SB451,37,11 149.14 (3) (b) Professional services for the diagnosis or treatment of injuries, illnesses, or conditions, other than mental or dental.

SB451, s. 94 Section 94. 149.14 (3) (c) 1. of the statutes is repealed and recreated to read:

SB451,37,16 149.14 (3) (c) 1. Inpatient hospital services, as defined in s. 632.89 (1) (d), outpatient services, as defined in s. 632.89 (1) (e), and transitional treatment arrangements, as defined in s. 632.89 (1) (f), only to the extent required under s. 632.89.

SB451, s. 95 Section 95. 149.14 (3) (c) 2. of the statutes is repealed.

SB451, s. 96 Section 96 . 149.14 (3) (c) 3. of the statutes is amended to read:

SB451,37,22 149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats., services for the chronically mentally ill in community support programs operated under s. 51.421.

SB451, s. 97 Section 97 . 149.14 (3) (c) 3. of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

SB451,38,4 149.14 (3) (c) 3. Subject to the limits under subd. 2. and to rules promulgated by the department of health and family services under s. 149.14 (3) (c) 3., 2003 stats. 1., services for the chronically mentally ill in community support programs operated under s. 51.421.

SB451, s. 98 Section 98. 149.14 (3) (d) of the statutes is amended to read:

SB451,38,6 149.14 (3) (d) Drugs requiring a physician's prescription, subject to sub. (4c).

SB451, s. 99 Section 99. 149.14 (3) (e) of the statutes is amended to read:

SB451,38,14 149.14 (3) (e) Services For persons eligible for Medicare, services of a licensed skilled nursing facility for eligible persons eligible for medicare, to the extent required by s. 632.895 (3) and for not more than an aggregate 120 days during a calendar year, if the services are of the type which that would qualify as reimbursable services under medicare Medicare. Coverage under this paragraph which that is not required by s. 632.895 (3) is subject to the any deductible and coinsurance requirements under sub. (5) provided by the authority.

SB451, s. 100 Section 100. 149.14 (3) (f) of the statutes is created to read:

SB451,38,17 149.14 (3) (f) Services of a home health agency, as defined in s. 50.49 (1) (a), only to the extent required under s. 632.895 (2).

SB451, s. 101 Section 101. 149.14 (3) (m) of the statutes is amended to read:

SB451,38,21 149.14 (3) (m) Oral surgery for excision of partially or completely unerupted, impacted teeth and oral surgery with respect to the gums and other tissues of the mouth when not performed in connection with the extraction or repair of teeth.

SB451, s. 102 Section 102. 149.14 (3) (o) of the statutes is amended to read:

SB451,38,25 149.14 (3) (o) Transportation Emergency and other medically necessary transportation provided by a licensed ambulance service to the nearest facility qualified to treat the a covered condition.

SB451, s. 103 Section 103. 149.14 (3) (p) of the statutes is renumbered 149.14 (3) (em).

SB451, s. 104 Section 104. 149.14 (4) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is repealed and recreated to read:

SB451,39,12 149.14 (4) Plan design. Subject to subs. (1) to (3), (5), and (6), the authority shall establish the plan design, after taking into consideration the levels of health insurance coverage provided in the state and medical economic factors, as appropriate. Subject to subs. (1) to (3), (5), and (6), the authority shall provide benefit levels, deductibles, copayment and coinsurance requirements, exclusions, and limitations under the plan that the authority determines generally reflect and are commensurate with comprehensive health insurance coverage offered in the private individual market in the state. The authority may develop additional benefit designs that are responsive to market conditions.

SB451, s. 105 Section 105. 149.14 (4) (d) of the statutes is amended to read:

SB451,39,17 149.14 (4) (d) That part of any charge for services or articles rendered or prescribed by a physician, dentist, or other health care personnel that exceeds the payment rate established by the department authority under s. 149.142 and reduced under ss. 149.143 and 149.144 or any charge not medically necessary.

SB451, s. 106 Section 106. 149.14 (4) (m) of the statutes is amended to read:

SB451,39,20 149.14 (4) (m) Experimental treatment, as determined by the department authority.

SB451, s. 107 Section 107. 149.14 (4c) of the statutes is repealed.

SB451, s. 108 Section 108. 149.14 (4m) of the statutes is renumbered 149.142 (2m) and amended to read:

SB451,40,4 149.142 (2m) Payment is payment in full. Except for copayments, coinsurance, or deductibles required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under ss. 149.142, 149.143 and 149.144 sub. (1) and may not bill an eligible person who receives the service or article for any amount by which the charge for the service or article is reduced under s. 149.142, 149.143 or 149.144 sub. (1).

SB451, s. 109 Section 109. 149.14 (5) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is repealed and recreated to read: