LRBs0220/2
TJD:cjs:ph
2009 - 2010 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 2,
TO 2009 ASSEMBLY BILL 207
February 8, 2010 - Offered by Representative Benedict.
AB207-ASA2,1,5 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t)
2and 185.983 (1) (intro.); and to create 146.97, 609.895 and 632.792 of the
3statutes; relating to: requiring that patients be informed of any charge for
4clinic services and requiring disclosure of insurance coverage of a charge for
5clinic services.
Analysis by the Legislative Reference Bureau
This substitute amendment requires a health care facility or health care
provider that itemizes a charge for clinic services to notify a patient that it may
impose the charge for clinic services in addition to the charge for services provided
by the health care provider during a health care facility visit. The health care facility
or health care provider must make the notification orally at the time the
appointment is made if the patient makes the appointment in person or by telephone
and electronically or in writing within 24 hours after the appointment is made if the
patient makes the appointment electronically. Upon request of the patient, the
health care facility or health care provider must provide the patient with a good faith
estimate of the charge for clinic services before the end of the second business day
after the day the patient makes the request for the estimate. On any bill imposing
the charge, the health care facility or health care provider must identify the charge

as a "charge for clinic services" but may charge an amount different from the amount
given in a good faith estimate. A health care facility or health care provider is not
required to make the notification that a charge for clinic services may be imposed if
either 1) the health care facility or health care provider provided the notification
within the 12 months before the appointment is requested for a health care facility
visit for the same services or 2) the health care facility or health care provider
previously provided the notification and the patient had a health care facility visit
for the same services within the 12 months before the appointment is requested.
Beginning on January 1, 2011, this substitute amendment also requires health
insurance policies and self-insured governmental and school district health plans to
disclose in a policy, plan, or certificate of coverage all of the following regarding the
charge for clinic services: whether the policy or plan covers a charge for clinic services
and to what extent the charge is covered, whether the policy or plan imposes
limitations on the coverage of the charge for clinic services, and whether a patient's
payment of all or part of the charge for clinic services counts toward any deductible
under the policy or plan. The disclosure requirement applies to individual and group
health insurance policies, including limited service health organizations, preferred
provider plans, defined network plans, and cooperative sickness care associations;
to health care plans, including a self-insured plan, offered by the state to its
employees; and to self-insured health plans of a city, town, village, county, or school
district.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB207-ASA2, s. 1 1Section 1. 40.51 (8) of the statutes, as affected by 2009 Wisconsin Act 28, is
2amended to read:
AB207-ASA2,2,63 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
4shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
5and (10), 632.747, 632.748, 632.792, 632.83, 632.835, 632.85, 632.853, 632.855,
6632.87 (3) to (6), 632.885, 632.895 (5m) and (8) to (17), and 632.896.
AB207-ASA2, s. 2 7Section 2. 40.51 (8m) of the statutes, as affected by 2009 Wisconsin Act 28, is
8amended to read:
AB207-ASA2,3,29 40.51 (8m) Every health care coverage plan offered by the group insurance
10board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,

1632.748, 632.792, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885, and 632.895
2(11) to (17).
AB207-ASA2, s. 3 3Section 3. 66.0137 (4) of the statutes, as affected by 2009 Wisconsin Act 28,
4is amended to read:
AB207-ASA2,3,105 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
6a village provides health care benefits under its home rule power, or if a town
7provides health care benefits, to its officers and employees on a self-insured basis,
8the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
9632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.792, 632.85, 632.853, 632.855, 632.87
10(4), (5), and (6), 632.885, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB207-ASA2, s. 4 11Section 4. 120.13 (2) (g) of the statutes, as affected by 2009 Wisconsin Act 28,
12is amended to read:
AB207-ASA2,3,1613 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
15632.792, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.895 (9) to
16(17), 632.896, and 767.513 (4).
AB207-ASA2, s. 5 17Section 5. 146.97 of the statutes is created to read:
AB207-ASA2,3,18 18146.97 Charges for clinic services. (1) In this section:
AB207-ASA2,3,2319 (a) "Charge for clinic services" means a billing charge by a health care facility
20or a health care provider for use of the health care facility during a patient's health
21care facility visit with a health care provider indicated by a billing code for clinic
22services under the Healthcare Common Procedure Coding System, as described in
2345 CFR 162.1002.
AB207-ASA2,3,2524 (b) "Clinic" means a place that is used primarily for the provision of services
25of a health care provider.
AB207-ASA2,4,2
1(c) "Health care facility" has the meaning given in s. 146.997 (1) (c) and includes
2a clinic and an ambulatory surgery center, as defined in s. 153.01 (1g).
AB207-ASA2,4,33 (d) "Health care provider" has the meaning given in s. 146.81 (1) (a) to (k).
AB207-ASA2,4,6 4(2) Except as provided in sub. (3), if a health care facility or a health care
5provider itemizes on a bill a charge for clinic services, the health care facility or
6health care provider shall do all of the following:
AB207-ASA2,4,117 (a) 1. If a patient makes an appointment for a health care facility visit in person
8or over the telephone, notify the patient orally at the time the appointment is made
9that the patient may receive, in addition to a charge for the services provided by the
10health care provider during the visit, a charge for clinic services, which may be on
11a separate bill.
AB207-ASA2,4,1612 2. If a patient makes an appointment for a health care facility visit
13electronically, notify the patient electronically or in writing within 24 hours of the
14health care provider receiving the electronic appointment request that the patient
15may receive, in addition to a charge for the services provided by the health care
16provider during the visit, a charge for clinic services, which may be on a separate bill.
AB207-ASA2,4,1917 (b) Upon request of the patient and before the end of the 2nd business day after
18the day on which the request is made, provide the patient with a good faith estimate
19of the charge for clinic services.
AB207-ASA2,4,2120 (c) Identify in any bill for the health care facility visit the charge for clinic
21services as a "clinic service charge."
AB207-ASA2,4,23 22(3) A health care facility or health care provider is not required to provide the
23notification under sub. (2) (a) 1. or 2. if one of the following applies:
AB207-ASA2,5,224 (a) Within the 12 months immediately preceding the patient's request for the
25appointment, the health care facility or health care provider provided the patient the

1notification under sub. (2) (a) 1. or 2. for a health care facility visit for the same
2services.
AB207-ASA2,5,73 (b) Before the patient requested the appointment, the health care facility or
4health care provider provided the patient the notification under sub. (2) (a) 1. or 2.
5for a health care facility visit for the same services, and the patient had a visit for the
6same services within the 12 months immediately preceding the patient's request for
7the appointment.
AB207-ASA2,5,10 8(4) The health care facility or the health care provider may charge to the
9patient an actual charge for clinic services that is different from the good faith
10estimate of the charge for clinic services provided under sub. (2) (b).
AB207-ASA2, s. 6 11Section 6. 185.981 (4t) of the statutes, as affected by 2009 Wisconsin Act 28,
12is amended to read:
AB207-ASA2,5,1613 185.981 (4t) A sickness care plan operated by a cooperative association is
14subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.792,
15632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (10) to
16(17), and 632.897 (10) and chs. 149 and 155.
AB207-ASA2, s. 7 17Section 7. 185.983 (1) (intro.) of the statutes, as affected by 2009 Wisconsin
18Act 28
, is amended to read:
AB207-ASA2,5,2519 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
20exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
21601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
22631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.792, 632.795, 632.85,
23632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (5) and (9) to (17),
24632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
25association shall:
AB207-ASA2, s. 8
1Section 8. 609.895 of the statutes is created to read:
AB207-ASA2,6,4 2609.895 Disclosure of charge for clinic services coverage. Limited
3service health organizations, preferred provider plans, and defined network plans
4are subject to s. 632.792.
AB207-ASA2, s. 9 5Section 9. 632.792 of the statutes is created to read:
AB207-ASA2,6,7 6632.792 Disclosure of charge for clinic services coverage. (1)
7Definitions. In this section:
AB207-ASA2,6,88 (a) "Charge for clinic services" has the meaning given in s. 146.97 (1) (a).
AB207-ASA2,6,99 (b) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB207-ASA2,6,1010 (c) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
AB207-ASA2,6,13 11(2) Required disclosure. Every disability insurance policy and every
12self-insured health plan shall disclose of all of the following in any policy, plan, or
13certificate of coverage:
AB207-ASA2,6,1414 (a) Whether the policy or plan covers a charge for clinic services.
AB207-ASA2,6,1515 (b) The extent of, and limitations on, coverage of a charge for clinic services.
AB207-ASA2,6,1716 (c) Whether a patient's payment for all or part of a charge for clinic services
17counts toward satisfying any deductible amount under the policy or plan.
AB207-ASA2, s. 10 18Section 10 . Initial applicability.
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