(b) "Support liability" means an amount that is entered in the statewide support lien docket under s. 49.854.
(2) Before paying an insurance claim of $500 or more to any individual, an insurer that is authorized to do business in this state shall do all of the following:
(a) Verify with the department of health and family services, in the manner required by the department, whether the individual to whom the claim is to be paid has a medical assistance liability.
(b) Check the statewide support lien docket to determine whether the individual to whom the claim is to be paid has a support liability.
(3) If an individual to whom a claim of $500 or more is to be paid has a support liability or a medical assistance liability, or both, the insurer shall distribute the claim proceeds as follows:
(a) First, if there is a support liability, to the department of workforce development to pay the support liability, up to the amount of the support liability or the amount of the claim, whichever is less.
(b) Next, if there is a medical assistance liability, to the department of health and family services to pay the medical assistance liability, up to the amount of the medical assistance liability or the amount of the claim proceeds remaining, whichever is less.
(c) Last, to the individual, the remainder of the claim proceeds, if any.
(4) The department of health and family services shall promulgate rules for the administration of this section, including procedures for insurers to follow and any notice and hearing requirements. Notwithstanding s. 227.24 (3), the rules under this subsection may be promulgated as emergency rules under s. 227.24 without a finding of emergency.
SECTION 9321. Initial applicability; Health and Family Services.
(1) INSURANCE CLAIM INTERCEPT. If any insurance policy that is in effect on the effective date of this subsection contains a provision that is inconsistent with the treatment of section 49.895 of the statutes, the treatment of section 49.895 of the statutes first applies to that policy on the date on which it is renewed.
(End)
LRB-1549LRB-1549/1
DAK:kjf:jf
2007 - 2008 LEGISLATURE
DOA:......Jablonsky, BB0364 - AIDS insurance premium subsidy program to pay for Medicare Part D premiums
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Health
Currently, DHFS subsidizes the premium costs for health insurance coverage, except for premiums for the federal Medicare program (Medicare), of low-income persons who have HIV infections and are unable to continue employment or must reduce employment hours because of illnesses or medical conditions arising from the HIV infections. Medicare has programs of coverage for hospital care, physicians' services, and prescription drugs.
This bill changes the restriction on subsidization by DHFS of Medicare premiums to allow subsidization for premiums for Medicare prescription drug coverage, for low-income persons with HIV infections, no or reduced employment, and HIV-related illnesses or medical conditions.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 252.16 (1) (d) of the statutes is amended to read:
252.16 (1) (d) "Medicare" has the meaning given in s. 49.498 (1) (f) means coverage under part A, part B, or part D of Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395hhh.
SECTION 2. 252.16 (4) (a) of the statutes is amended to read:
252.16 (4) (a) Except as provided in pars. (b) and (d), if an individual satisfies sub. (3), the department shall pay the full amount of each premium payment for the individual's health insurance coverage under the group health plan or individual health policy under sub. (3) (dm), on or after the date on which the individual becomes eligible for a subsidy under sub. (3). Except as provided in pars. (b) and (d), the department shall pay the full amount of each premium payment regardless of whether the individual's health insurance coverage under sub. (3) (dm) includes coverage of the individual's dependents. Except as provided in par. (b), the department shall terminate the payments under this section when the individual's health insurance coverage ceases or when the individual no longer satisfies sub. (3), whichever occurs first. The department may not make payments under this section for premiums for medicare, except for premiums for coverage for part D of Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395hhh.
(End)
LRB-1550LRB-1550/1
DAK:wlj:pg
2007 - 2008 LEGISLATURE
DOA:......Milioto, BB0359 - Quality home care funded by grants for community programs
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
health and human services
Health
Currently, DHFS distributes numerous grants for community programs.
This bill requires DHFS to distribute at least $167,000 in each fiscal year as a grant to an organization to provide services to consumers and providers of supportive home care and personal care.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 46.48 (9) of the statutes is created to read:
46.48 (9) QUALITY HOME CARE PROGRAM. The department shall distribute at least $167,000 in each fiscal year as a grant to an organization to provide services to consumers and providers of supportive home care and personal care.
(End)
LRB-1553LRB-1553/P2
PJK:wlj&jld:pg
2007 - 2008 LEGISLATURE
DOA:......Rhodes, BB0387 - Insurance coverage of autism, Asperger's and pervasive developmental disorders
For 2007-09 Budget -- Not Ready For Introduction
2007 BILL
AN ACT ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
Insurance
This bill requires health insurance policies and self-insured governmental and school district health plans to cover the cost of treatment for an insured for autism, Asperger's syndrome, and pervasive developmental disorder not otherwise specified if the treatment is provided by a psychiatrist, a psychologist, or a social worker who is certified or licensed to practice psychotherapy. A policy or plan is not required to cover more than four hours of treatment per month, however. The coverage requirement applies to both individual and group health insurance policies and plans, including defined network plans and cooperative sickness care associations; to health care plans offered by the state to its employees, including a self-insured plan; and to self-insured health plans of counties, cities, towns, villages, and school districts. The requirement specifically does not apply to limited-scope benefit plans, medicare replacement or supplement policies, long-term care policies, or policies covering only certain specified diseases. The coverage may be subject to any limitations or exclusions or cost-sharing provisions that apply generally under the policy or plan.
For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1. 40.51 (8) of the statutes is amended to read:
40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to (6), 632.895 (5m) and (8) to (14) (15), and 632.896.
SECTION 2. 40.51 (8m) of the statutes is amended to read:
40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to (14) (15).
SECTION 3. 66.0137 (4) of the statutes is amended to read:
66.0137 (4) SELF-INSURED HEALTH PLANS. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14) (15), 632.896, and 767.513 (4).
SECTION 4. 111.91 (2) (n) of the statutes is amended to read:
111.91 (2) (n) The provision to employees of the health insurance coverage required under s. 632.895 (11) to (14) (15).
SECTION 5. 120.13 (2) (g) of the statutes is amended to read:
120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14) (15), 632.896, and 767.513 (4).
SECTION 6. 185.981 (4t) of the statutes is amended to read:
185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (10) to (14) (15), and 632.897 (10) and chs. 149 and 155.
SECTION 7. 185.983 (1) (intro.) of the statutes is amended to read:
185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (5) and (9) to (14) (15), 632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association shall:
SECTION 8. 609.87 of the statutes is created to read:
609.87 Coverage of treatment for autism spectrum disorders. Defined network plans are subject to s. 632.895 (15).
SECTION 9. 632.895 (15) of the statutes is created to read:
632.895 (15) TREATMENT FOR AUTISM SPECTRUM DISORDERS. (a) In this subsection, "autism spectrum disorder" means any of the following:
1. Autism disorder.
2. Asperger's syndrome.
3. Pervasive developmental disorder not otherwise specified.
(b) 1. Subject to subd. 2., and except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, shall provide coverage for an insured of treatment for an autism spectrum disorder if the treatment is provided by any of the following:
a. A psychiatrist, as defined in s. 146.34 (1) (h).
b. A psychologist, as defined in s. 146.34 (1) (i).
c. A social worker, as defined in s. 252.15 (1) (er), who is certified or licensed to practice psychotherapy, as defined in s. 457.01 (8m).
2. A disability insurance policy or self-insured health plan is not required to cover the cost of more than 4 hours per month of the treatment specified in subd. 1.
(c) The coverage required under par. (b) may be subject to any limitations, exclusions, and cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.
(d) This subsection does not apply to any of the following:
1. A disability insurance policy that covers only certain specified diseases.
2. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).
3. A long-term care insurance policy.
4. A medicare replacement policy or a medicare supplement policy.
SECTION 9325. Initial applicability; Insurance.
(1) COVERAGE OF TREATMENT FOR AUTISM SPECTRUM DISORDERS. The treatment of sections 40.51 (8) and (8m), 66.0137 (4), 111.91 (2) (n), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.87, and 632.895 (15) of the statutes first applies to all of the following:
(a) Except as provided in paragraphs (b) and (c), disability insurance policies that are issued or renewed, and self-insured governmental or school district health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.
