Amendment AA1-SB322

SB322-AA1,31,7 456.12 Exemption. This chapter does not apply to a person who acts in the capacity of an administrator of a nursing home operated by adherents of a church or religious denomination which subscribes to the act of healing by prayer and the principles of which do not include medical treatment, if the person does not use in connection with his or her name any title or designation tending to imply that the person is a nursing home administrator.

SB322-AA1, s. 89 Section 89. 609.22 (2) of the statutes is amended to read:

SB322-AA1,31,12 609.22 (2) Adequate choice. A defined network plan that is not a preferred provider plan shall ensure that, with respect to covered benefits, each enrollee has adequate choice among participating providers and that the providers are, to the extent consistent with s. 628.36 (2) (b) 3. and (2m), accessible and qualified.

SB322-AA1, s. 90 Section 90. 609.32 (2) (a) of the statutes is amended to read:

SB322-AA1,31,22 609.32 (2) (a) A defined network plan shall develop , consistent with s. 628.36 (2) (b) 3. and (2m), a process for selecting participating providers, including written policies and procedures that the plan uses for review and approval of providers. After consulting with appropriately qualified providers, the plan shall establish, to the extent consistent with s. 628.36 (2) (b) 3. and (2m), minimum professional requirements for its participating providers. The process for selection shall include verification of a provider's license or certificate, including the history of any suspensions or revocations, and the history of any liability claims made against the provider.

SB322-AA1, s. 91 Section 91. 628.36 (1) of the statutes is renumbered 628.36 (1m) and amended to read:

SB322-AA1,32,4 628.36 (1m) Payment methods. Any corporation operating a voluntary health care plan may pay health care professionals on a salary, per patient , or fee-for-service basis to provide health care to policyholders or beneficiaries of the corporation.

SB322-AA1, s. 92 Section 92. 628.36 (1c) (intro.) of the statutes is created to read:

SB322-AA1,32,6 628.36 (1c) Definitions. (intro.) In this section:

SB322-AA1, s. 93 Section 93. 628.36 (2) (a) (intro.) of the statutes is amended to read:

SB322-AA1,32,8 628.36 (2) (a) (intro.) In this section subsection:

SB322-AA1, s. 94 Section 94. 628.36 (2) (b) 3. of the statutes is amended to read:

SB322-AA1,32,13 628.36 (2) (b) 3. Except as provided in subd. subds. 4. and 4m., and subject to sub. (2m) (e), no provider may be denied the opportunity to participate in a health care plan, other than a health maintenance organization, a limited service health organization or a preferred provider plan, under the terms of the plan.

SB322-AA1, s. 95 Section 95. 628.36 (2) (b) 4. of the statutes is amended to read:

SB322-AA1,32,18 628.36 (2) (b) 4. Any health care plan may exclude a provider from participation in the health care plan for cause related to the practice of his or her profession. A health care plan that excludes a provider from participation shall advise the provider in writing of the reason for the exclusion.

SB322-AA1, s. 96 Section 96. 628.36 (2) (b) 4m. of the statutes is created to read:

SB322-AA1,32,23 628.36 (2) (b) 4m. Subdivision 3. applies to a health maintenance organization, limited service health organization, or preferred provider plan only with respect to a provider located in the geographic service area of the health maintenance organization, limited service health organization, or preferred provider plan.

SB322-AA1, s. 97 Section 97. 628.36 (2m) (title) of the statutes is repealed and recreated to read:

SB322-AA1,32,25 628.36 (2m) (title) Annual participation election period.

SB322-AA1, s. 98 Section 98. 628.36 (2m) (a) (intro.) and 2m. of the statutes are consolidated, renumbered 628.36 (2m) (ac) and amended to read:

SB322-AA1,33,5 628.36 (2m) (ac) In this subsection: 2m. "Pharmaceutical, "health care services" do not include the administration of a drug product or device or vaccine under s. 450.035.

SB322-AA1, s. 99 Section 99. 628.36 (2m) (a) 1. of the statutes is renumbered 628.36 (1c) (a).

SB322-AA1, s. 100 Section 100. 628.36 (2m) (a) 2. of the statutes is renumbered 628.36 (1c) (b).

SB322-AA1, s. 101 Section 101. 628.36 (2m) (a) 3. of the statutes is renumbered 628.36 (1c) (c).

SB322-AA1, s. 102 Section 102. 628.36 (2m) (e) 1. of the statutes is amended to read:

SB322-AA1,33,21 628.36 (2m) (e) 1. A health maintenance organization, limited service health organization, or preferred provider plan that provides coverage of pharmaceutical health care services when that are performed by one or more pharmacists health care professionals who are selected by the organization or plan but who are not full-time salaried employees or partners of the organization or plan shall provide an annual period of at least 30 days during which any pharmacist registered under ch. 450 health care professional who provides those health care services, who has been granted a credential, as defined in s. 440.01 (2) (a), to practice in this state, and who is located in the geographic service area of the organization or plan may elect to participate in the health maintenance organization, limited service health organization, or preferred provider plan under its terms as a selected provider for at least one year.

