AB222: Bill Text

LRB-0095/2

PJK:kaf:km

1997 - 1998 LEGISLATURE

1997 Assembly BILL 222

March 27, 1997 - Introduced by Representatives Cullen, Wasserman, Robson, Ryba, Harsdorf, Carpenter, Bock, Krug, Brandemuehl, Kreuser, Baldwin, Krusick, Notestein, Boyle and Black, cosponsored by Senators Burke, Moen, Wirch and Grobschmidt. Referred to Committee on Mandates.

AB222,1,6 An Act to amend 40.51 (8), 60.23 (25), 66.184, 120.13 (2) (g), 185.981 (4t) and 185.983 (1) (intro.); to repeal and recreate 40.51 (8), 40.51 (8m), 60.23 (25), 66.184, 120.13 (2) (g), 185.981 (4t) and 185.983 (1) (intro.); and to create 40.51 (8m), 111.91 (2) (n) and 632.895 (11) of the statutes; relating to: insurance coverage of hospital or home care after childbirth and granting rule-making authority.

Analysis by the Legislative Reference Bureau

This bill requires every health insurance policy (called "disability insurance policy" in the statutes), including health care plans offered by health maintenance organizations, preferred provider plans and the state, and every self-insured health plan of the state or a county, city, village, town or school district, to provide coverage of inpatient hospital services or home care visits, or a combination of both, for a specified length of time after the birth of a child if the policy or plan provides maternity coverage. The bill requires coverage of at least 48 hours of inpatient hospital services or home care visits, or a combination of both, after childbirth for mother and child if the child was born by natural childbirth, and coverage of at least 96 hours of inpatient hospital services or home care visits, or a combination of both, after childbirth for mother and child if the child was born by caesarean section. The required coverage may be subject to deductibles or copayments that apply to coverage of other services under the policy or plan. The bill also specifies that for purposes of coverage, the type of services and the length of time that the services are provided are at the discretion of the mother's or child's health care provider in consultation with the mother. Insurers and administrators and self-insurers of self-insured health plans are prohibited from taking any adverse action against a health care provider who recommends or orders a hospital stay or home care visits after the birth of a child for the length of time for which coverage is required under the bill. In addition, insurers and administrators of self-insured health plans to which the coverage requirement applies are required to provide notice of the requirement to insureds at the earlier of the commencement or renewal of the insured's coverage.

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:

AB222, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

AB222,2,4 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895 (5m) and (8) to (10) (11) and 632.896.

AB222, s. 2 Section 2. 40.51 (8) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,2,9 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.745 (1) to (3) and (5), 632.747, 632.87 (3) to (5), 632.895 (5m) and (8) to (11) and 632.896.

AB222, s. 3 Section 3. 40.51 (8m) of the statutes is created to read:

AB222,2,12 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with s. 632.895 (11).

AB222, s. 4 Section 4. 40.51 (8m) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,3,3 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 632.745 (1) to (3) and (5), 632.747 and 632.895 (11).

AB222, s. 5 Section 5. 60.23 (25) of the statutes is amended to read:

AB222,3,7 60.23 (25) Self-insured health plans. Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (11) and 632.896.

AB222, s. 6 Section 6. 60.23 (25) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,3,13 60.23 (25) Self-insured health plans. Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) and (11) and 632.896.

AB222, s. 7 Section 7. 66.184 of the statutes is amended to read:

AB222,3,20 66.184 Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB222, s. 8 Section 8. 66.184 of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,4,3 66.184 Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB222, s. 9 Section 9. 111.91 (2) (n) of the statutes is created to read:

AB222,4,6 111.91 (2) (n) The provision to employes of the health insurance coverage required under s. 632.895 (11).

AB222, s. 10 Section 10. 120.13 (2) (g) of the statutes is amended to read:

AB222,4,10 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB222, s. 11 Section 11. 120.13 (2) (g) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,4,16 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB222, s. 12 Section 12. 185.981 (4t) of the statutes is amended to read:

AB222,4,20 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.87 (2m), (3), (4) and (5), 632.895 (10) and (11) and 632.897 (10) and ch. 155.

AB222, s. 13 Section 13. 185.981 (4t) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,4,25 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3), (4) and (5), 632.895 (10) and (11) and 632.897 (10) and ch. 155.

AB222, s. 14 Section 14. 185.983 (1) (intro.) of the statutes is amended to read:

AB222,5,7 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72 (2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5), (9) and (10) and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

AB222, s. 15 Section 15. 185.983 (1) (intro.) of the statutes, as affected by 1995 Wisconsin Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB222,5,15 185.983 (1) (intro.)  Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72 (2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5) and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

AB222, s. 16 Section 16. 632.895 (11) of the statutes is created to read:

AB222,5,21 632.895 (11) Inpatient hospital services and home care visits after childbirth. (a) Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides maternity coverage shall provide coverage for mother and child of the usual and customary charges for all of the following:

AB222,5,24 1. After the birth of a child by vaginal delivery, inpatient hospital services or home care visits, or a combination of both, related to the birth of the child for a period of at least 48 hours.

AB222,6,3 2. After the birth of a child by caesarean section, inpatient hospital services or home care visits, or a combination of both, related to the birth of the child for a period of at least 96 hours.

AB222,6,8 (b) For purposes of the coverage required under par. (a), the type of care provided, whether inpatient hospital services or home care visits or a combination of both, as well as the length of time that the care is provided, shall be at the discretion of the mother's or child's health care provider in consultation with the mother.

AB222,6,10 (c) The coverage required under par. (a) may be subject to any copayments or deductibles that apply generally under the policy or plan to other covered services.

AB222,6,17 (d) An insurer providing coverage under a disability insurance policy described in par. (a), or an administrator or self-insurer of a self-insured health plan described in par. (a), may not take any adverse action against a health care provider on the basis that the health care provider recommended or ordered, on one or more occasions, inpatient hospital services or home care visits, or a combination of both, after the birth of a child for the length of time required under par. (a) for coverage of such services.

AB222,7,5 (e) Every insurer that issues or renews a policy described in par. (a) on or after the effective date of this paragraph .... [revisor inserts date], shall provide written notice of the provisions of pars. (a) to (d) and of any rules promulgated under par. (f) to the insureds under the policy at the issuance of a new policy or first renewal of a policy in effect on the effective date of this paragraph .... [revisor inserts date]. Every administrator of a self-insured health plan described in par. (a) that is established, extended, modified or renewed on or after the effective date of this paragraph .... [revisor inserts date], shall provide written notice of the provisions of pars. (a) to (d) and of any rules promulgated under par. (f) to the insureds under the plan at the establishment of a new plan or extension, modification or renewal, whichever occurs first, of a plan in existence on the effective date of this paragraph .... [revisor inserts date]. The notice required under this paragraph may be provided as part of any written policy, group certificate or plan provided to an insured at the same time.

AB222,7,7 (f) The commissioner shall promulgate rules regarding home care visits for which coverage is required under par. (a) that address all of the following: