LRBb1326/1
PJK:hmh:jf
2001 - 2002 LEGISLATURE
ASSEMBLY AMENDMENT 19,
TO ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2001 SENATE BILL 55
June 29, 2001 - Offered by Representatives Bock, Miller and Berceau.
SB55-ASA1-AA19,1,74
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
5shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
6and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
7(5),
632.89, 632.895 (5m) and (8) to (14)
, and 632.896.
SB55-ASA1-AA19,1,119
40.51
(8m) Every health care coverage plan offered by the group insurance
10board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
11632.748, 632.83, 632.835, 632.85, 632.853, 632.855
, 632.89, and 632.895 (11) to (14).".
SB55-ASA1-AA19,2,62
46.10
(8) (d) After due regard to the case and to a spouse and minor children
3who are lawfully dependent on the property for support, compromise or waive any
4portion of any claim of the state or county for which a person specified under sub. (2)
5is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
6by any other 3rd party.".
SB55-ASA1-AA19,2,229
46.10
(14) (a) Except as provided in pars. (b) and (c), liability of a person
10specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons
11under 18 years of age at community mental health centers, a county mental health
12complex under s. 51.08, the centers for the developmentally disabled, Mendota
13mental health institute
, and Winnebago mental health institute or care and
14maintenance of persons under 18 years of age in residential, nonmedical facilities
15such as group homes, foster homes, treatment foster homes, child caring institutions
, 16and juvenile correctional institutions is determined in accordance with the
17cost-based fee established under s. 46.03 (18). The department shall bill the liable
18person up to any amount of liability not paid by an insurer under s. 632.89 (2) or
(2m) 19(4m) or by other 3rd party benefits, subject to rules which include formulas governing
20ability to pay promulgated by the department under s. 46.03 (18). Any liability of the
21patient not payable by any other person terminates when the patient reaches age 18,
22unless the liable person has prevented payment by any act or omission.".
SB55-ASA1-AA19,3,6
166.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
2a village provides health care benefits under its home rule power, or if a town
3provides health care benefits, to its officers and employees on a self-insured basis,
4the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
5632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5),
6632.89, 632.895 (9) to (14), 632.896
, and 767.25 (4m) (d).".
SB55-ASA1-AA19,3,119
111.91
(2) (qm) The requirements under s. 632.89 related to coverage of
10treatment for nervous and mental disorders and alcoholism and other drug abuse
11problems.".
SB55-ASA1-AA19,3,1714
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1549.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
16632.85, 632.853, 632.855, 632.87 (4) and (5),
632.89, 632.895 (9) to (14), 632.896
, and
17767.25 (4m) (d).".
SB55-ASA1-AA19,3,2320
185.981
(4t) A sickness care plan operated by a cooperative association is
21subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
22632.853, 632.855, 632.87 (2m), (3), (4)
, and (5),
632.89, 632.895 (10) to (14)
, and
23632.897 (10) and chs. 149 and 155.
SB55-ASA1-AA19,4,7
1185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
2exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
3601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
4631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
5632.855, 632.87 (2m), (3), (4)
, and (5),
632.89, 632.895 (5) and (9) to (14), 632.896
, and
6632.897 (10) and chs. 609, 630, 635, 645
, and 646, but the sponsoring association
7shall:".
SB55-ASA1-AA19,4,1410
301.12
(8) (d) After due regard to the case and to a spouse and minor children
11who are lawfully dependent on the property for support, compromise or waive any
12portion of any claim of the state or county for which a person specified under sub. (2)
13is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
14by any other 3rd party.
SB55-ASA1-AA19,5,216
301.12
(14) (a) Except as provided in pars. (b) and (c), liability of a person
17specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
18years of age in residential, nonmedical facilities such as group homes, foster homes,
19treatment foster homes, child caring institutions
, and juvenile correctional
20institutions is determined in accordance with the cost-based fee established under
21s. 301.03 (18). The department shall bill the liable person up to any amount of
22liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by other 3rd-party
23benefits, subject to rules which include formulas governing ability to pay
24promulgated by the department under s. 301.03 (18). Any liability of the resident not
1payable by any other person terminates when the resident reaches age 17, unless the
2liable person has prevented payment by any act or omission.".
SB55-ASA1-AA19,5,6
5609.86 Coverage of alcoholism and other diseases. Managed care plans
6are subject to s. 632.89.".
SB55-ASA1-AA19,5,10
9632.89 (title)
Required coverage of Coverage of mental disorders,
10alcoholism, and other diseases.
SB55-ASA1-AA19,5,1212
632.89
(1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
SB55-ASA1-AA19,5,1615
632.89
(1) (er) "Self-insured health plan" has the meaning given in s. 632.745
16(24).
SB55-ASA1-AA19,5,1818
632.89
(2) (title)
Required coverage
for group plans.
SB55-ASA1-AA19, s. 3761f
19Section 3761f. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
20amended to read:
SB55-ASA1-AA19,6,221
632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
22policy issued by an insurer health benefit plan and a self-insured health plan shall
23provide coverage of nervous and mental disorders and alcoholism and other drug
1abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 2(dm) and sub. (3).
SB55-ASA1-AA19, s. 3761gm
5Section 3761gm. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c)
6and amended to read:
SB55-ASA1-AA19,6,117
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
8group
or blanket disability insurance policy issued by an insurer health benefit plan
9or a self-insured health plan provides coverage of any inpatient hospital treatment,
10the
policy plan shall provide coverage for inpatient hospital services for the
11treatment of conditions under par. (a)
1. as provided in subd. 2.
SB55-ASA1-AA19, s. 3761hm
13Section 3761hm. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d)
14and amended to read:
SB55-ASA1-AA19,6,1915
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
16blanket disability insurance policy issued by an insurer health benefit plan or a
17self-insured health plan provides coverage of any outpatient treatment, the
policy 18plan shall provide coverage for outpatient services for the treatment of conditions
19under par. (a)
1. as provided in subd. 2.
SB55-ASA1-AA19, s. 3761im
21Section 3761im. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2)
22(dm) and amended to read:
SB55-ASA1-AA19,7,323
632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
24arrangements. If a group
or blanket disability insurance policy issued by an insurer 25health benefit plan or a self-insured health plan provides coverage of any inpatient
1hospital treatment or any outpatient treatment, the
policy plan shall provide
2coverage for transitional treatment arrangements for the treatment of conditions
3under par. (a)
1. as provided in subd. 2.
SB55-ASA1-AA19,7,107
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
8not apply to a health care plan offered by a limited service health organization, as
9defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
10that is not a managed care plan, as defined in s. 609.01 (3c).
SB55-ASA1-AA19,7,1713
632.89
(3) Equal coverage requirement. (a)
Group plans. A group health
14benefit plan or a self-insured health plan that provides coverage for the treatment
15of nervous and mental disorders and alcoholism and other drug abuse problems shall
16provide the same coverage for that treatment that it provides for the treatment of
17physical conditions.
SB55-ASA1-AA19,7,2118
(b)
Individual plans. If an individual health benefit plan provides coverage for
19the treatment of nervous or mental disorders or alcoholism or other drug abuse
20problems, the individual health benefit plan shall provide the same coverage for that
21treatment that it provides for the treatment of physical conditions.
SB55-ASA1-AA19,8,222
(c)
All coverage components. The requirements under this subsection apply to
23all coverage-related components, including rates; exclusions and limitations;
24deductibles; copayments; coinsurance; annual and lifetime payment limits;
1out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
2duration or frequency of coverage; and medical necessity definitions.
