Amendment SSA1-SB308

LRBs0396/2

PJK:wlj:km

1999 - 2000 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, TO 1999 SENATE BILL 308

March 24, 2000 - Offered by Senator Panzer.

SB308-SSA1,1,5 An Act to repeal 20.145 (1) (c); to amend 46.10 (8) (d), 46.10 (14) (a), 51.01 (3n), 51.038, 51.04, 301.12 (8) (d) and 301.12 (14) (a); and to create 20.145 (1) (c), 40.53 and 111.91 (2) (t) of the statutes; relating to: state employe health insurance coverage of nervous and mental disorders, alcoholism and other drug abuse problems, an actuarial study or evaluation and making an appropriation.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB308-SSA1, s. 1 Section 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table

SB308-SSA1, s. 2 Section 2. 20.145 (1) (c) of the statutes is created to read:

SB308-SSA1,2,3 20.145 (1) (c) Actuarial study contract. The amounts in the schedule for the costs of the contract under 1999 Wisconsin Act .... (this act), section 13 (1) (a).

SB308-SSA1, s. 3 Section 3. 20.145 (1) (c) of the statutes, as created by 1999 Wisconsin Act .... (this act), is repealed.

SB308-SSA1, s. 4 Section 4. 40.53 of the statutes is created to read:

SB308-SSA1,2,8 40.53 Coverage of mental disorders, alcoholism and other diseases. (1) Definitions. In this section:

SB308-SSA1,2,10 (a) "Collateral" means a member of an insured's immediate family, as defined in s. 632.895 (1) (d).

SB308-SSA1,2,11 (b) "Hospital" means any of the following:

SB308-SSA1,2,12 1. A hospital licensed under s. 50.35.

SB308-SSA1,2,13 2. An approved private treatment facility as defined in s. 51.45 (2) (b).

SB308-SSA1,2,14 3. An approved public treatment facility as defined in s. 51.45 (2) (c).

SB308-SSA1,2,17 (c) "Inpatient hospital services" means services for the treatment of nervous and mental disorders or alcoholism and other drug abuse problems that are provided in a hospital to a bed patient in the hospital.

SB308-SSA1,2,21 (d) "Outpatient services" means nonresidential services for the treatment of nervous or mental disorders or alcoholism or other drug abuse problems provided to an insured and, if for the purpose of enhancing the treatment of the insured, a collateral by any of the following:

SB308-SSA1,2,25 1. A program in an outpatient treatment facility, if both are approved by the department of health and family services, the program is established and maintained according to rules promulgated under s. 51.42 (7) (b) and the facility is certified under s. 51.04.

SB308-SSA1,3,2 2. A licensed physician who has completed a residency in psychiatry, in an outpatient treatment facility or the physician's office.

SB308-SSA1,3,5 3. A licensed psychologist who is listed in the national register of health service providers in psychology or who is certified by the American board of professional psychology.

SB308-SSA1,3,10 (e) "Transitional treatment arrangements" means services for the treatment of nervous or mental disorders or alcoholism or other drug abuse problems that are provided to an insured in a less restrictive manner than are inpatient hospital services but in a more intensive manner than are outpatient services, and that are specified by the secretary by rule under sub. (4).

SB308-SSA1,3,15 (2) Required coverage. (a) Conditions covered. Notwithstanding s. 632.89, a health care coverage plan offered by the state under s. 40.51 (6) or by the group insurance board under s. 40.51 (7) shall provide coverage of nervous and mental disorders and alcoholism and other drug abuse problems if required by pars. (b) to (d) and as provided in pars. (b) to (d) and sub. (3).

SB308-SSA1,3,18 (b) Coverage of inpatient hospital services. If a health care coverage plan provides coverage of any inpatient hospital treatment, the plan shall provide coverage for inpatient hospital services for the treatment of conditions under par. (a).

SB308-SSA1,3,21 (c) Coverage of outpatient services. If a health care coverage plan provides coverage of any outpatient treatment, the plan shall provide coverage for outpatient services for the treatment of conditions under par. (a).

SB308-SSA1,3,25 (d) Coverage of transitional treatment arrangements. If a health care coverage plan provides coverage of any inpatient hospital treatment or any outpatient treatment, the plan shall provide coverage for transitional treatment arrangements for the treatment of conditions under par. (a).

SB308-SSA1,4,8 (3) Equal coverage requirement. A health care coverage plan that provides coverage for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems shall provide the same coverage for that treatment that it provides for the treatment of physical conditions. This requirement applies to all coverage-related components, including rates; exclusions and limitations; deductibles; copayments; coinsurance; annual and lifetime payment limits; out-of-pocket limits; out-of-network charges; day, visit or appointment limits; duration or frequency of coverage; and medical necessity definitions.

SB308-SSA1,4,13 (4) Specification of transitional treatment arrangements by rule. The secretary, with the approval of the group insurance board, shall specify by rule the services for the treatment of nervous or mental disorders or alcoholism or other drug abuse problems, including but not limited to day hospitalization, that are covered under sub. (2) (d).

SB308-SSA1,4,20 (5) Liability to the state or county. Any health care coverage plan providing hospital treatment coverage is liable to the state or county for any costs incurred for services an inpatient health care facility, as defined in s. 50.135 (1), or community-based residential facility, as defined in s. 50.01 (1g), owned or operated by a state or county, provides to a patient regardless of the patient's liability for the services, to the extent that the insurer is liable to the patient for services provided at any other inpatient health care facility or community-based residential facility.

SB308-SSA1,4,23 (6) Exclusions. (a) Medicare. No health care coverage plan, insurer or other organization subject to this section is required to duplicate coverage available under the federal medicare program.

SB308-SSA1,5,2 (b) Certain health care plans. This section does not apply to a health care coverage plan offered by a preferred provider plan, as defined in s. 609.01 (4), that is not a managed care plan, as defined in s. 609.01 (3c), or by a limited service health organization, as defined in s. 609.01 (3).

SB308-SSA1, s. 5 Section 5. 46.10 (8) (d) of the statutes is amended to read:

SB308-SSA1,5,8 46.10 (8) (d) After due regard to the case and to a spouse and minor children who are lawfully dependent on the property for support, compromise or waive any portion of any claim of the state or county for which a person specified under sub. (2) is liable, but not any claim payable by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by any other 3rd party.

SB308-SSA1, s. 6 Section 6. 46.10 (14) (a) of the statutes is amended to read:

SB308-SSA1,5,24 46.10 (14) (a) Except as provided in pars. (b) and (c), liability of a person specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons under 18 years of age at community mental health centers, a county mental health complex under s. 51.08, the centers for the developmentally disabled, Mendota mental health institute Mental Health Institute and Winnebago mental health institute Mental Health Institute or care and maintenance of persons under 18 years of age in residential, nonmedical facilities such as group homes, foster homes, treatment foster homes, child caring institutions and juvenile correctional institutions is determined in accordance with the cost-based fee established under s. 46.03 (18). The department shall bill the liable person up to any amount of liability not paid by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by other 3rd party benefits, subject to rules which include formulas governing ability to pay promulgated by the department under s. 46.03 (18). Any liability of the patient not payable by any other person terminates when the patient reaches age 18, unless the liable person has prevented payment by any act or omission.

SB308-SSA1, s. 7 Section 7. 51.01 (3n) of the statutes is amended to read:

SB308-SSA1,6,5 51.01 (3n) "Community mental health program" means a program to provide community-based outpatient mental health services that is operated by or under contract with a county department of community programs or that requests payment for the services under the medical assistance program or under benefits required under s. 40.53 (2) or 632.89 (2).

SB308-SSA1, s. 8 Section 8. 51.038 of the statutes is amended to read:

SB308-SSA1,6,14 51.038 Outpatient mental health clinic certification. Except as provided in s. 51.032, if a facility that provides mental health services on an outpatient basis holds current accreditation from the council on accreditation of services for families and children, the department may accept evidence of this accreditation as equivalent to the standards established by the department, for the purpose of certifying the facility for the receipt of funds for services provided as a benefit to a medical assistance recipient under s. 49.46 (2) (b) 6. f., a community aids funding recipient under s. 51.423 (2) or as mandated coverage under s. 40.53 or 632.89.

SB308-SSA1, s. 9 Section 9. 51.04 of the statutes is amended to read:

SB308-SSA1,6,21 51.04 Treatment facility certification. Except as provided in s. 51.032, any treatment facility may apply to the department for certification of the facility for the receipt of funds for services provided as a benefit to a medical assistance recipient under s. 49.46 (2) (b) 6. f. or to a community aids funding recipient under s. 51.423 (2) or provided as mandated coverage under s. 40.53 or 632.89. The department shall annually charge a fee for each certification.

SB308-SSA1, s. 10 Section 10. 111.91 (2) (t) of the statutes is created to read:

SB308-SSA1,6,24 111.91 (2) (t) The requirements under s. 40.53 related to coverage of treatment for nervous and mental disorders and alcoholism and other drug abuse problems.

SB308-SSA1, s. 11 Section 11. 301.12 (8) (d) of the statutes is amended to read:

SB308-SSA1,7,5 301.12 (8) (d) After due regard to the case and to a spouse and minor children who are lawfully dependent on the property for support, compromise or waive any portion of any claim of the state or county for which a person specified under sub. (2) is liable, but not any claim payable by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by any other 3rd party.

SB308-SSA1, s. 12 Section 12. 301.12 (14) (a) of the statutes is amended to read:

SB308-SSA1,7,17 301.12 (14) (a) Except as provided in pars. (b) and (c), liability of a person specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17 years of age in residential, nonmedical facilities such as group homes, foster homes, treatment foster homes, child caring institutions and juvenile correctional institutions is determined in accordance with the cost-based fee established under s. 301.03 (18). The department shall bill the liable person up to any amount of liability not paid by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by other 3rd-party benefits, subject to rules which include formulas governing ability to pay promulgated by the department under s. 301.03 (18). Any liability of the resident not payable by any other person terminates when the resident reaches age 17, unless the liable person has prevented payment by any act or omission.

SB308-SSA1, s. 13 Section 13 . Nonstatutory provisions.

SB308-SSA1,7,19 (1) Actuarial study on cost.

SB308-SSA1,8,7 (a) Study requirements. The office of the commissioner of insurance shall enter into a contract for an actuarial study or evaluation to determine whether, and to what extent, the requirements under section 40.53 of the statutes, as created by this act, are likely to increase the cost of health insurance coverage. The study or evaluation shall make this determination separately for the health insurance coverage that is offered by the state under s. 40.51 (6) and by the group insurance board under s. 40.51 (7) and separately for health insurance coverage purchased directly in the private market by individuals and families and by private employers for their employes, as if the requirements under section 40.53 of the statutes, as created by this act, applied to such health insurance coverage. The office of the commissioner of insurance shall report the results of the study or evaluation to the appropriate standing committees of the legislature in the manner provided under section 13.172 (3) of the statutes no later than June 1, 2001.

SB308-SSA1,8,19 (b) Funding study. The office of the commissioner of insurance may not encumber or expend moneys from the appropriation under section 20.145 (1) (c) of the statutes, as created by this act, unless the office of the commissioner of insurance first notifies the joint committee on finance in writing of the proposed encumbrance or expenditure. If the cochairpersons of the joint committee on finance do not notify the office of the commissioner of insurance within 14 working days after the date of the office's notification that the committee has scheduled a meeting to review the proposed encumbrance or expenditure, the moneys may be encumbered or expended as proposed by the office. If, within 14 working days after the date of the office's notification, the cochairpersons of the committee notify the office that the committee has scheduled a meeting to review the proposed encumbrance or expenditure, the moneys may be encumbered or expended only upon approval of the committee.

SB308-SSA1, s. 14 Section 14. Initial applicability.

SB308-SSA1,8,21 (1) This act first applies to all of the following: