AB50-ASA2-AA8,184,1313632.87 (7) (a) In this subsection: AB50-ASA2-AA8,184,14141. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp). AB50-ASA2-AA8,184,16152. “Qualified treatment trainee” has the meaning given in s. DHS 35.03 16(17m), Wis. Adm. Code. AB50-ASA2-AA8,184,2117(b) No policy, plan, or contract may exclude coverage for mental health or 18behavioral health treatment or services provided by a qualified treatment trainee 19within the scope of the qualified treatment trainee’s education and training if the 20policy, plan, or contract covers the mental health or behavioral health treatment or 21services when provided by another health care provider. AB50-ASA2-AA8,184,2323(1) Qualified treatment trainee coverage. AB50-ASA2-AA8,185,424(a) For policies and plans containing provisions inconsistent with these
1sections, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 2(1) (intro.), 609.713, and 632.87 (7) first applies to policy or plan years beginning on 3January 1 of the year following the year in which this paragraph takes effect, except 4as provided in par. (b). AB50-ASA2-AA8,185,105(b) For policies and plans that are affected by a collective bargaining 6agreement containing provisions inconsistent with these sections, the treatment of 7ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 8632.87 (7) first applies to policy or plan years beginning on the effective date of this 9paragraph or on the day on which the collective bargaining agreement is entered 10into, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,185,1512(1) Qualified treatment trainee coverage. The treatment of ss. 40.51 (8) 13and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7) and 14Section 9323 (1) of this act take effect on the first day of the 4th month beginning 15after publication.”. AB50-ASA2-AA8,185,221840.51 (8) Every health care coverage plan offered by the state under sub. (6) 19shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 20632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 21632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6) and (8), 632.885, 22632.89, 632.895 (5m) and (8) to (17), and 632.896. AB50-ASA2-AA8,186,4
140.51 (8m) Every health care coverage plan offered by the group insurance 2board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 3(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 4632.861, 632.867, 632.87 (8), 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA8,186,12666.0137 (4) Self-insured health plans. If a city, including a 1st class city, 7or a village provides health care benefits under its home rule power, or if a town 8provides health care benefits, to its officers and employees on a self-insured basis, 9the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 10632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 11632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6) and (8), 632.885, 632.89, 12632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,186,1714120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 1549.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and 16(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to 17(6) and (8), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,33518Section 335. 185.983 (1) (intro.) of the statutes is amended to read: AB50-ASA2-AA8,187,219185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a 20cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 21646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 22601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 23631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795, 24632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6) and (8),
1632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 2620, 630, 635, 645, and 646, but the sponsoring association shall: AB50-ASA2-AA8,187,64609.714 Substance abuse counselor coverage. Limited service health 5organizations, preferred provider plans, and defined network plans are subject to s. 6632.87 (8). AB50-ASA2-AA8,187,88632.87 (8) (a) In this subsection: AB50-ASA2-AA8,187,991. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp). AB50-ASA2-AA8,187,11102. “Substance abuse counselor” means a substance abuse counselor certified 11under s. 440.88. AB50-ASA2-AA8,187,1612(b) No policy, plan, or contract may exclude coverage for alcoholism or other 13drug abuse treatment or services provided by a substance abuse counselor within 14the scope of the substance abuse counselor’s education and training if the policy, 15plan, or contract covers the alcoholism or other drug abuse treatment or services 16when provided by another health care provider. AB50-ASA2-AA8,187,1818(1) Substance abuse counselor coverage. AB50-ASA2-AA8,188,219(a) For policies and plans containing provisions inconsistent with the 20treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 21609.714, and 632.87 (8), the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 22(2) (g), 185.983 (1) (intro.), 609.714, and 632.87 (8) first applies to policy or plan
1years beginning on January 1 of the year following the year in which this paragraph 2takes effect, except as provided in par. (b). AB50-ASA2-AA8,188,93(b) For policies and plans that are affected by a collective bargaining 4agreement containing provisions inconsistent with the treatment of ss. 40.51 (8) 5and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.714, and 632.87 (8), the 6treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 7609.714, and 632.87 (8) first applies to policy or plan years beginning on the 8effective date of this paragraph or on the day on which the collective bargaining 9agreement is newly established, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,188,1411(1) Substance abuse counselor coverage. The treatment of ss. 40.51 (8) 12and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.714, and 632.87 (8) and 13Section 9323 (1) of this act take effect on the first day of the 4th month beginning 14after publication.”. AB50-ASA2-AA8,188,211740.51 (8) Every health care coverage plan offered by the state under sub. (6) 18shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 19632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 20632.85, 632.851, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885, 21632.89, 632.895 (5m) and (8) to (17), and 632.896. AB50-ASA2-AA8,189,32340.51 (8m) Every health care coverage plan offered by the group insurance
1board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 2(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.851, 632.853, 3632.855, 632.861, 632.867, 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA8,189,11566.0137 (4) Self-insured health plans. If a city, including a 1st class city, 6or a village provides health care benefits under its home rule power, or if a town 7provides health care benefits, to its officers and employees on a self-insured basis, 8the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 9632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 10632.851, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 11632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,189,1613120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 1449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and 15(b) 2., 632.747 (3), 632.798, 632.85, 632.851, 632.853, 632.855, 632.861, 632.867, 16632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,34217Section 342. 185.983 (1) (intro.) of the statutes is amended to read: AB50-ASA2-AA8,190,218185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a 19cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 20646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 21601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 22631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795, 23632.798, 632.85, 632.851, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6),
1632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 2620, 630, 635, 645, and 646, but the sponsoring association shall: AB50-ASA2-AA8,190,54609.825 Coverage of emergency ambulance services. (1) In this 5section: AB50-ASA2-AA8,190,66(a) “Ambulance service provider” has the meaning given in s. 256.01 (3). AB50-ASA2-AA8,190,107(b) “Self-insured governmental plan” means a self-insured health plan of the 8state or a county, city, village, town, or school district that has a network of 9participating providers and imposes on enrollees in the self-insured health plan 10different requirements for using providers that are not participating providers. AB50-ASA2-AA8,190,1511(2) A defined network plan, preferred provider plan, or self-insured 12governmental plan that provides coverage of emergency medical services shall 13cover emergency ambulance services provided by an ambulance service provider 14that is not a participating provider at a rate that is not lower than the greatest rate 15that is any of the following: AB50-ASA2-AA8,190,1716(a) A rate that is set or approved by a local governmental entity in the 17jurisdiction in which the emergency ambulance services originated. AB50-ASA2-AA8,190,2318(b) A rate that is 400 percent of the current published rate for the provided 19emergency ambulance services established by the federal centers for medicare and 20medicaid services under title XVIII of the federal Social Security Act, 42 USC 1395 21et seq., in the same geographic area or a rate that is equivalent to the rate billed by 22the ambulance service provider for emergency ambulance services provided, 23whichever is less. AB50-ASA2-AA8,191,3
1(c) The contracted rate at which the defined network plan, preferred provider 2plan, or self-insured governmental plan would reimburse a participating 3ambulance service provider for the same emergency ambulance services. AB50-ASA2-AA8,191,94(3) No defined network plan, preferred provider plan, or self-insured 5governmental plan may impose a cost-sharing amount on an enrollee for emergency 6ambulance services provided by an ambulance service provider that is not a 7participating provider at a rate that is greater than the requirements that would 8apply if the emergency ambulance services were provided by a participating 9ambulance service provider. AB50-ASA2-AA8,191,1310(4) No ambulance service provider that receives reimbursement under this 11section may bill an enrollee for any additional amount for emergency ambulance 12services except for any copayment, coinsurance, deductible, or other cost-sharing 13responsibilities required to be paid by the enrollee. AB50-ASA2-AA8,191,1514(5) For purposes of this section, “emergency ambulance services” does not 15include air ambulance services. AB50-ASA2-AA8,191,1817632.851 Reimbursement of emergency ambulance services. (1) In this 18section: AB50-ASA2-AA8,191,1919(a) “Ambulance service provider” has the meaning given in s. 256.01 (3). AB50-ASA2-AA8,191,2320(b) “Clean claim” means a claim that has no defect of impropriety, including a 21lack of required substantiating documentation or any particular circumstance that 22requires special treatment that prevents timely payment from being made on the 23claim. AB50-ASA2-AA8,192,1
