SB40: Bill Text

SB40,1598,6 632.48 (3) Notice of changes. An insurer that receives a request from the department of health and family services under s. 49.47 (4) (cr) 2. for notification shall comply with the request and notify the department of any changes to or payments made under the annuity contract to which the request for notification relates.

SB40, s. 3667 Section 3667. 632.68 (2) (b) 3m. of the statutes is amended to read:

SB40,1598,11 632.68 (2) (b) 3m. If a natural person who does not have a social security number, provides on a form prescribed by the department of workforce development children and families a statement made or subscribed under oath or affirmation that the applicant does not have a social security number.

SB40, s. 3668 Section 3668. 632.68 (2) (bc) 1. of the statutes is amended to read:

SB40,1598,16 632.68 (2) (bc) 1. The commissioner shall disclose a social security number obtained under par. (b) to the department of workforce development children and families in the administration of s. 49.22, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3669 Section 3669. 632.68 (2) (bm) 1. of the statutes is amended to read:

SB40,1599,2 632.68 (2) (bm) 1. Notwithstanding par. (b), the commissioner may not issue a license under this subsection to a natural person who is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or who fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3670 Section 3670. 632.68 (2) (e) of the statutes is amended to read:

SB40,1599,14 632.68 (2) (e) Except as provided in sub. (3), a license issued under this subsection shall be renewed annually on July 1 upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually on July 1 upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development children and families, that the licensee does not have a social security number.

SB40, s. 3671 Section 3671. 632.68 (3) (b) 1. of the statutes is amended to read:

SB40,1599,24 632.68 (3) (b) 1. The commissioner shall suspend, limit or refuse to renew a viatical settlement provider license issued to a natural person if the natural person is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or if the natural person fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3672 Section 3672. 632.68 (4) (b) of the statutes is amended to read:

SB40,1600,15 632.68 (4) (b) A person may apply to the commissioner for a viatical settlement broker license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person unless the applicant does not have a social security number, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mr) shall accompany the application. The commissioner may not issue a license under this subsection unless the applicant provides his or her social security number, unless the applicant does not have a social security number, or its federal employer identification number, whichever is applicable. If the applicant is a natural person who does not have a social security number, the commissioner may not issue a license under this subsection unless the applicant provides, on a form prescribed by the department of workforce development children and families, a statement made or subscribed under oath or affirmation that the applicant does not have a social security number.

SB40, s. 3673 Section 3673. 632.68 (4) (bc) 1. of the statutes is amended to read:

SB40,1600,20 632.68 (4) (bc) 1. The commissioner shall disclose a social security number obtained under par. (b) to the department of workforce development children and families in the administration of s. 49.22, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3674 Section 3674. 632.68 (4) (bm) 1. of the statutes is amended to read:

SB40,1601,4 632.68 (4) (bm) 1. The commissioner may not issue a license under this subsection to a natural person who is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or who fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3675 Section 3675. 632.68 (4) (c) of the statutes is amended to read:

SB40,1601,16 632.68 (4) (c) Except as provided in sub. (5), a license issued under this subsection shall be renewed annually on July 1 upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually, except as provided in sub. (5), on July 1 upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development children and families, that the licensee does not have a social security number.

SB40, s. 3676 Section 3676. 632.68 (5) (b) 1. of the statutes is amended to read:

SB40,1602,2 632.68 (5) (b) 1. The commissioner shall suspend, limit or refuse to renew a viatical settlement broker license issued to a natural person if the natural person is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or if the natural person fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3677 Section 3677. 632.726 of the statutes is created to read:

SB40,1602,7 632.726 Current procedural terminology code changes. (1) In this section, "current procedural terminology code" means a number established by the American Medical Association that a health care provider puts on a health insurance claim form to describe the services that he or she performed.

SB40,1602,12 (2) If an insurer changes a current procedural terminology code that was submitted by a health care provider on a health insurance claim form, the insurer shall include on the explanation of benefits form the reason for the change to the current procedural terminology code and shall cite on the explanation of benefits form the source for the change.

SB40, s. 3678 Section 3678. 632.745 (6) (a) 2m. of the statutes is amended to read:

SB40,1602,14 632.745 (6) (a) 2m. A family long-term care district under s. 46.2895.

SB40, s. 3679 Section 3679. 632.746 (7m) (b) 1. of the statutes is amended to read:

SB40,1602,18 632.746 (7m) (b) 1. The employee or dependent is eligible for benefits under the Medical Assistance program under s. 49.471 or 49.472 or for coverage under the Badger Care health care program under s. 49.665.

SB40, s. 3680 Section 3680. 632.857 of the statutes is created to read:

SB40,1603,2 632.857 Explanation required for restriction or termination of coverage. If an insurer restricts or terminates an insured's coverage for the treatment of a condition or complaint and, as a result, the insured becomes liable for payment for all of his or her treatment for the condition or complaint, the insurer shall provide on the explanation of benefits form a detailed explanation of the clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer's restriction or termination of coverage.

SB40, s. 3681 Section 3681. 632.875 (2) (g) of the statutes is amended to read:

SB40,1603,6 632.875 (2) (g) A reasonable detailed explanation of the factual basis clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer's restriction or termination of coverage.

SB40, s. 3682 Section 3682. 632.89 (1) (am) of the statutes is created to read:

SB40,1603,9 632.89 (1) (am) "Consumer price index" means the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.

SB40, s. 3683 Section 3683. 632.89 (2) (b) 1. of the statutes is amended to read:

SB40,1603,16 632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability insurance policy issued by an insurer provides coverage of inpatient hospital treatment or outpatient treatment or both, the policy shall provide coverage in every policy year as provided in pars. (c) to (dm), as appropriate, except that the total coverage under the policy for a policy year need not exceed $7,000 $20,250 or the equivalent benefits measured in services rendered.

SB40, s. 3684 Section 3684. 632.89 (2) (c) 2. b. of the statutes is amended to read:

SB40,1603,22 632.89 (2) (c) 2. b. Seven thousand Twenty thousand two hundred fifty dollars minus any applicable cost sharing at the level charged under the policy for inpatient hospital services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $6,300 $18,250 in equivalent benefits measured in services rendered.

SB40, s. 3685 Section 3685. 632.89 (2) (d) 2. of the statutes is amended to read:

SB40,1604,3 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $2,000 $3,450 minus any applicable cost sharing at the level charged under the policy for outpatient services or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $1,800 $3,100 in equivalent benefits measured in services rendered.

SB40, s. 3686 Section 3686. 632.89 (2) (dm) 2. of the statutes is amended to read:

SB40,1604,10 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $3,000 $5,200 minus any applicable cost sharing at the level charged under the policy for transitional treatment arrangements or the equivalent benefits measured in services rendered or, if the policy does not use cost sharing, $2,700 $4,650 in equivalent benefits measured in services rendered.

SB40, s. 3687 Section 3687. 632.89 (2) (f) of the statutes is created to read:

SB40,1604,15 632.89 (2) (f) Report on coverage limits. The department of health and family services shall report annually to the governor and the legislature on revising the coverage limits specified in this subsection based on the change in the consumer price index for medical costs.

SB40, s. 3688 Section 3688. 632.895 (15) of the statutes is created to read:

SB40,1604,18 632.895 (15) Treatment for autism spectrum disorders. (a) In this subsection, "autism spectrum disorder" means any of the following:

SB40,1604,19 1. Autism disorder.

SB40,1604,20 2. Asperger's syndrome.

SB40,1604,21 3. Pervasive developmental disorder not otherwise specified.

SB40,1604,25 (b) 1. Subject to subd. 2., and except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, shall provide coverage for an insured of treatment for an autism spectrum disorder if the treatment is provided by any of the following:

SB40,1605,1 a. A psychiatrist, as defined in s. 146.34 (1) (h).

SB40,1605,2 b. A psychologist, as defined in s. 146.34 (1) (i).

SB40,1605,4 c. A social worker, as defined in s. 252.15 (1) (er), who is certified or licensed to practice psychotherapy, as defined in s. 457.01 (8m).

SB40,1605,6 2. A disability insurance policy or self-insured health plan is not required to cover the cost of more than 4 hours per month of the treatment specified in subd. 1.

SB40,1605,9 (c) The coverage required under par. (b) may be subject to any limitations, exclusions, and cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB40,1605,10 (d) This subsection does not apply to any of the following:

SB40,1605,11 1. A disability insurance policy that covers only certain specified diseases.

SB40,1605,14 2. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

SB40,1605,15 3. A long-term care insurance policy.

SB40,1605,16 4. A medicare replacement policy or a medicare supplement policy.

SB40, s. 3689 Section 3689. 632.897 (10) (am) 2. of the statutes is amended to read:

SB40,1605,21 632.897 (10) (am) 2. Provide family coverage under the group policy or individual policy for the individual's child, if eligible for coverage, upon application by the individual, the child's other parent, the department of workforce development children and families or the county child support agency under s. 59.53 (5).

SB40, s. 3690 Section 3690. 633.14 (1) (e) of the statutes is amended to read:

SB40,1606,2 633.14 (1) (e) If an individual who does not have a social security number, provides on a form prescribed by the department of workforce development children and families a statement made or subscribed under oath or affirmation that he or she does not have a social security number.

SB40, s. 3691 Section 3691. 633.14 (2c) (a) of the statutes is amended to read:

SB40,1606,7 633.14 (2c) (a) The commissioner shall disclose a social security number obtained under sub. (1) (d) to the department of workforce development children and families in the administration of s. 49.22, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3692 Section 3692. 633.14 (2m) (a) of the statutes is amended to read:

SB40,1606,17 633.14 (2m) (a) Notwithstanding sub. (1), the commissioner may not issue a license under this section if the individual applying for the license is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or if the individual fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3693 Section 3693. 633.15 (1m) of the statutes is amended to read:

SB40,1607,5 633.15 (1m) Social security number, federal employer identification number or statement. At an annual renewal, an administrator shall provide his or her social security number, if the administrator is an individual unless he or she does not have a social security number, or its federal employer identification number, if the administrator is a corporation, limited liability company or partnership, if the social security number or federal employer identification number was not previously provided on the application for the license or at a previous renewal of the license. If an administrator who is an individual does not have a social security number, the individual shall provide to the commissioner, at each annual renewal and on a form prescribed by the department of workforce development children and families, a statement made or subscribed under oath or affirmation that the administrator does not have a social security number.

SB40, s. 3694 Section 3694. 633.15 (2) (c) of the statutes is amended to read:

SB40,1607,16 633.15 (2) (c) Failure to pay support or to comply with subpoena or warrant. The commissioner shall suspend, limit or refuse to renew a license issued under this section to an individual if the individual is delinquent in court-ordered payments of child or family support, maintenance, birth expenses, medical expenses or other expenses related to the support of a child or former spouse, or if the individual fails to comply, after appropriate notice, with a subpoena or warrant issued by the department of workforce development children and families or a county child support agency under s. 59.53 (5) and related to paternity or child support proceedings, as provided in a memorandum of understanding entered into under s. 49.857.

SB40, s. 3695 Section 3695. 645.09 (2) (a) of the statutes is amended to read:

SB40,1608,2 645.09 (2) (a) Causes of delinquency. The commissioner may include in his or her annual report, not later than the 2nd annual report following the initiation of any formal proceedings under this chapter, a detailed analysis of the basic causes and the contributing factors making the initiation of formal proceedings necessary, and may make recommendations for remedial legislation. For this purpose the commissioner may appoint a special assistant qualified in insurance, finance, and accounting to conduct the study and prepare the analysis, and may determine the special assistant's compensation, which shall be paid from the appropriation under s. 20.145 (1) (g) 1.

