AB927,24,1712
609.655
(5) (b) Paragraph (a) does not permit a
health maintenance
13organization managed care plan to reimburse a provider for less than the full cost
14of the services provided or an amount negotiated with the provider, solely because
15the reimbursement rate for the service would have been less if provided by a
selected 16participating provider within the geographical service area of the
health
17maintenance organization managed care plan.
AB927, s. 62
18Section
62. 609.70 of the statutes is amended to read:
AB927,24,21
19609.70 Chiropractic coverage. Health maintenance organizations, limited
20Limited service health organizations and
preferred provider managed care plans are
21subject to s. 632.87 (3).
AB927, s. 63
22Section
63. 609.75 of the statutes is amended to read:
AB927,25,4
23609.75 Adopted children coverage.
Health maintenance organizations,
24limited Limited service health organizations and
preferred provider managed care 25plans are subject to s. 632.896. Coverage of health care services obtained by adopted
1children and children placed for adoption may be subject to any requirements that
2the
health maintenance organization, limited service health organization or
3preferred provider managed care plan imposes under s. 609.05 (2) and (3) on the
4coverage of health care services obtained by other
enrolled participants enrollees.
AB927,25,9
7609.77 Coverage of breast reconstruction. Health maintenance
8organizations, limited Limited service health organizations and
preferred provider 9managed care plans are subject to s. 632.895 (13).
AB927,25,15
12609.78 Coverage of treatment for the correction of
13temporomandibular disorders. Health maintenance organizations, limited 14Limited service health organizations and
preferred provider managed care plans are
15subject to s. 632.895 (11).
AB927,25,21
18609.79 Coverage of hospital and ambulatory surgery center charges
19and anesthetics for dental care. Health maintenance organizations, limited 20Limited service health organizations and
preferred provider managed care plans are
21subject to s. 632.895 (12).
AB927, s. 67
22Section
67. 609.80 of the statutes is amended to read:
AB927,26,3
23609.80 Coverage of mammograms. Health maintenance organizations and
24preferred provider Managed care plans are subject to s. 632.895 (8). Coverage of
25mammograms under s. 632.895 (8) may be subject to any requirements that the
1health maintenance organization or preferred provider managed care plan imposes
2under s. 609.05 (2) and (3) on the coverage of other health care services obtained by
3enrolled participants enrollees.
AB927, s. 68
4Section
68. 609.81 of the statutes is amended to read:
AB927,26,8
5609.81 Coverage related to HIV infection. Health maintenance
6organizations, limited Limited service health organizations and
preferred provider 7managed care plans are subject to s. 631.93.
Health maintenance organizations and
8preferred provider Managed care plans are subject to s. 632.895 (9).
AB927, s. 69
9Section
69. 609.91 (1) (intro.) of the statutes is amended to read:
AB927,26,1510
609.91
(1) (title)
Immunity of enrolled participants enrollees and
11policyholders. (intro.) Except as provided in sub. (1m), an
enrolled participant 12enrollee or policyholder of a health maintenance organization insurer is not liable for
13health care costs that are incurred on or after January 1, 1990, and that are covered
14under a policy or certificate issued by the health maintenance organization insurer,
15if any of the following applies:
AB927, s. 70
16Section
70. 609.91 (1) (b) 2. of the statutes is amended to read:
AB927,26,1917
609.91
(1) (b) 2. Is physician services provided under a contract with the health
18maintenance organization insurer or by a
selected
participating provider of the
19health maintenance organization insurer.
AB927, s. 71
20Section
71. 609.91 (1) (b) 3. of the statutes is amended to read:
AB927,26,2321
609.91
(1) (b) 3. Is services, equipment, supplies or drugs that are ancillary or
22incidental to services described in subd. 2. and are provided by the contracting
23provider or
selected participating provider.
AB927, s. 72
24Section
72. 609.91 (1m) of the statutes is amended to read:
AB927,27,5
1609.91
(1m) Immunity of medical assistance recipients. An
enrolled
2participant enrollee, policyholder or insured under a policy issued by an insurer to
3the department of health and family services under s. 49.45 (2) (b) 2. to provide
4prepaid health care to medical assistance recipients is not liable for health care costs
5that are covered under the policy.
AB927, s. 73
6Section
73. 609.91 (2) of the statutes is amended to read:
AB927,27,127
609.91
(2) Prohibited recovery attempts. No person may bill, charge, collect
8a deposit from, seek remuneration or compensation from, file or threaten to file with
9a credit reporting agency or have any recourse against an
enrolled participant 10enrollee, policyholder or insured, or any person acting on their behalf, for health care
11costs for which the
enrolled participant enrollee, policyholder or insured, or person
12acting on their behalf, is not liable under sub. (1) or (1m).
AB927, s. 74
13Section
74. 609.91 (3) of the statutes is amended to read:
AB927,27,1814
609.91
(3) Deductibles, copayments and premiums. Subsections (1) to (2) do not
15affect the liability of an
enrolled participant enrollee, policyholder or insured for any
16deductibles, copayments or premiums owed under the policy or certificate issued by
17the health maintenance organization insurer or by the insurer described in sub.
18(1m).
AB927, s. 75
19Section
75. 609.91 (4) (intro.) of the statutes is amended to read:
AB927,27,2320
609.91
(4) (intro.)
