SB55-ASA1-AA1,1307,5
1609.65
(1) (b) 2. The service is provided pursuant to an emergency detention
2under s. 51.15 or on an emergency basis to a person who is committed under s. 51.20
3and the provider notifies the limited service health organization, preferred provider
4plan
, or
managed care defined network plan within 72 hours after the initial
5provision of the service.
SB55-ASA1-AA1,1307,127
609.65
(2) If after receiving notice under sub. (1) (b) 2. the limited service health
8organization, preferred provider plan
, or
managed care defined network plan
9arranges for services to be provided by a provider with whom it has a provider
10agreement, the limited service health organization, preferred provider plan
, or
11managed care plan is not required to reimburse a provider under sub. (1) (b) 2. for
12any services provided after arrangements are made under this subsection.
SB55-ASA1-AA1,1307,2114
609.65
(3) A limited service health organization, preferred provider plan
, or
15managed care defined network plan is only required to make available, or make
16reimbursement for, an examination, evaluation
, or treatment under sub. (1) to the
17extent that the limited service health organization, preferred provider plan
, or
18managed care defined network plan would have made the medically necessary
19service available to the enrollee or reimbursed the provider for the service if any
20referrals required under s. 609.05 (3) had been made and the service had been
21performed by a participating provider.
SB55-ASA1-AA1,1307,2423
609.655
(1) (a) 1. Is covered as a dependent child under the terms of a policy
24or certificate issued by a
managed care defined network plan insurer.
SB55-ASA1-AA1,1308,2
1609.655
(1) (a) 2. Is enrolled in a school located in this state but outside the
2geographical service area of the
managed care defined network plan.
SB55-ASA1-AA1,1308,114
609.655
(2) If a policy or certificate issued by a
managed care defined network 5plan insurer provides coverage of outpatient services provided to a dependent
6student, the policy or certificate shall provide coverage of outpatient services, to the
7extent and in the manner required under sub. (3), that are provided to the dependent
8student while he or she is attending a school located in this state but outside the
9geographical service area of the
managed care defined network plan,
10notwithstanding the limitations regarding participating providers, primary
11providers
, and referrals under ss. 609.01 (2) and 609.05 (3).
SB55-ASA1-AA1,1308,1413
609.655
(3) (intro.) Except as provided in sub. (5), a
managed care defined
14network plan shall provide coverage for all of the following services:
SB55-ASA1-AA1,1308,2016
609.655
(3) (a) A clinical assessment of the dependent student's nervous or
17mental disorders or alcoholism or other drug abuse problems, conducted by a
18provider described in s. 632.89 (1) (e) 2. or 3. who is located in this state and in
19reasonably close proximity to the school in which the dependent student is enrolled
20and who may be designated by the
managed care defined network plan.
SB55-ASA1-AA1,1309,222
609.655
(3) (b) (intro.) If outpatient services are recommended in the clinical
23assessment conducted under par. (a), the recommended outpatient services
24consisting of not more than 5 visits to an outpatient treatment facility or other
25provider that is located in this state and in reasonably close proximity to the school
1in which the dependent student is enrolled and that may be designated by the
2managed care defined network plan, except as follows:
SB55-ASA1-AA1,1309,74
609.655
(3) (b) 1. Coverage is not required under this paragraph if the medical
5director of the
managed care defined network plan determines that the nature of the
6treatment recommended in the clinical assessment will prohibit the dependent
7student from attending school on a regular basis.
SB55-ASA1-AA1,1309,179
609.655
(4) (a) Upon completion of the 5 visits for outpatient services covered
10under sub. (3) (b), the medical director of the
managed care defined network plan and
11the clinician treating the dependent student shall review the dependent student's
12condition and determine whether it is appropriate to continue treatment of the
13dependent student's nervous or mental disorders or alcoholism or other drug abuse
14problems in reasonably close proximity to the school in which the student is enrolled.
15The review is not required if the dependent student is no longer enrolled in the school
16or if the coverage limits under the policy or certificate for treatment of nervous or
17mental disorders or alcoholism or other drug abuse problems have been exhausted.
SB55-ASA1-AA1,1310,219
609.655
(4) (b) Upon completion of the review under par. (a), the medical
20director of the
managed care defined network plan shall determine whether the
21policy or certificate will provide coverage of any further treatment for the dependent
22student's nervous or mental disorder or alcoholism or other drug abuse problems that
23is provided by a provider located in reasonably close proximity to the school in which
24the student is enrolled. If the dependent student disputes the medical director's
25determination, the dependent student may submit a written grievance under the
1managed care defined network plan's internal grievance procedure established
2under s. 632.83.
