Wisconsin Legislature: LRB-1561/1

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.

(b) Disability insurance policies covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

1. The day on which the collective bargaining agreement expires.

2. The day on which the collective bargaining agreement is extended, modified, or renewed.

(c) Self-insured governmental or school district health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified, or renewed on the earlier of the following:

1. The day on which the collective bargaining agreement expires.

2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SECTION 9425. Effective dates; Insurance.

(End)

LRB-1561LRB-1561/1
PJK:kjf&wlj:nwn
2007 - 2008 LEGISLATURE

DOA:......Rhodes, BB0384 - Increase limits for mental health and AODA coverage

For 2007-09 Budget -- Not Ready For Introduction

2007 BILL

AN ACT ...; relating to: the budget.

Analysis by the Legislative Reference Bureau

insurance

Under current law, a group health insurance policy (called a "disability insurance policy" in the statutes) that provides coverage of any inpatient hospital services must cover those services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of the lesser of 1) the expenses of 30 days of inpatient services; or 2) $7,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $6,300 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage of any outpatient hospital services, it must cover those services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of $2,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $1,800 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage of any inpatient or outpatient hospital services, it must cover the cost of transitional treatment arrangements (services, specified by rule by the commissioner of insurance, that are provided in a less restrictive manner than inpatient services but in a more intensive manner than outpatient services) for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of $3,000 minus the applicable cost sharing under the policy or, if there is no cost sharing under the policy, $2,700 in equivalent benefits measured in services rendered. If a group health insurance policy provides coverage for both inpatient and outpatient hospital services, the total coverage for all types of treatment for nervous and mental disorders and alcoholism and other drug abuse problems need not exceed $7,000, or the equivalent benefits measured in services rendered, in a policy year.

This bill changes the minimum amount of coverage that must be provided for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems on the basis of the change in the consumer price index for medical services since the coverage amounts in current law were enacted in 1985 and 1992. Inpatient services must be covered in the minimum amount of the lesser of 1) the expenses of 30 days of inpatient services; or 2) $20,250 minus the applicable cost sharing or, if there is no cost sharing under the policy, $18,250 in equivalent benefits measured in services rendered. Outpatient services must be covered in the minimum amount of $3,450 minus the applicable cost sharing or, if there is no cost sharing under the policy, $3,100 in equivalent benefits measured in services rendered. Transitional treatment arrangements must be covered in the minimum amount of $5,200 minus the applicable cost sharing or, if there is no cost sharing under the policy, $4,650 in equivalent benefits measured in services rendered. The total coverage for all types of treatment for nervous and mental disorders and alcoholism and other drug abuse problems need not exceed $20,250, or the equivalent benefits measured in services rendered, in a policy year.

The table below provides information on treatment category, current minimum coverage amount, year of enactment, and the proposed coverage amounts based on the increase in the federal cost-of-living for medical coverage "indexed" since the enactment of the current coverage amounts.

The bill also requires DHFS to report annually to the governor and legislature on the change in coverage limits necessary to conform with the change in the federal consumer price index for medical costs.

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. 632.89 (1) (am) of the statutes is created to read:

632.89 (1) (am) "Consumer price index" means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.

SECTION 2. 632.89 (2) (b) 1. of the statutes is amended to read:

632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability insurance policy issued by an insurer provides coverage of inpatient hospital treatment or outpatient treatment or both, the policy shall provide coverage in every policy year as provided in pars. (c) to (dm), as appropriate, except that the total coverage under the policy for a policy year need not exceed $7,000 $20,250 or the equivalent benefits measured in services rendered.

SECTION 3. 632.89 (2) (c) 2. b. of the statutes is amended to read:

632.89 (2) (c) 2. b. Seven thousand Twenty thousand two hundred fifty dollars minus any applicable cost sharing at the level charged under the policy for inpatient hospital services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $6,300 $18,250 in equivalent benefits measured in services rendered.

SECTION 4. 632.89 (2) (d) 2. of the statutes is amended to read:

632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $2,000 $3,450 minus any applicable cost sharing at the level charged under the policy for outpatient services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $1,800 $3,100 in equivalent benefits measured in services rendered.

SECTION 5. 632.89 (2) (dm) 2. of the statutes is amended to read:

632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $3,000 $5,200 minus any applicable cost sharing at the level charged under the policy for transitional treatment arrangements or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $2,700 $4,650 in equivalent benefits measured in services rendered.

SECTION 6. 632.89 (2) (f) of the statutes is created to read:

632.89 (2) (f) Report on coverage limits. The department of health and family services shall report annually to the governor and the legislature on revising the coverage limits specified in this subsection based on the change in the consumer price index for medical costs.

SECTION 9325. Initial applicability; Insurance.

(1) LIMITS FOR MENTAL HEALTH AND DRUG ABUSE COVERAGE. The treatment of section 632.89 (1) (am) and (2) (b) 1., (c) 2. b., (d) 2., (dm) 2., and (f) of the statutes first applies to a policy issued, renewed, or modified on the first day of the 13th month beginning after publication.

(End)

LRB-1562LRB-1562/P4
RLR:kjf&lmk:jf
2007 - 2008 LEGISLATURE

DOA:......Milioto, BB0385b - Family care resource center governing boards and local and regional committees

For 2007-09 Budget -- Not Ready For Introduction

2007 BILL

AN ACT ...; relating to: the budget.

Analysis by the Legislative Reference Bureau

This is a preliminary draft. An analysis will be provided in a later version.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SECTION 1. 46.27 (4) (am) of the statutes is amended to read:

46.27 (4) (am) If a local long-term care council in a county the governing board of a resource center assumes under s. 46.282 (3) (b) 46.283 (6) (b) 10. the duties of the county long-term support planning committee under this subsection, the county long-term support planning committee for the county is dissolved.

SECTION 2. 46.27 (4) (c) (intro.) of the statutes is amended to read:

46.27 (4) (c) (intro.) The planning committee shall develop, or, if a local long-term care council the governing board of a resource center has under s. 46.282 (3) (b) 46.283 (6) (b) 10. assumed the duties of the planning committee, the local long-term care council governing board of the resource center shall recommend a community options plan for participation in the program. The plan shall include:

SECTION 3. 46.27 (4) (c) 5. of the statutes is amended to read:

46.27 (4) (c) 5. A description of the method to be used by the committee or, if a local long-term care council the governing board of a resource center has under s. 46.282 (3) (b) 46.283 (6) (b) 10. assumed the duties of the planning committee, the local long-term care council governing board of the resource center to monitor the implementation of the program.

SECTION 4. 46.2805 (7m) of the statutes is repealed.

SECTION 5. 46.281 (1n) (d) of the statutes is created to read:

46.281 (1n) (d) 1. Establish regions for long-term care advisory committees under s. 46.2825, periodically review the boundaries of the regions, and, as appropriate, revise the boundaries.

2. Specify the number of members that each governing board of a resource center shall appoint to a regional long-term care advisory committee. The total number of committee members shall not exceed 25, and the department shall allot committee membership equally among the governing boards of resource centers operating within the boundaries of the regional long-term care advisory committee.

3. Provide information and staff assistance to assist regional long-term care advisory committees in performing the duties under s. 46.2825 (2).

****NOTE: This is reconciled s. 46.281 (1n) (d). This SECTION has been affected by the following LRB numbers: 0330 and 1562.

SECTION 6. 46.282 (title) of the statutes is repealed.

SECTION 7. 46.282 (2) of the statutes is repealed.

****NOTE: This is reconciled s. 46.282 (2). This SECTION has been affected by drafts with the following LRB numbers: 0330 and 1562.

SECTION 8. 46.282 (3) (title) of the statutes is repealed.

SECTION 9. 46.282 (3) (a) (intro.) of the statutes is repealed.

SECTION 10. 46.282 (3) (a) 1. of the statutes is repealed.

****NOTE: This is reconciled s. 46.282 (3) (a) 1. This SECTION has been affected by drafts with the following LRB numbers: 1524 and 1562.

SECTION 11. 46.282 (3) (a) 2. of the statutes is repealed.

SECTION 12. 46.282 (3) (a) 3. of the statutes is repealed.

SECTION 13. 46.282 (3) (a) 4. of the statutes is repealed.

SECTION 14. 46.282 (3) (a) 5. of the statutes is repealed.

SECTION 15. 46.282 (3) (a) 6. of the statutes is repealed.

SECTION 16. 46.282 (3) (a) 7. of the statutes is repealed.

SECTION 17. 46.282 (3) (a) 8. of the statutes is renumbered 46.2825 (2) (e) and amended to read:

46.2825 (2) (e) Monitor the pattern of enrollments and disenrollments in local care management organizations that provide services in the committee's region.

SECTION 18. 46.282 (3) (a) 9. of the statutes is renumbered 46.283 (6) (b) 3. and amended to read:

46.283 (6) (b) 3. Identify any gaps in services, living arrangements, and community resources and develop strategies to build local capacity to serve older persons and persons with physical or developmental disabilities needed by individuals belonging to the client groups served by the resource center, especially those with long-term care needs.

SECTION 19. 46.282 (3) (a) 10. of the statutes is renumbered 46.2825 (2) (g) and amended to read: