In addition, the bill requires group and individual health benefit plans and
governmental self-insured plans that provide coverage for the treatment of mental
health and substance abuse problems and that would cover at least one annual
physical examination to cover at least one annual screening for a covered individual
to determine the need for treatment of mental health and substance abuse problems
and for a female covered under the plan at least one screening during a pregnancy
for prepartum depression and at least one screening within six months after a live
birth, stillbirth, or miscarriage for postpartum depression to determine the need for
treatment. The bill also imposes a new requirement that the coverage under group
health benefit plans and governmental self-insured health plans for the treatment
of mental health and substance abuse problems must be the same as the coverage
under those plans for the treatment of physical conditions. This requirement for
equal coverage applies to such coverage components as deductibles, copayments,
annual and lifetime limits, and medical necessity definitions. The bill does not
require individual health benefit plans to cover the treatment of mental health and
substance abuse problems but, if an individual health benefit plan does cover the
treatment of any of those conditions, the individual health benefit plan must provide
the same coverage for that treatment as it does for the treatment of physical
conditions.

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:
SB375, s. 1 1Section 1. 40.51 (8) of the statutes, as affected by 2007 Wisconsin Act 36, is
2amended to read:
SB375,3,63 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
4shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
5and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
6(5) (6), 632.89, 632.895 (5m) and (8) to (15), and 632.896.
SB375, s. 2 7Section 2. 40.51 (8m) of the statutes, as affected by 2007 Wisconsin Act 36, is
8amended to read:
SB375,3,119 40.51 (8m) Every health care coverage plan offered by the group insurance
10board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
11632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.89, and 632.895 (11) to (15).
SB375, s. 3 12Section 3. 46.10 (8) (d) of the statutes is amended to read:
SB375,3,1713 46.10 (8) (d) After due regard to the case and to a spouse and minor children
14who are lawfully dependent on the property for support, compromise or waive any
15portion of any claim of the state or county for which a person specified under sub. (2)
16is liable, but not any claim payable by an insurer under s. 632.89 (2) or (2m) (4m) or
17by any other 3rd party.
SB375, s. 4 18Section 4. 46.10 (14) (a) of the statutes is amended to read:
SB375,4,1219 46.10 (14) (a) Except as provided in pars. (b) and (c), liability of a person
20specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons
21under 18 years of age at community mental health centers, a county mental health

1complex under s. 51.08, the centers for the developmentally disabled, the Mendota
2Mental Health Institute, and the Winnebago Mental Health Institute or care and
3maintenance of persons under 18 years of age in residential, nonmedical facilities
4such as group homes, foster homes, treatment foster homes, subsidized
5guardianship homes, residential care centers for children and youth, and juvenile
6correctional institutions is determined in accordance with the cost-based fee
7established under s. 46.03 (18). The department shall bill the liable person up to any
8amount of liability not paid by an insurer under s. 632.89 (2) or (2m) (4m) or by other
93rd-party benefits, subject to rules that include formulas governing ability to pay
10promulgated by the department under s. 46.03 (18). Any liability of the patient not
11payable by any other person terminates when the patient reaches age 18, unless the
12liable person has prevented payment by any act or omission.
SB375, s. 5 13Section 5. 66.0137 (4) of the statutes, as affected by 2007 Wisconsin Act 36,
14is amended to read:
SB375,4,2015 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
16a village provides health care benefits under its home rule power, or if a town
17provides health care benefits, to its officers and employees on a self-insured basis,
18the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
19632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and,
20(5), and (6), 632.89, 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).
SB375, s. 6 21Section 6. 111.91 (2) (qm) of the statutes is created to read:
SB375,4,2422 111.91 (2) (qm) The requirements under s. 632.89 relating to coverage of
23screening and treatment for nervous and mental disorders and alcoholism and other
24drug abuse problems.
SB375, s. 7
1Section 7. 120.13 (2) (g) of the statutes, as affected by 2007 Wisconsin Act 36,
2is amended to read:
SB375,5,63 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
5632.85, 632.853, 632.855, 632.87 (4) and, (5), and (6), 632.89, 632.895 (9) to (15),
6632.896, and 767.25 (4m) (d) 767.513 (4).
SB375, s. 8 7Section 8. 185.981 (4t) of the statutes, as affected by 2007 Wisconsin Act 36,
8is amended to read:
SB375,5,129 185.981 (4t) A sickness care plan operated by a cooperative association is
10subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
11632.853, 632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.89, 632.895 (10) to (15),
12and 632.897 (10) and chs. 149 and 155.
SB375, s. 9 13Section 9. 185.983 (1) (intro.) of the statutes, as affected by 2007 Wisconsin
14Act 36
, is amended to read:
SB375,5,2115 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
16exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
17601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
18631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
19632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.89, 632.895 (5) and (9) to (15),
20632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
21association shall:
SB375, s. 10 22Section 10. 301.12 (8) (d) of the statutes is amended to read:
SB375,6,223 301.12 (8) (d) After due regard to the case and to a spouse and minor children
24who are lawfully dependent on the property for support, compromise or waive any
25portion of any claim of the state or county for which a person specified under sub. (2)

