Amendment SA2-AB56

AB56-SA2,1927b Section 1927b. 253.06 (5) (b) 1. to 3. of the statutes are amended to read:

AB56-SA2,57,14 253.06 (5) (b) 1. Denial of the application to be a participant or authorized vendor or infant formula supplier.

AB56-SA2,57,17 2. Suspension Summary suspension or termination of authorization for an authorized vendor or infant formula supplier or, in the case of a food direct distribution center, termination of the contract.

AB56-SA2,57,19 3. Disqualification from the program under this section for a vendor, infant formula supplier, or participant.

AB56-SA2,1928b Section 1928b. 253.06 (5) (b) 6. to 8. of the statutes are created to read:

AB56-SA2,57,21 253.06 (5) (b) 6. Civil monetary penalty.

AB56-SA2,57,22 7. Warning letter.

AB56-SA2,57,23 8. Implementation of a corrective action plan.

AB56-SA2,1929b Section 1929b. 253.06 (5) (d) (intro.) and 6. of the statutes are amended to read:

AB56-SA2,58,10 253.06 (5) (d) (intro.) The department may directly assess a forfeiture provided for under par. (b) 4., recoupment provided for under par. (b) 5. and an enforcement assessment provided for under par. (c). If the department determines that a forfeiture, recoupment or enforcement assessment should be levied, or that authorization or eligibility should be summarily suspended or terminated, for a particular violation or for failure to correct it, the department shall send a notice of assessment, summary suspension or termination to the vendor, food infant formula supplier, direct distribution center or participant. The notice shall inform the vendor, food infant formula supplier, direct distribution center or participant of the right to a hearing under sub. (6) and shall specify all of the following:

AB56-SA2,58,13 6. If applicable, that the suspension or termination of authorization of the vendor or eligibility of the participant is effective beginning on the 15th day after receipt date of the notice of summary suspension or termination.

AB56-SA2,1930b Section 1930b. 253.06 (5) (e) of the statutes is renumbered 253.06 (5) (e) 1. and amended to read:

AB56-SA2,58,19 253.06 (5) (e) 1. The suspension or termination of authorization of a vendor, infant formula supplier, or direct distribution center or eligibility of a participant shall be effective beginning on the 15th day after receipt of the notice of suspension or termination.

AB56-SA2,59,3 2. All forfeitures, recoupments, and enforcement assessments shall be paid to the department within 15 days after receipt of notice of assessment or, if the forfeiture, recoupment, or enforcement assessment is contested under sub. (6), within 10 days after receipt of the final decision after exhaustion of administrative review, unless the final decision is adverse to the department or unless the final decision is appealed and the decision is stayed by court order under sub. (7). The department shall remit all forfeitures paid to the secretary of administration for deposit in the school fund. The department shall deposit all enforcement assessments in the appropriation under s. 20.435 (1) (gr).

AB56-SA2,1931b Section 1931b. 253.06 (5) (e) 3. of the statutes is created to read:

AB56-SA2,59,7 253.06 (5) (e) 3. The summary suspension of authorization of a vendor, infant formula supplier, or direct distribution center shall be effective immediately upon receipt of the notice under par. (d).

AB56-SA2,1932b Section 1932b. 253.06 (6) (b) of the statutes is amended to read:

AB56-SA2,59,24 253.06 (6) (b) A person may contest an assessment of forfeiture, recoupment or enforcement assessment, a denial, suspension or termination of authorization, a civil monetary penalty assessed in lieu of disqualification, a summary suspension, or a suspension or termination of eligibility by sending a written request for hearing under s. 227.44 to the division of hearings and appeals in the department of administration within 10 days after the receipt of the notice issued under sub. (3) (bm) or (5) (d). The administrator of the division of hearings and appeals may designate a hearing examiner to preside over the case and recommend a decision to the administrator under s. 227.46. The decision of the administrator of the division of hearings and appeals shall be the final administrative decision. The division of hearings and appeals shall commence the hearing and issue a final decision within 60 days after receipt of the request for hearing unless all of the parties consent to a later date. Proceedings before the division of hearings and appeals are governed by ch. 227. In any petition for judicial review of a decision by the division of hearings and appeals, the department, if not the petitioner who was in the proceeding before the division of hearings and appeals, shall be the named respondent.

AB56-SA2,1933b Section 1933b. 253.06 (8) of the statutes is amended to read:

AB56-SA2,60,4 253.06 (8) Inspection of premises. The department may visit and inspect each authorized vendor and infant formula supplier and each food direct distribution center, and for such purpose shall be given unrestricted access to the premises described in the authorization or contract.

AB56-SA2,1934b Section 1934b. 253.06 (9) and (10) of the statutes are created to read:

AB56-SA2,60,10 253.06 (9) Confidentiality of applicant and participant information. (a) Any information about an applicant or participant, whether it is obtained from the applicant or participant or another source or is generated as a result of application for the Women, Infants, and Children program, that identifies the applicant or participant or a family member of the applicant or participant is confidential.

AB56-SA2,60,20 (b) Except as explicitly permitted under this section, the department shall restrict the use and disclosure of confidential applicant and participant information to any person directly connected with the administration or enforcement of the Women, Infants, and Children program that the department determines has a need to know the information for Women, Infants, and Children program purposes. Persons who may be allowed to access confidential information under this paragraph include personnel from the local agencies, persons under contract with the department to perform research regarding the Women, Infants, and Children program, and persons that are investigating or prosecuting Women, Infants, and Children program violations of federal, state, or local law.

AB56-SA2,60,24 (c) The department or any local agency may use or disclose to public organizations confidential applicant and participant information for the administration of other programs that serve individuals eligible for the Women, Infants, and Children program in accordance with 7 CFR 246.26 (h).

AB56-SA2,61,4 (d) Staff of the department and local agencies who are required by state law to report known or suspected child abuse or neglect may disclose confidential applicant and participant information without the consent of the participant or applicant to the extent necessary to comply with the law.

AB56-SA2,61,18 (e) Except in the case of subpoenas or search warrants, the department and local agencies may disclose confidential applicant and participant information to individuals or entities not listed in this section only if the affected applicant or participant signs a release form authorizing the disclosure and specifying the parties to which the information may be disclosed. The department or local agency shall allow applicants and participants to refuse to sign the release form and shall notify the applicant or participant that signing the form is not a condition of eligibility and refusing to sign the form will not affect the applicant's or participant's application or participation in the Women, Infants, and Children program. Release forms authorizing disclosure to private physicians or other health care providers may be included as part of the Women, Infants, and Children program application or certification process. All other requests for applicants or participants to sign voluntary release forms may occur only after the application and certification process is complete.

AB56-SA2,62,4 (f) The department or local agency shall provide to an applicant or participant access to all information he or she has provided to the Women, Infants, and Children program. In the case of an applicant or participant who is an infant or child, the access may be provided to a parent or guardian of the infant or child, assuming that any issues regarding custody or guardianship have been settled. The department or local agency is not required to provide the applicant or participant or parent or guardian of an infant or child applicant or participant access to any other information in the file or record, including documentation of income provided by a 3rd party and staff assessments of an applicant or participant's condition or behavior, unless required by law or unless the information supports a state or local agency decision being appealed under 7 CFR 246.9.

AB56-SA2,62,10 (10) Confidentiality of vendor information. (a) Any information about a vendor, whether it is obtained from the vendor or another source, that individually identifies the vendor except for the vendor's name, address, telephone number, Internet or electronic mail address, store type, and Women, Infants, and Children program authorization status is confidential. The department shall restrict the use or disclosure of confidential vendor information to any of the following:

AB56-SA2,62,16 1. Persons directly connected with the administration or enforcement of the Women, Infants, and Children program or the food stamp program under s. 49.79 that the department determines has a need to know the information for purposes of these programs. These persons may include personnel from local agencies and persons investigating or prosecuting violations of Women, Infants, and Children program or food stamp program federal, state, or local laws.

