LRBs0287/1
PJK&CMH:jld/lmk/cjs:ch
2005 - 2006 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2005 ASSEMBLY BILL 617
November 10, 2005 - Offered by Representative Gunderson.
AB617-ASA1,1,4
1An Act to renumber 632.855 (3);
to amend 40.51 (8), 66.0137 (4), 120.13 (2) (g),
2185.981 (4t), 185.983 (1) (intro.), 632.855 (2) (intro.) and 632.87 (1); and
to
3create 632.855 (3) (bm) and 632.87 (6) of the statutes;
relating to: coverage
4of certain health care costs in cancer clinical trials.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB617-ASA1,1,96
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
7shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
8and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
9(5) (6), 632.895 (5m) and (8) to (14) and 632.896.
AB617-ASA1,2,411
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
12a village provides health care benefits under its home rule power, or if a town
1provides health care benefits, to its officers and employees on a self-insured basis,
2the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
3632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4)
and, 4(5),
and (6), 632.895 (9) to (14), 632.896 and 767.25 (4m) (d).
AB617-ASA1,2,96
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
749.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
8632.85, 632.853, 632.855, 632.87 (4)
and, (5),
and (6), 632.895 (9) to (14), 632.896 and
9767.25 (4m) (d).
AB617-ASA1,2,1411
185.981
(4t) A sickness care plan operated by a cooperative association is
12subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
13632.853, 632.855, 632.87 (2m), (3), (4)
and, (5),
and (6), 632.895 (10) to (14) and
14632.897 (10) and chs. 149 and 155.
AB617-ASA1, s. 5
15Section
5. 185.983 (1) (intro.) of the statutes is amended to read:
AB617-ASA1,2,2116
185.983
(1) Every such voluntary nonprofit sickness care plan shall be exempt
17from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42,
18601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95,
19632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855,
20632.87 (2m), (3), (4)
and, (5),
and (6), 632.895 (5) and (9) to (14), 632.896 and 632.897
21(10) and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
AB617-ASA1, s. 6
22Section
6. 632.855 (2) (intro.) of the statutes is amended to read:
AB617-ASA1,3,223
632.855
(2) Disclosure of limitations. (intro.)
A Subject to s. 632.87 (6), a 24health care plan or a self-insured health plan that limits coverage of experimental
1treatment shall define the limitation and disclose the limits in any agreement, policy
2or certificate of coverage. This disclosure shall include the following information:
AB617-ASA1, s. 7
3Section
7. 632.855 (3) of the statutes is renumbered 632.855 (3) (am).
AB617-ASA1, s. 8
4Section
8. 632.855 (3) (bm) of the statutes is created to read:
AB617-ASA1,3,75
632.855
(3) (bm) A health care plan or a self-insured health plan may not deny
6coverage under par. (am) of an experimental treatment, procedure, drug, or device
7for an insured if the denial violates s. 632.87 (6).
AB617-ASA1,3,139
632.87
(1) No insurer may refuse to provide or pay for benefits for health care
10services provided by a licensed health care professional on the ground that the
11services were not rendered by a physician as defined in s. 990.01 (28), unless the
12contract clearly excludes services by such practitioners, but no contract or plan may
13exclude services in violation of sub. (2), (2m), (3), (4)
or, (5)
, or (6).
AB617-ASA1,3,1615
632.87
(6) (a) 1. Except as provided in subd. 2., in this subsection, "routine
16patient care" means all of the following:
AB617-ASA1,3,1717
a. All health care services, items, and drugs for the treatment of cancer.
AB617-ASA1,3,2218
b. All health care services, items, and drugs that are typically provided in
19health care; including health care services, items, and drugs provided to a patient
20during the course of treatment in a cancer clinical trial for a condition or any of its
21complications; and that are consistent with the usual and customary standard of
22care, including the type and frequency of any diagnostic modality.
AB617-ASA1,4,823
2. "Routine patient care" does not include the health care service, item, or
24investigational drug that is the subject of the cancer clinical trial; any health care
25service, item, or drug provided solely to satisfy data collection and analysis needs
1that are not used in the direct clinical management of the patient; an investigational
2drug or device that has not been approved for market by the federal food and drug
3administration; transportation, lodging, food, or other expenses for the patient or a
4family member or companion of the patient that are associated with travel to or from
5a facility providing the cancer clinical trial; any services, items, or drugs provided by
6the cancer clinical trial sponsors free of charge for any patient; or any services, items,
7or drugs that are eligible for reimbursement by a person other than the insurer,
8including the sponsor of the cancer clinical trial.
AB617-ASA1,4,129
(b) No policy, plan, or contract may exclude coverage for the cost of any routine
10patient care that is administered to an insured in a cancer clinical trial satisfying the
11criteria under par. (c) and that would be covered under the policy, plan, or contract
12if the insured were not enrolled in a cancer clinical trial.
AB617-ASA1,4,1313
(c) A cancer clinical trial under par. (b) must satisfy all of the following criteria:
AB617-ASA1,4,1514
1. A purpose of the trial is to test whether the intervention potentially improves
15the trial participant's health outcomes.
AB617-ASA1,4,1716
2. The treatment provided as part of the trial is given with the intention of
17improving the trial participant's health outcomes.
AB617-ASA1,4,1918
3. The trial has therapeutic intent and is not designed exclusively to test
19toxicity or disease pathophysiology.
AB617-ASA1,4,2020
4. The trial does one of the following:
AB617-ASA1,4,2221
a. Tests how to administer a health care service, item, or drug for the treatment
22of cancer.
AB617-ASA1,4,2423
b. Tests responses to a health care service, item, or drug for the treatment of
24cancer.
AB617-ASA1,5,3
1c. Compares the effectiveness of health care services, items, or drugs for the
2treatment of cancer with that of other health care services, items, or drugs for the
3treatment of cancer.
AB617-ASA1,5,54
d. Studies new uses of health care services, items, or drugs for the treatment
5of cancer.
AB617-ASA1,5,66
5. The trial is approved by one of the following:
AB617-ASA1,5,87
a. A National Institute of Health, or one of its cooperative groups or centers,
8under the federal department of health and human services.
AB617-ASA1,5,99
b. The federal food and drug administration.
AB617-ASA1,5,1010
c. The federal department of defense.
AB617-ASA1,5,1111
d. The federal department of veterans affairs.
AB617-ASA1,5,1312
(d) 1. The coverage that may not be excluded under this subsection shall apply
13to all phases of a cancer clinical trial.
AB617-ASA1,5,1814
2. The coverage that may not be excluded under this subsection is subject to
15all terms, conditions, restrictions, exclusions, and limitations that apply to any other
16coverage under the policy, plan, or contract, including the treatment under the policy,
17plan, or contract of services performed by participating and nonparticipating
18providers.
AB617-ASA1,5,2119
(e) 1. Nothing in the subsection requires a policy, plan, or contract to offer; or
20prohibits a policy, plan, or contract from offering; cancer clinical trial services by a
21participating provider.
AB617-ASA1,5,2522
2. Nothing in this subsection requires services that are performed in a cancer
23clinical trial by a nonparticipating provider of a policy, plan, or contract to be
24reimbursed at the same rate as a participating provider of the policy, plan, or
25contract.
AB617-ASA1,6,22
(1) This act first applies to all of the following:
AB617-ASA1,6,53
(a) Except as provided in paragraphs (b) and (c), disability insurance policies
4that are issued or renewed, and self-insured health plans that are established,
5extended, modified, or renewed, on the effective date of this paragraph.
