Amendment ASA1-AB768

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.

AB768-ASA1, s. 594nm Section 594nm. 632.895 (11) (c) 2. of the statutes is created to read:

AB768-ASA1,459,16 632.895 (11) (c) 2. Notwithstanding subd. 1., the coverage required under this subsection for diagnostic procedures and medically necessary nonsurgical treatment for the correction of temporomandibular disorders may not exceed $1,250 annually.

AB768-ASA1, s. 594p Section 594p. 632.895 (11) (d) of the statutes is created to read:

AB768-ASA1,459,22 632.895 (11) (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any diagnostic procedures or medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

AB768-ASA1, s. 594q Section 594q. 632.895 (11) (e) of the statutes is created to read:

AB768-ASA1,459,24 632.895 (11) (e) This subsection does not apply to any of the following:

AB768-ASA1,459,25 1. A disability insurance policy that covers only dental care.

AB768-ASA1,460,1 2. A medicare supplement policy, as defined in s. 600.03 (28r).

AB768-ASA1, s. 594r Section 594r. 632.895 (12) (b) (intro.) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,460,9 632.895 (12) (b) (intro.) Every Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital or ambulatory surgery center charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies:

AB768-ASA1, s. 594s Section 594s. 632.895 (12) (d) of the statutes is created to read:

AB768-ASA1,460,12 632.895 (12) (d) This subsection does not apply to a disability insurance policy that covers only dental care.

AB768-ASA1, s. 595 Section 595. 632.897 (4) (d) (intro.) of the statutes is amended to read:

AB768-ASA1,460,21 632.897 (4) (d) (intro.) This subsection does not require individual coverage to be offered by an insurer offering group policies only. This subsection does not require an insurer to issue, or continue in force, an individual conversion policy covering a terminated insured or his or her spouse or dependent if benefits provided or available to the covered person under subds. 1. to 3., together with the converted policy's benefits, would result in overinsurance according to the insurer's standards for overinsurance, and these standards have been filed with and approved by the commissioner prior to use:

AB768-ASA1, s. 597 Section 597. 633.14 (2) (d) of the statutes is created to read:

AB768-ASA1,460,23 633.14 (2) (d) Provides its federal employer identification number.

AB768-ASA1, s. 597m Section 597m. 633.14 (2c) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 633.14 (2c) (a).

AB768-ASA1, s. 598 Section 598. 633.14 (2c) (b) of the statutes is created to read:

AB768-ASA1,461,4 633.14 (2c) (b) The commissioner may disclose any information received under sub. (1) (d) or (2) (d) or s. 633.15 (1m) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 598m Section 598m. 633.14 (2m) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 633.14 (2m) (a).

AB768-ASA1, s. 599 Section 599. 633.14 (2m) (b) of the statutes is created to read:

AB768-ASA1,461,10 633.14 (2m) (b) Notwithstanding subs. (1) and (2), the commissioner may not issue a license under this section if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 600 Section 600. 633.15 (1m) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,461,18 633.15 (1m) Social security or federal employer identification number. At an annual renewal, an administrator shall provide his or her social security number, if the administrator is an individual, or its federal employer identification number, if the administrator is a corporation, limited liability company or partnership, if the social security number or federal employer identification number was not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 600c Section 600c. 633.15 (2) (a) (title) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,461,22 633.15 (2) (a) (title) Nonpayment of annual renewal fee or failure to provide social security number or federal employer identification number.

AB768-ASA1, s. 600d Section 600d. 633.15 (2) (a) 1. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,6 633.15 (2) (a) 1. If an administrator fails to pay the annual renewal fee as provided under sub. (1) or fails to provide a social security number or federal employer identification number as required under sub. (1m), the commissioner shall suspend the administrator's license effective the day following the last day when the annual renewal fee may be paid, if the commissioner has given the administrator reasonable notice of when the fee must be paid to avoid suspension.

AB768-ASA1, s. 600e Section 600e. 633.15 (2) (a) 2. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,13 633.15 (2) (a) 2. If, within 60 days from the effective date of suspension under subd. 1., an administrator pays the annual renewal fee or provides the social security number or federal employer identification number, or both if the suspension was based upon a failure to do both, the commissioner shall reinstate the administrator's license effective as of the date of suspension.

AB768-ASA1, s. 600f Section 600f. 633.15 (2) (a) 3. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,19 633.15 (2) (a) 3. If payment is not made or the social security number or federal employer identification number is not provided within 60 days from the effective date of suspension under subd. 1., the commissioner shall revoke the administrator's license.

AB768-ASA1, s. 601 Section 601. 633.15 (2) (b) 1. (intro.) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,24 633.15 (2) (b) 1. (intro.) Except as provided in par. pars. (c) and (d), the commissioner may revoke, suspend or limit the license of an administrator after a hearing if the commissioner makes any of the following findings:

AB768-ASA1, s. 602 Section 602. 633.15 (2) (d) of the statutes is created to read:

AB768-ASA1,463,3 633.15 (2) (d) For liability for delinquent taxes. The commissioner shall revoke or refuse to renew a license issued under s. 633.14 if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 602c Section 602c. 645.69 (1) of the statutes is amended to read:

AB768-ASA1,463,9 645.69 (1) A claim against a health maintenance organization insurer or an insurer described in s. 609.91 (1m) for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), policyholder or insured of the health maintenance organization insurer or other insurer is not liable under ss. 609.91 to 609.935.

AB768-ASA1, s. 602e Section 602e. 645.69 (2) of the statutes is amended to read:

AB768-ASA1,463,13 645.69 (2) A claim for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB768-ASA1, s. 602g Section 602g. 646.31 (1) (d) 8. of the statutes is amended to read:

AB768-ASA1,463,17 646.31 (1) (d) 8. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization insurer is not liable under ss. 609.91 to 609.935.

AB768-ASA1, s. 602i Section 602i. 646.31 (1) (d) 9. of the statutes is amended to read:

AB768-ASA1,463,21 646.31 (1) (d) 9. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB768-ASA1, s. 603 Section 603. 701.06 (5) (intro.) of the statutes is amended to read:

AB768-ASA1,464,3 701.06 (5) Claims for public support. (intro.) Notwithstanding any provision in the creating instrument or subs. (1) and (2), if the settlor is legally obligated to pay for the public support of a beneficiary under s. 46.10 or 301.12 or the beneficiary is legally obligated to pay for the beneficiary's public support or that furnished the beneficiary's spouse or minor child under s. 46.10 or 301.12, upon application by the appropriate state department or county official, the court may:

AB768-ASA1, s. 604 Section 604. 751.15 of the statutes is created to read:

AB768-ASA1,464,7 751.15 Rules regarding the practice of law. (1) The supreme court is requested to enter into a memorandum of understanding with the department of revenue under s. 73.0301.

AB768-ASA1,464,12 (2) The supreme court is requested to promulgate rules that require each person, as a condition of membership in the state bar, to provide the board of bar examiners with his or her social security number and that prohibit the disclosure of that number to any person except the department of revenue for the sole purpose of making certifications under s. 73.0301.

AB768-ASA1,464,17 (3) The supreme court is requested to promulgate rules that deny an application for a license to practice law or revoke a license to practice law already issued if the applicant or licensee fails to provide the information required under rules promulgated under sub. (2) or if the department of revenue certifies that the applicant or licensee is liable for delinquent taxes under s. 73.0301.

AB768-ASA1, s. 605 Section 605. 753.075 (3) (a) of the statutes is amended to read:

AB768-ASA1,465,11 753.075 (3) (a) Temporary reserve judges shall receive a per diem of $205 $255.66. Commencing August 1, 1993, temporary reserve judges shall receive a per diem of $225. Commencing August 2, 1994, and every August 2 thereafter 1998, the per diem for temporary reserve judges shall be increased by the same percentage increase as the total percentage increase in authorized for circuit court judges' salaries authorized during the preceding 12-month period ending on August 1. While serving outside the county in which they reside temporary reserve judges shall also receive actual and necessary expenses incurred in the discharge of judicial duties. This per diem compensation is not subject to s. 40.26 but the combined amount of this compensation and any other judicial compensation together with retirement annuities under the Wisconsin retirement system, the Milwaukee county retirement fund and other state, county, municipal, or other Wisconsin governmental retirement funds received by him or her during any one calendar year shall not exceed the yearly compensation of a circuit judge. The per diem compensation and actual and necessary expenses shall be paid from the appropriation under s. 20.625 (1) (a) when the judge is assigned to a circuit court and from the appropriation under s. 20.660 (1) (a) when the judge is assigned to the court of appeals.

AB768-ASA1, s. 605b Section 605b. 758.19 (4m) of the statutes is repealed.

AB768-ASA1, s. 605c Section 605c. 758.19 (6) (b) of the statutes is amended to read:

AB768-ASA1,465,22 758.19 (6) (b) From the appropriation under s. 20.625 (1) (e), the director of state courts, beginning on July 1, 1995, shall annually on July 1 pay to each county the county's share, as determined under par. (c), of the total appropriation under s. 20.625 (1) (e). The payment is designed to defray a county's guardian ad litem costs but, except as provided in par. (d), the director of state courts may not require a county to account for the county's guardian ad litem costs or the manner in which or the purposes for which the county expends the payment. The payment shall be made only to those counties that submit the information required under par. (d) by the preceding May 15.

AB768-ASA1, s. 605g Section 605g. 758.19 (6) (d) (intro.) of the statutes is amended to read:

AB768-ASA1,466,3 758.19 (6) (d) (intro.) Annually, no later than July 1 May 15, each county shall submit to the director of state courts, in a format that the director of state courts establishes, all of the following:

AB768-ASA1, s. 605j Section 605j. 758.19 (6) (e) of the statutes is created to read:

AB768-ASA1,466,8 758.19 (6) (e) 1. No county may receive a payment under subd. 2. or par. (b) that results in the county receiving more than the total cost of guardian ad litem compensation that the county incurred and reported to the director of state courts under par. (d) 1.

AB768-ASA1,466,19 2. After calculating the payment amount for each county under par. (c) 2., the director of state courts shall distribute any money remaining, after deducting the amount to be paid under par. (b), to those counties that reported as required under par. (d) and whose payment amount under par. (b) is less than the total cost of guardian ad litem compensation that the county incurred and reported to the director of state courts under par. (d) 1. The additional amount distributed to a county under this subdivision shall be determined by using the procedures under par. (c) 2., except that the sum to be used in the multiplication shall be the money remaining after deducting the amount to be paid under par. (b). The money to be distributed under this subdivision shall be added to the amount to be paid under par. (b) and made as a single payment to each county on July 1.

AB768-ASA1, s. 606 Section 606. 767.32 (1) (b) 4. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,467,3 767.32 (1) (b) 4. A difference between the amount of child support ordered by the court to be paid by the payer and the amount that the payer would have been required to pay based on the percentage standard established by the department under s. 49.22 (9) if the court did not use the percentage standard in determining the child support payments and did not provide the information required under s. 46.10 (14) (d), 301.12 (14) (d), 767.25 (1n) , 767.51 (5d) or 767.62 (4) (f), whichever is appropriate.

AB768-ASA1, s. 607 Section 607. 767.32 (2r) of the statutes is amended to read:

AB768-ASA1,467,8 767.32 (2r) If the court revises a judgment or order providing for child support that was entered under s. 48.355 (2) (b) 4., 48.357 (5m), 48.363 (2), 938.183 (2), 938.355 (2) (b) 4., 938.357 (5m) or 938.363 (2), the court shall determine child support in the manner provided in s. 46.10 (14) or 301.12 (14), whichever is applicable.

AB768-ASA1, s. 608 Section 608. 767.32 (2s) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,467,15 767.32 (2s) In an action under sub. (1), the court may not approve a stipulation for the revision of a judgment or order with respect to an amount of child support or family support unless the stipulation provides for payment of an amount of child support or family support that is determined in the manner required under s. 46.10 (14), 301.12 (14), 767.25 , 767.51 or 767.62 (4), whichever is appropriate.

AB768-ASA1, s. 609 Section 609. 779.14 (1) (title) of the statutes is created to read:

AB768-ASA1,467,17 779.14 (1) (title) Definition.

AB768-ASA1, s. 610 Section 610. 779.14 (1e) (title) of the statutes is created to read:

AB768-ASA1,467,20 779.14 (1e) (title) Contract requirements regarding duties of prime contractor.

AB768-ASA1, s. 611 Section 611. 779.14 (1e) (b) of the statutes is created to read:

AB768-ASA1,468,2 779.14 (1e) (b) All contracts that are in excess of $30,000, as indexed under sub. (1s), and that are for the performance of labor or furnishing materials for a public improvement or public work shall contain a provision under which the prime contractor agrees, to the extent practicable, to maintain a list of all subcontractors and suppliers performing labor or furnishing materials under the contract.

AB768-ASA1, s. 612 Section 612. 779.14 (1m) (title) of the statutes is created to read:

AB768-ASA1,468,4 779.14 (1m) (title) Payment and performance assurance requirements.

AB768-ASA1, s. 613 Section 613. 779.14 (1m) (a) of the statutes, as affected by 1997 Wisconsin Acts 27 and 39, is renumbered 779.14 (1e) (a) and amended to read: