The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB362-SSA1,3,63
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, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
6(6), 632.885,
632.89, 632.895 (5m) and (8) to (17), and 632.896.
SB362-SSA1,4,4
140.51
(8m) Every health care coverage plan offered by the group insurance
2board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
3632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885,
632.89, and 632.895
4(11) to (17).
SB362-SSA1,4,106
46.10
(8) (d) After due regard to the case and to a spouse and minor children
7who are lawfully dependent on the property for support, compromise or waive any
8portion of any claim of the state or county for which a person specified under sub. (2)
9is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
10by any other 3rd party.
SB362-SSA1, s. 4
11Section
4. 46.10 (14) (a) of the statutes is amended to read:
SB362-SSA1,5,212
46.10
(14) (a) Except as provided in pars. (b) and (c), liability of a person
13specified in sub. (2) or s. 46.03 (18) for inpatient care and maintenance of persons
14under 18 years of age at community mental health centers, a county mental health
15complex under s. 51.08, the centers for the developmentally disabled, the Mendota
16Mental Health Institute, and the Winnebago Mental Health Institute or care and
17maintenance of persons under 18 years of age in residential, nonmedical facilities
18such as group homes, foster homes, treatment foster homes, subsidized
19guardianship homes, residential care centers for children and youth, and juvenile
20correctional institutions is determined in accordance with the cost-based fee
21established under s. 46.03 (18). The department shall bill the liable person up to any
22amount of liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by other
233rd-party benefits, subject to rules that include formulas governing ability to pay
24promulgated by the department under s. 46.03 (18). Any liability of the patient not
1payable by any other person terminates when the patient reaches age 18, unless the
2liable person has prevented payment by any act or omission.
SB362-SSA1,5,84
49.345
(8) (d) After due regard to the case and to a spouse and minor children
5who are lawfully dependent on the property for support, compromise or waive any
6portion of any claim of the state or county for which a person specified under sub. (2)
7is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
8by any other 3rd party.
SB362-SSA1, s. 6
9Section
6. 49.345 (14) (a) of the statutes is amended to read:
SB362-SSA1,5,2010
49.345
(14) (a) Except as provided in pars. (b) and (c), liability of a person
11specified in sub. (2) or s. 49.32 (1) for care and maintenance of persons under 18 years
12of age in residential, nonmedical facilities such as group homes, foster homes,
13treatment foster homes, subsidized guardianship homes, and residential care
14centers for children and youth is determined in accordance with the cost-based fee
15established under s. 49.32 (1). The department shall bill the liable person up to any
16amount of liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by other
173rd-party benefits, subject to rules that include formulas governing ability to pay
18established by the department under s. 49.32 (1). Any liability of the person not
19payable by any other person terminates when the person reaches age 18, unless the
20liable person has prevented payment by any act or omission.
SB362-SSA1,6,323
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
24a village provides health care benefits under its home rule power, or if a town
25provides health care benefits, to its officers and employees on a self-insured basis,
1the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
2632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5),
3and (6), 632.885,
632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB362-SSA1, s. 8
4Section
8. 111.91 (2) (qm) of the statutes is created to read:
SB362-SSA1,6,75
111.91
(2) (qm) The requirements under s. 632.89 relating to coverage of
6treatment for nervous and mental disorders and alcoholism and other drug
7problems.
SB362-SSA1,6,1310
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1149.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
12632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885,
632.89, 632.895 (9) to (17),
13632.896, and 767.513 (4).
SB362-SSA1,6,1916
185.981 (4t) A sickness care plan operated by a cooperative association is
17subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
18632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885,
632.89, 632.895 (10) to
19(17), and 632.897 (10) and chs. 149 and 155.
SB362-SSA1,7,322
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
23exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
24601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
25631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
1632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885,
632.89, 632.895 (5) and (9) to (17),
2632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
3association shall:
SB362-SSA1,7,95
301.12
(8) (d) After due regard to the case and to a spouse and minor children
6who are lawfully dependent on the property for support, compromise or waive any
7portion of any claim of the state or county for which a person specified under sub. (2)
8is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
9by any other 3rd party.
SB362-SSA1,7,2111
301.12
(14) (a) Except as provided in pars. (b) and (c), liability of a person
12specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
13years of age in residential, nonmedical facilities such as group homes, foster homes,
14treatment foster homes, residential care centers for children and youth and juvenile
15correctional institutions is determined in accordance with the cost-based fee
16established under s. 301.03 (18). The department shall bill the liable person up to
17any amount of liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by
18other 3rd-party benefits, subject to rules which include formulas governing ability
19to pay promulgated by the department under s. 301.03 (18). Any liability of the
20resident not payable by any other person terminates when the resident reaches age
2117, unless the liable person has prevented payment by any act or omission.
SB362-SSA1,7,24
23609.71 Coverage of alcoholism and other diseases. Defined network
24plans are subject to s. 632.89.
SB362-SSA1,8,2
1632.89 (title)
Required coverage of Coverage of mental disorders,
2alcoholism, and other diseases.
SB362-SSA1,8,54
632.89
(1) (at) "Group health benefit plan" has the meaning given in s. 632.745
5(9).
SB362-SSA1, s. 17
6Section
17. 632.89 (1) (b) of the statutes is repealed and recreated to read:
SB362-SSA1,8,77
632.89
(1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
SB362-SSA1, s. 18
8Section
18. 632.89 (1) (em) of the statutes is repealed and recreated to read:.
SB362-SSA1,8,109
632.89
(1) (em) "Self-insured health plan" has the meaning given in s. 632.745
10(24).
SB362-SSA1, s. 19
11Section
19. 632.89 (2) (title) of the statutes is amended to read:
SB362-SSA1,8,1212
632.89
(2) (title)
Required coverage
for group plans.
SB362-SSA1, s. 20
13Section
20. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
14amended to read:
SB362-SSA1,8,1915
632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
16policy issued by an insurer health benefit plan and a self-insured health plan shall
17provide coverage of nervous and mental disorders and alcoholism and other drug
18abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 19(dm) and subs. (3) to (3f).
SB362-SSA1, s. 23
22Section
23. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
23amended to read:
SB362-SSA1,9,324
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
25group
or blanket disability insurance policy issued by an insurer health benefit plan
1or a self-insured health plan provides coverage of any inpatient hospital treatment,
2the
policy plan shall provide coverage for inpatient hospital services for the
3treatment of conditions under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 25
5Section
25. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
6amended to read:
SB362-SSA1,9,117
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
8blanket disability insurance policy issued by an insurer health benefit plan or a
9self-insured health plan provides coverage of any outpatient treatment, the
policy 10plan shall provide coverage for outpatient services for the treatment of conditions
11under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 27
13Section
27. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
14and amended to read:
SB362-SSA1,9,2015
632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
16arrangements. If a group
or blanket disability insurance policy issued by an insurer 17health benefit plan or a self-insured health plan provides coverage of any inpatient
18hospital treatment or any outpatient treatment, the
policy plan shall provide
19coverage for transitional treatment arrangements for the treatment of conditions
20under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 29
22Section
29. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
23amended to read:
SB362-SSA1,9,2624
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
25not apply to a health care plan offered by a limited service health organization, as
1defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
2that is not a defined network plan, as defined in s. 609.01 (1b).
SB362-SSA1, s. 30
3Section
30. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
SB362-SSA1,10,195
632.89
(3) Limitations. For a group health benefit plan and a self-insured
6health plan that provide coverage of the treatment of nervous and mental disorders
7and alcoholism and other drug abuse problems, and for an individual health benefit
8plan that provides coverage of the treatment of nervous and mental disorders or
9alcoholism and other drug abuse problems, the exclusions and limitations;
10deductibles; copayments; coinsurance; annual and lifetime payment limitations;
11out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
12limitations regarding referrals to nonphysician providers and treatment programs;
13and duration or frequency of coverage limits under the plan may be no more
14restrictive for coverage of the treatment of nervous and mental disorders or
15alcoholism and other drug abuse problems than the most common or frequent type
16of treatment limitations applied to substantially all other coverage under the plan.
17The plan shall include in any overall deductible amount or annual or lifetime limit
18or out-of-pocket limit for the plan, expenses incurred for the treatment of nervous
19and mental disorders or alcoholism and other drug abuse problems.
SB362-SSA1,11,521
632.89
(3c) Exemption for cost increase. (a) Notwithstanding sub. (3), an
22employer that provides health care coverage for its employees through a group
23health benefit plan or a self-insured health plan that provides coverage of the
24treatment of nervous and mental disorders and alcoholism and other drug abuse
25problems may elect for the employer's plan to be exempt from the requirements
1under sub. (3) during the plan year following any plan year in which, as a result of
2the requirements under sub. (3), there is an increase under the plan in the employer's
3total cost of coverage for the treatment of physical conditions and nervous and
4mental disorders and alcoholism and other drug abuse problems by a percentage that
5exceeds either of the following:
SB362-SSA1,11,66
1. Two percent in the first plan year in which the requirements apply.
SB362-SSA1,11,87
2. One percent in any plan year after the first plan year in which the
8requirements apply.
SB362-SSA1,11,179
(b) A cost increase specified under par. (a) may not be determined until the
10employer's group health benefit plan or self-insured health plan has complied with
11the requirements under sub. (3) for at least the first 6 months of the plan year for
12which the increase is to be determined. The cost increase shall be determined, and
13certified, by a qualified actuary, as defined in s. 623.06 (1c). A copy of the actuary's
14determination, and all underlying documentation that the actuary relied on in
15making the determination, shall be filed with and, in accordance with rules
16promulgated by the commissioner, retained by the insurer issuing the group health
17benefit plan or by the self-insured health plan.
SB362-SSA1,11,2118
(c) A group health benefit plan or a self-insured health plan that qualifies for
19an exemption under par. (a) and for which the employer providing coverage under
20the plan has elected for the plan to be exempt from the requirements under sub. (3)
21during a plan year shall promptly notify all enrollees under the plan.