SB55-ASA1-AA1,1310,84
609.655
(5) (a) A policy or certificate issued by a
managed care defined network 5plan insurer is required to provide coverage for the services specified in sub. (3) only
6to the extent that the policy or certificate would have covered the service if it had been
7provided to the dependent student by a participating provider within the
8geographical service area of the
managed care defined network plan.
SB55-ASA1-AA1,1310,1410
609.655
(5) (b) Paragraph (a) does not permit a
managed care defined network 11plan to reimburse a provider for less than the full cost of the services provided or an
12amount negotiated with the provider, solely because the reimbursement rate for the
13service would have been less if provided by a participating provider within the
14geographical service area of the
managed care defined network plan.
SB55-ASA1-AA1,1310,18
16609.70 Chiropractic coverage. Limited service health organizations,
17preferred provider plans
, and
managed care defined network plans are subject to s.
18632.87 (3).
SB55-ASA1-AA1,1311,2
20609.75 Adopted children coverage. Limited service health organizations,
21preferred provider plans
, and
managed care defined network plans are subject to s.
22632.896. Coverage of health care services obtained by adopted children and children
23placed for adoption may be subject to any requirements that the limited service
24health organization, preferred provider plan
, or
managed care defined network plan
1imposes under s. 609.05 (2) and (3) on the coverage of health care services obtained
2by other enrollees.
SB55-ASA1-AA1,1311,6
4609.77 Coverage of breast reconstruction. Limited service health
5organizations, preferred provider plans
, and
managed care defined network plans
6are subject to s. 632.895 (13).
SB55-ASA1-AA1,1311,11
8609.78 Coverage of treatment for the correction of
9temporomandibular disorders. Limited service health organizations, preferred
10provider plans
, and
managed care
defined network plans are subject to s. 632.895
11(11).
SB55-ASA1-AA1,1311,16
13609.79 Coverage of hospital and ambulatory surgery center charges
14and anesthetics for dental care. Limited service health organizations, preferred
15provider plans
, and
managed care
defined network plans are subject to s. 632.895
16(12).
SB55-ASA1-AA1,1311,22
18609.80 Coverage of mammograms. Managed care Defined network plans
19are subject to s. 632.895 (8). Coverage of mammograms under s. 632.895 (8) may be
20subject to any requirements that the
managed care
defined network plan imposes
21under s. 609.05 (2) and (3) on the coverage of other health care services obtained by
22enrollees.
SB55-ASA1-AA1,1312,2
24609.81 Coverage related to HIV infection. Limited service health
25organizations, preferred provider plans
, and
managed care defined network plans
1are subject to s. 631.93.
Managed care
Defined network plans are subject to s.
2632.895 (9).
SB55-ASA1-AA1,1312,6
4609.82 Coverage without prior authorization for emergency medical
5condition treatment. Limited service health organizations, preferred provider
6plans
, and
managed care defined network plans are subject to s. 632.85.
SB55-ASA1-AA1,1312,10
8609.83 Coverage of drugs and devices. Limited service health
9organizations, preferred provider plans
, and
managed care defined network plans
10are subject to s. 632.853.
SB55-ASA1-AA1,1312,14
12609.84 Experimental treatment. Limited service health organizations,
13preferred provider plans
, and
managed care defined network plans are subject to s.
14632.855.
SB55-ASA1-AA1,1312,17
16609.88 Coverage of immunizations.
Managed care Defined network plans
17are subject to s. 632.895 (14).
SB55-ASA1-AA1,1312,21
19609.89 Written reason for coverage denial. Limited service health
20organizations, preferred provider plans
, and
managed care defined network plans
21are subject to s. 631.17.
SB55-ASA1-AA1,1312,25
23609.90 Restrictions related to domestic abuse. Limited service health
24organizations, preferred provider plans
, and
managed care defined network plans
25are subject to s. 631.95.".
SB55-ASA1-AA1,1313,4
3632.872 Prohibiting denial of payment for certain procedures. (1) In
4this section:
SB55-ASA1-AA1,1313,55
(a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB55-ASA1-AA1,1313,76
(b) "Medicare Part B" means the federal supplementary medical insurance
7program under
42 USC 1395j to
1395w-2.
SB55-ASA1-AA1,1313,13
8(2) An insurer may not deny payment under an individual or group disability
9insurance policy or a certificate of group disability insurance for a medical or surgical
10service or procedure on the basis that the service or procedure is an integral
11component of a 2nd medical or surgical service or procedure unless, under medicare
12Part B, payment for the first service or procedure is included in the payment for the
132nd service or procedure.".
SB55-ASA1-AA1,1313,2116
635.02
(2) "Case characteristics" means the demographic, actuarially based
17characteristics of the employees of a small employer, and the employer, if covered,
18such as age, sex,
and geographic location
and occupation, used by a small employer
19insurer to determine premium rates for a small employer. "Case characteristics"
20does not include loss or claim history, health status,
occupation, duration of coverage
, 21or other factors related to claim experience.
SB55-ASA1-AA1,1313,2323
635.02
(3e) "Eligible employee" has the meaning given in s. 632.745 (5) (a).
SB55-ASA1-AA1,1314,7
1635.02
(7) "Small employer" means, with respect to a calendar year and a plan
2year, an employer that employed an average of at least 2 but not more than 50
eligible 3employees on business days during the preceding calendar year, or that is reasonably
4expected to employ an average of at least 2 but not more than 50
eligible employees
5on business days during the current calendar year if the employer was not in
6existence during the preceding calendar year, and that employs at least 2
eligible 7employees on the first day of the plan year.
SB55-ASA1-AA1,1314,129
635.05
(2) (a) 2. An adjustment, not to exceed 15% per year, adjusted
10proportionally for rating periods of less than one year, for such rating factors as claim
11experience, health status
, occupation, and duration of coverage, determined in
12accordance with the small employer insurer's rate manual or rating procedures.
SB55-ASA1-AA1,1314,1514
635.05
(7) Specifying the manner in which rates must be published under s.
15635.12.
SB55-ASA1-AA1,1314,22
17635.12 Annual publication of rates. Every small employer insurer shall
18annually publish the small employer insurer's current new business premium rates.
19The rates shall be published in the manner and according to categories required by
20rule under s. 635.05 (7). New business premium rates for coverage under the health
21care coverage program under subch. X of ch. 40 shall be published as required under
22s. 40.98 (2) (d).".
SB55-ASA1-AA1,1315,5
1632.895
(14) (c) The coverage required under par. (b) may not be subject to any
2deductibles, copayments
, or coinsurance under the policy or plan. This paragraph
3applies to a
managed care defined network plan, as defined in s. 609.01
(3c) (1b), only
4with respect to appropriate and necessary immunizations provided by providers
5participating, as defined in s. 609.01 (3m), in the plan.
SB55-ASA1-AA1,1315,107
632.895
(14) (d) 3. A health care plan offered by a limited service health
8organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
9in s. 609.01 (4), that is not a
managed care defined network plan, as defined in s.
10609.01
(3c) (1b).".
SB55-ASA1-AA1,1315,1613
704.07
(5) Carpet cleaning. (a) Notwithstanding subs. (1), (2) (a), and (3) (a),
14a landlord may deduct from a tenant's security deposit at the end of the tenant's
15tenancy carpet cleaning costs incurred by the landlord due to normal wear and tear
16of the carpet if all of the following apply:
SB55-ASA1-AA1,1315,1817
1. The landlord provided the tenant with a written document separate from the
18lease regarding the deduction for carpet cleaning costs.
SB55-ASA1-AA1,1315,1919
2. The document was entitled "Nonstandard Rental Provisions."
SB55-ASA1-AA1,1315,2020
3. The conditions required by rule under par. (b) are satisfied.
SB55-ASA1-AA1,1315,2421
(b) The department of agriculture, trade and consumer protection shall
22promulgate a rule that specifies conditions that must be satisfied in order for a
23landlord to deduct from a security deposit the carpet cleaning costs specified in par.
24(a).".
SB55-ASA1-AA1,1316,63
753.075
(2) (a) Any person who has served a total of 6 or more years as a
4supreme court justice, a court of appeals judge or a circuit judge
and who was not
5defeated at the most recent time that he or she sought election to a circuit court
6judgeship.
SB55-ASA1-AA1,1316,97
(b) Any person who was eligible to serve as a reserve judge before May 1, 1992
,
8and who was not defeated at the most recent time that he or she sought election to
9a circuit court judgeship.".