Amendment ASA1-AB768

AB768-ASA1,448,20 609.91 (4) (a) An agreement, other than a notice of election or termination of election in accordance with s. 609.92 or 609.925, entered into by the provider, the health maintenance organization insurer, the insurer described in sub. (1m) or any other person, at any time, whether oral or written and whether implied or explicit, including an agreement that purports to hold the enrolled participant enrollee, policyholder or insured liable for health care costs.

AB768-ASA1, s. 566cLv Section 566cLv. 609.91 (4) (b) of the statutes is amended to read:

AB768-ASA1,449,2 609.91 (4) (b) A breach of or default on an agreement by the health maintenance organization insurer, the insurer described in sub. (1m) or any other person to compensate the provider, directly or indirectly, for health care costs, including health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1) or (1m).

AB768-ASA1, s. 566cLx Section 566cLx. 609.91 (4) (c) of the statutes is amended to read:

AB768-ASA1,449,12 609.91 (4) (c) The insolvency of the health maintenance organization insurer or any person contracting with the health maintenance organization insurer or provider, or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency or bankruptcy proceedings involving the health maintenance organization insurer or other person, including delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the health maintenance organization insurer or other person has agreed to compensate, directly or indirectly, the provider for health care costs for which the enrolled participant enrollee or policyholder is not liable under sub. (1).

AB768-ASA1, s. 566cLz Section 566cLz. 609.91 (4) (cm) of the statutes is amended to read:

AB768-ASA1,449,21 609.91 (4) (cm) The insolvency of the insurer described in sub. (1m) or any person contracting with the insurer or provider, or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency or bankruptcy proceedings involving the insurer or other person, including delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the insurer or other person has agreed to compensate, directly or indirectly, the provider for health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1m).

AB768-ASA1, s. 566cnb Section 566cnb. 609.91 (4) (d) of the statutes is amended to read:

AB768-ASA1,450,2 609.91 (4) (d) The inability of the provider or other person who is owed compensation for health care costs to obtain compensation from the health maintenance organization insurer, the insurer described in sub. (1m) or any other person for health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1) or (1m).

AB768-ASA1, s. 566cnd Section 566cnd. 609.92 (5) of the statutes is amended to read:

AB768-ASA1,450,8 609.92 (5) Provider of physician services. A provider who is not under contract with a health maintenance organization insurer and who is not a selected participating provider of a health maintenance organization insurer is not subject to s. 609.91 (1) (b) 2. with respect to health care costs incurred by an enrolled participant enrollee of that health maintenance organization insurer.

AB768-ASA1, s. 566cnf Section 566cnf. 609.94 (1) (b) of the statutes is amended to read:

AB768-ASA1,450,12 609.94 (1) (b) Each selected participating provider of the health maintenance organization insurer, at the time that the provider becomes a selected participating provider.

AB768-ASA1, s. 571b Section 571b. 628.095 of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,450,20 628.095 Social security and federal employer identification numbers on license applications or at time of fee payment. (1) Required on applications. An application for a license issued under this subchapter shall contain the applicant's social security number, if the applicant is a natural person, or the applicant's federal employer identification number, if the applicant is not a natural person.

AB768-ASA1,450,24 (2) Refusal to issue license. The commissioner may not issue a license, including a temporary license, under this subchapter unless the applicant provides his or her social security number, if the applicant is a natural person, or provides the applicant's federal tax identification number, if the applicant is not a natural person.

AB768-ASA1,451,6 (3) Required when annual fee paid. At the time that the annual fee is paid under s. 601.31 (1) (m), an intermediary who is a natural person shall provide his or her social security number, and an intermediary that is not a natural person shall provide its federal employer identification number, if the social security number or federal employer identification number was not provided on the application for the license or previously when the annual fee was paid.

AB768-ASA1,451,10 (4) Disclosure. (a) The commissioner shall disclose a social security number obtained under sub. (1) or (3) to the department of workforce development in the administration of s. 49.22, as provided in a memorandum of understanding entered into under s. 49.857.

AB768-ASA1,451,13 (b) The commissioner may disclose any information received under sub. (1) or (3) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 572b Section 572b. 628.097 (title) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,451,17 628.097 (title) Refusal to issue; failure to pay support or to comply with subpoena or warrant; tax delinquency.

AB768-ASA1, s. 572c Section 572c. 628.097 (1) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 628.097 (1) (a).

AB768-ASA1, s. 572d Section 572d. 628.097 (1) (a) (title) of the statutes is created to read:

AB768-ASA1,451,22 628.097 (1) (a) (title) For failure to pay support or to comply with subpoena or warrant.

AB768-ASA1, s. 572e Section 572e. 628.097 (1) (b) of the statutes is created to read:

AB768-ASA1,452,2 628.097 (1) (b) For liability for delinquent taxes. The commissioner shall refuse to issue a license, including a temporary license, under this subchapter if the department of revenue certifies under s. 73.0301 that the applicant for the license is liable for delinquent taxes.

AB768-ASA1, s. 572f Section 572f. 628.097 (2) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 628.097 (2) (a).

AB768-ASA1, s. 572g Section 572g. 628.097 (2) (a) (title) of the statutes is created to read:

AB768-ASA1,452,7 628.097 (2) (a) (title) For failure to pay support or to comply with subpoena or warrant.

AB768-ASA1, s. 572h Section 572h. 628.097 (2) (b) of the statutes is created to read:

AB768-ASA1,452,12 628.097 (2) (b) For liability for delinquent taxes. The commissioner shall refuse to extend a temporary license under s. 628.09 (4) if the department of revenue certifies under s. 73.0301 that the person holding the temporary license is liable for delinquent taxes.

AB768-ASA1, s. 573 Section 573. 628.10 (2) (b) of the statutes is amended to read:

AB768-ASA1,452,22 628.10 (2) (b) For other reasons. After Except as provided in pars. (c) to (d), after a hearing, the commissioner may revoke, suspend or limit in whole or in part the license of any intermediary if the commissioner finds that the licensee is unqualified as an intermediary, is not of good character or has repeatedly or knowingly violated an insurance statute or rule or a valid order of the commissioner under s. 601.41 (4), or if the intermediary's methods and practices in the conduct of business endanger, or financial resources are inadequate to safeguard, the legitimate interests of customers and the public. Nothing in this paragraph limits the authority of the commissioner to suspend summarily an intermediary's license under s. 227.51 (3).

AB768-ASA1, s. 574 Section 574. 628.10 (2) (cm) of the statutes is created to read:

AB768-ASA1,453,2 628.10 (2) (cm) For liability for delinquent taxes. The commissioner shall revoke the license of an intermediary, including a temporary license under s. 628.09, if the department of revenue certifies under s. 73.0301 that the intermediary is liable for delinquent taxes.

AB768-ASA1, s. 575b Section 575b. 628.10 (2) (d) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,453,15 628.10 (2) (d) (title) For failure to provide social security or federal employer identification number. If an intermediary who is a natural person fails to provide a social security number or federal employer identification number as required under s. 628.095 (3), the commissioner shall suspend or limit the license of the intermediary, effective the day following the last day on which the annual fee under s. 601.31 (1) (m) may be paid, if the commissioner has given the intermediary reasonable notice of when the fee must be paid to avoid suspension or limitation. If the intermediary provides the social security number or federal employer identification number within 60 days from the effective date of the suspension, the commissioner shall reinstate the intermediary's license effective as of the date of suspension.

AB768-ASA1, s. 575m Section 575m. 628.34 (3) (a) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,453,24 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.745 632.746 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB768-ASA1, s. 576b Section 576b. 632.68 (2) (b) (intro.) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,454,11 632.68 (2) (b) (intro.) A person may apply to the commissioner for a viatical settlement provider license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mm) shall accompany the application. After any investigation of the applicant that the commissioner determines is sufficient, the commissioner shall issue a viatical settlement provider license to an applicant that satisfies all of the following:

AB768-ASA1, s. 577b Section 577b. 632.68 (2) (b) 2. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,454,15 632.68 (2) (b) 2. Provides complete information on the application, including the applicant's social security number or federal employer identification number.

AB768-ASA1, s. 577m Section 577m. 632.68 (2) (bc) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (2) (bc) 1.

AB768-ASA1, s. 578 Section 578. 632.68 (2) (bc) 2. of the statutes is created to read:

AB768-ASA1,454,21 632.68 (2) (bc) 2. The commissioner may disclose a social security number or federal employer identification number received under par. (b) or (e) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 578m Section 578m. 632.68 (2) (bm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (2) (bm) 1.

AB768-ASA1, s. 579 Section 579. 632.68 (2) (bm) 2. of the statutes is created to read:

AB768-ASA1,455,3 632.68 (2) (bm) 2. Notwithstanding par. (b), the commissioner may not issue a license under this subsection if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 580m Section 580m. 632.68 (2) (cm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (2) (cm) 1.

AB768-ASA1, s. 581 Section 581. 632.68 (2) (cm) 2. of the statutes is created to read:

AB768-ASA1,455,9 632.68 (2) (cm) 2. If the commissioner denies an application for a license under this subsection for delinquent taxes, the applicant is entitled to a hearing under s. 73.0301 (5) (a) but is not entitled to a hearing under par. (c).

AB768-ASA1, s. 582b Section 582b. 632.68 (2) (e) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,455,16 632.68 (2) (e) Except as provided in sub. (3), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing the licensee's social security number or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 584m Section 584m. 632.68 (3) (b) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (3) (b) 1.

AB768-ASA1, s. 585 Section 585. 632.68 (3) (b) 2. of the statutes is created to read:

AB768-ASA1,455,22 632.68 (3) (b) 2. The commissioner shall revoke or refuse to renew a viatical settlement provider license if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 586b Section 586b. 632.68 (4) (b) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,456,8 632.68 (4) (b) A person may apply to the commissioner for a viatical settlement broker license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mr) shall accompany the application. The commissioner may not issue a license under this subsection unless the applicant provides his or her social security number or its federal employer identification number, whichever is applicable.

AB768-ASA1, s. 586m Section 586m. 632.68 (4) (bc) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (4) (bc) 1.

AB768-ASA1, s. 587 Section 587. 632.68 (4) (bc) 2. of the statutes is created to read:

AB768-ASA1,456,14 632.68 (4) (bc) 2. The commissioner may disclose a social security number or federal employer identification number received under par. (b) or (c) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 587m Section 587m. 632.68 (4) (bm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (4) (bm) 1.

AB768-ASA1, s. 588 Section 588. 632.68 (4) (bm) 2. of the statutes is created to read:

AB768-ASA1,456,20 632.68 (4) (bm) 2. The commissioner may not issue a license under this subsection if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 589c Section 589c. 632.68 (4) (c) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,457,2 632.68 (4) (c) Except as provided in sub. (5), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing the licensee's social security number or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 591m Section 591m. 632.68 (5) (b) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (5) (b) 1.

AB768-ASA1, s. 592 Section 592. 632.68 (5) (b) 2. of the statutes is created to read:

AB768-ASA1,457,8 632.68 (5) (b) 2. The commissioner shall revoke or refuse to renew a viatical settlement broker license if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 593 Section 593. 632.7495 (1) (a) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,457,15 632.7495 (1) (a) Except as provided in subs. (2) and (3) to (4) and notwithstanding s. 631.36 (2) to (4m), an insurer that provides individual health benefit plan coverage shall renew such coverage or continue such coverage in force at the option of the insured individual and, if applicable, the association through which the individual has coverage.

AB768-ASA1, s. 594 Section 594. 632.7495 (4) of the statutes is created to read:

AB768-ASA1,457,19 632.7495 (4) Notwithstanding subs. (1) and (2) and s. 631.36 (4), an insurer is not required to renew individual health benefit plan coverage that is marketed and designed to provide short-term coverage as a bridge between coverages.

AB768-ASA1, s. 594c Section 594c. 632.853 of the statutes is created to read:

AB768-ASA1,458,2 632.853 Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a physician may present medical evidence to obtain an individual patient exception for coverage of a prescription drug or device not routinely covered by the plan. The process shall include timelines for both urgent and nonurgent review.

AB768-ASA1, s. 594d Section 594d. 632.855 of the statutes is created to read:

AB768-ASA1,458,5 632.855 Requirements if experimental treatment limited. (1) Definitions. In this section:

AB768-ASA1,458,6 (a) "Health care plan" has the meaning given in s. 628.36 (2) (a) 1.

AB768-ASA1,458,7 (b) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).

AB768-ASA1,458,11 (2) Disclosure of limitations. A health care plan or a self-insured health plan that limits coverage of experimental treatment shall define the limitation and disclose the limits in any agreement, policy or certificate of coverage. This disclosure shall include the following information:

AB768-ASA1,458,12 (a) Who is authorized to make a determination on the limitation.

AB768-ASA1,458,14 (b) The criteria the plan uses to determine whether a treatment, procedure, drug or device is experimental.

AB768-ASA1,458,22 (3) Denial of treatment. A health care plan or a self-insured health plan that receives a request for prior authorization of an experimental procedure that includes all of the required information upon which to make a decision shall, within 5 working days after receiving the request, issue a coverage decision. If the health care plan or self-insured health plan denies coverage of an experimental treatment, procedure, drug or device for an insured who has a terminal condition or illness, the health care plan or self-insured health plan shall, as part of its coverage decision, provide the insured with a denial letter that includes all of the following:

AB768-ASA1,458,24 (a) A statement setting forth the specific medical and scientific reasons for denying coverage.

AB768-ASA1,459,2 (b) Notice of the insured's right to appeal and a description of the appeal procedure.

AB768-ASA1, s. 594m Section 594m. 632.895 (11) (a) (intro.) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,459,10 632.895 (11) (a) (intro.) Every Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

AB768-ASA1, s. 594n Section 594n. 632.895 (11) (c) of the statutes, as created by 1997 Wisconsin Act 27, is renumbered 632.895 (11) (c) 1.