SB362-SSA1,12,222
(d) Regardless of a cost increase as specified in par. (a), an employer may elect
23for the employer's plan to continue to be subject to the requirements under sub. (3).
24If an employer elects for the employer's plan to be exempt from the requirements
25under sub. (3), during the plan year in which it is exempt the group health benefit
1plan or self-insured health plan shall comply with the coverage requirements under
2s. 632.89 (2) (a) to (dm), 2007 stats.
SB362-SSA1,12,104
632.89
(3f) Exemption for small employers. (a) Notwithstanding sub. (3), an
5employer that provides health care coverage for its employees through a group
6health benefit plan that provides coverage of the treatment of nervous and mental
7disorders and alcoholism and other drug abuse problems may elect for the employer's
8plan to be exempt from the requirements under sub. (3) during a plan year if, on the
9first day of the plan year, the employer will have fewer than 10 eligible employees,
10as defined in s. 632.745 (5).
SB362-SSA1,12,1711
(b) A group health benefit plan that qualifies for an exemption under par. (a)
12and for which the employer providing coverage under the plan has elected for the
13plan to be exempt from the requirements under sub. (3) during a plan year shall
14promptly notify all enrollees under the employer's plan. During the plan year in
15which it is exempt from the requirements under sub. (3), the group health benefit
16plan shall comply with the coverage requirements under s. 632.89 (2) (a) to (dm),
172007 stats.
SB362-SSA1,13,1020
632.89
(3p) Availability of plan information. A group health benefit plan and
21a self-insured health plan that provide coverage of the treatment of nervous and
22mental disorders and alcoholism and other drug abuse problems, and an individual
23health benefit plan that provides coverage of the treatment of nervous and mental
24disorders or alcoholism and other drug abuse problems, shall, upon request, make
25available to any current or potential insured, participant, beneficiary, or contracting
1provider the criteria for determining medical necessity under the plan with respect
2to that coverage. If a group health benefit plan or a self-insured health plan that
3provides coverage of the treatment of nervous and mental disorders and alcoholism
4and other drug abuse problems denies any particular insured, participant, or
5beneficiary coverage for services for that treatment, or if an individual health benefit
6plan that provides coverage of the treatment of nervous and mental disorders or
7alcoholism and other drug abuse problems denies any particular insured coverage
8for services for that treatment, the plan shall, upon request, make the reason for the
9denial available to the insured, participant, or beneficiary, in addition to complying
10with s. 632.857, if applicable.
SB362-SSA1, s. 36
11Section
36. 632.89 (4) (title) of the statutes is repealed and recreated to read:
SB362-SSA1,13,1212
632.89
(4) (title)
Rules.
SB362-SSA1, s. 37
13Section
37. 632.89 (4) of the statutes is renumbered 632.89 (4) (a).
SB362-SSA1,13,2215
632.89
(4) (b) 1. The commissioner shall promulgate rules for the
16administration of this section, including rules that specify the information that must
17be provided in the notices under subs. (3c) (c) and (3f) (b) and the manner in which
18the notices must be given, that specify who is responsible for the actuarial study and
19determination under sub. (3c) (b), and that specify retention requirements for the
20determination and underlying documentation. In promulgating the rules, the
21commissioner shall follow, as a minimum standard, any relevant federal regulations
22or guidelines that are in effect.
SB362-SSA1,14,523
2. Using the procedure under s. 227.24, the commissioner may promulgate the
24rules under subd. 1. for the period before the effective date of any permanent rules
25promulgated under subd. 1., but not to exceed the period authorized under s. 227.24
1(1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the commissioner
2is not required to provide evidence that promulgating a rule under this subdivision
3as an emergency rule is necessary for the preservation of the public peace, health,
4safety, or welfare and is not required to make a finding of emergency for a rule
5promulgated under this subdivision.
SB362-SSA1, s. 39
6Section
39. 632.89 (5) (title) of the statutes is repealed and recreated to read:
SB362-SSA1,14,77
632.89
(5) (title)
Exclusions.
SB362-SSA1, s. 40
8Section
40. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
SB362-SSA1, s. 41
9Section
41. 632.89 (5) (a) (title) of the statutes is created to read:
SB362-SSA1,14,1010
632.89
(5) (a) (title)
Medicare.
SB362-SSA1,14,1412
632.89
(5) (c)
Coverage of autism treatment. This section does not apply to
13coverage of treatment for autism spectrum disorder, as defined in s. 632.895 (12m)
14(a) 1., to which s. 632.895 (12m) applies.
SB362-SSA1,14,1818
(1) This act first applies to all of the following:
SB362-SSA1,14,2119
(a) Except as provided in paragraphs (b) and (c
), health benefit plans that are
20issued or renewed, and governmental self-insured health plans that are established,
21extended, modified, or renewed, on the effective date of this paragraph.
SB362-SSA1,14,2422
(b) Health benefit plans covering employees who are affected by a collective
23bargaining agreement containing provisions inconsistent with this act that are
24issued or renewed on the earlier of the following: