LRB-1614/1
PJK:skg:jlb
1995 - 1996 LEGISLATURE
February 14, 1995 - Introduced by Representatives Schneider, Robson,
Ziegelbauer, Baldus, Boyle, Notestein, R. Potter, Ryba, Wilder
and L.
Young
. Referred to Committee on Insurance, Securities and Corporate Policy.
AB129,1,4 1An Act to amend 40.51 (8), 185.981 (4t), 185.983 (1) (intro.) and 632.87 (1); and
2to create 609.71 and 632.87 (6) of the statutes; relating to: requiring insurers
3to cover treatment of a condition by an acupuncturist if there is coverage for
4treatment of the condition by a physician.
Analysis by the Legislative Reference Bureau
This bill requires insurers, including health maintenance organizations,
preferred provider plans, limited service health organizations and plans provided by
the state, to cover the diagnosis and treatment of a condition by an acupuncturist,
within the scope of the acupuncturist's certificate, if diagnosis and treatment of the
condition by a physician is covered. Referral to an acupuncturist from a physician
is not required for coverage of the acupuncture services.
Current law contains the same mandated coverage provision for chiropractic
services if a condition is covered when treated by a physician, and for optometric
services if vision care is covered and the same service or procedure is covered when
provided by another health care provider.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB129, s. 1 5Section 1. 40.51 (8) of the statutes is amended to read:
AB129,2,3
140.51 (8) Every health care coverage plan offered by the state under sub. (6)
2shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5) (6),
3632.895 (5m) and (8) to (10) and 632.896.
AB129, s. 2 4Section 2. 185.981 (4t) of the statutes is amended to read:
AB129,2,75 185.981 (4t) A sickness care plan operated by a cooperative association is
6subject to ss. 252.14, 631.89, 632.72 (2), 632.87 (2m), (3), (4) and (5) to (6), 632.895
7(10) and 632.897 (10) and ch. 155.
AB129, s. 3 8Section 3. 185.983 (1) (intro.) of the statutes is amended to read:
AB129,2,149 185.983 (1) (intro.)  Every such voluntary nonprofit sickness care plan shall be
10exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
11601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
12(2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5) to (6), 632.895 (5), (9) and
13(10), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and
14646, but the sponsoring association shall:
AB129, s. 4 15Section 4. 609.71 of the statutes is created to read:
AB129,2,17 16609.71 Acupuncture coverage. Health maintenance organizations, limited
17service health organizations and preferred provider plans are subject to s. 632.87 (6).
AB129, s. 5 18Section 5. 632.87 (1) of the statutes is amended to read:
AB129,2,2419 632.87 (1) No insurer may refuse to provide or pay for benefits for health care
20services provided by a licensed an acupuncturist who is certified or another health
21care professional who is licensed on the ground that the services were not rendered
22by a physician as defined in s. 990.01 (28), unless the contract clearly excludes
23services by such practitioners, but no contract or plan may exclude services in
24violation of sub. (2m), (3), (4) or, (5) or (6).
AB129, s. 6 25Section 6. 632.87 (6) of the statutes is created to read:
AB129,3,6
1632.87 (6) (a) No policy, plan or contract may exclude coverage for diagnosis and
2treatment of a condition or complaint by an acupuncturist who is certified under ch.
3451, within the scope of the acupuncturist's certificate, if the policy, plan or contract
4covers diagnosis and treatment of the condition or complaint by a licensed physician
5or osteopath, even if different nomenclature is used to describe the condition or
6complaint. This paragraph does not:
AB129,3,87 1. Prohibit the application of deductibles or coinsurance provisions to
8acupuncturist and physician charges on an equal basis.
AB129,3,119 2. Prohibit the application of cost containment or quality assurance measures
10to acupuncturist and physician services in a like manner, consistent with this
11section.
AB129,3,1312 (b) No insurer may require an examination by or a referral from a physician
13as a condition precedent for the receipt of an acupuncturist's services under par. (a).
AB129, s. 7 14Section 7. Initial applicability.
AB129,3,16 15(1)  This act first applies to policies, plans or contracts issued or renewed on the
16first day of the 5th month beginning after publication.
AB129,3,1717 (End)
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