SB157,3,97
40.51
(8m) Every health care coverage plan offered by the group insurance
8board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
9632.748, 632.83, 632.835, 632.85, 632.853, 632.855
, 632.89, and 632.895 (11) to (14).
SB157, s. 3
10Section
3. 46.10 (8) (d) of the statutes is amended to read:
SB157,3,1511
46.10
(8) (d) After due regard to the case and to a spouse and minor children
12who are lawfully dependent on the property for support, compromise or waive any
13portion of any claim of the state or county for which a person specified under sub. (2)
14is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
15by any other 3rd party.
SB157, s. 4
16Section
4. 46.10 (14) (a) of the statutes is amended to read:
SB157,4,517
46.10
(14) (a) Except as provided in pars. (b) and (c), liability of a person
18specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons
19under 18 years of age at community mental health centers, a county mental health
20complex under s. 51.08, the centers for the developmentally disabled, Mendota
21mental health institute
, and Winnebago mental health institute or care and
22maintenance of persons under 18 years of age in residential, nonmedical facilities
23such as group homes, foster homes, treatment foster homes, child caring institutions
, 24and juvenile correctional institutions is determined in accordance with the
25cost-based fee established under s. 46.03 (18). The department shall bill the liable
1person up to any amount of liability not paid by an insurer under s. 632.89 (2) or
(2m) 2(4m) or by other 3rd party benefits, subject to rules which include formulas governing
3ability to pay promulgated by the department under s. 46.03 (18). Any liability of the
4patient not payable by any other person terminates when the patient reaches age 18,
5unless the liable person has prevented payment by any act or omission.
SB157, s. 5
6Section
5. 60.23 (25) of the statutes is amended to read:
SB157,4,107
60.23
(25) Self-insured health plans. Provide health care benefits to its
8officers and employees on a self-insured basis if the self-insured plan complies with
9ss. 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85,
10632.853, 632.855, 632.87 (4) and (5),
632.89, 632.895 (9) and (11) to (14)
, and 632.896.
SB157, s. 6
11Section
6. 66.0137 (4) of the statutes is amended to read:
SB157,4,1712
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
13a village provides health care benefits under its home rule power, or if a town
14provides health care benefits, to its officers and employees on a self-insured basis,
15the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
16632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5),
17632.89, 632.895 (9) to (14), 632.896
, and 767.25 (4m) (d).
SB157, s. 7
18Section
7. 111.91 (2) (qm) of the statutes is created to read:
SB157,4,2119
111.91
(2) (qm) The requirements under s. 632.89 related to coverage of
20treatment for nervous and mental disorders and alcoholism and other drug abuse
21problems.
SB157, s. 8
22Section
8. 120.13 (2) (g) of the statutes is amended to read:
SB157,5,223
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
2449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
1632.85, 632.853, 632.855, 632.87 (4) and (5),
632.89, 632.895 (9) to (14), 632.896
, and
2767.25 (4m) (d).
SB157, s. 9
3Section
9. 185.981 (4t) of the statutes is amended to read:
SB157,5,74
185.981
(4t) A sickness care plan operated by a cooperative association is
5subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
6632.853, 632.855, 632.87 (2m), (3), (4) and (5),
632.89, 632.895 (10) to (14)
, and
7632.897 (10) and chs. 149 and 155.
SB157, s. 10
8Section
10. 185.983 (1) (intro.) of the statutes is amended to read:
SB157,5,159
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
10exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
11601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
12631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
13632.855, 632.87 (2m), (3), (4) and (5),
632.89, 632.895 (5) and (9) to (14), 632.896
, and
14632.897 (10) and chs. 609, 630, 635, 645
, and 646, but the sponsoring association
15shall:
SB157, s. 11
16Section
11. 301.12 (8) (d) of the statutes is amended to read:
SB157,5,2117
301.12
(8) (d) After due regard to the case and to a spouse and minor children
18who are lawfully dependent on the property for support, compromise or waive any
19portion of any claim of the state or county for which a person specified under sub. (2)
20is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
21by any other 3rd party.
SB157, s. 12
22Section
12. 301.12 (14) (a) of the statutes is amended to read:
SB157,6,823
301.12
(14) (a) Except as provided in pars. (b) and (c), liability of a person
24specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
25years of age in residential, nonmedical facilities such as group homes, foster homes,
1treatment foster homes, child caring institutions
, and juvenile correctional
2institutions is determined in accordance with the cost-based fee established under
3s. 301.03 (18). The department shall bill the liable person up to any amount of
4liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by other 3rd-party
5benefits, subject to rules which include formulas governing ability to pay
6promulgated by the department under s. 301.03 (18). Any liability of the resident not
7payable by any other person terminates when the resident reaches age 17, unless the
8liable person has prevented payment by any act or omission.
SB157, s. 13
9Section
13. 609.86 of the statutes is created to read:
SB157,6,11
10609.86 Coverage of alcoholism and other diseases. Managed care plans
11are subject to s. 632.89.
SB157, s. 14
12Section
14. 632.89 (title) of the statutes is amended to read:
SB157,6,14
13632.89 (title)
Required coverage of Coverage of mental disorders,
14alcoholism, and other diseases.
