LRB-3030/1
CMH&PJK:cjs:rs
2005 - 2006 LEGISLATURE
August 19, 2005 - Introduced by Representatives Gunderson, Davis, Wasserman,
Albers, Ballweg, Benedict, Berceau, Bies, Boyle, Fields, Gronemus, Hahn,
Hines, Kaufert, Krawczyk, Kreibich, Kreuser, Lehman, Lothian, Molepske,
Montgomery, Musser, Nelson, Ott, Pettis, Sheridan, Steinbrink, Townsend,
Turner, Van Akkeren, Van Roy, Vos
and Vruwink, cosponsored by Senators
Stepp, Roessler, Brown, Darling, Erpenbach, Hansen, Kanavas, A. Lasee,
Lassa, Olsen, Risser, Wirch
and Zien. Referred to Committee on Insurance.
AB617,1,4 1An Act to renumber 632.855 (3); to amend 40.51 (8), 66.0137 (4), 120.13 (2) (g),
2185.981 (4t), 185.983 (1) (intro.), 632.855 (2) (intro.) and 632.87 (1); and to
3create
632.855 (3) (bm) and 632.87 (6) of the statutes; relating to: coverage
4of certain health care costs in cancer clinical trials.
Analysis by the Legislative Reference Bureau
This bill prohibits a health care plan from denying coverage for a health care
service, item, or drug administered in a cancer clinical trial if the service, item, or
drug would have been covered had it not been administered in a clinical trial and if
the clinical trial meets certain requirements. First, the clinical trial must test how
to administer a health care service, item, or drug; test responses to a service, item,
or drug; compare the effectiveness of services, items, or drugs; or study new uses of
services, items, or drugs. Also, the clinical trial must be approved by one of the
following: 1) a National Institute of Health; 2) the Federal Food and Drug
Administration; 3) the U.S. Department of Defense; 4) the U.S. Department of
Veterans Affairs; or 5) an institution that is approved by the Office for Human
Research Protections of the U.S. Department of Health and Human Services.
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:
AB617, s. 1
1Section 1. 40.51 (8) of the statutes is amended to read:
AB617,2,52 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
4and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
5(5) (6), 632.895 (5m) and (8) to (14) and 632.896.
AB617, s. 2 6Section 2. 66.0137 (4) of the statutes is amended to read:
AB617,2,127 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
8a village provides health care benefits under its home rule power, or if a town
9provides health care benefits, to its officers and employees on a self-insured basis,
10the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
11632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and,
12(5), and (6), 632.895 (9) to (14), 632.896 and 767.25 (4m) (d).
AB617, s. 3 13Section 3. 120.13 (2) (g) of the statutes is amended to read:
AB617,2,1714 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1549.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
16632.85, 632.853, 632.855, 632.87 (4) and, (5), and (6), 632.895 (9) to (14), 632.896 and
17767.25 (4m) (d).
AB617, s. 4 18Section 4. 185.981 (4t) of the statutes is amended to read:
AB617,2,2219 185.981 (4t) A sickness care plan operated by a cooperative association is
20subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
21632.853, 632.855, 632.87 (2m), (3), (4) and, (5), and (6), 632.895 (10) to (14) and
22632.897 (10) and chs. 149 and 155.
AB617, s. 5 23Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
AB617,3,424 185.983 (1) Every such voluntary nonprofit sickness care plan shall be exempt
25from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42,

1601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95,
2632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855,
3632.87 (2m), (3), (4) and, (5), and (6), 632.895 (5) and (9) to (14), 632.896 and 632.897
4(10) and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
AB617, s. 6 5Section 6. 632.855 (2) (intro.) of the statutes is amended to read:
AB617,3,96 632.855 (2) Disclosure of limitations. (intro.) A Subject to s. 632.87 (6), a
7health care plan or a self-insured health plan that limits coverage of experimental
8treatment shall define the limitation and disclose the limits in any agreement, policy
9or certificate of coverage. This disclosure shall include the following information:
AB617, s. 7 10Section 7. 632.855 (3) of the statutes is renumbered 632.855 (3) (am).
AB617, s. 8 11Section 8. 632.855 (3) (bm) of the statutes is created to read:
AB617,3,1412 632.855 (3) (bm) A health care plan or a self-insured health plan may not deny
13coverage under par. (am) of an experimental treatment, procedure, drug, or device
14for an insured if the denial violates s. 632.87 (6).
AB617, s. 9 15Section 9. 632.87 (1) of the statutes is amended to read:
AB617,3,2016 632.87 (1) No insurer may refuse to provide or pay for benefits for health care
17services provided by a licensed health care professional on the ground that the
18services were not rendered by a physician as defined in s. 990.01 (28), unless the
19contract clearly excludes services by such practitioners, but no contract or plan may
20exclude services in violation of sub. (2), (2m), (3), (4) or, (5), or (6).
AB617, s. 10 21Section 10. 632.87 (6) of the statutes is created to read:
AB617,4,222 632.87 (6) No policy, plan, or contract may exclude coverage for any health care
23service, item, or drug for the treatment of cancer that is administered in a clinical
24trial if the policy, plan, or contract would have covered the health care service, item,

1or drug had it not been administered in a clinical trial and if the clinical trial satisfies
2all of the following:
AB617,4,33 (a) The clinical trial does one of the following:
AB617,4,54 1. Tests how to administer a health care service, item, or drug for the treatment
5of cancer.
AB617,4,76 2. Tests responses to a health care service, item, or drug for the treatment of
7cancer.
AB617,4,108 3. Compares the effectiveness of health care services, items, or drugs for the
9treatment of cancer with that of other health care services, items, or drugs for the
10treatment of cancer.
AB617,4,1211 4. Studies new uses of health care services, items, or drugs for the treatment
12of cancer.
AB617,4,1313 (b) The clinical trial is approved by one of the following:
AB617,4,1514 1. A National Institute of Health, or one of its cooperative groups or centers,
15under the federal department of health and human services.
AB617,4,1616 2. The federal food and drug administration.
AB617,4,1717 3. The federal department of defense.
AB617,4,1818 4. The federal department of veterans affairs.
AB617,4,2119 5. An institutional review board of an institution that is approved by the office
20for human research protections of the federal department of health and human
21services.
AB617, s. 11 22Section 11. Initial applicability.
AB617,4,2323 (1) This act first applies to all of the following:
AB617,5,3
1(a) Except as provided in paragraphs (b) and (c), disability insurance policies
2that are issued or renewed, and self-insured health plans that are established,
3extended, modified, or renewed, on the effective date of this paragraph.
AB617,5,64 (b) Disability insurance policies covering employees who are affected by a
5collective bargaining agreement containing provisions inconsistent with this act
6that are issued or renewed on the earlier of the following:
AB617,5,7 71. The day on which the collective bargaining agreement expires.
AB617,5,9 82. The day on which the collective bargaining agreement is extended, modified,
9or renewed.
AB617,5,1210 (c) Self-insured health plans covering employees who are affected by a
11collective bargaining agreement containing provisions inconsistent with this act
12that are established, extended, modified, or renewed on the earlier of the following:
AB617,5,13 131. The day on which the collective bargaining agreement expires.
AB617,5,15 142. The day on which the collective bargaining agreement is extended, modified,
15or renewed.
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