SENATE AMENDMENT 2,
TO SENATE SUBSTITUTE AMENDMENT 1,
TO 2007 SENATE BILL 40
June 26, 2007 - Offered by Senator
Robson.
SB40-SSA1-SA2,1,4
4"
Section 733mr. 36.27 (3n) (b) 2. of the statutes is amended to read:
SB40-SSA1-SA2,1,75
36.27
(3n) (b) 2.
An Except as provided in subd. 2m., an unremarried surviving
6spouse of an eligible veteran. The remission under this subdivision applies only
7during the first 10 years after the veteran died.
SB40-SSA1-SA2,2,29
36.27
(3n) (b) 2m. An unremarried surviving spouse of an eligible veteran who
10had a child with the eligible veteran. The remission under this subdivision applies
11only until 10 years after the youngest child that the spouse had with the eligible
1veteran reaches or would have reached 18 years of age, or during the first 10 years
2after the veteran died, whichever is longer.".
SB40-SSA1-SA2,2,4
4"
Section 738mr. 38.24 (7) (b) 2. of the statutes is amended to read:
SB40-SSA1-SA2,2,75
38.24
(7) (b) 2.
An Except as provided in subd. 2m., an unremarried surviving
6spouse of an eligible veteran. The remission under this subdivision applies only
7during the first 10 years after the veteran died.
SB40-SSA1-SA2,2,139
38.24
(7) (b) 2m. An unremarried surviving spouse of an eligible veteran who
10had a child with the eligible veteran. The remission under this subdivision applies
11only until 10 years after the youngest child that the spouse had with the eligible
12veteran reaches or would have reached 18 years of age, or during the first 10 years
13after the veteran died, whichever is longer.".
SB40-SSA1-SA2,2,1916
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
17shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
18and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
19(6), 632.895 (5m) and (8) to
(14) (15), and 632.896.
SB40-SSA1-SA2,2,2321
40.51
(8m) Every health care coverage plan offered by the group insurance
22board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
23632.748, 632.83, 632.835, 632.85, 632.853, 632.855
, and 632.895 (11) to
(14) (15).".
SB40-SSA1-SA2,3,2
1"
Section 1545t. 49.45 (22) of the statutes is renumbered 49.45 (22) (intro.) and
2amended to read:
SB40-SSA1-SA2,3,63
49.45
(22) Medical assistance services provided by health maintenance
4organizations. (intro.) If the department contracts with health maintenance
5organizations for the provision of medical assistance it shall
give do all of the
6following:
SB40-SSA1-SA2,3,11
7(a) Give special consideration to health maintenance organizations that
8provide or that contract to provide comprehensive, specialized health care services
9to pregnant teenagers.
If the department contracts with health maintenance
10organizations for the provision of medical assistance, the department shall
11determine
SB40-SSA1-SA2,3,19
12(b) Determine which medical assistance recipients who have attained the age
13of 2 but have not attained the age of 6 and who are at risk for lead poisoning have
14not received lead screening from those health maintenance organizations
. The
15department shall and report annually to the appropriate standing committees of the
16legislature under s. 13.172 (3) on the percentage of medical assistance recipients
17under the age of 2 who received a lead screening test in that year provided by a health
18maintenance organization compared with the percentage that the department set as
19a goal for that year.
SB40-SSA1-SA2,3,2521
49.45
(22) (c) 1. Calculate that portion of any increase in the capitation rate
22paid to each health maintenance organization under this subsection after the
23effective date of this paragraph .... [revisor inserts date], if the increase is made to
24reflect increases in fee-for-service medical assistance payment rates to one or more
25class of providers.
SB40-SSA1-SA2,4,6
12. Require each health maintenance organization to increase its payments to
2any class of providers for services to medical assistance recipients in amounts that
3the department determines are consistent with both the purpose and intent of the
4fee-for-service rate increase and the objective of reducing unnecessary utilization
5through managed care, and to amend its contracts with service providers
6correspondingly.
SB40-SSA1-SA2,4,87
3. Conduct audits to ensure that health maintenance organizations comply
8with the requirement of this paragraph.".
SB40-SSA1-SA2,4,1611
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
13provides health care benefits, to its officers and employees on a self-insured basis,
14the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
15632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5),
16and (6), 632.895 (9) to
(14) (15), 632.896
, and 767.513 (4).".
SB40-SSA1-SA2,4,2019
111.91
(2) (n) The provision to employees of the health insurance coverage
20required under s. 632.895 (11) to
(14) (15).".
SB40-SSA1-SA2,5,223
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
2449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
1632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to
(14) (15), 632.896
, and
2767.513 (4).".
SB40-SSA1-SA2,5,85
185.981
(4t) A sickness care plan operated by a cooperative association is
6subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
7632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (10) to
(14) (15), and
8632.897 (10) and chs. 149 and 155.
SB40-SSA1-SA2,5,1610
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
11exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
12601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
13631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
14632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (5) and (9) to
(14) (15), 632.896
, and
15632.897 (10) and chs. 609, 630, 635, 645
, and 646, but the sponsoring association
16shall:".
SB40-SSA1-SA2,5,20
19609.87 Coverage of treatment for autism spectrum disorders. Defined
20network plans are subject to s. 632.895 (15).".
SB40-SSA1-SA2,6,2
23632.726 Current procedural terminology code changes. (1) In this
24section, "current procedural terminology code" means a number established by the
1American Medical Association that a health care provider puts on a health insurance
2claim form to describe the services that he or she performed.
SB40-SSA1-SA2,6,7
3(2) If an insurer changes a current procedural terminology code that was
4submitted by a health care provider on a health insurance claim form, the insurer
5shall include on the explanation of benefits form the reason for the change to the
6current procedural terminology code and shall cite on the explanation of benefits
7form the source for the change.".
SB40-SSA1-SA2,6,16
10632.857 Explanation required for restriction or termination of
11coverage. If an insurer restricts or terminates an insured's coverage for the
12treatment of a condition or complaint and, as a result, the insured becomes liable for
13payment for all of his or her treatment for the condition or complaint, the insurer
14shall provide on the explanation of benefits form a detailed explanation of the clinical
15rationale and of the basis in the policy, plan, or contract or in applicable law for the
16insurer's restriction or termination of coverage.
SB40-SSA1-SA2,6,2018
632.875
(2) (g) A
reasonable detailed explanation of the
factual basis clinical
19rationale and of the basis in the policy, plan
, or contract or in applicable law for the
20insurer's restriction or termination of coverage.
SB40-SSA1-SA2,6,2322
632.89
(1) (am) "Consumer price index" means the consumer price index for all
23urban consumers, U.S. city average, as determined by the U.S. department of labor.
SB40-SSA1-SA2,7,6
1632.89
(2) (b) 1. Except as provided in subd. 2., if a group or blanket disability
2insurance policy issued by an insurer provides coverage of inpatient hospital
3treatment or outpatient treatment or both, the policy shall provide coverage in every
4policy year as provided in pars. (c) to (dm), as appropriate, except that the total
5coverage under the policy for a policy year need not exceed
$7,000 $20,250 or the
6equivalent benefits measured in services rendered.
SB40-SSA1-SA2,7,128
632.89
(2) (c) 2. b.
Seven thousand
Twenty thousand two hundred fifty dollars
9minus any applicable cost sharing at the level charged under the policy for inpatient
10hospital services or the equivalent benefits measured in services rendered or, if the
11policy does not use cost sharing,
$6,300 $18,250 in equivalent benefits measured in
12services rendered.
SB40-SSA1-SA2,7,1814
632.89
(2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall
15provide coverage in every policy year for not less than
$2,000 $3,450 minus any
16applicable cost sharing at the level charged under the policy for outpatient services
17or the equivalent benefits measured in services rendered or, if the policy does not use
18cost sharing,
$1,800 $3,100 in equivalent benefits measured in services rendered.
SB40-SSA1-SA2,7,2520
632.89
(2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall
21provide coverage in every policy year for not less than
$3,000 $5,200 minus any
22applicable cost sharing at the level charged under the policy for transitional
23treatment arrangements or the equivalent benefits measured in services rendered
24or, if the policy does not use cost sharing,
$2,700
$4,650 in equivalent benefits
25measured in services rendered.
SB40-SSA1-SA2,8,52
632.89
(2) (f)
Report on coverage limits. The department of health and family
3services shall report annually to the governor and the legislature on revising the
4coverage limits specified in this subsection based on the change in the consumer price
5index for medical costs.
SB40-SSA1-SA2,8,87
632.895
(15) Treatment for autism spectrum disorders. (a) In this subsection,
8"autism spectrum disorder" means any of the following:
SB40-SSA1-SA2,8,99
1. Autism disorder.
SB40-SSA1-SA2,8,1010
2. Asperger's syndrome.
SB40-SSA1-SA2,8,1111
3. Pervasive developmental disorder not otherwise specified.
SB40-SSA1-SA2,8,1512
(b) Except as provided in par. (d), every disability insurance policy, and every
13self-insured health plan of the state or a county, city, town, village, or school district,
14shall provide coverage for an insured of treatment for an autism spectrum disorder
15if the treatment is provided by any of the following:
SB40-SSA1-SA2,8,1616
1. A psychiatrist, as defined in s. 146.34 (1) (h).
SB40-SSA1-SA2,8,1717
2. A person who practices psychology, as described in s. 455.01 (5).
SB40-SSA1-SA2,8,1918
3. A social worker, as defined in s. 252.15 (1) (er), who is certified or licensed
19to practice psychotherapy, as defined in s. 457.01 (8m).
SB40-SSA1-SA2,8,2020
4. A speech-language pathologist, as defined in s. 459.20 (4).
SB40-SSA1-SA2,8,2221
5. A paraprofessional working under the supervision of a provider listed under
22subds. 1. to 4.
SB40-SSA1-SA2,8,2423
6. A professional working under the supervision of an outpatient mental health
24clinic certified under s. 51.038.
SB40-SSA1-SA2,9,3
1(c) The coverage required under par. (b) may be subject to any limitations,
2exclusions, and cost-sharing provisions that apply generally under the disability
3insurance policy or self-insured health plan.
SB40-SSA1-SA2,9,44
(d) This subsection does not apply to any of the following:
SB40-SSA1-SA2,9,55
1. A disability insurance policy that covers only certain specified diseases.
SB40-SSA1-SA2,9,86
2. A health care plan offered by a limited service health organization, as defined
7in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
8a defined network plan, as defined in s. 609.01 (1b).
SB40-SSA1-SA2,9,99
3. A long-term care insurance policy.
SB40-SSA1-SA2,9,1010
4. A medicare replacement policy or a medicare supplement policy.".