Conditions not affecting the immunity. The immunity of
21an
enrolled participant enrollee, policyholder or insured for health care costs, to the
22extent of the immunity provided under this section and ss. 609.92 to 609.935, is not
23affected by any of the following:
AB927, s. 76
24Section
76. 609.91 (4) (a) of the statutes is amended to read:
AB927,28,6
1609.91
(4) (a) An agreement, other than a notice of election or termination of
2election in accordance with s. 609.92 or 609.925, entered into by the provider, the
3health maintenance organization insurer, the insurer described in sub. (1m) or any
4other person, at any time, whether oral or written and whether implied or explicit,
5including an agreement that purports to hold the
enrolled participant enrollee,
6policyholder or insured liable for health care costs.
AB927, s. 77
7Section
77. 609.91 (4) (b) of the statutes is amended to read:
AB927,28,128
609.91
(4) (b) A breach of or default on an agreement by the health
9maintenance organization insurer, the insurer described in sub. (1m) or any other
10person to compensate the provider, directly or indirectly, for health care costs,
11including health care costs for which the
enrolled participant enrollee, policyholder
12or insured is not liable under sub. (1) or (1m).
AB927, s. 78
13Section
78. 609.91 (4) (c) of the statutes is amended to read:
AB927,28,2214
609.91
(4) (c) The insolvency of the health maintenance organization insurer
15or any person contracting with the health maintenance organization insurer or
16provider, or the commencement or the existence of conditions permitting the
17commencement of insolvency, delinquency or bankruptcy proceedings involving the
18health maintenance organization insurer or other person, including delinquency
19proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the health
20maintenance organization insurer or other person has agreed to compensate,
21directly or indirectly, the provider for health care costs for which the
enrolled
22participant enrollee or policyholder is not liable under sub. (1).
AB927, s. 79
23Section
79. 609.91 (4) (cm) of the statutes is amended to read:
AB927,29,624
609.91
(4) (cm) The insolvency of the insurer described in sub. (1m) or any
25person contracting with the insurer or provider, or the commencement or the
1existence of conditions permitting the commencement of insolvency, delinquency or
2bankruptcy proceedings involving the insurer or other person, including
3delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite
4whether the insurer or other person has agreed to compensate, directly or indirectly,
5the provider for health care costs for which the
enrolled participant enrollee,
6policyholder or insured is not liable under sub. (1m).
AB927, s. 80
7Section
80. 609.91 (4) (d) of the statutes is amended to read:
AB927,29,128
609.91
(4) (d) The inability of the provider or other person who is owed
9compensation for health care costs to obtain compensation from the health
10maintenance organization insurer, the insurer described in sub. (1m) or any other
11person for health care costs for which the
enrolled participant enrollee, policyholder
12or insured is not liable under sub. (1) or (1m).
AB927, s. 81
13Section
81. 609.92 (5) of the statutes is amended to read:
AB927,29,1814
609.92
(5) Provider of physician services. A provider who is not under
15contract with a health maintenance organization insurer and who is not a
selected 16participating provider of a health maintenance organization insurer is not subject
17to s. 609.91 (1) (b) 2. with respect to health care costs incurred by an
enrolled
18participant enrollee of that health maintenance organization insurer.
AB927, s. 82
19Section
82. 609.94 (1) (b) of the statutes is amended to read:
AB927,29,2220
609.94
(1) (b) Each
selected participating provider of the health maintenance
21organization insurer, at the time that the provider becomes a
selected participating 22provider.
AB927, s. 83
23Section
83. 645.69 (1) of the statutes is amended to read:
AB927,30,324
645.69
(1) A claim against a health maintenance organization insurer or an
25insurer described in s. 609.91 (1m) for health care costs, as defined in s. 609.01 (1j),
1for which an
enrolled participant enrollee, as defined in s. 609.01 (1d), policyholder
2or insured of the health maintenance organization insurer or other insurer is not
3liable under ss. 609.91 to 609.935.
AB927, s. 84
4Section
84. 645.69 (2) of the statutes is amended to read:
AB927,30,75
645.69
(2) A claim for health care costs, as defined in s. 609.01 (1j), for which
6an
enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a
7health maintenance organization is not liable for any reason.
AB927, s. 85
8Section
85. 646.31 (1) (d) 8. of the statutes is amended to read:
AB927,30,119
646.31
(1) (d) 8. Made for health care costs, as defined in s. 609.01 (1j), for which
10an
enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a
11health maintenance organization insurer is not liable under ss. 609.91 to 609.935.
AB927, s. 86
12Section
86. 646.31 (1) (d) 9. of the statutes is amended to read:
AB927,30,1513
646.31
(1) (d) 9. Made for health care costs, as defined in s. 609.01 (1j), for which
14an
enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a
15health maintenance organization is not liable for any reason.
AB927,30,2017
(1)
If a contract that is in effect on January 1, 1999, that is affected by this act
18and that was not issued or renewed after the effective date of this subsection contains
19terms or provisions that are inconsistent with the requirements under this act, this
20act first applies to that contract upon renewal.
AB927,30,2521
(2) If a contract that is in effect on January 1, 1999, that is affected by this act
22and that is affected by a collective bargaining agreement that was not extended,
23modified or renewed after the effective date of this subsection contains terms or
24provisions that are inconsistent with this act, this act first applies to that contract
25on the earlier of the following:
AB927,31,1
1(a) The day on which the collective bargaining agreement expires.
AB927,31,32
(b) The day on which the collective bargaining agreement is extended, modified
3or renewed.
AB927, s. 88
4Section
88.
Effective dates. This act takes effect on January 1, 1999, or on
5the day after publication, whichever is later, except as follows:
AB927,31,66
(1)
Section
87 of this act takes effect on the day after publication.