LRB-0095/2
PJK:kaf:km
1997 - 1998 LEGISLATURE
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
1An Act to amend 40.51 (8), 60.23 (25), 66.184, 120.13 (2) (g), 185.981 (4t) and
2185.983 (1) (intro.);
to repeal and recreate 40.51 (8), 40.51 (8m), 60.23 (25),
366.184, 120.13 (2) (g), 185.981 (4t) and 185.983 (1) (intro.); and
to create 40.51
4(8m), 111.91 (2) (n) and 632.895 (11) of the statutes;
relating to: insurance
5coverage of hospital or home care after childbirth and granting rule-making
6authority.
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
1Section
1. 40.51 (8) of the statutes is amended to read:
AB222,2,42
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895
4(5m) and (8) to
(10) (11) and 632.896.
AB222,2,97
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
8shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.745 (1) to (3) and (5),
9632.747, 632.87 (3) to (5), 632.895 (5m) and (8) to (11) and 632.896.
AB222, s. 3
10Section
3. 40.51 (8m) of the statutes is created to read:
AB222,2,1211
40.51
(8m) Every health care coverage plan offered by the group insurance
12board under sub. (7) shall comply with s. 632.895 (11).
AB222, s. 4
13Section
4. 40.51 (8m) of the statutes, as affected by
1995 Wisconsin Act 289 14and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:
AB222,3,3
140.51
(8m) Every health care coverage plan offered by the group insurance
2board under sub. (7) shall comply with ss. 632.745 (1) to (3) and (5), 632.747 and
3632.895 (11).
AB222, s. 5
4Section
5. 60.23 (25) of the statutes is amended to read:
AB222,3,75
60.23
(25) Self-insured health plans. Provide health care benefits to its
6officers and employes on a self-insured basis if the self-insured plan complies with
7ss. 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9)
and (11) and 632.896.
AB222, s. 6
8Section
6. 60.23 (25) of the statutes, as affected by
1995 Wisconsin Act 289 and
91997 Wisconsin Act .... (this act), is repealed and recreated to read:
AB222,3,1310
60.23
(25) Self-insured health plans. Provide health care benefits to its
11officers and employes on a self-insured basis if the self-insured plan complies with
12ss. 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3),
13632.87 (4) and (5), 632.895 (9) and (11) and 632.896.
AB222, s. 7
14Section
7. 66.184 of the statutes is amended to read:
AB222,3,20
1566.184 Self-insured health plans. If a city, including a 1st class city, or a
16village provides health care benefits under its home rule power, or if a town provides
17health care benefits, to its officers and employes on a self-insured basis, the
18self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
19632.87 (4) and (5), 632.895 (9)
and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51
20(3m) (d).
AB222,4,3
2366.184 Self-insured health plans. If a city, including a 1st class city, or a
24village provides health care benefits under its home rule power, or if a town provides
25health care benefits, to its officers and employes on a self-insured basis, the
1self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
2632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) to
3(11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).
AB222, s. 9
4Section
9. 111.91 (2) (n) of the statutes is created to read:
AB222,4,65
111.91
(2) (n) The provision to employes of the health insurance coverage
6required under s. 632.895 (11).
AB222, s. 10
7Section
10. 120.13 (2) (g) of the statutes is amended to read:
AB222,4,108
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9)
and (10) to
10(11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).
AB222, s. 11
11Section
11. 120.13 (2) (g) of the statutes, as affected by
1995 Wisconsin Act 289 12and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:
AB222,4,1613
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2.,
15632.747 (3), 632.87 (4) and (5), 632.895 (9) to (11), 632.896, 767.25 (4m) (d) and 767.51
16(3m) (d).
AB222, s. 12
17Section
12. 185.981 (4t) of the statutes is amended to read:
AB222,4,2018
185.981
(4t) A sickness care plan operated by a cooperative association is
19subject to ss. 252.14, 631.89, 632.72 (2), 632.87 (2m), (3), (4) and (5), 632.895 (10)
and
20(11) and 632.897 (10) and ch. 155.
AB222, s. 13
21Section
13. 185.981 (4t) of the statutes, as affected by
1995 Wisconsin Act 289 22and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:
AB222,4,2523
185.981
(4t) A sickness care plan operated by a cooperative association is
24subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3),
25(4) and (5), 632.895 (10) and (11) and 632.897 (10) and ch. 155.
AB222, s. 14
1Section
14. 185.983 (1) (intro.) of the statutes is amended to read:
AB222,5,72
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
3exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
4601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
5(2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5)
, (9) and (10) 6and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635,
7645 and 646, but the sponsoring association shall:
AB222, s. 15
8Section
15. 185.983 (1) (intro.) of the statutes, as affected by
1995 Wisconsin
9Act 289 and 1997 Wisconsin Act .... (this act), is repealed and recreated to read:
AB222,5,1510
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
11exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
12601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
13(2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5),
14632.895 (5) and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609,
15630, 635, 645 and 646, but the sponsoring association shall:
AB222, s. 16
16Section
16. 632.895 (11) of the statutes is created to read:
AB222,5,2117
632.895
(11) Inpatient hospital services and home care visits after
18childbirth. (a) Every disability insurance policy, and every self-insured health plan
19of the state or a county, city, village, town or school district, that provides maternity
20coverage shall provide coverage for mother and child of the usual and customary
21charges for all of the following:
AB222,5,2422
1. After the birth of a child by vaginal delivery, inpatient hospital services or
23home care visits, or a combination of both, related to the birth of the child for a period
24of at least 48 hours.
AB222,6,3
12. After the birth of a child by caesarean section, inpatient hospital services or
2home care visits, or a combination of both, related to the birth of the child for a period
3of at least 96 hours.
AB222,6,84
(b) For purposes of the coverage required under par. (a), the type of care
5provided, whether inpatient hospital services or home care visits or a combination
6of both, as well as the length of time that the care is provided, shall be at the
7discretion of the mother's or child's health care provider in consultation with the
8mother.
AB222,6,109
(c) The coverage required under par. (a) may be subject to any copayments or
10deductibles that apply generally under the policy or plan to other covered services.
AB222,6,1711
(d) An insurer providing coverage under a disability insurance policy described
12in par. (a), or an administrator or self-insurer of a self-insured health plan described
13in par. (a), may not take any adverse action against a health care provider on the
14basis that the health care provider recommended or ordered, on one or more
15occasions, inpatient hospital services or home care visits, or a combination of both,
16after the birth of a child for the length of time required under par. (a) for coverage
17of such services.
AB222,7,518
(e) Every insurer that issues or renews a policy described in par. (a) on or after
19the effective date of this paragraph .... [revisor inserts date], shall provide written
20notice of the provisions of pars. (a) to (d) and of any rules promulgated under par. (f)
21to the insureds under the policy at the issuance of a new policy or first renewal of a
22policy in effect on the effective date of this paragraph .... [revisor inserts date]. Every
23administrator of a self-insured health plan described in par. (a) that is established,
24extended, modified or renewed on or after the effective date of this paragraph ....
25[revisor inserts date], shall provide written notice of the provisions of pars. (a) to (d)
1and of any rules promulgated under par. (f) to the insureds under the plan at the
2establishment of a new plan or extension, modification or renewal, whichever occurs
3first, of a plan in existence on the effective date of this paragraph .... [revisor inserts
4date]. The notice required under this paragraph may be provided as part of any
5written policy, group certificate or plan provided to an insured at the same time.
AB222,7,76
(f) The commissioner shall promulgate rules regarding home care visits for
7which coverage is required under par. (a) that address all of the following:
AB222,7,88
1. Qualifications of persons providing home care visits.
AB222,7,99
2. Reasonable and appropriate frequency of visits.
AB222,7,1010
3. Reasonable and appropriate duration of individual visits.