LRB-1049/5
PJK:kjf:rs
2007 - 2008 LEGISLATURE
January 4, 2008 - Introduced by Senators Hansen, Lehman, Breske, Carpenter,
Erpenbach, Harsdorf, Miller, Risser, Robson, Vinehout and Wirch,
cosponsored by Representatives
Albers, Benedict, Berceau, Black, Boyle,
Cullen, Fields, Grigsby, Hintz, Kaufert, Mason, Nelson, A. Ott, Pocan,
Pope-Roberts, Seidel, Sheridan, Sherman, Shilling, Sinicki, Smith, Soletski,
Toles, Turner, Young and Zepnick. Referred to Committee on Health,
Human Services, Insurance, and Job Creation.
SB375,1,10
1An Act to repeal 632.89 (1) (em), 632.89 (2) (a) 2., 632.89 (2) (b), 632.89 (2) (c)
22., 632.89 (2) (d) 2., 632.89 (2) (dm) 2., 632.89 (3m), 632.89 (6) and 632.89 (7);
3to renumber 632.89 (2m) and 632.89 (5);
to renumber and amend 632.89 (2)
4(a) 1., 632.89 (2) (c) 1., 632.89 (2) (d) 1., 632.89 (2) (dm) 1. and 632.89 (2) (e);
to
5amend 40.51 (8), 40.51 (8m), 46.10 (8) (d), 46.10 (14) (a), 66.0137 (4), 120.13 (2)
6(g), 185.981 (4t), 185.983 (1) (intro.), 301.12 (8) (d), 301.12 (14) (a), 632.89 (title),
7632.89 (2) (title) and 632.89 (5) (title);
to repeal and recreate 632.89 (1) (b);
8and
to create 111.91 (2) (qm), 609.86, 632.89 (1) (er), 632.89 (2p), 632.89 (3) and
9632.89 (5) (a) (title) of the statutes;
relating to: health insurance coverage of
10nervous and mental disorders, alcoholism, and other drug abuse problems.
Analysis by the Legislative Reference Bureau
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 (mental health and substance 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 mental
health and substance 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 for the treatment of
mental health and substance 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. Transitional
treatment arrangements include 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. If a group health insurance
policy provides coverage for both inpatient and outpatient hospital services, the total
coverage for all types of treatment for mental health and substance problems is not
required to exceed $7,000, or the equivalent benefits measured in services rendered,
in a policy year.
This bill removes the specified minimum amounts of coverage that a group
health insurance policy must provide for the treatment of mental health and
substance abuse problems but retains the requirements with respect to providing the
coverage. Except for group plans providing limited benefits, the bill specifically
applies the requirements to all types of group health benefit plans, including defined
network plans, insurance plans offered by the state, and self-insured health plans
of the state and municipalities.
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:
SB375,3,63
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.
SB375,3,119
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.
SB375,4,2015
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.
SB375,5,63
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).
SB375,5,129
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.
SB375,5,2115
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: