SB322-AA1,32,66 628.36 (1c) Definitions. (intro.) In this section:
SB322-AA1, s. 93 7Section 93. 628.36 (2) (a) (intro.) of the statutes is amended to read:
SB322-AA1,32,88 628.36 (2) (a) (intro.) In this section subsection:
SB322-AA1, s. 94 9Section 94. 628.36 (2) (b) 3. of the statutes is amended to read:
SB322-AA1,32,1310 628.36 (2) (b) 3. Except as provided in subd. subds. 4. and 4m., and subject to
11sub. (2m) (e)
, no provider may be denied the opportunity to participate in a health
12care plan, other than a health maintenance organization, a limited service health
13organization or a preferred provider plan,
under the terms of the plan.
SB322-AA1, s. 95 14Section 95. 628.36 (2) (b) 4. of the statutes is amended to read:
SB322-AA1,32,1815 628.36 (2) (b) 4. Any health care plan may exclude a provider from participation
16in the health care plan for cause related to the practice of his or her profession. A
17health care plan that excludes a provider from participation shall advise the provider
18in writing of the reason for the exclusion.
SB322-AA1, s. 96 19Section 96. 628.36 (2) (b) 4m. of the statutes is created to read:
SB322-AA1,32,2320 628.36 (2) (b) 4m. Subdivision 3. applies to a health maintenance organization,
21limited service health organization, or preferred provider plan only with respect to
22a provider located in the geographic service area of the health maintenance
23organization, limited service health organization, or preferred provider plan.
SB322-AA1, s. 97 24Section 97. 628.36 (2m) (title) of the statutes is repealed and recreated to read:
SB322-AA1,32,2525 628.36 (2m) (title) Annual participation election period.
SB322-AA1, s. 98
1Section 98. 628.36 (2m) (a) (intro.) and 2m. of the statutes are consolidated,
2renumbered 628.36 (2m) (ac) and amended to read:
SB322-AA1,33,53 628.36 (2m) (ac) In this subsection: 2m. "Pharmaceutical, "health care
4services" do not include the administration of a drug product or device or vaccine
5under s. 450.035.
SB322-AA1, s. 99 6Section 99. 628.36 (2m) (a) 1. of the statutes is renumbered 628.36 (1c) (a).
SB322-AA1, s. 100 7Section 100. 628.36 (2m) (a) 2. of the statutes is renumbered 628.36 (1c) (b).
SB322-AA1, s. 101 8Section 101. 628.36 (2m) (a) 3. of the statutes is renumbered 628.36 (1c) (c).
SB322-AA1, s. 102 9Section 102. 628.36 (2m) (e) 1. of the statutes is amended to read:
SB322-AA1,33,2110 628.36 (2m) (e) 1. A health maintenance organization, limited service health
11organization, or preferred provider plan that provides coverage of pharmaceutical
12health care services when that are performed by one or more pharmacists health care
13professionals
who are selected by the organization or plan but who are not full-time
14salaried employees or partners of the organization or plan shall provide an annual
15period of at least 30 days during which any pharmacist registered under ch. 450
16health care professional who provides those health care services, who has been
17granted a credential, as defined in s. 440.01 (2) (a), to practice in this state, and who
18is located in the geographic service area of the organization or plan
may elect to
19participate in the health maintenance organization, limited service health
20organization, or preferred provider plan under its terms as a selected provider for at
21least one year.
SB322-AA1, s. 103 22Section 103. 628.36 (2m) (e) 2. of the statutes is amended to read:
SB322-AA1,34,223 628.36 (2m) (e) 2. Except as provided in subd. 3., subd. 1. applies to health
24maintenance organizations on and after May 10, 1984. Except as provided in subd.
254., subd. 1. applies to
, limited service health organizations, and preferred provider

1plans on or after April 28, 1990 the effective date of this subdivision .... [revisor
2inserts date]
.
SB322-AA1, s. 104 3Section 104. 628.36 (2m) (e) 3. of the statutes is amended to read:
SB322-AA1,34,114 628.36 (2m) (e) 3. If compliance with the requirements of subd. 1. during the
5period specified in subd. 2. would impair any provision of a contract between a health
6maintenance organization, limited service health organization, or preferred
7provider plan
and any other person, and if the contract provision was in existence
8prior to May 10, 1984 the effective date of this subdivision .... [revisor inserts date],
9then immediately after the expiration of all such contract provisions the health
10maintenance organization, limited service health organization, or preferred
11provider plan
shall comply with the requirements of subd. 1.
SB322-AA1, s. 105 12Section 105. 628.36 (2m) (e) 4. of the statutes is repealed.
SB322-AA1, s. 106 13Section 106. 628.36 (3) of the statutes is amended to read:
SB322-AA1,34,2214 628.36 (3) Exemption by rule. By rule the commissioner may exempt from the
15application of any part of subs. (1) (1m) to (2m) plans which that provide innovative
16approaches to the delivery of health care or which that are designed to contain health
17care costs, and which that cannot operate successfully consistent with all of the
18provisions in subs. (1) (1m) to (2m). The commissioner may promulgate such a rule
19only if on a finding that the interests of the public require such plans as an
20experiment, to supply health care services that are not otherwise available in
21adequate quantity or quality, or to contain health care costs. The promulgated rule
22shall be as narrow as is compatible with the success of the plans.".
SB322-AA1,34,23 233. Page 2, line 1: delete " Section 1" and substitute "Section 106m".
SB322-AA1,34,24 244. Page 2, line 8: after that line insert:
SB322-AA1,35,1
1" Section 107. 632.89 (1) (am) of the statutes is created to read:
SB322-AA1,35,32 632.89 (1) (am) "Consumer price index" means the consumer price index for all
3urban consumers, U.S. city average, as determined by the U.S. department of labor.
SB322-AA1, s. 108 4Section 108. 632.89 (1) (b) of the statutes is created to read:
SB322-AA1,35,75 632.89 (1) (b) "Diagnostic testing" means procedures used to exclude the
6existence of conditions other than nervous or mental disorders or alcoholism or other
7drug abuse problems.
SB322-AA1, s. 109 8Section 109. 632.89 (2) (b) 1. of the statutes is amended to read:
SB322-AA1,35,149 632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability
10insurance policy issued by an insurer provides coverage of inpatient hospital
11treatment or outpatient treatment or both, the policy shall provide coverage in every
12policy year as provided in pars. (c) to (dm), as appropriate, except that the total
13coverage under the policy for a policy year need not exceed $7,000 $16,800 or the
14equivalent benefits measured in services rendered.
SB322-AA1, s. 110 15Section 110. 632.89 (2) (c) 2. b. of the statutes is amended to read:
SB322-AA1,35,2016 632.89 (2) (c) 2. b. Seven thousand Sixteen thousand eight hundred dollars
17minus any applicable cost sharing at the level charged under the policy for inpatient
18hospital services or the equivalent benefits measured in services rendered or, if the
19policy does not use cost sharing, $6,300 $15,100 in equivalent benefits measured in
20services rendered.
SB322-AA1, s. 111 21Section 111. 632.89 (2) (d) 2. of the statutes is amended to read:
SB322-AA1,36,222 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall
23provide coverage in every policy year for not less than $2,000 $3,100 minus any
24applicable cost sharing at the level charged under the policy for outpatient services

1or the equivalent benefits measured in services rendered or, if the policy does not use
2cost sharing, $1,800 $2,800 in equivalent benefits measured in services rendered.
SB322-AA1, s. 112 3Section 112. 632.89 (2) (dm) 2. of the statutes is amended to read:
SB322-AA1,36,94 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall
5provide coverage in every policy year for not less than $3,000 $4,600 minus any
6applicable cost sharing at the level charged under the policy for transitional
7treatment arrangements or the equivalent benefits measured in services rendered
8or, if the policy does not use cost sharing, $2,700 $4,100 in equivalent benefits
9measured in services rendered.
SB322-AA1, s. 113 10Section 113. 632.89 (2) (f) of the statutes is created to read:
SB322-AA1,36,1411 632.89 (2) (f) Report on coverage limits. The department of health and family
12services shall report annually to the governor and the legislature on revising the
13coverage limits specified in this subsection based on the change in the consumer price
14index for medical costs.
SB322-AA1, s. 114 15Section 114. 632.89 (6) and (7) of the statutes are created to read:
SB322-AA1,36,1816 632.89 (6) Prescription drugs and diagnostic testing. (a) The coverage
17amounts specified in sub. (2) shall not include costs incurred for prescription drugs
18or diagnostic testing.
SB322-AA1,36,2019 (b) The department of health and family services may specify, by rule, the
20diagnostic testing procedures to which par. (a) applies.
SB322-AA1,36,23 21(7) Treatment of costs. The coverage amounts specified in sub. (2) apply to
22actual payments or reimbursements made by an insurer if the payment or
23reimbursement amounts are less than the amounts charged by a provider.".
SB322-AA1,36,24 245. Page 2, line 9: delete " Section 2" and substitute "Section 114c".
SB322-AA1,37,1
16. Page 2, line 17: delete " Section 3" and substitute "Section 114m".
SB322-AA1,37,2 27. Page 3, line 2: after that line insert:
SB322-AA1,37,4 3" Section 115. 895.48 (1m) of the statutes, as affected by 2003 Wisconsin Act
433
, is renumbered 895.48 (1m) (a).
SB322-AA1, s. 116 5Section 116. 895.48 (1m) (b) of the statutes is created to read:
SB322-AA1,37,76 895.48 (1m) (b) This subsection does not apply to health care services provided
7by a volunteer health care provider under s. 146.89.
SB322-AA1, s. 117 8Section 117 . Nonstatutory provisions.
SB322-AA1,37,129 (1) The department of health and family services shall submit in proposed form
10the rules required under section 46.03 (44) of the statutes, as created by this act, to
11the legislative council staff under section 227.15 (1) of the statutes no later than the
12first day of the 7th month beginning after the effective date of this subsection.
SB322-AA1, s. 118 13Section 118 . Initial applicability.
SB322-AA1,37,1614 (1) The treatment of section 49.688 (4r) of the statutes first applies to eligibility
15determinations made and deductible amounts paid on the effective date of this
16subsection.
SB322-AA1,37,2117 (2) If an insurance policy that is in effect on the effective date of this subsection
18contains a provision that is inconsistent with the treatment of section 632.89 (6) or
19(7) of the statutes, the treatment of section 632.89 (6) or (7) of the statutes, whichever
20is inconsistent, first applies to that insurance policy on the date on which it is
21renewed.
SB322-AA1,37,2422 (3) The treatment of sections 632.89 (1) (am) and (2) (b) 1., (c) 2. b., (d) 2., (dm)
232., and (f) of the statutes first applies to a policy issued, renewed, or modified on the
24first day of the 13th month beginning after publication.
SB322-AA1,38,6
1(4) The treatment of sections 146.89 (2) (a), (c), and (d), (3) (b) (intro.), (c), and
2(d) (intro.), and (3m) and 895.48 (1m) of the statutes, the renumbering and
3amendment of section 146.89 (1) of the statutes, and the creation of section 146.89
4(1) (d), (g), and (h) and 895.48 (1m) (b) of the statutes first applies to applications
5submitted under section 146.89 (2) (a) of the statutes, as affected by this act, on the
6effective date of this subsection.
SB322-AA1,38,97 (5) The renumbering and amendment of section 456.08 of the statutes and the
8creation of section 456.08 (1), (2), (3), and (4) of the statutes first apply to applications
9received on the effective date of this subsection.
SB322-AA1,38,1410 (6) The treatment of sections 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., and 12.,
11(ar), (e), and (L), 49.47 (4) (am) 1. and 2., (c) 1. and 3., (cg) 3., and (h), and 49.665 (4)
12(a) 1. and (d) of the statutes first applies to eligibility determinations for the Medical
13Assistance and Badger Care health care programs that are made on the effective
14date of this subsection.
SB322-AA1, s. 119 15Section 119. Effective dates. This act takes effect on the day after
16publication, except as follows:
SB322-AA1,38,1817 (1) The treatment of section 49.688 (4r) of the statutes and Section 118 (1 ) of
18this act take effect on the first day of the 2nd month beginning after publication.
SB322-AA1,38,2119 (2) The treatment of sections 20.435 (4) (b) and (7) (bd), 49.45 (6ur) and 49.45
20(6v) of the statutes takes effect on takes effect on January 1, 2005, or on the day after
21publication, whichever is later.
SB322-AA1,38,2422 (3) The treatment of sections 100.31 (title), (1) (a), (ae), (as), (b), and (c), (2), (2r),
23and (4) of the statutes takes effect on the first day of the 3rd month beginning after
24publication.
SB322-AA1,39,3
1(4) The treatment of sections 46.03 (44), 441.07 (1) (d), 441.16 (3m), 448.015 (4),
2448.035, 448.04 (1) (a), 450.10 (1) (a) (intro.), and 450.11 (1) and (1g) of the statutes
3takes effect on the first day of the 13th month beginning after publication.
SB322-AA1,39,84 (5) The treatment of sections 456.02 (intro.), (1), (2), (3), (4), (5), and (6), 456.04
5(intro.), (1), (1m) (d) and (e), (2), (2m), (3), and (4), 456.08 (1), (2), (3), and (4), 456.09
6(1) (c), and 456.12 of the statutes and the renumbering and amendment of section
7456.08 of the statutes take effect on the first day of the 7th month beginning after
8publication.".
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