LRBb1862/1
PJK/GMM/RPN:cjs:pg
2001 - 2002 LEGISLATURE
ASSEMBLY AMENDMENT 21,
TO ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2001 SENATE BILL 55
June 29, 2001 - Offered by Representative Wasserman.
SB55-ASA1-AA21,1,64
103.10
(4) (am) Subject to pars. (b) and (c), an employee who is pregnant may
5take up to 9 hours of medical leave during each month of the employee's pregnancy
6for the purpose of receiving prenatal health care check-ups.
SB55-ASA1-AA21,1,128
103.10
(4) (b) No employee may take more than 2 weeks of medical leave
under
9par. (a) during a 12-month period.
No employee may take more than 81 hours of
10medical leave under par. (am) in a 12-month period. No employee may take more
11than 161 hours of medical leave for any combination of reasons specified in pars. (a)
12and (am) during a 12-month period.
SB55-ASA1-AA21,2,62
103.10
(7) (a) (intro.) If an employee requests family leave for a reason
3described in sub. (3) (b) 3. or requests medical leave
under sub. (4) (a), the employer
4may require the employee to provide certification, as described in par. (b), issued by
5the health care provider or Christian Science practitioner of the child, spouse,
6parent
, or employee, whichever is appropriate.
SB55-ASA1-AA21,2,138
103.10
(7) (am) If an employee requests medical leave under sub. (4) (am), the
9employer may require the employee to provide certification issued by the employee's
10health care provider or Christian Science practitioner stating that the employee is
11pregnant and the date on which the pregnancy commenced and its probable
12duration. No employer may require certification under this paragraph stating more
13than the information specified in this paragraph.
SB55-ASA1-AA21,2,1615
103.10
(7) (b) (intro.) No employer may require certification
under par. (a) 16stating more than the following:".
SB55-ASA1-AA21,2,2319
609.05
(3) Except as provided in ss.
609.22 (4), 609.22 (4m), 609.65 and
20609.655, a limited service health organization, preferred provider plan or managed
21care plan may require an enrollee to obtain a referral from the primary provider
22designated under sub. (2) to another participating provider prior to obtaining health
23care services from that participating provider.
SB55-ASA1-AA21,3,7
1609.16 Appeals. (1) After using the procedure under s. 632.83, a grievant may
2appeal the decision of a managed care plan under s. 632.83 either under this section
3or under s. 632.835, if applicable. An appeal under this section shall be made to a
4physician who is licensed under ch. 448, who is not a participating provider of the
5managed care plan and who specializes in the type of medical practice to which the
6grievance relates. The decision of the physician hearing the appeal under this
7section is binding on the grievant and the managed care plan.
SB55-ASA1-AA21,3,10
8(2) A managed care plan must include information regarding the appeal
9procedure under this section in policies or certificates provided to enrollees and must
10provide such information to an enrollee or prospective enrollee upon request.
SB55-ASA1-AA21,3,13
11(3) The commissioner shall promulgate rules for the appeal procedure under
12this section, including rules related to how an enrollee requests an appeal and how
13the physician hearing the appeal is selected.
SB55-ASA1-AA21,3,2016
609.22
(4) (a) 1. A managed care plan may not require an enrollee of the
17managed care plan to obtain a referral for coverage of services provided by a
18participating provider who is a physician licensed under ch. 448 and who specializes
19in a particular type of medical practice, regardless of whether the participating
20provider is the enrollee's primary provider.
SB55-ASA1-AA21,4,223
609.22
(4) (a) 3. A managed care plan must include information regarding
24referral procedures the requirement under subd. 1. in policies or certificates
1provided to enrollees and must provide such information to an enrollee or prospective
2enrollee upon request.
SB55-ASA1-AA21,4,5
4609.39 Right to sue. A person may bring an action in tort against a managed
5care plan for a bad faith denial of coverage.".
SB55-ASA1-AA21,4,7
7"
(1r) Specialist providers under managed care plans.
SB55-ASA1-AA21,4,13
8(a
) Except as provided in paragraph (b
), if a policy or certificate that is affected
9by the treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2., and 3. of the statutes
10contains terms or provisions that are inconsistent with the treatment of sections
11609.05 (3) and 609.22 (4) (a) 1., 2., and 3. of the statutes, the treatment of sections
12609.05 (3) and 609.22 (4) (a) 1., 2., and 3. of the statutes first applies to that policy
13or certificate upon renewal.
SB55-ASA1-AA21,4,18
14(b
) The treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2., and 3. of the
15statutes first applies to policies or group certificates covering employes who are
16affected by a collective bargaining agreement containing provisions that are
17inconsistent with the treatment of sections 609.05 (3) and 609.22 (4) (a) 1., 2., and
183. of the statutes that are issued or renewed on the earlier of the following:
SB55-ASA1-AA21,4,19
191. The day on which the collective bargaining agreement expires.
SB55-ASA1-AA21,4,21
202. The day on which the collective bargaining agreement is extended, modified
21or renewed.
SB55-ASA1-AA21,4,22
22(1s) Appeals of decisions of managed care plans.
SB55-ASA1-AA21,5,3
1(a) The treatment of section 609.16 (1) of the statutes first applies to grievances
2arising on September 1, 2001, or on the effective date of this paragraph, whichever
3is later.
SB55-ASA1-AA21,5,6
4(b) The treatment of section 609.16 (2) of the statutes first applies to policies
5issued or renewed on September 1, 2001, or on the effective date of this paragraph,
6whichever is later.
SB55-ASA1-AA21,5,8
7(1t) Lawsuits against managed care plans. The treatment of section 609.39 of
8the statutes first applies to claims arising on the effective date of this subsection.".
SB55-ASA1-AA21,5,15
10"
(10q) Medical leave for prenatal check-ups. The treatment of section 103.10
11(4) (am) and (b) and (7) (a) (intro.), (am), and (b) (intro.) of the statutes first applies
12to an employee, as defined in section 103.10 (1) (b) of the statutes, who is affected by
13a collective bargaining agreement that contains provisions inconsistent with that
14treatment on the day on which the collective bargaining agreement expires or is
15extended, modified, or renewed, whichever occurs first.".
SB55-ASA1-AA21,5,19
17"
(1
) Appeals of decisions of managed care plans. The treatment of section
18609.16 (1) and (2) of the statutes takes effect on September 1, 2001, or on the effective
19date of this subsection, whichever is later.".
