LRBa0896/1
PJK:wlj:jf
1999 - 2000 LEGISLATURE
ASSEMBLY AMENDMENT 17,
TO ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 1999 ASSEMBLY BILL 518
November 2, 1999 - Offered by Representative Wasserman.
AB518-ASA1-AA17,1,106
609.05
(3) Except as provided in ss.
609.22 (4), 609.65 and 609.655, a limited
7service health organization, preferred provider plan or managed care plan may
8require an enrollee to obtain a referral from the primary provider designated under
9sub. (2) to another participating provider prior to obtaining health care services from
10that participating provider.".
AB518-ASA1-AA17,1,12
12"
Section 17c. 609.22 (4) (a) 1. of the statutes is repealed and recreated to read:
AB518-ASA1-AA17,2,5
1609.22
(4) (a) 1. A managed care plan may not require an enrollee of the
2managed care plan to obtain a referral for coverage of services provided by a
3participating provider who is a physician licensed under ch. 448 and who specializes
4in a particular type of medical practice, regardless of whether the participating
5provider is the enrollee's primary provider.
AB518-ASA1-AA17,2,118
609.22
(4) (a) 3. A managed care plan must include information regarding
9referral procedures the prohibition under subd. 1. in policies or certificates provided
10to enrollees and must provide such information to an enrollee or prospective enrollee
11upon request.".
AB518-ASA1-AA17,2,14
14(1) Specialist providers under managed care plans.
AB518-ASA1-AA17,2,20
15(a) Except as provided in paragraph (b
), if a policy or certificate that is affected
16by the treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2. and 3. of the statutes
17contains terms or provisions that are inconsistent with the treatment of sections
18609.05 (3) and 609.22 (4) (a) 1., 2. and 3. of the statutes, the treatment of sections
19609.05 (3) and 609.22 (4) (a) 1., 2. and 3. of the statutes first applies to that policy or
20certificate upon renewal.
AB518-ASA1-AA17,3,2
21(b
) The treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2. and 3. of the
22statutes first applies to policies or group certificates covering employes who are
23affected by a collective bargaining agreement containing provisions that are
1inconsistent with the treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2. and 3.
2of the statutes that are issued or renewed on the earlier of the following:
AB518-ASA1-AA17,3,3
31. The day on which the collective bargaining agreement expires.
AB518-ASA1-AA17,3,5
42. The day on which the collective bargaining agreement is extended, modified
5or renewed.".