AB56-SA2,62,22 2. Persons directly connected with the administration or enforcement of any federal or state law or local ordinance. Before releasing information to a state or local entity, the department shall enter into a written agreement with the requesting party specifying that the information may not be used or redisclosed except for purposes directly connected with the administration or enforcement of the federal or state law or local ordinance.

AB56-SA2,62,25 3. A vendor that is subject to an adverse action under sub. (5), including a claim, to the extent that the confidential information concerns the vendor that is subject to the adverse action and is related to the adverse action.

AB56-SA2,63,8 (b) The department may disclose to all authorized vendors and applicants to be a vendor sanctions that have been imposed on vendors if the disclosure identifies only the vendor's name, address, length of the disqualification or amount of the monetary penalty, and a summary of the reason for the sanction provided in the notice of adverse action under sub. (5). The information under this paragraph may be disclosed only after all administrative and judicial review is exhausted and the department has prevailed regarding the sanction imposed on the vendor or after the time period for requesting administrative and judicial review has expired.”.

AB56-SA2,63,9 100. Page 445, line 17: after that line insert:

AB56-SA2,63,10 “ Section 1935w. 253.07 (1) (a) 3. of the statutes is created to read:

AB56-SA2,63,11 253.07 (1) (a) 3. Pregnancy termination.

AB56-SA2,1936w Section 1936w. 253.07 (1) (b) 3. of the statutes is created to read:

AB56-SA2,63,13 253.07 (1) (b) 3. Pregnancy termination.

AB56-SA2,1937w Section 1937w. 253.07 (5) (b) (intro.) of the statutes is renumbered 253.07 (5) (b) and amended to read:

AB56-SA2,63,19 253.07 (5) (b) Subject to par. (c), a A public entity that receives women's health funds under this section may provide some or all of the funds to other public or private entities provided that the recipient of the funds does not do any of the following:.

AB56-SA2,1938w Section 1938w. 253.07 (5) (b) 1. to 3. of the statutes are repealed.

AB56-SA2,1939w Section 1939w. 253.07 (5) (c) of the statutes is repealed.

AB56-SA2,1940w Section 1940w. 253.075 of the statutes is repealed.”.

AB56-SA2,63,23 101. Page 446, line 1: delete lines 1 to 2 and substitute:

AB56-SA2,64,2 “254.151 (2m) Award grants for residential lead hazard abatement, residential lead hazard reduction, and lead abatement worker training.”.

AB56-SA2,64,4 102. Page 448, line 25: delete the material beginning with that line and ending with page 449, line 2, and substitute:

AB56-SA2,64,5 “ Section 1950m. 255.06 (2) (i) of the statutes is amended to read:

AB56-SA2,64,7 255.06 (2) (i) Multiple sclerosis services. Allocate and expend at least up to $60,000 as reimbursement for the provision of multiple sclerosis services to women.”.

AB56-SA2,64,8 103. Page 454, line 2: after that line insert:

AB56-SA2,64,9 “ Section 2069f. 601.83 (1) (a) of the statutes is amended to read:

AB56-SA2,64,22 601.83 (1) (a) The commissioner shall administer a state-based reinsurance program known as the healthcare stability plan in accordance with the specific terms and conditions approved by the federal department of health and human services dated July 29, 2018. Before December 31, 2023, the commissioner may not request from the federal department of health and human services a modification, suspension, withdrawal, or termination of the waiver under 42 USC 18052 under which the healthcare stability plan under this subchapter operates unless legislation has been enacted specifically directing the modification, suspension, withdrawal, or termination. Before December 31, 2023, the commissioner may request renewal, without substantive change, of the waiver under 42 USC 18052 under which the health care stability plan operates in accordance with s. 20.940 (4) unless legislation has been enacted that is contrary to such a renewal request. The commissioner shall comply with applicable timing in and requirements of s. 20.940.”.

