WI A 4
bill text, brackets have special meaning:
[A> <A] contains added text, and
[D> <D] contains deleted text.
1999 Regular Session
1999 WI A 4
to pass the Assembly Committee on
Health pursuant to Senate Joint Resolution 1
1999 ASSEMBLY BILL 4
14, 1999 - Introduced by Representatives SCHNEIDER, ZIEGELBAUER, BOYLE
and BERCEAU. Referred to Committee on Health.
ACT to amend 40.51 (8), 185.981 (4t), 185.983 (1) (intro.) and 632.87
(1); and to create 111.91 (2) (r), 609.71 and 632.87 (6) of the statutes;
relating to: requiring insurers to cover treatment of a condition by an
acupuncturist if there is coverage for treatment of the condition by a
physician and prohibiting collective bargaining by the state with respect
to the requirement.
Analysis by the Legislative Reference Bureau
bill requires insurers, including health maintenance organizations, preferred
provider plans, limited service health organizations and plans provided
by the state, to cover the diagnosis and treatment of a condition by an
acupuncturist, within the scope of the acupuncturist's certificate, if
diagnosis and treatment of the condition by a physician is covered. Referral
to an acupuncturist from a physician is not required for coverage of the
law contains the same coverage requirement for the diagnosis and treatment
of a condition or complaint by certain other types of health care providers,
including chiropractors, dentists and optometrists, if there is coverage
for the diagnosis and treatment of the condition or complaint by a physician.
bill also provides that the coverage requirement for acupuncture services
under plans provided by the state is not subject to collective bargaining
by the state.
further information see the state and local fiscal estimate, which will
be printed as an appendix to this bill.
people of the state of Wisconsin, represented in senate and assembly,
do enact as follows:
1. 40.51 (8) of the statutes is amended to read:
(8) Every health care coverage plan offered by the state under sub. (6)
shall comply with ss.631.89,631.90,631.93 (2), 632.72(2), 632.746(1) to
(8) and (10), 632.747,632.748, 632.85,632.853,632.855, 632.87(3) to [D>
(5) <D][A> (6),<A] 632.895 (5m) and (8) to [D>
(13) <D] [A>(14) <A] and 632.896.
2. 111.91 (2) (r) of the statutes is created to read:
(2) (r) The provision to employees of the health insurance coverage required
under 5. 632.87 (6).
3. 185.981 (4t) of the statutes is amended to read:
(4t) A sickness care plan operated by a cooperative association is subject
to ss.252.14,631,72 (2), 632.745 to 632.749, 632.85,632.853, 632.855,
632.87 (2m) [D>, (3), (4) and (5)<D] [A>
to (6) <A], 632.895 (10) to (13) and 632.897(10) and chs. 149
4. 185.983 (1) (intro) of the statues is amended to read:
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13,
601.41, 601.43, 601.44, 601.45, 611.67,619.04,628.34(10),631.89, 631.93,632.72(2),
632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855,
632.87 (2m) [D>, (3), (4), and (5) <D] [A>
to (6) <A] 632.897 (10) and chs. 609, 630, 635, 645 and 646,
but the sponsoring association shall:
5. 609.71 of the statutes is created to read:
Acupuncture coverage. Limited service health organizations, preferred
provider plans and managed care plans are subject to s. 632.87(6).
6. 632.87 (1) of the statutes is amended to read:
(1) No insurer may refuse to provide or pay for benefits for health care
services provided by a [D> licensed
care professional [A> who holds a credential,
as defined in s. 440.01 (2)(a), <A] on the ground that the services
were not rendered by a physician, as defined in s. 990.01(28), unless
the contract clearly excludes services by such practitioners, but no contract
or plan may exclude services by such practitioners, but not contract or
plan may exclude services in violation of sub. (2),(2m), (3), (4) [D>
or, <D] (5) [A> or 6.<A]
SECTION 7. 632.87 (6) of the
statutes is created to read:
632.87(6)(a) No policy, plan
or contract may exclude coverage for diagnosis and treatment of a condition
or complaint by an acupuncturist who is certified under ch. 451, within
the scope of the acupuncturist's certificate, if the policy, plan or contract
covers diagnosis and treatment of the condition or complaint by a licensed
physician or osteopath, even if different nomenclature is used to describe
the condition or complaint. This paragraph does not:
1. Prohibit the application
of deductibles or coinsurance provisions to acupuncturist and physician
charges on an equal basis.
2. Prohibit the application
of cost containment or quality assurance measures to acupuncturist and
physician services in a like manner, consistent with this section.
(b) No insurer may require
an examination by or a referral from a physician as a condition precedent
for the receipt of an acupuncturist's services under par.(a).
SECTION 8. Initial application.
(1) This act first applies
to all of the following.
(a) Except as provided in
paragraph (b), policies, plans and contracts that are issued or renewed
on the effective date of this paragraph.
(b) Policies, plans and contracts
covering employees who are affected by a collective bargaining agreement
containing provisions inconsistent with this act that are issued or renewed
on the earlier of the following:
1. The day on which the collective
bargaining agreement expires.
2. The day on which the collective
bargaining agreement is extended, modified or renewed.
SECTION 9. Effective date.
(1) This act takes effect
on the first day of the 6th month beginning after publication.
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