March 24, 2000 - Offered by Senator Panzer.
SB308-SSA1,1,5 1An Act to repeal 20.145 (1) (c); to amend 46.10 (8) (d), 46.10 (14) (a), 51.01 (3n),
251.038, 51.04, 301.12 (8) (d) and 301.12 (14) (a); and to create 20.145 (1) (c),
340.53 and 111.91 (2) (t) of the statutes; relating to: state employe health
4insurance coverage of nervous and mental disorders, alcoholism and other drug
5abuse problems, an actuarial study or evaluation and making an appropriation.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB308-SSA1, s. 1 6Section 1. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
7the following amounts for the purposes indicated: - See PDF for table PDF
SB308-SSA1, s. 2
1Section 2. 20.145 (1) (c) of the statutes is created to read:
SB308-SSA1,2,32 20.145 (1) (c) Actuarial study contract. The amounts in the schedule for the
3costs of the contract under 1999 Wisconsin Act .... (this act), section 13 (1) (a).
SB308-SSA1, s. 3 4Section 3. 20.145 (1) (c) of the statutes, as created by 1999 Wisconsin Act ....
5(this act), is repealed.
SB308-SSA1, s. 4 6Section 4. 40.53 of the statutes is created to read:
SB308-SSA1,2,8 740.53 Coverage of mental disorders, alcoholism and other diseases. (1)
8Definitions. In this section:
SB308-SSA1,2,109 (a) "Collateral" means a member of an insured's immediate family, as defined
10in s. 632.895 (1) (d).
SB308-SSA1,2,1111 (b) "Hospital" means any of the following:
SB308-SSA1,2,1212 1. A hospital licensed under s. 50.35.
SB308-SSA1,2,1313 2. An approved private treatment facility as defined in s. 51.45 (2) (b).
SB308-SSA1,2,1414 3. An approved public treatment facility as defined in s. 51.45 (2) (c).
SB308-SSA1,2,1715 (c) "Inpatient hospital services" means services for the treatment of nervous
16and mental disorders or alcoholism and other drug abuse problems that are provided
17in a hospital to a bed patient in the hospital.
SB308-SSA1,2,2118 (d) "Outpatient services" means nonresidential services for the treatment of
19nervous or mental disorders or alcoholism or other drug abuse problems provided to
20an insured and, if for the purpose of enhancing the treatment of the insured, a
21collateral by any of the following:
SB308-SSA1,2,2522 1. A program in an outpatient treatment facility, if both are approved by the
23department of health and family services, the program is established and
24maintained according to rules promulgated under s. 51.42 (7) (b) and the facility is
25certified under s. 51.04.
SB308-SSA1,3,2
12. A licensed physician who has completed a residency in psychiatry, in an
2outpatient treatment facility or the physician's office.
SB308-SSA1,3,53 3. A licensed psychologist who is listed in the national register of health service
4providers in psychology or who is certified by the American board of professional
5psychology.
SB308-SSA1,3,106 (e) "Transitional treatment arrangements" means services for the treatment
7of nervous or mental disorders or alcoholism or other drug abuse problems that are
8provided to an insured in a less restrictive manner than are inpatient hospital
9services but in a more intensive manner than are outpatient services, and that are
10specified by the secretary by rule under sub. (4).
SB308-SSA1,3,15 11(2) Required coverage. (a) Conditions covered. Notwithstanding s. 632.89,
12a health care coverage plan offered by the state under s. 40.51 (6) or by the group
13insurance board under s. 40.51 (7) shall provide coverage of nervous and mental
14disorders and alcoholism and other drug abuse problems if required by pars. (b) to
15(d) and as provided in pars. (b) to (d) and sub. (3).
SB308-SSA1,3,1816 (b) Coverage of inpatient hospital services. If a health care coverage plan
17provides coverage of any inpatient hospital treatment, the plan shall provide
18coverage for inpatient hospital services for the treatment of conditions under par. (a).
SB308-SSA1,3,2119 (c) Coverage of outpatient services. If a health care coverage plan provides
20coverage of any outpatient treatment, the plan shall provide coverage for outpatient
21services for the treatment of conditions under par. (a).
SB308-SSA1,3,2522 (d) Coverage of transitional treatment arrangements. If a health care coverage
23plan provides coverage of any inpatient hospital treatment or any outpatient
24treatment, the plan shall provide coverage for transitional treatment arrangements
25for the treatment of conditions under par. (a).
SB308-SSA1,4,8
1(3) Equal coverage requirement. A health care coverage plan that provides
2coverage for the treatment of nervous and mental disorders and alcoholism and other
3drug abuse problems shall provide the same coverage for that treatment that it
4provides for the treatment of physical conditions. This requirement applies to all
5coverage-related components, including rates; exclusions and limitations;
6deductibles; copayments; coinsurance; annual and lifetime payment limits;
7out-of-pocket limits; out-of-network charges; day, visit or appointment limits;
8duration or frequency of coverage; and medical necessity definitions.
SB308-SSA1,4,13 9(4) Specification of transitional treatment arrangements by rule. The
10secretary, with the approval of the group insurance board, shall specify by rule the
11services for the treatment of nervous or mental disorders or alcoholism or other drug
12abuse problems, including but not limited to day hospitalization, that are covered
13under sub. (2) (d).
SB308-SSA1,4,20 14(5) Liability to the state or county. Any health care coverage plan providing
15hospital treatment coverage is liable to the state or county for any costs incurred for
16services an inpatient health care facility, as defined in s. 50.135 (1), or
17community-based residential facility, as defined in s. 50.01 (1g), owned or operated
18by a state or county, provides to a patient regardless of the patient's liability for the
19services, to the extent that the insurer is liable to the patient for services provided
20at any other inpatient health care facility or community-based residential facility.
SB308-SSA1,4,23 21(6) Exclusions. (a) Medicare. No health care coverage plan, insurer or other
22organization subject to this section is required to duplicate coverage available under
23the federal medicare program.
SB308-SSA1,5,224 (b) Certain health care plans. This section does not apply to a health care
25coverage plan offered by a preferred provider plan, as defined in s. 609.01 (4), that

1is not a managed care plan, as defined in s. 609.01 (3c), or by a limited service health
2organization, as defined in s. 609.01 (3).
SB308-SSA1, s. 5 3Section 5. 46.10 (8) (d) of the statutes is amended to read:
SB308-SSA1,5,84 46.10 (8) (d) After due regard to the case and to a spouse and minor children
5who are lawfully dependent on the property for support, compromise or waive any
6portion of any claim of the state or county for which a person specified under sub. (2)
7is liable, but not any claim payable by an insurer under s. 40.53 (2) or (5) or 632.89
8(2) or (2m) or by any other 3rd party.
SB308-SSA1, s. 6 9Section 6. 46.10 (14) (a) of the statutes is amended to read:
SB308-SSA1,5,2410 46.10 (14) (a) Except as provided in pars. (b) and (c), liability of a person
11specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons
12under 18 years of age at community mental health centers, a county mental health
13complex under s. 51.08, the centers for the developmentally disabled, Mendota
14mental health institute Mental Health Institute and Winnebago mental health
15institute
Mental Health Institute or care and maintenance of persons under 18 years
16of age in residential, nonmedical facilities such as group homes, foster homes,
17treatment foster homes, child caring institutions and juvenile correctional
18institutions is determined in accordance with the cost-based fee established under
19s. 46.03 (18). The department shall bill the liable person up to any amount of liability
20not paid by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by other 3rd
21party benefits, subject to rules which include formulas governing ability to pay
22promulgated by the department under s. 46.03 (18). Any liability of the patient not
23payable by any other person terminates when the patient reaches age 18, unless the
24liable person has prevented payment by any act or omission.
SB308-SSA1, s. 7 25Section 7. 51.01 (3n) of the statutes is amended to read:
SB308-SSA1,6,5
151.01 (3n) "Community mental health program" means a program to provide
2community-based outpatient mental health services that is operated by or under
3contract with a county department of community programs or that requests payment
4for the services under the medical assistance program or under benefits required
5under s. 40.53 (2) or 632.89 (2).
SB308-SSA1, s. 8 6Section 8. 51.038 of the statutes is amended to read:
SB308-SSA1,6,14 751.038 Outpatient mental health clinic certification. Except as provided
8in s. 51.032, if a facility that provides mental health services on an outpatient basis
9holds current accreditation from the council on accreditation of services for families
10and children, the department may accept evidence of this accreditation as equivalent
11to the standards established by the department, for the purpose of certifying the
12facility for the receipt of funds for services provided as a benefit to a medical
13assistance recipient under s. 49.46 (2) (b) 6. f., a community aids funding recipient
14under s. 51.423 (2) or as mandated coverage under s. 40.53 or 632.89.
SB308-SSA1, s. 9 15Section 9. 51.04 of the statutes is amended to read:
SB308-SSA1,6,21 1651.04 Treatment facility certification. Except as provided in s. 51.032, any
17treatment facility may apply to the department for certification of the facility for the
18receipt of funds for services provided as a benefit to a medical assistance recipient
19under s. 49.46 (2) (b) 6. f. or to a community aids funding recipient under s. 51.423
20(2) or provided as mandated coverage under s. 40.53 or 632.89. The department shall
21annually charge a fee for each certification.
SB308-SSA1, s. 10 22Section 10. 111.91 (2) (t) of the statutes is created to read:
SB308-SSA1,6,2423 111.91 (2) (t) The requirements under s. 40.53 related to coverage of treatment
24for nervous and mental disorders and alcoholism and other drug abuse problems.
SB308-SSA1, s. 11 25Section 11. 301.12 (8) (d) of the statutes is amended to read:
SB308-SSA1,7,5
1301.12 (8) (d) After due regard to the case and to a spouse and minor children
2who are lawfully dependent on the property for support, compromise or waive any
3portion of any claim of the state or county for which a person specified under sub. (2)
4is liable, but not any claim payable by an insurer under s. 40.53 (2) or (5) or 632.89
5(2) or (2m) or by any other 3rd party.
SB308-SSA1, s. 12 6Section 12. 301.12 (14) (a) of the statutes is amended to read:
SB308-SSA1,7,177 301.12 (14) (a) Except as provided in pars. (b) and (c), liability of a person
8specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
9years of age in residential, nonmedical facilities such as group homes, foster homes,
10treatment foster homes, child caring institutions and juvenile correctional
11institutions is determined in accordance with the cost-based fee established under
12s. 301.03 (18). The department shall bill the liable person up to any amount of
13liability not paid by an insurer under s. 40.53 (2) or (5) or 632.89 (2) or (2m) or by other
143rd-party benefits, subject to rules which include formulas governing ability to pay
15promulgated by the department under s. 301.03 (18). Any liability of the resident not
16payable by any other person terminates when the resident reaches age 17, unless the
17liable person has prevented payment by any act or omission.
SB308-SSA1, s. 13 18Section 13 . Nonstatutory provisions.
SB308-SSA1,7,1919 (1) Actuarial study on cost.
SB308-SSA1,8,720 (a) Study requirements. The office of the commissioner of insurance shall enter
21into a contract for an actuarial study or evaluation to determine whether, and to what
22extent, the requirements under section 40.53 of the statutes, as created by this act,
23are likely to increase the cost of health insurance coverage. The study or evaluation
24shall make this determination separately for the health insurance coverage that is
25offered by the state under s. 40.51 (6) and by the group insurance board under s. 40.51

1(7) and separately for health insurance coverage purchased directly in the private
2market by individuals and families and by private employers for their employes, as
3if the requirements under section 40.53 of the statutes, as created by this act, applied
4to such health insurance coverage. The office of the commissioner of insurance shall
5report the results of the study or evaluation to the appropriate standing committees
6of the legislature in the manner provided under section 13.172 (3) of the statutes no
7later than June 1, 2001.
SB308-SSA1,8,198 (b) Funding study. The office of the commissioner of insurance may not
9encumber or expend moneys from the appropriation under section 20.145 (1) (c) of
10the statutes, as created by this act, unless the office of the commissioner of insurance
11first notifies the joint committee on finance in writing of the proposed encumbrance
12or expenditure. If the cochairpersons of the joint committee on finance do not notify
13the office of the commissioner of insurance within 14 working days after the date of
14the office's notification that the committee has scheduled a meeting to review the
15proposed encumbrance or expenditure, the moneys may be encumbered or expended
16as proposed by the office. If, within 14 working days after the date of the office's
17notification, the cochairpersons of the committee notify the office that the committee
18has scheduled a meeting to review the proposed encumbrance or expenditure, the
19moneys may be encumbered or expended only upon approval of the committee.
SB308-SSA1, s. 14 20Section 14. Initial applicability.
SB308-SSA1,8,2121 (1) This act first applies to all of the following:
SB308-SSA1,8,2322 (a) Except as provided in paragraph (b), health care coverage plans that are
23issued or renewed on the effective date of this paragraph.
SB308-SSA1,9,3
1(b) Health care coverage plans covering employes who are affected by a
2collective bargaining agreement containing provisions inconsistent with this act
3that are issued or renewed on the earlier of the following:
SB308-SSA1,9,4 41. The day on which the collective bargaining agreement expires.
SB308-SSA1,9,6 52. The day on which the collective bargaining agreement is extended, modified
6or renewed.
SB308-SSA1, s. 15 7Section 15. Effective dates. This act takes effect on the first day of the 6th
8month beginning after publication, except as follows:
SB308-SSA1,9,109 (1) Actuarial study on cost. Section 13 (1) of this act takes effect on the day
10after publication.
SB308-SSA1,9,1211 (2) Funding for study. The repeal of section 20.145 (1) (c) of the statutes takes
12effect on July 1, 2001.
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