1is liable, but not any claim payable by an insurer under s. 632.89 (2) or (2m) (4m) or
2by any other 3rd party.
SB375, s. 11 3Section 11. 301.12 (14) (a) of the statutes is amended to read:
SB375,6,144 301.12 (14) (a) Except as provided in pars. (b) and (c), liability of a person
5specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
6years of age in residential, nonmedical facilities such as group homes, foster homes,
7treatment foster homes, child caring institutions, and juvenile correctional
8institutions is determined in accordance with the cost-based fee established under
9s. 301.03 (18). The department shall bill the liable person up to any amount of
10liability not paid by an insurer under s. 632.89 (2) or (2m) (4m) or by other 3rd-party
11benefits, subject to rules which include formulas governing ability to pay
12promulgated by the department under s. 301.03 (18). Any liability of the resident not
13payable by any other person terminates when the resident reaches age 17, unless the
14liable person has prevented payment by any act or omission.
SB375, s. 12 15Section 12. 609.86 of the statutes is created to read:
SB375,6,17 16609.86 Coverage of alcoholism and other diseases. Defined network
17plans are subject to s. 632.89.
SB375, s. 13 18Section 13. 632.89 (title) of the statutes is amended to read:
SB375,6,20 19632.89 (title) Required coverage of Coverage of mental disorders,
20alcoholism, and other diseases.
SB375, s. 14 21Section 14. 632.89 (1) (b) of the statutes is repealed and recreated to read:
SB375,6,2222 632.89 (1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
SB375, s. 15 23Section 15. 632.89 (1) (em) of the statutes is repealed.
SB375, s. 16 24Section 16. 632.89 (1) (er) of the statutes is created to read:
SB375,7,2
1632.89 (1) (er) "Self-insured health plan" has the meaning given in s. 632.745
2(24).
SB375, s. 17 3Section 17. 632.89 (2) (title) of the statutes is amended to read:
SB375,7,44 632.89 (2) (title) Required coverage for group plans.
SB375, s. 18 5Section 18. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
6amended to read:
SB375,7,117 632.89 (2) (a) Conditions covered. A group or blanket disability insurance
8policy issued by an insurer
health benefit plan and a self-insured health plan shall
9provide coverage of nervous and mental disorders and alcoholism and other drug
10abuse problems if required by pars. (c) to (dm) and as provided in pars. (b) (c) to (e)
11(dm) and subs. (2p) and (3).
SB375, s. 19 12Section 19. 632.89 (2) (a) 2. of the statutes is repealed.
SB375, s. 20 13Section 20. 632.89 (2) (b) of the statutes is repealed.
SB375, s. 21 14Section 21. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
15amended to read:
SB375,7,2016 632.89 (2) (c) Minimum coverage Coverage of inpatient hospital services. If a
17group or blanket disability insurance policy issued by an insurer health benefit plan
18or a self-insured health plan
provides coverage of any inpatient hospital treatment,
19the policy plan shall provide coverage for inpatient hospital services for the
20treatment of conditions under par. (a) 1. as provided in subd. 2.
SB375, s. 22 21Section 22. 632.89 (2) (c) 2. of the statutes is repealed.
SB375, s. 23 22Section 23. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
23amended to read:
SB375,8,324 632.89 (2) (d) Minimum coverage Coverage of outpatient services. If a group or
25blanket disability insurance policy issued by an insurer
health benefit plan or a

1self-insured health plan
provides coverage of any outpatient treatment, the policy
2plan shall provide coverage for outpatient services for the treatment of conditions
3under par. (a) 1. as provided in subd. 2.
SB375, s. 24 4Section 24. 632.89 (2) (d) 2. of the statutes is repealed.
SB375, s. 25 5Section 25. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
6and amended to read:
SB375,8,127 632.89 (2) (dm) Minimum coverage Coverage of transitional treatment
8arrangements.
If a group or blanket disability insurance policy issued by an insurer
9health benefit plan or a self-insured health plan provides coverage of any inpatient
10hospital treatment or any outpatient treatment, the policy plan shall provide
11coverage for transitional treatment arrangements for the treatment of conditions
12under par. (a) 1. as provided in subd. 2.
SB375, s. 26 13Section 26. 632.89 (2) (dm) 2. of the statutes is repealed.
SB375, s. 27 14Section 27. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
15amended to read:
SB375,8,1916 632.89 (5) (b) Exclusion Certain health care plans. This subsection section does
17not apply to a health care plan offered by a limited service health organization, as
18defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4),
19that is not a defined network plan, as defined in s. 609.01 (1b)
.
SB375, s. 28 20Section 28. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
SB375, s. 29 21Section 29. 632.89 (2p) of the statutes is created to read:
SB375,9,222 632.89 (2p) Additional required coverage of screenings. If a group health
23benefit plan, individual health benefit plan, or self-insured health plan that
24provides coverage for the treatment of nervous and mental disorders and alcoholism

1and other drug abuse problems would provide coverage of at least one annual
2physical examination, the plan shall provide coverage of all of the following:
SB375,9,53 (a) For an individual who has coverage under the plan, at least one annual
4screening for nervous and mental disorders and alcoholism and other drug abuse
5problems to determine the individual's need for treatment.
SB375,9,106 (b) For a female individual who has coverage under the plan, with respect to
7any pregnancy at least one screening during the pregnancy for prepartum
8depression and at least one screening within 6 months after a live birth, stillbirth,
9or miscarriage for postpartum depression to determine the individual's need for
10treatment.
SB375, s. 30 11Section 30. 632.89 (3) of the statutes is created to read:
SB375,9,1612 632.89 (3) Equal coverage requirement. (a) Group plans. A group health
13benefit plan or a self-insured health plan that provides coverage for the treatment
14of nervous and mental disorders and alcoholism and other drug abuse problems shall
15provide the same coverage for that treatment that it provides for the treatment of
16physical conditions.
SB375,9,2017 (b) Individual plans. If an individual health benefit plan provides coverage for
18the treatment of nervous or mental disorders or alcoholism or other drug abuse
19problems, the individual health benefit plan shall provide the same coverage for that
20treatment that it provides for the treatment of physical conditions.
SB375,9,2521 (c) All coverage components. The requirements under this subsection apply to
22all coverage-related components, including rates; exclusions and limitations;
23deductibles; copayments; coinsurance; annual and lifetime payment limits;
24out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
25duration or frequency of coverage; and medical necessity definitions.
SB375, s. 31
1Section 31. 632.89 (3m) of the statutes is repealed.
SB375, s. 32 2Section 32. 632.89 (5) (title) of the statutes is amended to read:
SB375,10,33 632.89 (5) (title) Medicare exclusion Exclusions.
SB375, s. 33 4Section 33. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
SB375, s. 34 5Section 34. 632.89 (5) (a) (title) of the statutes is created to read:
SB375,10,66 632.89 (5) (a) (title) Medicare.
SB375, s. 35 7Section 35. 632.89 (6) of the statutes is repealed.
SB375, s. 36 8Section 36. 632.89 (7) of the statutes is repealed.
SB375, s. 37 9Section 37. Initial applicability.
SB375,10,1010 (1) This act first applies to all of the following:
SB375,10,1311 (a) Except as provided in paragraphs (b) and (c ), health benefit plans that are
12issued or renewed, and self-insured governmental health plans that are established,
13extended, modified, or renewed, on the effective date of this paragraph.
SB375,10,1614 (b) Health benefit plans covering employees who are affected by a collective
15bargaining agreement containing provisions inconsistent with this act that are
16issued or renewed on the earlier of the following:
SB375,10,17 171. The day on which the collective bargaining agreement expires.
SB375,10,19 182. The day on which the collective bargaining agreement is extended, modified,
19or renewed.
SB375,10,2320 (c) Self-insured governmental health plans covering employees who are
21affected by a collective bargaining agreement containing provisions inconsistent
22with this act that are established, extended, modified, or renewed on the earlier of
23the following:
SB375,10,24 241. The day on which the collective bargaining agreement expires.
SB375,11,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
SB375, s. 38 3Section 38. Effective date.
SB375,11,54 (1) This act takes effect on the first day of the 7th month beginning after
5publication.
SB375,11,66 (End)
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