SB337: Bill Text

SB337,3,10 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), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.513 (4).

SB337, s. 4 Section 4. 120.13 (2) (g) of the statutes is amended to read:

SB337,3,15 120.13 (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), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.513 (4).

SB337, s. 5 Section 5. 146.903 of the statutes is created to read:

SB337,3,18 146.903 Disclosures required of health care providers. (1) In this section:

SB337,3,19 (a) "Ambulatory surgery center" has the meaning given in 42 CFR 416.2.

SB337,3,22 (b) "Clinic" means a place, other than a residence, that is used primarily for the provision of nursing, medical, podiatric, dental, chiropractic, or optometric care and treatment.

SB337,3,24 (c) "Diagnosis-related groups" means a classification of inpatient hospital discharges specified under 42 CFR 412.60.

SB337,4,2 (d) "Health care provider" has the meaning given in s. 146.81 (1) and includes a clinic and an ambulatory surgery center.

SB337,4,4 (e) "Medical Assistance" means health care benefits provided under subch. IV of ch. 49.

SB337,4,8 (f) "Usual and customary charge" means the amount that a health care provider usually and customarily charges for a health care service, diagnostic test, or procedure, before any discount or contractual rate applicable to certain patients or payers is applied.

SB337,4,11 (2) Except as provided in sub. (5), a health care provider or the health care provider's designee shall, upon request by and at no cost to a health care consumer, disclose to the consumer all of the following, under the following circumstances:

SB337,4,15 (a) Within a reasonable period of time after the request, the usual and customary charges, assuming no medical complications, for an inpatient or outpatient health care service, diagnostic test, or procedure that is specified by the consumer and that is provided by the health care provider.

SB337,4,17 (b) Immediately upon request, on the site of the health care provider, as a single document, all of the following:

SB337,4,22 1. The usual and customary charge, assuming no medical complications, for each of the 50 health care services, diagnostic tests, or procedures, relevant to the treatment of particular presenting conditions, that the health care provider most frequently performs. The information under this subdivision shall be classified as follows:

SB337,4,24 a. If provided concerning inpatient or outpatient services by a hospital, in the form of diagnosis-related groups.

SB337,5,4 b. If provided by a physician, in the form of presenting conditions, including the total charges for codes under the Current Procedural Terminology of the American Medical Association that are most frequently performed as a result of the presenting conditions.

SB337,5,12 c. If provided by a health care provider other than a hospital or physician, in a grouping form similar to that under subd. 1. a. or b. Notwithstanding the requirement under subd. 1. (intro.) that 50 health care services, diagnostic tests, or procedures be disclosed, if the health care provider under this subd. 1. c. performs fewer than 50 health care services, diagnostic tests, or procedures on a regular basis, the health care provider shall indicate that fact and disclose those health care services, diagnostic tests, or procedures that the health care provider performs on a regular basis.

SB337,5,16 2. If the health care provider is certified as a provider of Medical Assistance, the Medical Assistance payment rates, as specified on the Web site of the department, for the provider for the health care services, diagnostic tests, or procedures specified in subd. 1.

SB337,5,18 3. The average allowable payment from private, 3rd party payers for the health care services, diagnostic tests, or procedures specified in subd. 1.

SB337,5,20 4. The average of the charges and payment rates specified in subd. 1., 2., and 3. for each health care service, diagnostic test, or procedure specified in subd. 1.

SB337,5,23 (3) Information on charges or payment rates that is provided to a health care consumer under sub. (2) shall be updated annually by the health care provider and may not be construed as a legally binding estimate of the cost to the consumer.

SB337,6,5 (4) Except as provided in sub. (5), a health care provider shall prominently display, in the area of the health care provider's practice or facility that is most commonly frequented by health care consumers, a statement informing the consumers that they have the right to request charge or payment rate information for health care services, diagnostic tests, or procedures from the health care provider or, under s. 632.798, all of the following from their insurers or self-insured health plans:

SB337,6,8 (a) A good faith estimate of the reimbursement that the insurer or self-insured health plan would expect to pay a specified provider for a specified health care service.

SB337,6,10 (b) A good faith estimate of the insured's total out-of-pocket cost for the specified health care service provided by the specified provider.

SB337,6,11 (5) This section does not apply to any of the following:

SB337,6,13 (a) A health care provider that practices individually and not in association with another health care provider.

SB337,6,15 (b) Health care providers that are an association of 3 or fewer individual health care providers.

SB337, s. 6 Section 6. 185.981 (4t) of the statutes is amended to read:

SB337,6,20 185.981 (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, 632.798, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (10) to (14), and 632.897 (10) and chs. 149 and 155.

SB337, s. 7 Section 7. 185.983 (1) (intro.) of the statutes is amended to read:

SB337,7,3 185.983 (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, 632.798, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (5) and (9) to (14), 632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association shall:

SB337, s. 8 Section 8. 609.71 of the statutes is created to read:

SB337,7,6 609.71 Disclosure of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.798.

SB337, s. 9 Section 9. 632.798 of the statutes is created to read:

SB337,7,8 632.798 Disclosure of payments. (1) Definitions. In this section:

SB337,7,9 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

SB337,7,11 (b) "Insured" includes an enrollee under a self-insured health plan and a representative or designee of an insured or enrollee.

SB337,7,13 (c) "Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.

SB337,7,18 (2) Provide information. (a) A self-insured health plan or an insurer that provides coverage under a disability insurance policy shall, at the request of an insured, provide to the insured a good faith estimate of the reimbursement that the insurer or self-insured health plan would expect to pay a specified provider for a specified health care service.

SB337,7,22 (b) If requested by the insured, the insurer or self-insured health plan under par. (a) shall also provide to the insured a good faith estimate of the insured's total out-of-pocket cost for the specified health care service provided by the specified provider.

SB337,7,24 (c) An estimate provided by an insurer or self-insured health plan under this section is not a legally binding estimate of the reimbursement or out-of-pocket cost.

SB337,8,2 (d) An insurer or self-insured health plan may not charge an insured for providing the information under this section.

SB337, s. 10 Section 10. Initial applicability.

SB337,8,11 (1) Disclosure of payments and out-of-pocket costs. If a disability insurance policy or a governmental self-insured health plan that is in effect on the effective date of this subsection contains a provision that is inconsistent with the treatment of section 40.51 (8) or (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.71, or 632.798 of the statutes, the treatment of section 40.51 (8) or (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.71, or 632.798 of the statutes first applies to that disability insurance policy or governmental self-insured health plan on the date on which it is modified, extended, or renewed.

SB337, s. 11 Section 11. Effective date.

SB337,8,14 (1) This act takes effect on the first day of the 7th month beginning after publication.

SB337,8,15 (End)