The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB274, s. 1
1Section
1. 609.22 (2) of the statutes is amended to read:
AB274,2,52
609.22
(2) Adequate choice. A defined network plan that is not a preferred
3provider plan shall ensure that, with respect to covered benefits, each enrollee has
4adequate choice among participating providers and that the providers are
, to the
5extent consistent with s. 628.36 (2) (b) 3. and (2m), accessible and qualified.
AB274, s. 2
6Section
2. 609.32 (2) (a) of the statutes is amended to read:
AB274,3,67
609.32
(2) (a) A defined network plan shall develop
, consistent with s. 628.36
8(2) (b) 3. and (2m), a process for selecting participating providers, including written
9policies and procedures that the plan uses for review and approval of providers. After
1consulting with appropriately qualified providers, the plan shall establish
, to the
2extent consistent with s. 628.36 (2) (b) 3. and (2m), minimum professional
3requirements for its participating providers. The process for selection shall include
4verification of a provider's license or certificate, including the history of any
5suspensions or revocations, and the history of any liability claims made against the
6provider.
AB274, s. 3
7Section
3. 628.36 (1) of the statutes is renumbered 628.36 (1m) and amended
8to read:
AB274,3,129
628.36
(1m) Payment methods. Any corporation operating a voluntary health
10care plan may pay health care professionals on a salary, per patient
, or
11fee-for-service basis to provide health care to policyholders or beneficiaries of the
12corporation.
AB274, s. 4
13Section
4. 628.36 (1c) (intro.) of the statutes is created to read:
AB274,3,1414
628.36
(1c) Definitions. (intro.) In this section:
AB274, s. 5
15Section
5. 628.36 (2) (a) (intro.) of the statutes is amended to read:
AB274,3,1616
628.36
(2) (a) (intro.) In this
section subsection:
AB274, s. 6
17Section
6. 628.36 (2) (b) 3. of the statutes is amended to read:
AB274,3,2118
628.36
(2) (b) 3. Except as provided in
subd. subds. 4.
and 4m., and subject to
19sub. (2m) (e), no provider may be denied the opportunity to participate in a health
20care plan
, other than a health maintenance organization, a limited service health
21organization or a preferred provider plan, under the terms of the plan.
AB274, s. 7
22Section
7. 628.36 (2) (b) 4. of the statutes is amended to read:
AB274,4,223
628.36
(2) (b) 4. Any health care plan may exclude a provider from participation
24in the health care plan for cause related to the practice of his or her profession.
A
1health care plan that excludes a provider from participation shall advise the provider
2in writing of the reason for the exclusion.
AB274, s. 8
3Section
8. 628.36 (2) (b) 4m. of the statutes is created to read:
AB274,4,74
628.36
(2) (b) 4m. Subdivision 3. applies to a health maintenance organization,
5limited service health organization, or preferred provider plan only with respect to
6a provider located in the geographic service area of the health maintenance
7organization, limited service health organization, or preferred provider plan.
AB274, s. 9
8Section
9. 628.36 (2m) (title) of the statutes is repealed and recreated to read:
AB274,4,99
628.36
(2m) (title)
Annual participation election period.
AB274, s. 10
10Section
10. 628.36 (2m) (a) (intro.) and 2m. of the statutes are consolidated,
11renumbered 628.36 (2m) (ac) and amended to read:
AB274,4,1412
628.36
(2m) (ac) In this subsection
: 2m. "Pharmaceutical, "health care 13services" do not include the administration of a drug product or device or vaccine
14under s. 450.035.
AB274, s. 11
15Section
11. 628.36 (2m) (a) 1. of the statutes is renumbered 628.36 (1c) (a).
AB274, s. 12
16Section
12. 628.36 (2m) (a) 2. of the statutes is renumbered 628.36 (1c) (b).
AB274, s. 13
17Section
13. 628.36 (2m) (a) 3. of the statutes is renumbered 628.36 (1c) (c).
AB274, s. 14
18Section
14. 628.36 (2m) (e) 1. of the statutes is amended to read:
AB274,5,519
628.36
(2m) (e) 1. A health maintenance organization, limited service health
20organization
, or preferred provider plan that provides coverage of
pharmaceutical 21health care services
when that are performed by one or more
pharmacists health care
22professionals who are selected by the organization or plan but who are not full-time
23salaried employees or partners of the organization or plan shall provide an annual
24period of at least 30 days during which any
pharmacist registered under ch. 450 25health care professional who provides those health care services, who has been
1granted a credential, as defined in s. 440.01 (2) (a), to practice in this state, and who
2is located in the geographic service area of the organization or plan may elect to
3participate in the health maintenance organization, limited service health
4organization
, or preferred provider plan under its terms as a selected provider for at
5least one year.
AB274, s. 15
6Section
15. 628.36 (2m) (e) 2. of the statutes is amended to read:
AB274,5,117
628.36
(2m) (e) 2. Except as provided in subd. 3., subd. 1. applies to health
8maintenance organizations
on and after May 10, 1984. Except as provided in subd.
94., subd. 1. applies to, limited service health organizations
, and preferred provider
10plans on or after
April 28, 1990 the effective date of this subdivision .... [revisor
11inserts date].
AB274, s. 16
12Section
16. 628.36 (2m) (e) 3. of the statutes is amended to read:
AB274,5,2013
628.36
(2m) (e) 3. If compliance with the requirements of subd. 1. during the
14period specified in subd. 2. would impair any provision of a contract between a health
15maintenance organization
, limited service health organization, or preferred
16provider plan and any other person, and if the contract provision was in existence
17prior to
May 10, 1984 the effective date of this subdivision .... [revisor inserts date],
18then immediately after the expiration of all such contract provisions the health
19maintenance organization
, limited service health organization, or preferred
20provider plan shall comply with the requirements of subd. 1.
AB274, s. 17
21Section
17. 628.36 (2m) (e) 4. of the statutes is repealed.
AB274, s. 18
22Section
18. 628.36 (3) of the statutes is amended to read:
AB274,6,623
628.36
(3) Exemption by rule. By rule the commissioner may exempt from the
24application of any part of subs.
(1) (1m) to (2m) plans
which that provide innovative
25approaches to the delivery of health care or
which
that are designed to contain health
1care costs, and
which that cannot operate successfully consistent with all of the
2provisions in subs.
(1) (1m) to (2m). The commissioner may promulgate such a rule
3only if on a finding that the interests of the public require such plans as an
4experiment, to supply health care services that are not otherwise available in
5adequate quantity or quality, or to contain health care costs. The promulgated rule
6shall be as narrow as is compatible with the success of the plans.