LRB-2320/1
PJK&DAK:jld:pg
2007 - 2008 LEGISLATURE
July 19, 2007 - Introduced by Representatives Bies, Grigsby, Albers, Berceau,
Black, Davis, Gunderson, Hahn, Hintz, Hubler, Kaufert, Mursau, A. Ott,
Pope-Roberts, Sheridan, Soletski, Townsend, Wasserman, Zepnick
and
Benedict, cosponsored by Senators Miller, Darling, Erpenbach, Hansen,
Lehman, Risser, Vinehout, Wirch
and Roessler. Referred to Committee on
Health and Healthcare Reform.
AB463,1,7 1An Act to amend 49.46 (2) (b) 6. (intro.) and 609.655 (3) (a); and to create 49.45
2(30g), 49.46 (2) (b) 6. Lr., 632.89 (1) (dm) and 632.89 (1) (e) 4. of the statutes;
3relating to: mental health professionals who may provide outpatient services
4for the treatment of nervous and mental conditions and alcoholism and other
5drug abuse problems or who, under Medical Assistance, may provide
6psychotherapy and alcohol and other drug abuse services and exempting
7certain Medical Assistance benefits from physician prescription requirements.
Analysis by the Legislative Reference Bureau
Under current law, a group health insurance policy that provides coverage of
any outpatient treatment is required to provide coverage for outpatient services for
the treatment of nervous and mental disorders and alcoholism and other drug abuse
problems in the minimum amount of $2,000, minus the applicable cost sharing, per
insured per year. The outpatient services that must be covered are those provided
by: 1) a program in an outpatient treatment facility, both of which must be approved
by the Department of Health and Family Services (DHFS), and the program must
be established and maintained according to rules promulgated by DHFS and the
facility must be certified by DHFS; 2) a licensed physician who has completed a
residency in psychiatry; or 3) a licensed psychologist who is listed in the national
register of health service professionals in psychology or who is certified by the

American Board of Professional Psychology. This bill requires group health
insurance policies to cover the services of clinical social workers, marriage and family
therapists, and professional counselors for the outpatient treatment of nervous and
mental disorders and alcoholism and other drug abuse problems. Under current law,
the services of these types of providers are covered when provided as part of a
program in an outpatient treatment facility, if both the program and facility are
approved by DHFS. All three types of providers must be licensed to practice by the
Marriage and Family Therapy, Professional Counseling, and Social Work Examining
Board in the Department of Regulation and Licensing. The bill also requires a
defined network plan to cover the services of these three types of providers when such
a provider conducts a clinical assessment of nervous or mental disorders or
alcoholism or other drug abuse problems of a dependent student with coverage under
the plan who is attending school in this state but outside the geographic service area
of the plan.
Currently, under the Medical Assistance (MA) program, certain mental health
services, alcohol and other drug abuse (AODA) services, and community-based
psychosocial services, if prescribed by a physician, are provided as benefits to MA
recipients. The psychosocial services may be provided only under certain
supervision requirements and by a program that is certified by DHFS. This bill
exempts certain MA mental health and AODA services from the requirement that,
in order for reimbursement to the service provider, they first be prescribed by a
physician. The bill also requires that licensed clinical social workers, marriage and
family therapists, and professional counselors (licensed mental health
professionals) and psychologists be included as providers of MA-reimbursable
psychotherapy and AODA services. Lastly, the bill establishes psychotherapy and
AODA services by licensed mental health professionals and psychologists as an MA
benefit and prohibits DHFS from requiring that licensed mental health
professionals be supervised, prohibits DHFS from requiring that clinical
psychotherapy or AODA services be provided under a certified program, and
prohibits DHFS from requiring that a physician or other health care provider first
prescribe the psychotherapy or AODA services before the professional or
psychologist provides the services to an MA recipient.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB463, s. 1 1Section 1. 49.45 (30g) of the statutes is created to read:
AB463,3,82 49.45 (30g) Psychotherapy and alcohol and other drug abuse services. The
3department shall include licensed mental health professionals, as defined in s.
4632.89 (1) (dm), and licensed psychologists, as defined in s. 455.01 (4), as providers
5of psychotherapy and of alcohol and other drug abuse services. Except for services

1provided under sub. (30e), the department may not require that licensed mental
2health professionals or licensed psychologists be supervised; may not require that
3clinical psychotherapy or alcohol and other drug abuse services be provided under
4a certified program; and, notwithstanding subs. (9) and (9m), may not require that
5a physician or other health care provider first prescribe psychotherapy or alcohol and
6other drug abuse to be provided by a licensed mental health professional or licensed
7psychologist before the professional or psychologist may provide the services to the
8recipient.
AB463, s. 2 9Section 2. 49.46 (2) (b) 6. (intro.) of the statutes is amended to read:
AB463,3,1110 49.46 (2) (b) 6. (intro.) The following services if that, other than under subd.
116. f., fm., k., and Lr., are
prescribed by a physician:
AB463, s. 3 12Section 3. 49.46 (2) (b) 6. Lr. of the statutes is created to read:
AB463,3,1413 49.46 (2) (b) 6. Lr. Psychotherapy and alcohol and other drug abuse services,
14as specified under s. 49.45 (30g).
AB463, s. 4 15Section 4. 609.655 (3) (a) of the statutes is amended to read:
AB463,3,2016 609.655 (3) (a) A clinical assessment of the dependent student's nervous or
17mental disorders or alcoholism or other drug abuse problems, conducted by a
18provider described in s. 632.89 (1) (e) 2. or, 3., or 4. who is located in this state and
19in reasonably close proximity to the school in which the dependent student is
20enrolled and who may be designated by the defined network plan.
AB463, s. 5 21Section 5. 632.89 (1) (dm) of the statutes is created to read:
AB463,3,2422 632.89 (1) (dm) "Licensed mental health professional" means a clinical social
23worker who is licensed under ch. 457, a marriage and family therapist who is licensed
24under ch. 457, or a professional counselor who is licensed under ch. 457.
AB463, s. 6 25Section 6. 632.89 (1) (e) 4. of the statutes is created to read:
AB463,4,1
1632.89 (1) (e) 4. A licensed mental health professional.
AB463, s. 7 2Section 7. Initial applicability.
AB463,4,73 (1) If a group health insurance policy that is in effect on the effective date of this
4subsection contains a provision that is inconsistent with the treatment of section
5632.89 (1) (dm) and (e) 4. of the statutes, the treatment of section 632.89 (1) (dm) and
6(e) 4. of the statutes first applies to that insurance policy on the date on which it is
7renewed.
AB463,4,88 (End)
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