AB56-SA2,2070i Section 2070i. 609.713 of the statutes is created to read:

AB56-SA2,65,2 609.713 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

AB56-SA2,2071i Section 2071i. 609.847 of the statutes is created to read:

AB56-SA2,65,6 609.847 Preexisting condition discrimination and certain benefit limits prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.728.

AB56-SA2,2072i Section 2072i. 625.12 (1) (a) of the statutes is amended to read:

AB56-SA2,65,9 625.12 (1) (a) Past and prospective loss and expense experience within and outside of this state, except as provided in s. 632.728.

AB56-SA2,2073i Section 2073i. 625.12 (1) (e) of the statutes is amended to read:

AB56-SA2,65,12 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, including the judgment of technical personnel.

AB56-SA2,2074i Section 2074i. 625.12 (2) of the statutes is amended to read:

AB56-SA2,65,22 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

AB56-SA2,2075i Section 2075i. 625.15 (1) of the statutes is amended to read:

AB56-SA2,66,6 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may itself establish rates and supplementary rate information for one or more market segments based on the factors in s. 625.12 and, if the rates are for motor vehicle liability insurance, subject to s. 632.365, or the insurer may use rates and supplementary rate information prepared by a rate service organization, with average expense factors determined by the rate service organization or with such modification for its own expense and loss experience as the credibility of that experience allows.

AB56-SA2,2076i Section 2076i. 628.34 (3) (a) of the statutes is amended to read:

AB56-SA2,66,14 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.”.

AB56-SA2,66,15 104. Page 454, line 12: after that line insert:

AB56-SA2,66,16 “ Section 2079i. 632.728 of the statutes is created to read:

AB56-SA2,66,18 632.728 Coverage of persons with preexisting conditions; guaranteed issue; benefit limits. (1) Definitions. In this section:

AB56-SA2,66,19 (a) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB56-SA2,66,20 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB56-SA2,67,2 (2) Guaranteed issue. (a) Every individual health benefit plan shall accept every individual in this state who, and every group health benefit plan shall accept every employer in this state that, applies for coverage, regardless of sexual orientation, gender identity, or whether or not any employee or individual has a preexisting condition. A health benefit plan may restrict enrollment in coverage described in this paragraph to open or special enrollment periods.

AB56-SA2,67,5 (b) The commissioner shall establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan to allow individuals, including individuals who do not have coverage, to enroll in coverage.

AB56-SA2,67,10 (3) Prohibiting discrimination based on health status. (a) An individual health benefit plan or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

AB56-SA2,67,11 1. Health status.

AB56-SA2,67,12 2. Medical condition, including both physical and mental illnesses.

AB56-SA2,67,13 3. Claims experience.

AB56-SA2,67,14 4. Receipt of health care.

AB56-SA2,67,15 5. Medical history.

AB56-SA2,67,16 6. Genetic information.

AB56-SA2,67,18 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

AB56-SA2,67,19 8. Disability.

AB56-SA2,68,2 (b) An insurer offering an individual health benefit plan or a self-insured health plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor under par. (a) with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the plan.

AB56-SA2,68,6 (c) Nothing in this subsection prevents an insurer offering an individual health benefit plan or a self-insured health plan from establishing premium discounts or rebates or modifying otherwise applicable cost sharing in return for adherence to programs of health promotion and disease prevention.

AB56-SA2,68,9 (4) Premium rate variation. A health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific plan based only on the following considerations:

AB56-SA2,68,10 (a) Whether the policy or plan covers an individual or a family.

AB56-SA2,68,11 (b) Rating area in the state, as established by the commissioner.

AB56-SA2,68,14 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

AB56-SA2,68,15 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

AB56-SA2,68,17 (5) Annual and lifetime limits. An individual or group health benefit plan or a self-insured health plan may not establish any of the following:

AB56-SA2,68,19 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.