Amendment SSA1-SB418

SB418-SSA1,8,4 (e) Each hospital shall prominently display, in the area of the hospital that is most commonly frequented by health care consumers, a statement informing the consumers that they have the right to receive a copy of the document under par. (a) from the hospital and, if the requirements, if any, under s. 632.798 (2) (d) are met, a good faith estimate, from their insurers or self-insured health plans, of the insured's total out-of-pocket cost according to the insured's benefit terms for the specified health care service in the geographic region in which the health care service will be provided.

SB418-SSA1,8,6 (5) Penalty. (a) Whoever violates sub. (3) or (4) may be required to forfeit not more than $250 for each violation.

SB418-SSA1,8,12 (b) The department may directly assess forfeitures provided for under par. (a). If the department determines that a forfeiture should be assessed for a particular violation, the department shall send a notice of assessment to the alleged violator. The notice shall specify the amount of the forfeiture assessed, the violation, and the statute or rule alleged to have been violated, and shall inform the alleged violator of the right to a hearing under par. (c).

SB418-SSA1,8,24 (c) An alleged violator may contest an assessment of a forfeiture by sending, within 10 days after receipt of notice under par. (b), a written request for a hearing under s. 227.44 to the division of hearings and appeals created under s. 15.103 (1). The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under s. 227.46. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days after receipt of the request for a hearing and shall issue a final decision within 15 days after the close of the hearing. Proceedings before the division are governed by ch. 227. In any petition for judicial review of a decision by the division, the party, other than the petitioner, who was in the proceeding before the division shall be the named respondent.

SB418-SSA1,9,6 (d) All forfeitures shall be paid to the department within 10 days after receipt of notice of assessment or, if the forfeiture is contested under par. (c), within 10 days after receipt of the final decision after exhaustion of administrative review, unless the final decision is appealed and the order is stayed by court order. The department shall remit all forfeitures paid to the secretary of administration for deposit in the school fund.

SB418-SSA1,9,10 (e) The attorney general may bring an action in the name of the state to collect any forfeiture imposed under this subsection if the forfeiture has not been paid following the exhaustion of all administrative and judicial reviews. The only issue to be contested in any such action is whether the forfeiture has been paid.

SB418-SSA1, s. 6 Section 6. 153.21 (title) of the statutes is amended to read:

SB418-SSA1,9,12 153.21 (title) Consumer guide; list for hospital charge disclosures.

SB418-SSA1, s. 7 Section 7. 153.21 (3) of the statutes is created to read:

SB418-SSA1,9,19 153.21 (3) The entity under contract under s. 153.05 (2m) (a) shall, using data collected under s. 153.05 (1) (b), annually identify the 75 diagnosis related groups for which hospitals in this state most frequently provide inpatient care and the 75 outpatient surgical procedures most frequently performed by hospitals in this state, and shall distribute a list of the identified diagnosis related groups and surgical procedures to all hospitals in the state and to the department.

SB418-SSA1, s. 8 Section 8. 185.981 (4t) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB418-SSA1,9,25 185.981 (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), 632.885, 632.895 (10) to (17), and 632.897 (10) and chs. 149 and 155.

SB418-SSA1, s. 9 Section 9. 185.983 (1) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB418-SSA1,10,9 185.983 (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), 632.885, 632.895 (5) and (9) to (17), 632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association shall:

SB418-SSA1, s. 10 Section 10. 609.71 of the statutes is created to read:

SB418-SSA1,10,12 609.71 Disclosure of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.798.

SB418-SSA1, s. 11 Section 11. 632.798 of the statutes is created to read:

SB418-SSA1,10,14 632.798 Out-of-pocket costs. (1) Definitions. In this section:

SB418-SSA1,10,15 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

SB418-SSA1,10,17 (b) "Health care provider" has the meaning given in s. 146.903 (1) (c) and includes a hospital, as defined in s. 50.33 (2).

SB418-SSA1,10,19 (c) "Insured" includes an enrollee under a self-insured health plan and a representative or designee of an insured or enrollee.

SB418-SSA1,10,21 (d) "Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.

SB418-SSA1,11,3 (2) Provide estimate. (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, as of the date of the request and assuming no medical complications or modifications in the insured's treatment plan, of the insured's total out-of-pocket cost according to the insured's benefit terms for a specified health care service in the geographic region in which the health care service will be provided.

SB418-SSA1,11,5 (b) An estimate provided by an insurer or self-insured health plan under this section is not a legally binding estimate of the out-of-pocket cost.

SB418-SSA1,11,7 (c) An insurer or self-insured health plan may not charge an insured for providing the information under this section.

SB418-SSA1,11,10 (d) Before providing the information requested under par. (a), the insurer or self-insured health plan may require the insured to provide in writing any of the following information:

SB418-SSA1,11,11 1. The name of the health care provider providing the service.

SB418-SSA1,11,12 2. The facility at which the service will be provided.

SB418-SSA1,11,13 3. The date the service will be provided.

SB418-SSA1,11,14 4. The health care provider's estimate of the charge for the service.

SB418-SSA1,11,17 5. The codes for the service under the Current Procedural Terminology of the American Medical Association or under the Current Dental Terminology of the American Dental Association.

SB418-SSA1,11,20 (e) The requirement to provide the information requested under par. (a) does not apply if the health care provider providing the health care service is any of the following:

SB418-SSA1,11,22 1. A health care provider that practices individually or in association with not more than 2 other individual health care providers.

SB418-SSA1,11,24 2. A health care provider that is an association of 3 or fewer individual health care providers.

SB418-SSA1, s. 12 Section 12. Initial applicability.

SB418-SSA1,12,7 (1) Disclosures. If a disability insurance policy or a governmental self-insured health plan that is in effect on the effective date of this subsection, or a contract or agreement between a provider and a health care plan that is in effect on the effective date of this subsection, contains a provision that is inconsistent with this act, this act first applies to that disability insurance policy, governmental self-insured health plan, or contract or agreement on the date on which it is modified, extended, or renewed.

SB418-SSA1, s. 13 Section 13. Effective date.

SB418-SSA1,12,10 (1) This act takes effect on the first day of the 10th month beginning after publication.

SB418-SSA1,12,11 (End)