Amendment SA4-SB375

LRBa1528/1

PJK:kmg:jf

2001 - 2002 LEGISLATURE

SENATE AMENDMENT 4, TO 2001 SENATE BILL 375

March 7, 2002 - Offered by Senators Breske and Moen.

SB375-SA4,1,1 At the locations indicated, amend the bill as follows:

SB375-SA4,1,3 1. Page 2, line 4: after "insurers," insert "providing notice of the right to independent review,".

SB375-SA4,1,4 2. Page 9, line 25: after that line insert:

SB375-SA4,1,6 " Section 23c. 632.835 (2) (b) of the statutes, as created by 1999 Wisconsin Act 155, is amended to read:

SB375-SA4,2,2 632.835 (2) (b) Whenever If an adverse determination or an experimental treatment determination is made, the insurer involved in the determination shall provide notice to the insured of the insured's right to obtain the independent review required under this section, how to request the review, and the time within which the review must be requested. The notice shall include a current listing of independent review organizations certified under sub. (4). An independent review under this section may be conducted only by an independent review organization certified under sub. (4) and selected by the insured.

SB375-SA4, s. 23d Section 23d. 632.835 (2) (bg) of the statutes is created to read:

SB375-SA4,2,6 632.835 (2) (bg) Notwithstanding par. (b), an insurer is not required to provide the notice under par. (b) to an insured until the insurer sends notice of the disposition of the internal grievance if all of the following apply:

SB375-SA4,2,11 1. The health benefit plan issued by the insurer contains a description of the independent review procedure under this section, including an explanation of the insured's rights under par. (d), how to request the review, the time within which the review must be requested, and how to obtain a current listing of independent review organizations certified under sub. (4).

SB375-SA4,2,20 2. The insurer includes on its explanation of benefits form a statement that the insured may have a right to an independent review after the internal grievance process and that an insured may be entitled to expedited independent review with respect to an urgent matter. The statement shall also include a reference to the section of the policy or certificate that contains the description of the independent review procedure as required under subd. 1. The statement shall provide a toll-free telephone number and website, if appropriate, where consumers may obtain additional information regarding internal grievance and independent review processes.

SB375-SA4,3,5 3. For any adverse determination or experimental treatment determination for which an explanation of benefits is not provided to the insured, the insurer provides a notice that the insured may have a right to an independent review after the internal grievance process and that an insured may be entitled to expedited, independent review with respect to an urgent matter. The notice shall also include a reference to the section of the policy or certificate that contains the description of the independent review procedure as required under subd. 1. The notice shall provide a toll-free telephone number and website, if appropriate, where consumers may obtain additional information regarding internal grievance and independent review processes.".

SB375-SA4,3,6 3. Page 11, line 12: after that line insert:

SB375-SA4,3,8 " Section 26m. Effective dates. This act takes effect on the day after publication, except as follows:

SB375-SA4,3,12 (1x) Notice of independent review. The treatment of section 632.835 (2) (b) and (bg) of the statutes takes effect on the date stated in the notice published by the commissioner of insurance in the Wisconsin Administrative Register under section 632.835 (8) of the statutes.".

SB375-SA4,3,13 (End)