Amendment ASA1-AB768

AB768-ASA1,442,23 609.655 (3) (b) (intro.) If outpatient services are recommended in the clinical assessment conducted under par. (a), the recommended outpatient services consisting of not more than 5 visits to an outpatient treatment facility or other provider that is located in this state and in reasonably close proximity to the school in which the dependent student is enrolled and that may be designated by the health maintenance organization managed care plan, except as follows:

AB768-ASA1, s. 566chz Section 566chz. 609.655 (3) (b) 1. of the statutes is amended to read:

AB768-ASA1,443,4 609.655 (3) (b) 1. Coverage is not required under this paragraph if the medical director of the health maintenance organization managed care plan determines that the nature of the treatment recommended in the clinical assessment will prohibit the dependent student from attending school on a regular basis.

AB768-ASA1, s. 566cjb Section 566cjb. 609.655 (4) (a) of the statutes is amended to read:

AB768-ASA1,443,15 609.655 (4) (a) Upon completion of the 5 visits for outpatient services covered under sub. (3) (b), the medical director of the health maintenance organization managed care plan and the clinician treating the dependent student shall review the dependent student's condition and determine whether it is appropriate to continue treatment of the dependent student's nervous or mental disorders or alcoholism or other drug abuse problems in reasonably close proximity to the school in which the student is enrolled. The review is not required if the dependent student is no longer enrolled in the school or if the coverage limits under the policy or certificate for treatment of nervous or mental disorders or alcoholism or other drug abuse problems have been exhausted.

AB768-ASA1, s. 566cjd Section 566cjd. 609.655 (4) (b) of the statutes is amended to read:

AB768-ASA1,443,25 609.655 (4) (b) Upon completion of the review under par. (a), the medical director of the health maintenance organization managed care plan shall determine whether the policy or certificate will provide coverage of any further treatment for the dependent student's nervous or mental disorder or alcoholism or other drug abuse problems that is provided by a provider located in reasonably close proximity to the school in which the student is enrolled. If the dependent student disputes the medical director's determination, the dependent student may submit a written grievance under the health maintenance organization's managed care plan's internal grievance procedure established under s. 609.15.

AB768-ASA1, s. 566cje Section 566cje. 609.655 (5) (a) of the statutes is amended to read:

AB768-ASA1,444,7 609.655 (5) (a) A policy or certificate issued by a health maintenance organization managed care plan insurer is required to provide coverage for the services specified in sub. (3) only to the extent that the policy or certificate would have covered the service if it had been provided to the dependent student by a selected participating provider within the geographical service area of the health maintenance organization managed care plan.

AB768-ASA1, s. 566cjg Section 566cjg. 609.655 (5) (b) of the statutes is amended to read:

AB768-ASA1,444,14 609.655 (5) (b) Paragraph (a) does not permit a health maintenance organization managed care plan to reimburse a provider for less than the full cost of the services provided or an amount negotiated with the provider, solely because the reimbursement rate for the service would have been less if provided by a selected participating provider within the geographical service area of the health maintenance organization managed care plan.

AB768-ASA1, s. 566cji Section 566cji. 609.70 of the statutes is amended to read:

AB768-ASA1,444,18 609.70 Chiropractic coverage. Health maintenance organizations, limited Limited service health organizations and , preferred provider plans and managed care plans are subject to s. 632.87 (3).

AB768-ASA1, s. 566cjk Section 566cjk. 609.75 of the statutes is amended to read:

AB768-ASA1,445,2 609.75 Adopted children coverage. Health maintenance organizations, limited Limited service health organizations and, preferred provider plans and managed care plans are subject to s. 632.896. Coverage of health care services obtained by adopted children and children placed for adoption may be subject to any requirements that the health maintenance organization, limited service health organization or, preferred provider plan or managed care plan imposes under s. 609.05 (2) and (3) on the coverage of health care services obtained by other enrolled participants enrollees.

AB768-ASA1, s. 566cjm Section 566cjm. 609.77 of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,445,7 609.77 Coverage of breast reconstruction. Health maintenance organizations, limited Limited service health organizations and, preferred provider plans and managed care plans are subject to s. 632.895 (13).

AB768-ASA1, s. 566cjo Section 566cjo. 609.78 of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,445,13 609.78 Coverage of treatment for the correction of temporomandibular disorders. Health maintenance organizations, limited Limited service health organizations and , preferred provider plans and managed care plans are subject to s. 632.895 (11).

AB768-ASA1, s. 566cjq Section 566cjq. 609.79 of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,445,19 609.79 Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care. Health maintenance organizations, limited Limited service health organizations and , preferred provider plans and managed care plans are subject to s. 632.895 (12).

AB768-ASA1, s. 566cjs Section 566cjs. 609.80 of the statutes is amended to read:

AB768-ASA1,446,2 609.80 Coverage of mammograms. Health maintenance organizations and preferred provider Managed care plans are subject to s. 632.895 (8). Coverage of mammograms under s. 632.895 (8) may be subject to any requirements that the health maintenance organization or preferred provider managed care plan imposes under s. 609.05 (2) and (3) on the coverage of other health care services obtained by enrolled participants enrollees.

AB768-ASA1, s. 566cju Section 566cju. 609.81 of the statutes is amended to read:

AB768-ASA1,446,8 609.81 Coverage related to HIV infection. Health maintenance organizations, limited Limited service health organizations and, preferred provider plans and managed care plans are subject to s. 631.93. Health maintenance organizations and preferred provider Managed care plans are subject to s. 632.895 (9).

AB768-ASA1, s. 566cjw Section 566cjw. 609.82 of the statutes is created to read:

AB768-ASA1,446,12 609.82 Coverage without prior authorization for emergency medical condition treatment. Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.85.

AB768-ASA1, s. 566cjy Section 566cjy. 609.82 of the statutes, as created by 1997 Wisconsin Act .... (this act), is repealed and recreated to read:

AB768-ASA1,446,17 609.82 Coverage without prior authorization for emergency medical condition treatment. Limited service health organizations, preferred provider plans and managed care plans are subject to s. 632.85.

AB768-ASA1, s. 566cLc Section 566cLc. 609.83 of the statutes is created to read:

AB768-ASA1,446,21 609.83 Coverage of drugs and devices. Limited service health organizations, preferred provider plans and managed care plans are subject to s. 632.853.

AB768-ASA1, s. 566cLe Section 566cLe. 609.84 of the statutes is created to read:

AB768-ASA1,446,24 609.84 Experimental treatment. Limited service health organizations, preferred provider plans and managed care plans are subject to s. 632.855.

AB768-ASA1, s. 566cLf Section 566cLf. 609.91 (1) (intro.) of the statutes is amended to read:

AB768-ASA1,447,6 609.91 (1) (title) Immunity of enrolled participants enrollees and policyholders. (intro.) Except as provided in sub. (1m), an enrolled participant enrollee or policyholder of a health maintenance organization insurer is not liable for health care costs that are incurred on or after January 1, 1990, and that are covered under a policy or certificate issued by the health maintenance organization insurer, if any of the following applies:

AB768-ASA1, s. 566cLh Section 566cLh. 609.91 (1) (b) 2. of the statutes is amended to read:

AB768-ASA1,447,10 609.91 (1) (b) 2. Is physician services provided under a contract with the health maintenance organization insurer or by a selected participating provider of the health maintenance organization insurer.

AB768-ASA1, s. 566cLj Section 566cLj. 609.91 (1) (b) 3. of the statutes is amended to read:

AB768-ASA1,447,14 609.91 (1) (b) 3. Is services, equipment, supplies or drugs that are ancillary or incidental to services described in subd. 2. and are provided by the contracting provider or selected participating provider.

AB768-ASA1, s. 566cLL Section 566cLL. 609.91 (1m) of the statutes is amended to read:

AB768-ASA1,447,20 609.91 (1m) Immunity of medical assistance recipients. An enrolled participant enrollee, policyholder or insured under a policy issued by an insurer to the department of health and family services under s. 49.45 (2) (b) 2. to provide prepaid health care to medical assistance recipients is not liable for health care costs that are covered under the policy.

AB768-ASA1, s. 566cLn Section 566cLn. 609.91 (2) of the statutes is amended to read:

AB768-ASA1,448,2 609.91 (2) Prohibited recovery attempts. No person may bill, charge, collect a deposit from, seek remuneration or compensation from, file or threaten to file with a credit reporting agency or have any recourse against an enrolled participant enrollee, policyholder or insured, or any person acting on their behalf, for health care costs for which the enrolled participant enrollee, policyholder or insured, or person acting on their behalf, is not liable under sub. (1) or (1m).

AB768-ASA1, s. 566cLp Section 566cLp. 609.91 (3) of the statutes is amended to read:

AB768-ASA1,448,8 609.91 (3) Deductibles, copayments and premiums. Subsections (1) to (2) do not affect the liability of an enrolled participant enrollee, policyholder or insured for any deductibles, copayments or premiums owed under the policy or certificate issued by the health maintenance organization insurer or by the insurer described in sub. (1m).

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

AB768-ASA1,448,13 609.91 (4) (intro.) Conditions not affecting the immunity. The immunity of an enrolled participant enrollee, policyholder or insured for health care costs, to the extent of the immunity provided under this section and ss. 609.92 to 609.935, is not affected by any of the following:

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

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: