This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB50-ASA2-AA8,33012Section 330. 632.87 (7) of the statutes is created to read:
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 trainees 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-AA8,932322Section 9323. Initial applicability; Insurance.
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-AA8,942311Section 9423. Effective dates; Insurance.
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-AA8,185,161672. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,185,1717Section 331. 40.51 (8) of the statutes is amended to read:
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-AA8,33223Section 332. 40.51 (8m) of the statutes is amended to read:
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-AA8,3335Section 333. 66.0137 (4) of the statutes is amended to read:
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-AA8,33413Section 334. 120.13 (2) (g) of the statutes is amended to read:
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-AA8,3363Section 336. 609.714 of the statutes is created to read:
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-AA8,3377Section 337. 632.87 (8) of the statutes is created to read:
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 counselors 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-AA8,932317Section 9323. Initial applicability; Insurance.
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-AA8,942310Section 9423. Effective dates; Insurance.
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-AA8,188,151573. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,188,1616Section 338. 40.51 (8) of the statutes is amended to read:
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-AA8,33922Section 339. 40.51 (8m) of the statutes is amended to read:
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-AA8,3404Section 340. 66.0137 (4) of the statutes is amended to read:
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-AA8,34112Section 341. 120.13 (2) (g) of the statutes is amended to read:
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-AA8,3433Section 343. 609.825 of the statutes is created to read:
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-AA8,34416Section 344. 632.851 of the statutes is created to read:
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-AA8,93235Section 9323. Initial applicability; Insurance.
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-AA8,942317Section 9423. Effective dates; Insurance.
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-AA8,193,222274. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,193,2323Section 345. 601.45 (1) of the statutes is amended to read:
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-AA8,3469Section 346. 601.455 of the statutes is created to read:
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 insureds 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:
Loading...
Loading...