SB40, s. 3696 Section 3696. 645.09 (2) (b) of the statutes is amended to read:

SB40,1608,12 645.09 (2) (b) Final study. The commissioner may include in his or her annual report, not later than the 2nd annual report following discharge of the receiver, a detailed study of the delinquency proceeding for each insurer subjected to a formal proceeding, with an analysis of the problems faced and their solutions. The commissioner may also suggest alternative solutions, as well as other material of interest, for the purpose of assisting and guiding liquidators or rehabilitators in the future. For this purpose the commissioner may appoint a special assistant qualified to conduct the study and prepare the analysis, and may determine his or her compensation, which shall be paid from the appropriation under s. 20.145 (1) (g) 1.

SB40, s. 3697 Section 3697. 645.46 (4) of the statutes is amended to read:

SB40,1608,20 645.46 (4) Defray all expenses of taking possession of, conserving, conducting, liquidating, disposing of, or otherwise dealing with the business and property of the insurer. If the property of the insurer does not contain sufficient cash or liquid assets to defray the costs incurred, the liquidator may advance the costs so incurred out of the appropriation under s. 20.145 (1) (g) 1. Any amounts so paid shall be deemed expense of administration and shall be repaid for the credit of the office of the commissioner of insurance out of the first available moneys of the insurer.

SB40, s. 3698 Section 3698. 647.02 (2) (g) of the statutes is amended to read:

SB40,1608,25 647.02 (2) (g) The figure to be used by the provider as the actual or projected length of a resident's stay in the facility in the formula in the contract provision required under s. 647.05 (9) (1m) (i) and supporting information showing how the figure was determined.

SB40, s. 3699 Section 3699. 647.04 (5) of the statutes is amended to read:

SB40,1609,6 647.04 (5) Inform the commissioner of any change in the figure used by the provider as the actual or projected length of a resident's stay in the facility in the formula in the contract provision required under s. 647.05 (9) (1m) (i) within 30 days after the change is made and submit supporting information showing how the change was determined.

SB40, s. 3700 Section 3700. 647.05 of the statutes is renumbered 647.05 (1m), and 647.05 (1m) (g), as renumbered, is amended to read:

SB40,1609,12 647.05 (1m) (g) Provides that if a resident dies or the continuing care contract is terminated after the first 30 days of occupancy, but within the first 90 days of occupancy, the provider will refund at least 90% of the amount computed under sub. (6) par. (f).

SB40, s. 3701 Section 3701. 647.05 (2m) of the statutes is created to read:

SB40,1609,16 647.05 (2m) Subject to s. 49.455, a continuing care contract may require that, before a resident applies for medical assistance, the resident must spend on his or her care the resources declared for purposes of admission to the facility.

SB40, s. 3702 Section 3702. 655.27 (2) of the statutes is amended to read:

SB40,1610,6 655.27 (2) Fund administration and operation. Management of the fund shall be vested with the board of governors. The commissioner shall either provide staff services necessary for the operation of the fund or, with the approval of the board of governors, contract for all or part of these services. Such a contract is subject to ss. 16.753 and, 16.765, and 16.771, but is otherwise exempt from subch. IV of ch. 16. The commissioner shall adopt rules governing the procedures for creating and implementing these contracts before entering into the contracts. At least annually, the contractor shall report to the commissioner and to the board of governors regarding all expenses incurred and subcontracting arrangements. If the board of governors approves, the contractor may hire legal counsel as needed to provide staff services. The cost of contracting for staff services shall be funded from the appropriation under s. 20.145 (2) (u). The fund shall pay to the commissioner amounts charged for organizational support services, which shall be credited to the appropriation account under s. 20.145 (1) (g) 2.