AB809: Bill Text

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 of the statutes is repealed.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 of the statutes is repealed.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.

AB809,14 Section 14. Initial applicability.

AB809,6,18 (1) Policy, plan, or contract provisions. The treatment of section 632.87 (3) (a) (intro.), 1., and 2., (ac), (am) 1. and 2., and (b) 3. and 3m. of the statutes first applies to all of the following:

AB809,6,22 (a) Except as provided in paragraphs (b) and (c), policies, plans, or contracts that are newly issued or renewed, and self-insured governmental or school district health plans that are newly established, extended, modified, or renewed, on the effective date of this paragraph.

AB809,7,2 (b) Policies, plans, or contracts covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with the treatment of those sections that are newly issued or renewed on the earlier of the following:

AB809,7,3 1. The day on which the collective bargaining agreement expires.

AB809,7,5 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB809,7,9 (c) Self-insured governmental or school district health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with the treatment of those sections that are newly established, extended, modified, or renewed on the earlier of the following:

AB809,7,10 1. The day on which the collective bargaining agreement expires.

AB809,7,12 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB809,7,15 (2) Insurer reports. The treatment of section 632.87 (3) (d) of the statutes first applies to reports that are due in the year beginning after the effective date of this subsection.

AB809,7,20 (3) Void exclusions or restrictions. The treatment of section 632.87 (3) (c) of the statutes first applies to exclusions or restrictions under policies, plans, or contracts that are newly issued or renewed, and self-insured governmental or school district health plans that are newly established, extended, modified, or renewed, on the effective date of this subsection.

AB809,7,21 (End)