1(c) “Emergency medical responder” has the meaning given in s. 256.01 (4p). AB50-ASA2-AA8,192,32(d) “Emergency medical services practitioner” has the meaning given in s. 3256.01 (5). AB50-ASA2-AA8,192,44(e) “Firefighter” has the meaning given in s. 36.27 (3m) (a) 1m. AB50-ASA2-AA8,192,55(f) “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp). AB50-ASA2-AA8,192,66(g) “Law enforcement officer” has the meaning given in s. 165.85 (2) (c). AB50-ASA2-AA8,192,77(h) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA8,192,138(2) (a) A disability insurance policy or self-insured health plan shall, within 930 days after receipt of a clean claim for covered emergency ambulance services, 10promptly remit payment for the covered emergency ambulance services directly to 11the ambulance service provider. No disability insurance policy or self-insured 12health plan may send a payment for covered emergency ambulance services to an 13enrollee. AB50-ASA2-AA8,192,1814(b) A disability insurance policy or self-insured health plan shall respond to a 15claim for covered emergency ambulance services that is not a clean claim by sending 16a written notice, within 30 days after receipt of the claim, acknowledging the date of 17receipt of the claim and informing the ambulance service provider of one of the 18following: AB50-ASA2-AA8,192,20191. That the disability insurance policy or self-insured health plan is declining 20to pay all or part of the claim, including the specific reason or reasons for the denial. AB50-ASA2-AA8,192,22212. That additional information is necessary to determine if all or part of the 22claim is payable and the specific additional information that is required. AB50-ASA2-AA8,193,423(3) A disability insurance policy or self-insured health plan shall remit
1payment for the transportation of any patient by ambulance as a medically 2necessary emergency ambulance service if the transportation was requested by an 3emergency medical services practitioner, an emergency medical responder, a 4firefighter, a law enforcement officer, or a health care provider. AB50-ASA2-AA8,193,66(1) Coverage of emergency ambulance services. AB50-ASA2-AA8,193,107(a) For policies and plans containing provisions inconsistent with ss. 609.825 8and 632.851, the treatment of ss. 609.825 and 632.851 first applies to policy or plan 9years beginning on the effective date of this paragraph, except as provided in par. 10(b). AB50-ASA2-AA8,193,1611(b) For policies and plans that are affected by a collective bargaining 12agreement containing provisions inconsistent with ss. 609.825 and 632.851, the 13treatment of ss. 609.825 and 632.851 first applies to policy or plan years beginning 14on the effective date of this paragraph or on the day on which the collective 15bargaining agreement is entered into, extended, modified, or renewed, whichever is 16later. AB50-ASA2-AA8,193,2118(1) Coverage of emergency ambulance services. The treatment of ss. 1940.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.825, and 20632.851 and Section 9323 (1) of this act take effect on the first day of the 4th month 21beginning after publication.”. AB50-ASA2-AA8,194,824601.45 (1) Costs to be paid by examinees. The reasonable costs of
1examinations and audits under ss. 601.43, 601.44, 601.455, and 601.83 (5) (f) shall 2be paid by examinees except as provided in sub. (4), either on the basis of a system 3of billing for actual salaries and expenses of examiners and other apportionable 4expenses, including office overhead, or by a system of regular annual billings to 5cover the costs relating to a group of companies, or a combination of such systems, 6as the commissioner may by rule prescribe. Additional funding, if any, shall be 7governed by s. 601.32. The commissioner shall schedule annual hearings under s. 8601.41 (5) to review current problems in the area of examinations. AB50-ASA2-AA8,194,1110601.455 Fair claims processing, health insurance transparency, and 11claim denial rate audits. (1) Definitions. In this section: AB50-ASA2-AA8,194,1712(a) “Claim denial” means the refusal by an insurer to provide payment under 13a disability insurance policy for a service, treatment, or medication recommended 14by a health care provider. “Claim denial” includes the prospective refusal to pay for 15a service, treatment, or medication when a disability insurance policy requires 16advance approval before a prescribed medical service, treatment, or medication is 17provided. AB50-ASA2-AA8,194,1818(b) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). AB50-ASA2-AA8,194,1919(c) “Health care provider” has the meaning given in s. 146.81 (1) (a) to (p). AB50-ASA2-AA8,194,2220(2) Claims processing. (a) Insurers shall process each claim for a disability 21insurance policy within a time frame that is reasonable and prevents an undue 22delay in an insured’s care, taking into account the medical urgency of the claim. AB50-ASA2-AA8,195,223(b) If an insurer determines additional information is needed to process a 24claim for a disability insurance policy, the insurer shall request the information
1from the insured within 5 business days of making the determination and shall 2provide at least 15 days for the insured to respond. AB50-ASA2-AA8,195,33(c) All claim denials shall include all of the following:
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