AB809: Bill Text

LRB-3416/1

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2015 - 2016 LEGISLATURE

2015 Assembly BILL 809

January 26, 2016 - Introduced by Representatives Bernier, Macco, Horlacher, A. Ott, Kremer, T. Larson, Thiesfeldt, E. Brooks, Tittl and Kulp, cosponsored by Senators Roth, Lasee and Ringhand. Referred to Committee on Insurance.

AB809,1,7 An Act to repeal 632.87 (3) (a) 1., 632.87 (3) (a) 2. and 632.87 (3) (b) 3.; to renumber 632.857; to renumber and amend 632.87 (3) (a) (intro.); to amend 632.87 (3) (c); and to create 632.857 (2), 632.87 (3) (ac), 632.87 (3) (am) 1., 632.87 (3) (am) 2., 632.87 (3) (b) 3m. and 632.87 (3) (d) of the statutes; relating to: nondiscriminatory insurance coverage of chiropractic services, providing an exemption from emergency rule procedures, granting rule-making authority, and providing a penalty.

Analysis by the Legislative Reference Bureau

Summary

This bill makes a number of changes to requirements for and prohibitions on health insurers with respect to coverage of chiropractic services and requires health insurers to file annual reports on their compliance with the requirements and prohibitions.

Policy prohibitions on excluding, restricting, or denying coverage

Under the bill, a health insurance policy may not restrict or deny coverage for the diagnosis and treatment of a condition or complaint by a chiropractor acting within the scope of his or her license and may not exclude, restrict, or deny coverage of items or services provided by a chiropractor acting within the scope of his or her license if the policy covers the diagnosis and treatment of the condition or complaint by a physician and the same items or services provided by a physician. This prohibition applies even if different nomenclature or codes are used to describe the condition or complaint or items or services.

Under current law, a policy is already prohibited from excluding coverage for the diagnosis and treatment of a condition or complaint by a chiropractor if the diagnosis and treatment of the condition or complaint are covered when provided by a physician, even if different nomenclature is used to describe the condition or complaint. Current law explicitly states that this prohibition does not preclude the application of deductibles or coinsurance to chiropractic and physician charges on an equal basis or the application of cost containment or quality assurance measures to chiropractic services in a manner that is consistent with cost containment or quality assurance measures that generally apply to physician services. The bill removes this statement of what is not precluded and provides that the new prohibition against excluding, restricting, or denying coverage of chiropractic services prohibits a policy, among other things, from applying cost containment measures or quality assurance or performance measures unequally to chiropractors and primary care physicians with respect to items or services that may be provided by chiropractors and primary care physicians and from requiring an insured to pay a higher copayment or coinsurance amount for services provided by a chiropractor than the copayment or coinsurance amount that the insured must pay for the same or similar services provided by a primary care physician.

Insurer requirement to provide timely access

Current law prohibits an insurer, under a health insurance policy that covers chiropractic services, from doing a number of things, including establishing underwriting standards that are more restrictive for chiropractic care than for care provided by other health care providers. The bill removes this prohibition and replaces it with another related to access to chiropractic services. The bill prohibits an insurer from establishing or maintaining a policy or provider network that fails to do either of the following: 1) provide insureds with reasonable and timely access to chiropractic care or 2) apply the same standards to chiropractors that are applied to primary care physicians to ensure that insureds receive the same reasonable and timely access to chiropractors that they receive to primary care physicians, including such standards as geographic accessibility, waiting times, and provider-to-insured ratios.

Insurer report

Finally, the bill requires every health insurer annually to file a report with the Office of the Commissioner of Insurance (OCI) that demonstrates the insurer's compliance in the previous year with the requirements and prohibitions related to equality of coverage between chiropractors and primary care physicians. OCI must promulgate rules for the content and format of the report and must make the filed reports publicly available on OCI's Internet site. The bill also authorizes OCI to impose on an insurer that fails to file a report when due a forfeiture of $1,000 per day for each day the report is overdue.

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:

AB809,1 Section 1. 632.857 of the statutes is renumbered 632.857 (1).

AB809,2 Section 2. 632.857 (2) of the statutes is created to read:

AB809,3,5 632.857 (2) Sections 632.87 (3) (b) 1. and 632.875, rather than this section, apply if the restriction or termination of coverage relates to treatment of a condition or complaint by a chiropractor acting within the scope of his or her license.

