LRBs0015/1
PJK:jld:jf
2009 - 2010 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2009 ASSEMBLY BILL 16
March 4, 2009 - Offered by Representative Cullen.
AB16-ASA1,1,4
1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 111.91 (2) (n), 120.13 (2) (g),
2185.981 (4t) and 185.983 (1) (intro.); and
to create 609.86 and 632.895 (16) of
3the statutes;
relating to: requiring health insurance coverage of hearing aids
4and cochlear implants for persons under 18 years of age.
Analysis by the Legislative Reference Bureau
This substitute amendment requires health insurance policies and plans to
cover the cost of hearing aids, which include any externally wearable instruments
or devices designed to enhance hearing, and cochlear implants, which include any
implantable instruments or devices designed to enhance hearing, that are prescribed
by a physician or audiologist in accordance with accepted professional medical or
audiological standards, for any child under 18 years of age who has coverage under
the policy or plan and who is certified as deaf or hearing impaired by a physician or
an audiologist. Treatment (defined as services, diagnoses, procedures, surgery, and
therapy provided by a health care professional) for such a child that is related to
hearing aids and cochlear implants is also required to be covered. Coverage for
hearing aids is not required to exceed the cost of one hearing aid per ear per child
more often than once every three years. 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 required coverage may be subject to any limitations,
cost-sharing provisions, or exclusions, other than a preexisting condition exclusion,
that apply generally under the policy or plan. An exception is that an individual
health insurance policy may impose a preexisting condition exclusion that does not
exceed one year with respect to coverage for cochlear implants and related
treatment. However, the substitute amendment requires an individual health
insurance policy that imposes a preexisting condition exclusion to cover the cost of
cochlear implants and related treatment during the preexisting condition exclusion
period if certain specified medical conditions occur during the period that make time
of the essence for a child to receive the implants and related treatment.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB16-ASA1,2,52
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
4and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
5(5) (6), 632.895 (5m) and (8) to
(15) (16), and 632.896.
AB16-ASA1,2,97
40.51
(8m) Every health care coverage plan offered by the group insurance
8board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
9632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to
(15) (16).
AB16-ASA1, s. 3
10Section
3. 66.0137 (4) of the statutes is amended to read:
AB16-ASA1,3,211
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
12a village provides health care benefits under its home rule power, or if a town
13provides health care benefits, to its officers and employees on a self-insured basis,
14the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
1632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4),
and 2(5)
, and (6), 632.895 (9) to
(15)
(16), 632.896, and
767.25 (4m) (d) 767.513 (4).
AB16-ASA1, s. 4
3Section
4. 111.91 (2) (n) of the statutes is amended to read:
AB16-ASA1,3,54
111.91
(2) (n) The provision to employees of the health insurance coverage
5required under s. 632.895 (11) to (14)
and (16).
AB16-ASA1, s. 5
6Section
5. 120.13 (2) (g) of the statutes is amended to read:
AB16-ASA1,3,107
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
849.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
9632.85, 632.853, 632.855, 632.87 (4)
and, (5)
, and (6), 632.895 (9) to
(15)
(16), 632.896,
10and
767.25 (4m) (d) 767.513 (4).
AB16-ASA1, s. 6
11Section
6. 185.981 (4t) of the statutes is amended to read:
AB16-ASA1,3,1512
185.981
(4t) A sickness care plan operated by a cooperative association is
13subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
14632.853, 632.855, 632.87 (2m), (3), (4),
and (5)
, and (6), 632.895 (10) to
(15) (16), and
15632.897 (10) and chs. 149 and 155.
AB16-ASA1, s. 7
16Section
7. 185.983 (1) (intro.) of the statutes is amended to read:
AB16-ASA1,3,2317
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
18exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
19601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
20631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
21632.855, 632.87 (2m), (3), (4),
and (5)
, and (6), 632.895 (5) and (9) to
(15) (16), 632.896,
22and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association
23shall:
AB16-ASA1,4,3
1609.86 Coverage of hearing aids, cochlear implants, and related
2treatment for infants and children. Defined network plans are subject to s.
3632.895 (16).
AB16-ASA1, s. 9
4Section
9. 632.895 (16) of the statutes is created to read:
AB16-ASA1,4,65
632.895
(16) Hearing aids, cochlear implants, and related treatment for
6infants and children. (a) In this subsection:
AB16-ASA1,4,87
1. "Cochlear implant" includes any implantable instrument or device that is
8designed to enhance hearing.
AB16-ASA1,4,129
2. "Hearing aid" means any externally wearable instrument or device designed
10for or offered for the purpose of aiding or compensating for impaired human hearing
11and any parts, attachments, or accessories of such an instrument or device, except
12batteries and cords.
AB16-ASA1,4,1313
3. "Physician" has the meaning given in s. 448.01 (5).
AB16-ASA1,4,1514
4. "Self-insured health plan" means a self-insured health plan of the state or
15a county, city, village, town, or school district.
AB16-ASA1,4,1716
5. "Treatment" means services, diagnoses, procedures, surgery, and therapy
17provided by a health care professional.
AB16-ASA1,4,2018
(b) 1. Subject to par. (c) and except as provided in par. (d), every disability
19insurance policy and every self-insured health plan shall provide the following
20coverages:
AB16-ASA1,5,221
a. Coverage of the cost of hearing aids and cochlear implants that are
22prescribed by a physician, or by an audiologist licensed under subch. II of ch. 459, in
23accordance with accepted professional medical or audiological standards, for a child
24covered under the policy or plan who is under 18 years of age and who is certified as
1deaf or hearing impaired by a physician or by an audiologist licensed under subch.
2II of ch. 459.
AB16-ASA1,5,53
b. Coverage of the cost of treatment related to hearing aids and cochlear
4implants, including procedures for the implantation of cochlear devices, for a child
5specified in subd. 1. a.
AB16-ASA1,5,76
2. Coverage of the cost of hearing aids under this subsection is not required to
7exceed the cost of one hearing aid per ear per child more often than once every 3 years.
AB16-ASA1,5,118
3. The coverage required under this subsection may be subject to any
9cost-sharing provisions, limitations, or exclusions, other than a preexisting
10condition exclusion, that apply generally under the disability insurance policy or
11self-insured health plan.
AB16-ASA1,5,1512
(c) 1. Notwithstanding par. (b) 3. and subject to subd. 2., an individual disability
13insurance policy may impose a preexisting condition exclusion that does not exceed
14one year with respect to the coverage required under this subsection for cochlear
15implants and related treatment.
AB16-ASA1,5,2116
2. An individual disability insurance policy that imposes a preexisting
17condition exclusion as authorized under subd. 1. shall nevertheless cover the cost of
18cochlear implants and related treatment for a child during the preexisting condition
19exclusion period if time is of the essence for the child to receive cochlear implants and
20related treatment as a result of the occurrence during that period of any of the
21following conditions:
AB16-ASA1,5,2222
a. Vestibular aqueduct syndrome.
AB16-ASA1,5,2323
b. Viral infection.
AB16-ASA1,5,2424
c. Ototoxicity.
AB16-ASA1,5,2525
d. Autoimmune inner ear disease.
AB16-ASA1,6,2
1e. Any other condition with respect to which a failure to intervene would likely
2negatively impact the child's outcome.
AB16-ASA1,6,33
(d) This subsection does not apply to any of the following:
AB16-ASA1,6,44
1. A disability insurance policy that covers only certain specified diseases.
AB16-ASA1,6,75
2. A health care plan offered by a limited service health organization, as defined
6in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
7a defined network plan, as defined in s. 609.01 (1b).
AB16-ASA1,6,88
3. A long-term care insurance policy.
AB16-ASA1,6,99
4. A medicare replacement policy or a medicare supplement policy.
AB16-ASA1,6,1111
(1) This act first applies to all of the following:
AB16-ASA1,6,1412
(a) Except as provided in paragraphs (b) and (c
), disability insurance policies
13that are issued or renewed, and governmental self-insured health plans that are
14established, extended, modified, or renewed, on the effective date of this paragraph.
AB16-ASA1,6,1715
(b) Disability insurance policies covering employees who are affected by a
16collective bargaining agreement containing provisions inconsistent with this act
17that are issued or renewed on the earlier of the following:
AB16-ASA1,6,18
181. The day on which the collective bargaining agreement expires.
AB16-ASA1,6,20
192. The day on which the collective bargaining agreement is extended, modified,
20or renewed.
AB16-ASA1,6,2421
(c) Governmental self-insured health plans covering employees who are
22affected by a collective bargaining agreement containing provisions inconsistent
23with this act that are established, extended, modified, or renewed on the earlier of
24the following: