AB111: Bill Text

LRB-1162/1

PJK:kaf:km

1997 - 1998 LEGISLATURE

1997 Assembly BILL 111

February 18, 1997 - Introduced by Representatives Schneider, Robson, Ziegelbauer, Gronemus, Baldwin, Notestein, L. Young, Boyle and Vander Loop. Referred to Committee on Consumer Affairs.

AB111,1,5 An Act to amend 40.51 (8), 185.981 (4t), 185.983 (1) (intro.) and 632.87 (1); and to create 111.91 (2) (n), 609.71 and 632.87 (6) of the statutes; relating to: requiring insurers to cover treatment of a condition by an acupuncturist if there is coverage for treatment of the condition by a physician and prohibiting collective bargaining with respect to the requirement.

Analysis by the Legislative Reference Bureau

This bill requires insurers, including health maintenance organizations, preferred provider plans, limited service health organizations and plans provided by the state, to cover the diagnosis and treatment of a condition by an acupuncturist, within the scope of the acupuncturist's certificate, if diagnosis and treatment of the condition by a physician is covered. Referral to an acupuncturist from a physician is not required for coverage of the acupuncture services.

Current law contains the same mandated coverage provision for chiropractic services if a condition is covered when treated by a physician, and for optometric services if vision care is covered and the same service or procedure is covered when provided by another health care provider.

The bill also provides that the coverage requirement for acupuncture services under plans provided by the state is not subject to collective bargaining by the state.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB111, s. 1 Section 1. 40.51 (8) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:

AB111,2,5 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.745 (1) to (3) and (5), 632.747, 632.87 (3) to (5) (6), 632.895 (5m) and (8) to (10) and 632.896.

AB111, s. 2 Section 2. 111.91 (2) (n) of the statutes is created to read:

AB111,2,8 111.91 (2) (n) The provision to employes of the health insurance coverage required under s. 632.87 (6).

AB111, s. 3 Section 3. 185.981 (4t) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:

AB111,2,13 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3), (4) and (5) to (6), 632.895 (10) and 632.897 (10) and ch. 155.

AB111, s. 4 Section 4. 185.983 (1) (intro.) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:

AB111,2,21 185.983 (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), 631.89, 631.93, 632.72 (2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m) , (3), (4) and (5) to (6), 632.895 (5), (9) and (10), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

AB111, s. 5 Section 5. 609.71 of the statutes is created to read:

AB111,3,3 609.71 Acupuncture coverage Health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.87 (6).

AB111, s. 6 Section 6. 632.87 (1) of the statutes is amended to read:

AB111,3,9 632.87 (1) No insurer may refuse to provide or pay for benefits for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the contract clearly excludes services by such practitioners, but no contract or plan may exclude services in violation of sub. (2), (2m), (3), (4) or, (5) or (6).

AB111, s. 7 Section 7. 632.87 (6) of the statutes is created to read:

AB111,3,16 632.87 (6) (a) No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by an acupuncturist who is certified under ch. 451, within the scope of the acupuncturist's certificate, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by a licensed physician or osteopath, even if different nomenclature is used to describe the condition or complaint. This paragraph does not:

AB111,3,18 1. Prohibit the application of deductibles or coinsurance provisions to acupuncturist and physician charges on an equal basis.

AB111,3,21 2. Prohibit the application of cost containment or quality assurance measures to acupuncturist and physician services in a like manner, consistent with this section.

AB111,3,23 (b) No insurer may require an examination by or a referral from a physician as a condition precedent for the receipt of an acupuncturist's services under par. (a).

AB111, s. 8 Section 8. Initial applicability.

AB111,3,25 (1) This act first applies to all of the following.

AB111,4,2 (a) Except as provided in paragraph (b), policies, plans and contracts that are issued or renewed on the effective date of this paragraph.

AB111,4,5 (b) Policies, plans and contracts covering employes 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:

AB111,4,6 1. The day on which the collective bargaining agreement expires.

AB111,4,8 2. The day on which the collective bargaining agreement is extended, modified or renewed.

AB111, s. 9 Section 9. Effective date.

AB111,4,11 (1) This act takes effect on the first day of the 5th month beginning after publication.

AB111,4,12 (End)