AB809,3 Section 3. 632.87 (3) (a) (intro.) of the statutes is renumbered 632.87 (3) (am) (intro.) and amended to read:

AB809,3,18 632.87 (3) (am) (intro.) No policy, plan, or contract may exclude, restrict, or deny coverage for diagnosis and treatment of a condition or complaint by a licensed chiropractor, or exclude, restrict, or deny coverage for items or services provided by a chiropractor, acting within the scope of the chiropractor's professional license, if the policy, plan, or contract covers diagnosis and treatment of the condition or complaint by a licensed physician or osteopath , or covers the same items or services provided by a physician, even if different nomenclature is or codes are used to describe the condition or complaint or items or services. Examination by or referral from a physician shall not be a condition precedent for receipt of chiropractic care under this paragraph. This paragraph does not prohibits, among other things, all of the following:

AB809,4 Section 4. 632.87 (3) (a) 1. of the statutes is repealed.

AB809,5 Section 5. 632.87 (3) (a) 2. of the statutes is repealed.

AB809,6 Section 6. 632.87 (3) (ac) of the statutes is created to read:

AB809,4,1 632.87 (3) (ac) In this subsection:

AB809,4,2 1. "Chiropractor" means a chiropractor licensed under ch. 446.

AB809,4,7 2. "Cost containment measure" means any mechanism, strategy, or program used by an insurer to reduce a benefit payment or costs under a health care policy, plan, or contract. "Cost containment measure" includes such practices as patient cost-sharing, utilization management, reimbursement adjustment, and limits on the number of visits.

AB809,4,9 3. "Patient cost-sharing" means the amount an insured pays out-of-pocket for health care items or services, including deductibles, copayments, and coinsurance.

AB809,4,10 4. "Physician" means a physician licensed under subch. II of ch. 448.

AB809,4,11 5. "Primary care physician" has the meaning given in s. 609.01 (4m).

AB809,4,15 6. "Quality or performance measure" means a specific qualitative or quantitative indicator that measures health outcomes; processes; structures; patient experience, access, or safety; or other results for an individual patient or a defined population of patients.

AB809,7 Section 7. 632.87 (3) (am) 1. of the statutes is created to read:

AB809,4,22 632.87 (3) (am) 1. Applying cost containment measures or quality or performance measures to chiropractors on an unequal basis compared to primary care physicians with respect to items or services that may be provided by both physicians and chiropractors acting within the scopes of their respective professional licenses, even if different nomenclature or codes are used to describe or identify the items or services.

AB809,8 Section 8. 632.87 (3) (am) 2. of the statutes is created to read:

AB809,5,2 632.87 (3) (am) 2. Imposing a copayment or coinsurance amount on an insured for services provided by a chiropractor that is greater than the copayment or coinsurance amount imposed on an insured for the same or similar services provided by a primary care physician.

AB809,9 Section 9. 632.87 (3) (b) 3. of the statutes is repealed.

AB809,10 Section 10. 632.87 (3) (b) 3m. of the statutes is created to read:

AB809,5,6 632.87 (3) (b) 3m. Establish or maintain a policy, plan, contract, or provider network that fails to do any of the following:

AB809,5,8 a. Provide insureds with reasonable and timely access to care provided by chiropractors.

AB809,5,13 b. Apply the same standards to chiropractors, in the same manner and using the same methodology, such as provider-to-insured ratios, waiting times, and geographic accessibility standards, that are applied to primary care physicians to ensure that insureds receive the same reasonable and timely access to chiropractors that insureds receive to primary care physicians.

AB809,11 Section 11. 632.87 (3) (c) of the statutes is amended to read:

AB809,5,16 632.87 (3) (c) An exclusion or a restriction that violates par. (am) or (b) is void in its entirety.

AB809,12 Section 12. 632.87 (3) (d) of the statutes is created to read:

AB809,6,2 632.87 (3) (d) Every insurer that provides health care coverage under a policy, plan, or contract shall annually, no later than February 1, file a report with the commissioner that demonstrates the insurer's compliance in the previous year with pars. (am) and (b). The commissioner shall prescribe by rule the manner of filing and the content and format of the report under this paragraph and shall make the filed reports available to the public on the office's Internet site. If an insurer that is required to file a report under this paragraph does not file the report by the time required under this paragraph, the commissioner may impose a forfeiture against the insurer of up to $1,000 per day for each day the report is overdue.

AB809,13 Section 13. Nonstatutory provisions.

AB809,6,14 (1) Emergency rule for insurer reports. Using the procedure under section 227.24 of the statutes, the commissioner of insurance may promulgate the rule required under section 632.87 (3) (d) of the statutes, as created by this act, for the period before the effective date of the permanent rule promulgated under section 632.87 (3) (d) of the statutes, as created by this act, but not to exceed the period authorized under section 227.24 (1) (c) of the statutes, subject to extension under section 227.24 (2) of the statutes. Notwithstanding section 227.24 (1) (a), (2) (b), and (3) of the statutes, the commissioner is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection.