AB995, s. 99
18Section
99. 628.36 (2m) (a) 1. of the statutes is renumbered 628.36 (1c) (a).
AB995, s. 100
19Section
100. 628.36 (2m) (a) 2. of the statutes is renumbered 628.36 (1c) (b).
AB995, s. 101
20Section
101. 628.36 (2m) (a) 3. of the statutes is renumbered 628.36 (1c) (c).
AB995, s. 102
21Section
102. 628.36 (2m) (e) 1. of the statutes is amended to read:
AB995,43,822
628.36
(2m) (e) 1. A health maintenance organization, limited service health
23organization
, or preferred provider plan that provides coverage of
pharmaceutical 24health care services
when that are performed by one or more
pharmacists health care
25professionals who are selected by the organization or plan but who are not full-time
1salaried employees or partners of the organization or plan shall provide an annual
2period of at least 30 days during which any
pharmacist registered under ch. 450 3health care professional who provides those health care services, who has been
4granted a credential, as defined in s. 440.01 (2) (a), to practice in this state, and who
5is located in the geographic service area of the organization or plan may elect to
6participate in the health maintenance organization, limited service health
7organization
, or preferred provider plan under its terms as a selected provider for at
8least one year.
AB995, s. 103
9Section
103. 628.36 (2m) (e) 2. of the statutes is amended to read:
AB995,43,1410
628.36
(2m) (e) 2. Except as provided in subd. 3., subd. 1. applies to health
11maintenance organizations
on and after May 10, 1984. Except as provided in subd.
124., subd. 1. applies to, limited service health organizations
, and preferred provider
13plans on or after
April 28, 1990 the effective date of this subdivision .... [revisor
14inserts date].
AB995, s. 104
15Section
104. 628.36 (2m) (e) 3. of the statutes is amended to read:
AB995,43,2316
628.36
(2m) (e) 3. If compliance with the requirements of subd. 1. during the
17period specified in subd. 2. would impair any provision of a contract between a health
18maintenance organization
, limited service health organization, or preferred
19provider plan and any other person, and if the contract provision was in existence
20prior to
May 10, 1984 the effective date of this subdivision .... [revisor inserts date],
21then immediately after the expiration of all such contract provisions the health
22maintenance organization
, limited service health organization, or preferred
23provider plan shall comply with the requirements of subd. 1.
AB995, s. 105
24Section
105. 628.36 (2m) (e) 4. of the statutes is repealed.
AB995, s. 106
25Section
106. 628.36 (3) of the statutes is amended to read:
AB995,44,9
1628.36
(3) Exemption by rule. By rule the commissioner may exempt from the
2application of any part of subs.
(1) (1m) to (2m) plans
which that provide innovative
3approaches to the delivery of health care or
which
that are designed to contain health
4care costs, and
which that cannot operate successfully consistent with all of the
5provisions in subs.
(1) (1m) to (2m). The commissioner may promulgate such a rule
6only if on a finding that the interests of the public require such plans as an
7experiment, to supply health care services that are not otherwise available in
8adequate quantity or quality, or to contain health care costs. The promulgated rule
9shall be as narrow as is compatible with the success of the plans.
AB995, s. 107
10Section
107. 632.89 (1) (am) of the statutes is created to read:
AB995,44,1211
632.89
(1) (am) "Consumer price index" means the consumer price index for all
12urban consumers, U.S. city average, as determined by the U.S. department of labor.
AB995, s. 108
13Section
108. 632.89 (1) (b) of the statutes is created to read:
AB995,44,1614
632.89
(1) (b) "Diagnostic testing" means procedures used to exclude the
15existence of conditions other than nervous or mental disorders or alcoholism or other
16drug abuse problems.
AB995, s. 109
17Section
109. 632.89 (2) (b) 1. of the statutes is amended to read:
AB995,44,2318
632.89
(2) (b) 1. Except as provided in subd. 2., if a group or blanket disability
19insurance policy issued by an insurer provides coverage of inpatient hospital
20treatment or outpatient treatment or both, the policy shall provide coverage in every
21policy year as provided in pars. (c) to (dm), as appropriate, except that the total
22coverage under the policy for a policy year need not exceed
$7,000 $16,800 or the
23equivalent benefits measured in services rendered.
AB995, s. 110
24Section
110. 632.89 (2) (c) 2. b. of the statutes is amended to read:
AB995,45,5
1632.89
(2) (c) 2. b.
Seven thousand Sixteen thousand eight hundred dollars
2minus any applicable cost sharing at the level charged under the policy for inpatient
3hospital services or the equivalent benefits measured in services rendered or, if the
4policy does not use cost sharing,
$6,300 $15,100 in equivalent benefits measured in
5services rendered.
AB995, s. 111
6Section
111. 632.89 (2) (d) 2. of the statutes is amended to read:
AB995,45,117
632.89
(2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall
8provide coverage in every policy year for not less than
$2,000 $3,100 minus any
9applicable cost sharing at the level charged under the policy for outpatient services
10or the equivalent benefits measured in services rendered or, if the policy does not use
11cost sharing,
$1,800 $2,800 in equivalent benefits measured in services rendered.
AB995, s. 112
12Section
112. 632.89 (2) (dm) 2. of the statutes is amended to read:
AB995,45,1813
632.89
(2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall
14provide coverage in every policy year for not less than
$3,000 $4,600 minus any
15applicable cost sharing at the level charged under the policy for transitional
16treatment arrangements or the equivalent benefits measured in services rendered
17or, if the policy does not use cost sharing,
$2,700
$4,100 in equivalent benefits
18measured in services rendered.
AB995, s. 113
19Section
113. 632.89 (2) (f) of the statutes is created to read:
AB995,45,2320
632.89
(2) (f)
Report on coverage limits. The department of health and family
21services shall report annually to the governor and the legislature on revising the
22coverage limits specified in this subsection based on the change in the consumer price
23index for medical costs.
AB995, s. 114
24Section
114. 632.89 (6) and (7) of the statutes are created to read:
AB995,46,3
1632.89
(6) Prescription drugs and diagnostic testing. (a) The coverage
2amounts specified in sub. (2) shall not include costs incurred for prescription drugs
3or diagnostic testing.
AB995,46,54
(b) The department of health and family services may specify, by rule, the
5diagnostic testing procedures to which par. (a) applies.
AB995,46,8
6(7) Treatment of costs. The coverage amounts specified in sub. (2) apply to
7actual payments or reimbursements made by an insurer if the payment or
8reimbursement amounts are less than the amounts charged by a provider.
AB995, s. 116
11Section
116. 895.48 (1m) (b) of the statutes is created to read:
AB995,46,1312
895.48
(1m) (b) This subsection does not apply to health care services provided
13by a volunteer health care provider under s. 146.89.
AB995,46,1815
(1) The department of health and family services shall submit in proposed form
16the rules required under section 46.03 (44) of the statutes, as created by this act, to
17the legislative council staff under section 227.15 (1) of the statutes no later than the
18first day of the 7th month beginning after the effective date of this subsection.
AB995,46,2220
(1) The treatment of section 49.688 (4r) of the statutes first applies to eligibility
21determinations made and deductible amounts paid on the effective date of this
22subsection.
AB995,47,223
(2) If an insurance policy that is in effect on the effective date of this subsection
24contains a provision that is inconsistent with the treatment of section 632.89 (6) or
25(7) of the statutes, the treatment of section 632.89 (6) or (7) of the statutes, whichever
1is inconsistent, first applies to that insurance policy on the date on which it is
2renewed.
AB995,47,53
(3) The treatment of sections 632.89 (1) (am) and (2) (b) 1., (c) 2. b., (d) 2., (dm)
42., and (f) of the statutes first applies to a policy issued, renewed, or modified on the
5first day of the 13th month beginning after publication.
AB995,47,116
(4) The treatment of sections 146.89 (2) (a), (c), and (d), (3) (b) (intro.), (c), and
7(d) (intro.), and (3m) and 895.48 (1m) of the statutes, the renumbering and
8amendment of section 146.89 (1) of the statutes, and the creation of section 146.89
9(1) (d), (g), and (h) and 895.48 (1m) (b) of the statutes first applies to applications
10submitted under section 146.89 (2) (a) of the statutes, as affected by this act, on the
11effective date of this subsection.
AB995,47,1412
(5)
The renumbering and amendment of section 456.08 of the statutes and the
13creation of section 456.08 (1), (2), (3), and (4) of the statutes first apply to applications
14received on the effective date of this subsection.
AB995,47,1915
(6) The treatment of sections 49.46 (1) (a) 1., 1g., 1m., 6., 9., 10., 11., and 12.,
16(ar), (e), and (L), 49.47 (4) (am) 1. and 2., (c) 1. and 3., (cg) 3., and (h), and 49.665 (4)
17(a) 1. and (d) of the statutes first applies to eligibility determinations for the Medical
18Assistance and Badger Care health care programs that are made on the effective
19date of this subsection.
AB995, s. 119
20Section
119.
Effective dates. This act takes effect on the day after
21publication, except as follows:
AB995,47,2322
(1)
The treatment of section 49.688 (4r) of the statutes and
Section 118 (1
) of
23this act take effect on the first day of the 2nd month beginning after publication.
AB995,48,3
1(2)
The treatment of sections 20.435 (4) (b) and (7) (bd), 49.45 (6ur) and 49.45
2(6v) of the statutes takes effect on takes effect on January 1, 2005, or on the day after
3publication, whichever is later.
AB995,48,64
(3)
The treatment of sections 100.31 (title), (1) (a), (ae), (as), (b), and (c), (2), (2r),
5and (4) of the statutes takes effect on the first day of the 3rd month beginning after
6publication.
AB995,48,97
(4)
The treatment of sections 46.03 (44), 441.07 (1) (d), 441.16 (3m), 448.015 (4),
8448.035, 448.04 (1) (a), 450.10 (1) (a) (intro.), and 450.11 (1) and (1g) of the statutes
9takes effect on the first day of the 13th month beginning after publication.
AB995,48,1410
(5)
The treatment of sections 456.02 (intro.), (1), (2), (3), (4), (5), and (6), 456.04
11(intro.), (1), (1m) (d) and (e), (2), (2m), (3), and (4), 456.08 (1), (2), (3), and (4), 456.09
12(1) (c), and 456.12 of the statutes and the renumbering and amendment of section
13456.08 of the statutes take effect on the first day of the 7th month beginning after
14publication.