AB75-SSA1, s. 3197r 15Section 3197r. 632.89 (1) (dm) of the statutes is created to read:
AB75-SSA1,1614,1816 632.89 (1) (dm) "Licensed mental health professional" means a clinical social
17worker who is licensed under ch. 457, a marriage and family therapist who is licensed
18under s. 457.10, or a professional counselor who is licensed under s. 457.12.
AB75-SSA1, s. 3197s 19Section 3197s. 632.89 (1) (e) 3. of the statutes is repealed and recreated to
20read:
AB75-SSA1,1614,2121 632.89 (1) (e) 3. A psychologist licensed under ch. 455.
AB75-SSA1, s. 3197t 22Section 3197t. 632.89 (1) (e) 4. of the statutes is created to read:
AB75-SSA1,1614,2423 632.89 (1) (e) 4. A licensed mental health professional practicing within the
24scope of his or her license under ch. 457 and applicable rules.
AB75-SSA1, s. 3197w 25Section 3197w. 632.895 (12m) of the statutes is created to read:
AB75-SSA1,1615,2
1632.895 (12m) Treatment for autism spectrum disorders. (a) In this
2subsection:
AB75-SSA1,1615,33 1. "Autism spectrum disorder" means any of the following:
AB75-SSA1,1615,44 a. Autism disorder.
AB75-SSA1,1615,55 b. Asperger's syndrome.
AB75-SSA1,1615,66 c. Pervasive developmental disorder not otherwise specified.
AB75-SSA1,1615,87 2. "Insured" includes an enrollee and a dependent with coverage under the
8disability insurance policy or self-insured health plan.
AB75-SSA1,1615,119 3. "Intensive-level services" means evidence-based behavioral therapy that is
10designed to help an individual with autism spectrum disorder overcome the
11cognitive, social, and behavioral deficits associated with that disorder.
AB75-SSA1,1615,1612 4. "Nonintensive-level services" means therapy that occurs after the
13completion of treatment with intensive-level services and that is designed to sustain
14and maximize gains made during treatment with intensive-level services or, for an
15individual who has not and will not receive intensive-level services, therapy that
16will improve the individual's condition.
AB75-SSA1,1615,1717 5. "Physician" has the meaning given in s. 146.34 (1) (g).
AB75-SSA1,1615,2318 (b) Subject to pars. (c) and (d), and except as provided in par. (e), every disability
19insurance policy, and every self-insured health plan of the state or a county, city,
20town, village, or school district, shall provide coverage for an insured of treatment
21for the mental health condition of autism spectrum disorder if the treatment is
22prescribed by a physician and provided by any of the following who are qualified to
23provide intensive-level services or nonintensive-level services:
AB75-SSA1,1615,2424 1. A psychiatrist, as defined in s. 146.34 (1) (h).
AB75-SSA1,1615,2525 2. A person who practices psychology, as described in s. 455.01 (5).
AB75-SSA1,1616,2
13. A social worker, as defined in s. 252.15 (1) (er), who is certified or licensed
2to practice psychotherapy, as defined in s. 457.01 (8m).
AB75-SSA1,1616,43 4. A paraprofessional working under the supervision of a provider listed under
4subds. 1. to 3.
AB75-SSA1,1616,65 5. A professional working under the supervision of an outpatient mental health
6clinic certified under s. 51.038.
AB75-SSA1,1616,77 6. A speech-language pathologist, as defined in s. 459.20 (4).
AB75-SSA1,1616,88 7. An occupational therapist, as defined in s. 448.96 (4).
AB75-SSA1,1616,179 (c) 1. The coverage required under par. (b) shall provide at least $60,000 for
10intensive-level services per insured per year, with a minimum of 30 to 35 hours of
11care per week for a minimum duration of 4 years, and at least $30,000 for
12nonintensive-level services per insured per year, except that these minimum
13coverage monetary amounts shall be adjusted annually, beginning in 2011, to reflect
14changes in the consumer price index for all urban consumers, U.S. city average, for
15the medical care group, as determined by the U.S. department of labor. The
16commissioner shall publish the new minimum coverage amounts under this
17subdivision each year, beginning in 2011, in the Wisconsin Administrative Register.
AB75-SSA1,1616,2118 2. Notwithstanding subd. 1., the minimum coverage monetary amounts or
19duration required for treatment under subd. 1., need not be met if it is determined
20by a supervising professional, in consultation with the insured's physician, that less
21treatment is medically appropriate.
AB75-SSA1,1616,2522 (d) The coverage required under par. (b) may be subject to deductibles,
23coinsurance, or copayments that generally apply to other conditions covered under
24the policy or plan. The coverage may not be subject to limitations or exclusions,
25including limitations on the number of treatment visits.
AB75-SSA1,1616,26
1(e) This subsection does not apply to any of the following:
AB75-SSA1,1617,22 1. A disability insurance policy that covers only certain specified diseases.
AB75-SSA1,1617,53 2. A health care plan offered by a limited service health organization, as defined
4in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
5a defined network plan, as defined in s. 609.01 (1b).
AB75-SSA1,1617,66 3. A long-term care insurance policy.
AB75-SSA1,1617,77 4. A medicare replacement policy or a medicare supplement policy.
AB75-SSA1,1617,128 (f) 1. The commissioner shall by rule further define "intensive-level services"
9and "nonintensive-level services" and define "paraprofessional" for purposes of par.
10(b) 4. and "qualified" for purposes of providing services under this subsection. The
11commissioner may promulgate rules governing the interpretation or administration
12of this subsection.
AB75-SSA1,1617,2013 2. Using the procedure under s. 227.24, the commissioner may promulgate the
14rules under subd. 1. for the period before the effective date of the permanent rules
15promulgated under subd. 1., but not to exceed the period authorized under s. 227.24
16(1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the commissioner
17is not required to provide evidence that promulgating a rule under this subdivision
18as an emergency rule is necessary for the preservation of the public peace, health,
19safety, or welfare and is not required to provide a finding of emergency for a rule
20promulgated under this subdivision.
AB75-SSA1, s. 3198 21Section 3198. 632.895 (14m) of the statutes is created to read:
AB75-SSA1,1617,2522 632.895 (14m) Coverage of dependents. (a) Subject to par. (b), every disability
23insurance policy, and every self-insured health plan of the state or a county, city,
24town, village, or school district, that provides coverage for a person as a dependent
25of an insured shall provide dependent coverage for a child of an insured.
AB75-SSA1,1618,2
1(b) A policy or plan is not required to provide dependent coverage for a child of
2an insured if any of the following applies:
AB75-SSA1,1618,33 1. The child is 27 years of age or older.
AB75-SSA1,1618,44 2. The child is married.
AB75-SSA1,1618,55 3. The child has other health care coverage.
AB75-SSA1,1618,76 4. The child is employed full time and his or her employer offers health care
7coverage to its employees.
AB75-SSA1,1618,98 5. Coverage of the insured through whom the child has dependent coverage
9under the policy or plan is discontinued or not renewed.
AB75-SSA1, s. 3198d 10Section 3198d. 632.895 (17) of the statutes is created to read:
AB75-SSA1,1618,1311 632.895 (17) Contraceptives and services. (a) In this subsection,
12"contraceptives" means drugs or devices approved by the federal food and drug
13administration to prevent pregnancy.
AB75-SSA1,1618,1714 (b) Every disability insurance policy, and every self-insured health plan of the
15state or of a county, city, town, village, or school district, that provides coverage of
16outpatient health care services, preventive treatments and services, or prescription
17drugs and devices shall provide coverage for all of the following:
AB75-SSA1,1618,1918 1. Contraceptives prescribed by a health care provider, as defined in s. 146.81
19(1).
AB75-SSA1,1618,2220 2. Outpatient consultations, examinations, procedures, and medical services
21that are necessary to prescribe, administer, maintain, or remove a contraceptive, if
22covered for any other drug benefits under the policy or plan.
AB75-SSA1,1619,223 (c) Coverage under par. (b) may be subject only to the exclusions, limitations,
24or cost-sharing provisions that apply generally to the coverage of outpatient health

1care services, preventive treatments and services, or prescription drugs and devices
2that is provided under the policy or self-insured health plan.
AB75-SSA1,1619,33 (d) This subsection does not apply to any of the following:
AB75-SSA1,1619,44 1. A disability insurance policy that covers only certain specified diseases.
AB75-SSA1,1619,75 2. A disability insurance policy, or a self-insured health plan of the state or a
6county, city, town, village, or school district, that provides only limited-scope dental
7or vision benefits.
AB75-SSA1,1619,108 3. A health care plan offered by a limited service health organization, as defined
9in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
10a defined network plan, as defined in s. 609.01 (1b).
AB75-SSA1,1619,1111 4. A long-term care insurance policy.
AB75-SSA1,1619,1212 5. A Medicare replacement policy or a Medicare supplement policy.
AB75-SSA1, s. 3199 13Section 3199. Chapter 648 of the statutes is created to read:
AB75-SSA1,1619,1414 CHAPTER 648
AB75-SSA1,1619,1615 Regulation of Care
16 Management Organizations
AB75-SSA1,1619,17 17648.01 Definitions. In this chapter:
AB75-SSA1,1619,19 18(1) "Care management organization" means an entity described in s. 46.284
19(3m).
AB75-SSA1,1619,20 20(2) "Department" means the department of health services.
AB75-SSA1,1619,21 21(3) "Enrollee" has the meaning given in s. 46.2805 (3).
AB75-SSA1,1619,23 22(4) "Permittee" means a care management organization issued a permit under
23this chapter.
AB75-SSA1,1619,25 24648.03 Applicability of other laws. Notwithstanding s. 600.01 (1) (b) 10. a.,
25ss. 600.01, 600.02, 600.03, and 600.12 apply to this chapter.
AB75-SSA1,1620,3
1648.05 Permit. (1) Permit required. After December 31, 2009, no care
2management organization may provide services to its enrollees without a permit
3under this chapter.
AB75-SSA1,1620,5 4(2) Application. A care management organization applying for a permit shall
5submit all of the following information in the format required by the commissioner:
AB75-SSA1,1620,86 (a) The names, addresses and occupations of all controlling persons and
7directors and principal officers of the care management organization currently and
8for the preceding 10 years, unless the commissioner waives this requirement.
AB75-SSA1,1620,109 (b) Business organization documents, including articles and bylaws if
10applicable.
AB75-SSA1,1620,1311 (c) A business plan approved by the department, including a projection of the
12anticipated operating results at the end of each of the next 3 years of operation, based
13on reasonable estimates of income and operating expenses.
AB75-SSA1,1620,1514 (d) Any other relevant documents or information that the commissioner
15reasonably requires after consulting with the department.
AB75-SSA1,1620,18 16(3) Standards for issuing permit. The commissioner may issue a permit to the
17care management organization if the commissioner finds, after consulting with the
18department, all of the following:
AB75-SSA1,1620,1919 (a) All requirements of law have been met.
AB75-SSA1,1620,2320 (b) All the directors and principal officers or any controlling person are
21trustworthy and competent and collectively have the competence and experience to
22engage in the proposed services and are not excluded from participation under 42
23USC 1320a-7
or 42 USC 1320a-7a.
AB75-SSA1,1620,2524 (c) The business plan is consistent with the interests of the care management
25organization's enrollees and the public.
AB75-SSA1,1621,3
1(4) Suspension or revocation. The commissioner may suspend or revoke a
2permit issued under this chapter if the commissioner finds, after consulting with the
3department, any of the following:
AB75-SSA1,1621,54 (a) The permittee violated a law or rule, including a rule establishing standards
5for the financial condition of care management organizations.
AB75-SSA1,1621,66 (b) The permittee is in a financially hazardous condition.
AB75-SSA1,1621,87 (c) The permittee is controlled or managed by persons who are incompetent or
8untrustworthy.
AB75-SSA1,1621,99 (d) The permittee conceals records from the commissioner.
AB75-SSA1,1621,1010 (e) The permittee's business plan is not in the public interest or is not prudent.
AB75-SSA1,1621,1211 (f) The permittee ceases to be certified by or maintain a contract with the
12department.
AB75-SSA1,1621,14 13648.10 Powers and duties of the commissioner. The commissioner may
14do any of the following:
AB75-SSA1,1621,17 15(1) Promulgate rules that are necessary to carry out the intent of this chapter,
16including, after consulting with the department, standards for the financial
17condition of care management organizations.
AB75-SSA1,1621,21 18(2) Use the authority granted under ss. 601.41, 601.42, 601.43, 601.44, 601.61,
19601.62, 601.63, and 601.64, including the authority to issue orders, to enforce this
20chapter and to ensure that a care management organization has sufficient financial
21resources.
AB75-SSA1,1621,23 22648.15 Reports and replies. (1) Reports. The commissioner may require
23from any care management organization any of the following:
AB75-SSA1,1622,3
1(a) Statements, reports, answers to questionnaires, and other information in
2whatever reasonable form the commissioner designates and at such reasonable
3intervals as the commissioner chooses, or from time to time.
AB75-SSA1,1622,54 (b) Full explanation of the programming of any data storage or communication
5system in use.
AB75-SSA1,1622,86 (c) Information from any books, records, electronic data processing systems,
7computers, or any other information storage system at any reasonable time in any
8reasonable manner.
AB75-SSA1,1622,109 (d) Statements, reports, audits, or certification from a certified public
10accountant or an actuary approved by the commissioner.
AB75-SSA1,1622,13 11(2) Forms. The commissioner, after consulting with the department, may
12prescribe forms for the reports under sub. (1) and specify who shall execute or certify
13such reports.
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