LRBb1290/1
PJK:wlj:km
1999 - 2000 LEGISLATURE
ASSEMBLY AMENDMENT 28,
TO ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 1999 ASSEMBLY BILL 133
June 29, 1999 - Offered by Representative Sinicki.
AB133-ASA1-AA28,1,11 At the locations indicated, amend the substitute amendment as follows:
AB133-ASA1-AA28,1,2 21. Page 1404, line 15: after that line insert:
AB133-ASA1-AA28,1,3 3" Section 3036c. 609.05 (2) of the statutes is amended to read:
AB133-ASA1-AA28,1,74 609.05 (2) Subject to s. 609.22 (4) and (4m), a limited service health
5organization, preferred provider plan or managed care plan may require an enrollee
6to designate a primary provider and to obtain health care services from the primary
7provider when reasonably possible.
AB133-ASA1-AA28, s. 3036f 8Section 3036f. 609.05 (3) of the statutes is amended to read:
AB133-ASA1-AA28,2,29 609.05 (3) Except as provided in ss. 609.22 (4m), 609.65 and 609.655, a limited
10service health organization, preferred provider plan or managed care plan may
11require an enrollee to obtain a referral from the primary provider designated under

1sub. (2) to another participating provider prior to obtaining health care services from
2that participating provider.
AB133-ASA1-AA28, s. 3036j 3Section 3036j. 609.22 (4m) of the statutes is created to read:
AB133-ASA1-AA28,2,124 609.22 (4m) Obstetric and gynecologic services. (a) A managed care plan
5that provides coverage of obstetric or gynecologic services may not require a female
6enrollee of the managed care plan to obtain a referral for coverage of those services
7provided by a participating provider who is a physician licensed under ch. 448 and
8who specializes in obstetrics and gynecology, regardless of whether the participating
9provider is the enrollee's primary provider. Notwithstanding sub. (4), the managed
10care plan may not require the enrollee to obtain a standing referral under the
11procedure established under sub. (4) (a) for coverage of the services specified in this
12paragraph.
AB133-ASA1-AA28,2,1313 (b) A managed care plan under par. (a) may not do any of the following:
AB133-ASA1-AA28,2,1514 1. Penalize or restrict the coverage of a female enrollee on account of her having
15obtained obstetric or gynecologic services in the manner provided under par. (a).
AB133-ASA1-AA28,2,1816 2. Penalize or restrict the contract of a participating provider on account of his
17or her having provided obstetric or gynecologic services in the manner provided
18under par. (a).
AB133-ASA1-AA28,2,2219 (c) A managed care plan under par. (a) shall provide written notice of the
20requirement under par. (a) in every policy or group certificate issued by the managed
21care plan and, during each open enrollment period, to every female enrollee and
22every female applicant for coverage.".
AB133-ASA1-AA28,2,23 232. Page 1592, line 23: after that line insert:
AB133-ASA1-AA28,2,24 24"(1m) Referrals for obstetric or gynecologic services.
AB133-ASA1-AA28,3,6
1(a) Except as provided in paragraph (b), if a policy or certificate that is affected
2by the treatment of sections 609.05 (2) and (3) and 609.22 (4m) of the statutes
3contains terms or provisions that are inconsistent with the treatment of sections
4609.05 (2) and (3) and 609.22 (4m) of the statutes, the treatment of sections 609.05
5(2) and (3) and 609.22 (4m) of the statutes first applies to that policy or certificate
6upon renewal.
AB133-ASA1-AA28,3,11 7(b) The treatment of sections 609.05 (2) and (3) and 609.22 (4m) of the statutes
8first applies to policies and group certificates covering employes who are affected by
9a collective bargaining agreement containing provisions that are inconsistent with
10the treatment of sections 609.05 (2) and (3) and 609.22 (4m) of the statutes that are
11issued or renewed on the earlier of the following:
AB133-ASA1-AA28,3,12 121. The day on which the collective bargaining agreement expires.
AB133-ASA1-AA28,3,14 132. The day on which the collective bargaining agreement is extended, modified
14or renewed.".
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