SB157, s. 15
15Section
15. 632.89 (1) (b) of the statutes is created to read:
SB157,6,1616
632.89
(1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
SB157, s. 16
17Section
16. 632.89 (1) (em) of the statutes is repealed.
SB157, s. 17
18Section
17. 632.89 (1) (er) of the statutes is created to read:
SB157,6,2019
632.89
(1) (er) "Self-insured health plan" has the meaning given in s. 632.745
20(24).
SB157, s. 18
21Section
18. 632.89 (2) (title) of the statutes is amended to read:
SB157,6,2222
632.89
(2) (title)
Required coverage
for group plans.
SB157, s. 19
23Section
19. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
24amended to read:
SB157,7,5
1632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
2policy issued by an insurer health benefit plan and a self-insured health plan shall
3provide coverage of nervous and mental disorders and alcoholism and other drug
4abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 5(dm) and sub. (3).
SB157, s. 20
6Section
20. 632.89 (2) (a) 2. of the statutes is repealed.
SB157, s. 21
7Section
21. 632.89 (2) (b) of the statutes is repealed.
SB157, s. 22
8Section
22. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
9amended to read:
SB157,7,1410
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
11group
or blanket disability insurance policy issued by an insurer health benefit plan
12or a self-insured health plan provides coverage of any inpatient hospital treatment,
13the
policy plan shall provide coverage for inpatient hospital services for the
14treatment of conditions under par. (a)
1. as provided in subd. 2.
SB157, s. 23
15Section
23. 632.89 (2) (c) 2. of the statutes is repealed.
SB157, s. 24
16Section
24. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
17amended to read:
SB157,7,2218
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
19blanket disability insurance policy issued by an insurer health benefit plan or a
20self-insured health plan provides coverage of any outpatient treatment, the
policy 21plan shall provide coverage for outpatient services for the treatment of conditions
22under par. (a)
1. as provided in subd. 2.
SB157, s. 25
23Section
25. 632.89 (2) (d) 2. of the statutes is repealed.
SB157, s. 26
24Section
26. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
25and amended to read:
SB157,8,6
1632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
2arrangements. If a group
or blanket disability insurance policy issued by an insurer 3health benefit plan or a self-insured health plan provides coverage of any inpatient
4hospital treatment or any outpatient treatment, the
policy plan shall provide
5coverage for transitional treatment arrangements for the treatment of conditions
6under par. (a)
1. as provided in subd. 2.
SB157, s. 27
7Section
27. 632.89 (2) (dm) 2. of the statutes is repealed.
SB157, s. 28
8Section
28. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
9amended to read:
SB157,8,1310
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
11not apply to a health care plan offered by a limited service health organization, as
12defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
13that is not a managed care plan, as defined in s. 609.01 (3c).
SB157, s. 29
14Section
29. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
SB157, s. 30
15Section
30. 632.89 (3) of the statutes is created to read:
SB157,8,2016
632.89
(3) Equal coverage requirement. (a)
Group plans. A group health
17benefit plan or a self-insured health plan that provides coverage for the treatment
18of nervous and mental disorders and alcoholism and other drug abuse problems shall
19provide the same coverage for that treatment that it provides for the treatment of
20physical conditions.
SB157,8,2421
(b)
Individual plans. If an individual health benefit plan provides coverage for
22the treatment of nervous or mental disorders or alcoholism or other drug abuse
23problems, the individual health benefit plan shall provide the same coverage for that
24treatment that it provides for the treatment of physical conditions.
SB157,9,5
1(c)
All coverage components. The requirements under this subsection apply to
2all coverage-related components, including rates; exclusions and limitations;
3deductibles; copayments; coinsurance; annual and lifetime payment limits;
4out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
5duration or frequency of coverage; and medical necessity definitions.
SB157, s. 31
6Section
31. 632.89 (3m) of the statutes is repealed.
SB157, s. 32
7Section
32. 632.89 (5) (title) of the statutes is amended to read:
SB157,9,88
632.89
(5) (title)
Medicare exclusion Exclusions.
SB157, s. 33
9Section
33. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
SB157, s. 34
10Section
34. 632.89 (5) (a) (title) of the statutes is created to read:
SB157,9,1111
632.89
(5) (a) (title)
Medicare.
SB157,9,1313
(1) This act first applies to all of the following:
SB157,9,1614
(a) Except as provided in paragraphs (b) and (c
), health benefit plans that are
15issued or renewed, and self-insured health plans that are established, extended,
16modified, or renewed, on the effective date of this paragraph.
SB157,9,1917
(b) Health benefit plans covering employees who are affected by a collective
18bargaining agreement containing provisions inconsistent with this act that are
19issued or renewed on the earlier of the following:
SB157,9,20
201. The day on which the collective bargaining agreement expires.
SB157,9,22
212. The day on which the collective bargaining agreement is extended, modified,
22or renewed.
SB157,9,2523
(c) Self-insured health plans covering employees who are affected by a
24collective bargaining agreement containing provisions inconsistent with this act
25that are established, extended, modified, or renewed on the earlier of the following:
SB157,10,1
11. The day on which the collective bargaining agreement expires.
SB157,10,3
22. The day on which the collective bargaining agreement is extended, modified,
3or renewed.
SB157,10,65
(1)
This act takes effect on the first day of the 6th month beginning after
6publication.