Amendment ASA2-AB207

AB207-ASA2, s. 4 Section 4. 120.13 (2) (g) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

AB207-ASA2,3,16 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.792, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.895 (9) to (17), 632.896, and 767.513 (4).

AB207-ASA2, s. 5 Section 5. 146.97 of the statutes is created to read:

AB207-ASA2,3,18 146.97 Charges for clinic services. (1) In this section:

AB207-ASA2,3,23 (a) "Charge for clinic services" means a billing charge by a health care facility or a health care provider for use of the health care facility during a patient's health care facility visit with a health care provider indicated by a billing code for clinic services under the Healthcare Common Procedure Coding System, as described in 45 CFR 162.1002.

AB207-ASA2,3,25 (b) "Clinic" means a place that is used primarily for the provision of services of a health care provider.

AB207-ASA2,4,2 (c) "Health care facility" has the meaning given in s. 146.997 (1) (c) and includes a clinic and an ambulatory surgery center, as defined in s. 153.01 (1g).

AB207-ASA2,4,3 (d) "Health care provider" has the meaning given in s. 146.81 (1) (a) to (k).

AB207-ASA2,4,6 (2) Except as provided in sub. (3), if a health care facility or a health care provider itemizes on a bill a charge for clinic services, the health care facility or health care provider shall do all of the following:

AB207-ASA2,4,11 (a) 1. If a patient makes an appointment for a health care facility visit in person or over the telephone, notify the patient orally at the time the appointment is made that the patient may receive, in addition to a charge for the services provided by the health care provider during the visit, a charge for clinic services, which may be on a separate bill.

AB207-ASA2,4,16 2. If a patient makes an appointment for a health care facility visit electronically, notify the patient electronically or in writing within 24 hours of the health care provider receiving the electronic appointment request that the patient may receive, in addition to a charge for the services provided by the health care provider during the visit, a charge for clinic services, which may be on a separate bill.

AB207-ASA2,4,19 (b) Upon request of the patient and before the end of the 2nd business day after the day on which the request is made, provide the patient with a good faith estimate of the charge for clinic services.

AB207-ASA2,4,21 (c) Identify in any bill for the health care facility visit the charge for clinic services as a "clinic service charge."

AB207-ASA2,4,23 (3) A health care facility or health care provider is not required to provide the notification under sub. (2) (a) 1. or 2. if one of the following applies:

AB207-ASA2,5,2 (a) Within the 12 months immediately preceding the patient's request for the appointment, the health care facility or health care provider provided the patient the notification under sub. (2) (a) 1. or 2. for a health care facility visit for the same services.

AB207-ASA2,5,7 (b) Before the patient requested the appointment, the health care facility or health care provider provided the patient the notification under sub. (2) (a) 1. or 2. for a health care facility visit for the same services, and the patient had a visit for the same services within the 12 months immediately preceding the patient's request for the appointment.

AB207-ASA2,5,10 (4) The health care facility or the health care provider may charge to the patient an actual charge for clinic services that is different from the good faith estimate of the charge for clinic services provided under sub. (2) (b).

AB207-ASA2, s. 6 Section 6. 185.981 (4t) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

AB207-ASA2,5,16 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.792, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (10) to (17), and 632.897 (10) and chs. 149 and 155.

AB207-ASA2, s. 7 Section 7. 185.983 (1) (intro.) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

AB207-ASA2,5,25 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.792, 632.795, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (5) and (9) to (17), 632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association shall:

AB207-ASA2, s. 8 Section 8. 609.895 of the statutes is created to read:

AB207-ASA2,6,4 609.895 Disclosure of charge for clinic services coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.792.

AB207-ASA2, s. 9 Section 9. 632.792 of the statutes is created to read:

AB207-ASA2,6,7 632.792 Disclosure of charge for clinic services coverage. (1) Definitions. In this section:

AB207-ASA2,6,8 (a) "Charge for clinic services" has the meaning given in s. 146.97 (1) (a).

AB207-ASA2,6,9 (b) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

AB207-ASA2,6,10 (c) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).

AB207-ASA2,6,13 (2) Required disclosure. Every disability insurance policy and every self-insured health plan shall disclose of all of the following in any policy, plan, or certificate of coverage:

AB207-ASA2,6,14 (a) Whether the policy or plan covers a charge for clinic services.

AB207-ASA2,6,15 (b) The extent of, and limitations on, coverage of a charge for clinic services.

AB207-ASA2,6,17 (c) Whether a patient's payment for all or part of a charge for clinic services counts toward satisfying any deductible amount under the policy or plan.

AB207-ASA2, s. 10 Section 10 . Initial applicability.

AB207-ASA2,6,21 (1) The treatment of sections 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.895, and 632.792 of the statutes first applies to all of the following:

AB207-ASA2,6,25 (a) Except as provided in paragraphs (b) and (c), disability insurance policies that are issued or renewed, and governmental or school district self-insured health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.

AB207-ASA2,7,3 (b) Disability insurance policies covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

AB207-ASA2,7,4 1. The day on which the collective bargaining agreement expires.

AB207-ASA2,7,6 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB207-ASA2,7,10 (c) Governmental or school district self-insured health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified, or renewed on the earlier of the following:

AB207-ASA2,7,11 1. The day on which the collective bargaining agreement expires.

AB207-ASA2,7,13 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB207-ASA2, s. 11 Section 11. Effective dates. This act takes effect on the day after publication, except as follows:

AB207-ASA2,7,18 (1) The treatment of sections 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.895, and 632.792 of the statutes and Section 10 of this act take effect on January 1, 2011.

AB207-ASA2,7,19 (End)