LRB-1273/2
PJK:jlg:km
1999 - 2000 LEGISLATURE
July 15, 1999 - Introduced by Representatives Urban, Underheim, Klusman,
Skindrud, Plouff, Albers, Musser, Powers, Brandemuehl, Seratti, Sykora,
Goetsch, Hahn, Nass and La Fave, cosponsored by Senators Darling, Rude
and Huelsman. Referred to Committee on Health.
AB414,1,3
1An Act to amend 149.14 (3) (intro.) of the statutes;
relating to: medical
2assistance certification of providers under the mandatory health insurance
3risk-sharing plan.
Analysis by the Legislative Reference Bureau
The health insurance risk-sharing plan (HIRSP) provides major medical
health insurance coverage for persons who are covered under medicare because they
are disabled, persons who have tested positive for HIV and persons who have been
refused coverage, or coverage at an affordable price, in the private health insurance
market because of their mental or physical health condition. Also eligible for
coverage are persons who do not currently have health insurance coverage, but who
were covered under certain types of health insurance coverage for at least 18 months
in the past. Responsibility for administering HIRSP is split between the department
of health and family services (DHFS) and a board of governors.
Generally, HIRSP provides coverage for services that are provided by
chiropractors who are licensed in this state and who are certified as medical
assistance providers and for services and articles that are provided by providers who
are certified as medical assistance providers and that were prescribed by physicians
who are licensed in this state, or in another state, and who are certified as medical
assistance providers. This bill removes the requirement that, for coverage of services
or articles prescribed by a physician who is licensed in another state, the physician
must be certified as a medical assistance provider. Instead, such a physician must
satisfy certification requirements of DHFS.
The bill also qualifies the requirement that, for coverage of services or articles
properly prescribed, the provider providing the service or article must be certified as
a medical assistance provider. Unless the provider is practicing in another state, the
provider must be certified as a medical assistance provider. If the provider is
practicing in another state, the provider must satisfy certification requirements of
DHFS.
In addition, the bill provides that HIRSP will cover the services of a
chiropractor who is licensed in another state if the chiropractor satisfies certification
requirements of DHFS.
For further information see the state 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:
AB414, s. 1
1Section
1. 149.14 (3) (intro.) of the statutes is amended to read:
AB414,3,22
149.14
(3) Covered expenses. (intro.) Except as restricted by cost containment
3provisions under s. 149.17 (4) and except as reduced by the board under s. 149.15 (3)
4(e) or by the department under s. 149.143 or 149.144, covered expenses for the
5coverage under this section shall be the usual and customary charges for the services
6provided by
persons a chiropractor who is licensed under ch. 446 and
who is certified
7under s. 49.45 (2) (a) 11
., or by a chiropractor who is licensed in another state and who
8satisfies certification requirements of the department. Except as restricted by cost
9containment provisions under s. 149.17 (4) and except as reduced by the board under
10s. 149.15 (3) (e) or by the department under s. 149.143 or 149.144, covered expenses
11for the coverage under this section shall also be the usual and customary charges for
12the following services and articles if the service or article is prescribed by a physician
13who is licensed under ch. 448
and who is certified under s. 49.45 (2) (a) 11., or
by a
14physician who is licensed in another state and who
is certified under s. 49.45 (2) (a)
1511. satisfies certification requirements of the department, and if the service or article
1is provided by a provider
who is certified under s. 49.45 (2) (a) 11.
, or who, if practicing
2in another state, satisfies certification requirements of the department:
AB414,3,54
(1) This act first applies to services and articles prescribed or provided on the
5effective date of this subsection.
