LRB-4490/1
TJD:bjk:rs
2009 - 2010 LEGISLATURE
April 22, 2010 - Introduced by Representatives Barca, Berceau, Hubler, Sinicki,
Zigmunt, Turner, Van Akkeren, Pope-Roberts, Smith, Schneider, Young and
Benedict, cosponsored by Senators Wirch and
A. Lasee. Referred to
Committee on Insurance.
AB974,1,3
1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
2(1) (intro.); and
to create 609.837 and 632.867 of the statutes;
relating to:
3insurance coverage of oral and injected chemotherapy.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies, and self-insured governmental and
school district health plans, that cover injected or intravenous chemotherapy or both
as a medical benefit and also cover oral chemotherapy, to cover oral chemotherapy
as a medical benefit, and apply to oral chemotherapy only the copayments or other
cost-sharing amounts that apply to injected or intravenous chemotherapy. In order
to comply with those requirements, an insurer or self-insured governmental or
school district health plan may not increase the copayment or cost-sharing amount
for intravenous or injected chemotherapy more than it increases the copayment or
cost-sharing amount for other medical treatment under the policy or plan.
The requirements of the bill apply to individual and group health insurance
policies, including limited service health organizations, preferred provider plans,
defined network plans, and cooperative associations' health care plans; to health
care plans, including a self-insured plan, offered by the state to its employees; and
to self-insured health plans of a city, town, village, county, or school district.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB974,2,63
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
4shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
5and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
6632.867, 632.87 (3) to (6), 632.885, 632.895 (5m) and (8) to (17), and 632.896.
AB974,2,129
40.51
(8m) Every health care coverage plan offered by the group insurance
10board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
11632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
632.867, 632.885, and
12632.895 (11) to (17).
AB974,2,2015
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
16a village provides health care benefits under its home rule power, or if a town
17provides health care benefits, to its officers and employees on a self-insured basis,
18the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
19632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
632.867, 20632.87 (4), (5), and (6), 632.885, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB974,3,63
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
5632.798, 632.85, 632.853, 632.855,
632.867, 632.87 (4), (5), and (6), 632.885, 632.895
6(9) to (17), 632.896, and 767.513 (4).
AB974,3,169
185.983
(1) (intro.) Every voluntary nonprofit health care plan operated by a
10cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
11646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
12601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
13631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
14632.853, 632.855,
632.867, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.895 (5)
15and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646,
16but the sponsoring association shall:
AB974, s. 6
17Section
6. 609.837 of the statutes is created to read:
AB974,3,20
18609.837 Copayment equality for oral and injected chemotherapy. 19Limited service health organizations, preferred provider plans, and defined network
20plans are subject to s. 632.867.
AB974, s. 7
21Section
7. 632.867 of the statutes is created to read:
AB974,3,22
22632.867 Oral and injected chemotherapy.
(1) Definitions. In this section:
AB974,3,2523
(a) "Chemotherapy" means drugs and biologics that kill cancer cells directly,
24including antineoplastics, biologic response modifiers, hormone therapy, and
25monoclonal antibodies, and that are used to do any of the following:
AB974,4,1
11. Cure a specific cancer.
AB974,4,22
2. Control tumor growth when cure is not possible.
AB974,4,33
3. Shrink tumors before surgery or radiation therapy.
AB974,4,54
4. Destroy microscopic cancer cells that may be present after a tumor is
5removed by surgery to prevent a cancer recurrence.
AB974,4,66
(b) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB974,4,77
(c) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
AB974,4,15
8(2) Copayment requirements; limitations. (a) An insurer under a disability
9insurance policy that covers injected or intravenous chemotherapy or both as a
10medical benefit and also covers oral chemotherapy, or a self-insured governmental
11body under a self-insured health plan that covers injected or intravenous
12chemotherapy or both as a medical benefit and also covers oral chemotherapy, shall
13cover oral chemotherapy as a medical benefit and apply to oral chemotherapy only
14the copayments or other cost-sharing amounts that apply to injected or intravenous
15chemotherapy under the policy or plan.
AB974,4,1916
(b) In order to comply with par. (a), an insurer or a self-insured governmental
17body described in par. (a) may not increase the copayment or cost-sharing amount
18for intravenous or injected chemotherapy more than it increases the copayment or
19cost-sharing amount for other medical treatment under the policy or plan.
AB974,4,2121
(1) This act first applies to all of the following:
AB974,4,2522
(a) Except as provided in paragraphs (b) and (c), disability insurance policies
23that are issued or renewed, and governmental or school district self-insured health
24plans that are established, extended, modified, or renewed, on the effective date of
25this paragraph.
AB974,5,3
1(b) Disability insurance policies covering employees who are affected by a
2collective bargaining agreement containing provisions inconsistent with this act
3that are issued or renewed on the earlier of the following:
AB974,5,4
41. The day on which the collective bargaining agreement expires.
AB974,5,6
52. The day on which the collective bargaining agreement is extended, modified,
6or renewed.
AB974,5,107
(c) Governmental or school district self-insured health plans covering
8employees who are affected by a collective bargaining agreement containing
9provisions inconsistent with this act that are established, extended, modified, or
10renewed on the earlier of the following:
AB974,5,11
111. The day on which the collective bargaining agreement expires.
AB974,5,13
122. The day on which the collective bargaining agreement is extended, modified,
13or renewed.
AB974,5,1515
(1)
This act takes effect on January 1, 2011.
