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 1An Act to amend 40.51 (8), 185.981 (4t), 185.983 (1) (intro.) and 632.87 (1); and
2to create 111.91 (2) (n), 609.71 and 632.87 (6) of the statutes; relating to:
3requiring insurers to cover treatment of a condition by an acupuncturist if there
4is coverage for treatment of the condition by a physician and prohibiting
5collective 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 1Section 1. 40.51 (8) of the statutes, as affected by 1995 Wisconsin Act 289, is
2amended to read:
AB111,2,53 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), 632.72 (2), 632.745 (1) to (3) and (5),
5632.747, 632.87 (3) to (5) (6), 632.895 (5m) and (8) to (10) and 632.896.
AB111, s. 2 6Section 2. 111.91 (2) (n) of the statutes is created to read:
AB111,2,87 111.91 (2) (n) The provision to employes of the health insurance coverage
8required under s. 632.87 (6).
AB111, s. 3 9Section 3. 185.981 (4t) of the statutes, as affected by 1995 Wisconsin Act 289,
10is amended to read:
AB111,2,1311 185.981 (4t) A sickness care plan operated by a cooperative association is
12subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3),
13(4) and (5)
to (6), 632.895 (10) and 632.897 (10) and ch. 155.
AB111, s. 4 14Section 4. 185.983 (1) (intro.) of the statutes, as affected by 1995 Wisconsin
15Act 289
, is amended to read:
AB111,2,2116 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
17exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
18601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
19(2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m) , (3), (4) and (5)
20to (6), 632.895 (5), (9) and (10), 632.896 and 632.897 (10), subch. II of ch. 619 and chs.
21609, 630, 635, 645 and 646, but the sponsoring association shall:
AB111, s. 5
1Section 5. 609.71 of the statutes is created to read:
AB111,3,3 2609.71 Acupuncture coverage Health maintenance organizations, limited
3service health organizations and preferred provider plans are subject to s. 632.87 (6).
AB111, s. 6 4Section 6. 632.87 (1) of the statutes is amended to read:
AB111,3,95 632.87 (1) No insurer may refuse to provide or pay for benefits for health care
6services provided by a licensed health care professional on the ground that the
7services were not rendered by a physician as defined in s. 990.01 (28), unless the
8contract clearly excludes services by such practitioners, but no contract or plan may
9exclude services in violation of sub. (2), (2m), (3), (4) or, (5) or (6).
AB111, s. 7 10Section 7. 632.87 (6) of the statutes is created to read:
AB111,3,1611 632.87 (6) (a) No policy, plan or contract may exclude coverage for diagnosis and
12treatment of a condition or complaint by an acupuncturist who is certified under ch.
13451, within the scope of the acupuncturist's certificate, if the policy, plan or contract
14covers diagnosis and treatment of the condition or complaint by a licensed physician
15or osteopath, even if different nomenclature is used to describe the condition or
16complaint. This paragraph does not:
AB111,3,1817 1. Prohibit the application of deductibles or coinsurance provisions to
18acupuncturist and physician charges on an equal basis.
AB111,3,2119 2. Prohibit the application of cost containment or quality assurance measures
20to acupuncturist and physician services in a like manner, consistent with this
21section.
AB111,3,2322 (b) No insurer may require an examination by or a referral from a physician
23as a condition precedent for the receipt of an acupuncturist's services under par. (a).
AB111, s. 8 24Section 8. Initial applicability.
AB111,3,2525 (1) This act first applies to all of the following.
AB111,4,2
1(a) Except as provided in paragraph (b), policies, plans and contracts that are
2issued or renewed on the effective date of this paragraph.
AB111,4,53 (b) Policies, plans and contracts covering employes who are affected by a
4collective bargaining agreement containing provisions inconsistent with this act
5that are issued or renewed on the earlier of the following:
AB111,4,6 61. The day on which the collective bargaining agreement expires.
AB111,4,8 72. The day on which the collective bargaining agreement is extended, modified
8or renewed.
AB111, s. 9 9Section 9. Effective date.
AB111,4,1110 (1) This act takes effect on the first day of the 5th month beginning after
11publication.
AB111,4,1212 (End)
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