Amendment ASA1-AB512

AB512-ASA1,11,8 2. One percent in any plan year after the first plan year in which the requirements apply.

AB512-ASA1,11,17 (b) A cost increase specified under par. (a) may not be determined until the employer's group health benefit plan or self-insured health plan has complied with the requirements under sub. (3) for at least the first 6 months of the plan year for which the increase is to be determined. The cost increase shall be determined, and certified, by a qualified actuary, as defined in s. 623.06 (1c). A copy of the actuary's determination, and all underlying documentation that the actuary relied on in making the determination, shall be filed with and, in accordance with rules promulgated by the commissioner, retained by the insurer issuing the group health benefit plan or by the self-insured health plan.

AB512-ASA1,11,21 (c) A group health benefit plan or a self-insured health plan that qualifies for an exemption under par. (a) and for which the employer providing coverage under the plan has elected for the plan to be exempt from the requirements under sub. (3) during a plan year shall promptly notify all enrollees under the plan.

AB512-ASA1,12,2 (d) Regardless of a cost increase as specified in par. (a), an employer may elect for the employer's plan to continue to be subject to the requirements under sub. (3). If an employer elects for the employer's plan to be exempt from the requirements under sub. (3), during the plan year in which it is exempt the group health benefit plan or self-insured health plan shall comply with the coverage requirements under s. 632.89 (2) (a) to (dm), 2007 stats.

AB512-ASA1, s. 33 Section 33. 632.89 (3f) of the statutes is created to read:

AB512-ASA1,12,10 632.89 (3f) Exemption for small employers. (a) Notwithstanding sub. (3), an employer that provides health care coverage for its employees through a group health benefit plan that provides coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems may elect for the employer's plan to be exempt from the requirements under sub. (3) during a plan year if, on the first day of the plan year, the employer will have fewer than 10 eligible employees, as defined in s. 632.745 (5).

AB512-ASA1,12,17 (b) A group health benefit plan that qualifies for an exemption under par. (a) and for which the employer providing coverage under the plan has elected for the plan to be exempt from the requirements under sub. (3) during a plan year shall promptly notify all enrollees under the employer's plan. During the plan year in which it is exempt from the requirements under sub. (3), the group health benefit plan shall comply with the coverage requirements under s. 632.89 (2) (a) to (dm), 2007 stats.

AB512-ASA1, s. 34 Section 34. 632.89 (3m) of the statutes is repealed.

AB512-ASA1, s. 35 Section 35. 632.89 (3p) of the statutes is created to read:

AB512-ASA1,13,10 632.89 (3p) Availability of plan information. A group health benefit plan and a self-insured health plan that provide coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems, and an individual health benefit plan that provides coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems, shall, upon request, make available to any current or potential insured, participant, beneficiary, or contracting provider the criteria for determining medical necessity under the plan with respect to that coverage. If a group health benefit plan or a self-insured health plan that provides coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems denies any particular insured, participant, or beneficiary coverage for services for that treatment, or if an individual health benefit plan that provides coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems denies any particular insured coverage for services for that treatment, the plan shall, upon request, make the reason for the denial available to the insured, participant, or beneficiary, in addition to complying with s. 632.857, if applicable.

AB512-ASA1, s. 36 Section 36. 632.89 (4) (title) of the statutes is repealed and recreated to read:

AB512-ASA1,13,12 632.89 (4) (title) Rules.

AB512-ASA1, s. 37 Section 37. 632.89 (4) of the statutes is renumbered 632.89 (4) (a).

AB512-ASA1, s. 38 Section 38. 632.89 (4) (b) of the statutes is created to read:

AB512-ASA1,13,22 632.89 (4) (b) 1. The commissioner shall promulgate rules for the administration of this section, including rules that specify the information that must be provided in the notices under subs. (3c) (c) and (3f) (b) and the manner in which the notices must be given, that specify who is responsible for the actuarial study and determination under sub. (3c) (b), and that specify retention requirements for the determination and underlying documentation. In promulgating the rules, the commissioner shall follow, as a minimum standard, any relevant federal regulations or guidelines that are in effect.

AB512-ASA1,14,5 2. Using the procedure under s. 227.24, the commissioner may promulgate the rules under subd. 1. for the period before the effective date of any permanent rules promulgated under subd. 1., but not to exceed the period authorized under s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the commissioner is not required to provide evidence that promulgating a rule under this subdivision as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to make a finding of emergency for a rule promulgated under this subdivision.

AB512-ASA1, s. 39 Section 39. 632.89 (5) (title) of the statutes is repealed and recreated to read:

AB512-ASA1,14,7 632.89 (5) (title) Exclusions.

AB512-ASA1, s. 40 Section 40. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).

AB512-ASA1, s. 41 Section 41. 632.89 (5) (a) (title) of the statutes is created to read:

AB512-ASA1,14,10 632.89 (5) (a) (title) Medicare.

AB512-ASA1, s. 42 Section 42. 632.89 (5) (c) of the statutes is created to read:

AB512-ASA1,14,14 632.89 (5) (c) Coverage of autism treatment. This section does not apply to coverage of treatment for autism spectrum disorder, as defined in s. 632.895 (12m) (a) 1., to which s. 632.895 (12m) applies.

AB512-ASA1, s. 43 Section 43. 632.89 (6) of the statutes is repealed.

AB512-ASA1, s. 44 Section 44. 632.89 (7) of the statutes is repealed.

AB512-ASA1, s. 45 Section 45. Initial applicability.

AB512-ASA1,14,18 (1) This act first applies to all of the following:

AB512-ASA1,14,21 (a) Except as provided in paragraphs (b) and (c ), health benefit plans that are issued or renewed, and governmental self-insured health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.

AB512-ASA1,14,24 (b) Health benefit plans 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:

AB512-ASA1,14,25 1. The day on which the collective bargaining agreement expires.

AB512-ASA1,15,2 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB512-ASA1,15,6 (c) Governmental 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:

AB512-ASA1,15,7 1. The day on which the collective bargaining agreement expires.

AB512-ASA1,15,9 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB512-ASA1, s. 46 Section 46. Effective date.

AB512-ASA1,15,12 (1) This act takes effect on the first day of the 7th month beginning after publication.

AB512-ASA1,15,13 (End)