SB322-AA1, s. 103 Section 103. 628.36 (2m) (e) 2. of the statutes is amended to read:

SB322-AA1,34,2 628.36 (2m) (e) 2. Except as provided in subd. 3., subd. 1. applies to health maintenance organizations on and after May 10, 1984. Except as provided in subd. 4., subd. 1. applies to, limited service health organizations, and preferred provider plans on or after April 28, 1990 the effective date of this subdivision .... [revisor inserts date].

SB322-AA1, s. 104 Section 104. 628.36 (2m) (e) 3. of the statutes is amended to read:

SB322-AA1,34,11 628.36 (2m) (e) 3. If compliance with the requirements of subd. 1. during the period specified in subd. 2. would impair any provision of a contract between a health maintenance organization, limited service health organization, or preferred provider plan and any other person, and if the contract provision was in existence prior to May 10, 1984 the effective date of this subdivision .... [revisor inserts date], then immediately after the expiration of all such contract provisions the health maintenance organization, limited service health organization, or preferred provider plan shall comply with the requirements of subd. 1.

SB322-AA1, s. 105 Section 105. 628.36 (2m) (e) 4. of the statutes is repealed.

SB322-AA1, s. 106 Section 106. 628.36 (3) of the statutes is amended to read:

SB322-AA1,34,22 628.36 (3) Exemption by rule. By rule the commissioner may exempt from the application of any part of subs. (1) (1m) to (2m) plans which that provide innovative approaches to the delivery of health care or which that are designed to contain health care costs, and which that cannot operate successfully consistent with all of the provisions in subs. (1) (1m) to (2m). The commissioner may promulgate such a rule only if on a finding that the interests of the public require such plans as an experiment, to supply health care services that are not otherwise available in adequate quantity or quality, or to contain health care costs. The promulgated rule shall be as narrow as is compatible with the success of the plans.".

SB322-AA1,34,23 3. Page 2, line 1: delete " Section 1" and substitute "Section 106m".

SB322-AA1,34,24 4. Page 2, line 8: after that line insert:

SB322-AA1,35,1 " Section 107. 632.89 (1) (am) of the statutes is created to read:

SB322-AA1,35,3 632.89 (1) (am) "Consumer price index" means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.

SB322-AA1, s. 108 Section 108. 632.89 (1) (b) of the statutes is created to read:

SB322-AA1,35,7 632.89 (1) (b) "Diagnostic testing" means procedures used to exclude the existence of conditions other than nervous or mental disorders or alcoholism or other drug abuse problems.

SB322-AA1, s. 109 Section 109. 632.89 (2) (b) 1. of the statutes is amended to read:

SB322-AA1,35,14 632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability insurance policy issued by an insurer provides coverage of inpatient hospital treatment or outpatient treatment or both, the policy shall provide coverage in every policy year as provided in pars. (c) to (dm), as appropriate, except that the total coverage under the policy for a policy year need not exceed $7,000 $16,800 or the equivalent benefits measured in services rendered.

SB322-AA1, s. 110 Section 110. 632.89 (2) (c) 2. b. of the statutes is amended to read:

SB322-AA1,35,20 632.89 (2) (c) 2. b. Seven thousand Sixteen thousand eight hundred dollars minus any applicable cost sharing at the level charged under the policy for inpatient hospital services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $6,300 $15,100 in equivalent benefits measured in services rendered.

SB322-AA1, s. 111 Section 111. 632.89 (2) (d) 2. of the statutes is amended to read:

SB322-AA1,36,2 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $2,000 $3,100 minus any applicable cost sharing at the level charged under the policy for outpatient services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $1,800 $2,800 in equivalent benefits measured in services rendered.

SB322-AA1, s. 112 Section 112. 632.89 (2) (dm) 2. of the statutes is amended to read:

SB322-AA1,36,9 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $3,000 $4,600 minus any applicable cost sharing at the level charged under the policy for transitional treatment arrangements or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $2,700 $4,100 in equivalent benefits measured in services rendered.

SB322-AA1, s. 113 Section 113. 632.89 (2) (f) of the statutes is created to read:

SB322-AA1,36,14 632.89 (2) (f) Report on coverage limits. The department of health and family services shall report annually to the governor and the legislature on revising the coverage limits specified in this subsection based on the change in the consumer price index for medical costs.

SB322-AA1, s. 114 Section 114. 632.89 (6) and (7) of the statutes are created to read:

SB322-AA1,36,18 632.89 (6) Prescription drugs and diagnostic testing. (a) The coverage amounts specified in sub. (2) shall not include costs incurred for prescription drugs or diagnostic testing.

SB322-AA1,36,20 (b) The department of health and family services may specify, by rule, the diagnostic testing procedures to which par. (a) applies.

SB322-AA1,36,23 (7) Treatment of costs. The coverage amounts specified in sub. (2) apply to actual payments or reimbursements made by an insurer if the payment or reimbursement amounts are less than the amounts charged by a provider.".

SB322-AA1,36,24 5. Page 2, line 9: delete " Section 2" and substitute "Section 114c".

SB322-AA1,37,1 6. Page 2, line 17: delete " Section 3" and substitute "Section 114m".

SB322-AA1,37,2 7. Page 3, line 2: after that line insert:

SB322-AA1,37,4 " Section 115. 895.48 (1m) of the statutes, as affected by 2003 Wisconsin Act 33, is renumbered 895.48 (1m) (a).

SB322-AA1, s. 116 Section 116. 895.48 (1m) (b) of the statutes is created to read:

SB322-AA1,37,7 895.48 (1m) (b) This subsection does not apply to health care services provided by a volunteer health care provider under s. 146.89.

SB322-AA1, s. 117 Section 117 . Nonstatutory provisions.

SB322-AA1,37,12 (1) The department of health and family services shall submit in proposed form the rules required under section 46.03 (44) of the statutes, as created by this act, to the legislative council staff under section 227.15 (1) of the statutes no later than the first day of the 7th month beginning after the effective date of this subsection.

SB322-AA1, s. 118 Section 118 . Initial applicability.

SB322-AA1,37,16 (1) The treatment of section 49.688 (4r) of the statutes first applies to eligibility determinations made and deductible amounts paid on the effective date of this subsection.

SB322-AA1,37,21 (2) If an insurance policy that is in effect on the effective date of this subsection contains a provision that is inconsistent with the treatment of section 632.89 (6) or (7) of the statutes, the treatment of section 632.89 (6) or (7) of the statutes, whichever is inconsistent, first applies to that insurance policy on the date on which it is renewed.

SB322-AA1,37,24 (3) The treatment of sections 632.89 (1) (am) and (2) (b) 1., (c) 2. b., (d) 2., (dm) 2., and (f) of the statutes first applies to a policy issued, renewed, or modified on the first day of the 13th month beginning after publication.

SB322-AA1,38,6 (4) The treatment of sections 146.89 (2) (a), (c), and (d), (3) (b) (intro.), (c), and (d) (intro.), and (3m) and 895.48 (1m) of the statutes, the renumbering and amendment of section 146.89 (1) of the statutes, and the creation of section 146.89 (1) (d), (g), and (h) and 895.48 (1m) (b) of the statutes first applies to applications submitted under section 146.89 (2) (a) of the statutes, as affected by this act, on the effective date of this subsection.

SB322-AA1,38,9 (5) The renumbering and amendment of section 456.08 of the statutes and the creation of section 456.08 (1), (2), (3), and (4) of the statutes first apply to applications received on the effective date of this subsection.

SB322-AA1,38,14 (6) The treatment of sections 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., and 12., (ar), (e), and (L), 49.47 (4) (am) 1. and 2., (c) 1. and 3., (cg) 3., and (h), and 49.665 (4) (a) 1. and (d) of the statutes first applies to eligibility determinations for the Medical Assistance and Badger Care health care programs that are made on the effective date of this subsection.

SB322-AA1, s. 119 Section 119. Effective dates. This act takes effect on the day after publication, except as follows:

SB322-AA1,38,18 (1) The treatment of section 49.688 (4r) of the statutes and Section 118 (1 ) of this act take effect on the first day of the 2nd month beginning after publication.

SB322-AA1,38,21 (2) The treatment of sections 20.435 (4) (b) and (7) (bd), 49.45 (6ur) and 49.45 (6v) of the statutes takes effect on takes effect on January 1, 2005, or on the day after publication, whichever is later.

SB322-AA1,38,24 (3) The treatment of sections 100.31 (title), (1) (a), (ae), (as), (b), and (c), (2), (2r), and (4) of the statutes takes effect on the first day of the 3rd month beginning after publication.

SB322-AA1,39,3 (4) The treatment of sections 46.03 (44), 441.07 (1) (d), 441.16 (3m), 448.015 (4), 448.035, 448.04 (1) (a), 450.10 (1) (a) (intro.), and 450.11 (1) and (1g) of the statutes takes effect on the first day of the 13th month beginning after publication.

SB322-AA1,39,8 (5) The treatment of sections 456.02 (intro.), (1), (2), (3), (4), (5), and (6), 456.04 (intro.), (1), (1m) (d) and (e), (2), (2m), (3), and (4), 456.08 (1), (2), (3), and (4), 456.09 (1) (c), and 456.12 of the statutes and the renumbering and amendment of section 456.08 of the statutes take effect on the first day of the 7th month beginning after publication.".

SB322-AA1,39,9 (End)