to work with HIRSP and other health care stakeholders to ensure that a plan exists to create the smoothest transition possible and that physicians are aware of the new deadlines and requirements. Contact Chris Rasch in the Society’s Government Relations Department with questions.

Back to May 16, 2013 Medigram