Amendment SA2-AB56

AB56-SA2,80,23 54. Screening for gonorrhea for pregnant and sexually active females 24 years of age or younger and females older than 24 years of age who are at risk for infection.

AB56-SA2,81,3 55. Screening for chlamydia for pregnant and sexually active females 24 years of age and younger and females older than 24 years of age who are at risk for infection.

AB56-SA2,81,5 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB56-SA2,81,8 57. Human immunodeficiency virus screening for adults who have attained the age of 15 years but have not attained the age of 66 years and individuals at high risk of infection who are younger than 15 years of age or older than 65 years of age.

AB56-SA2,81,9 58. All contraceptives and services in accordance with sub. (17).

AB56-SA2,81,11 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. preventive services task force.

AB56-SA2,81,14 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration's Bright Futures project.

AB56-SA2,81,17 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the federal advisory committee on immunization practices.

AB56-SA2,81,20 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB56-SA2,81,24 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB56-SA2,82,3 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB56-SA2,82,13 3. Except as otherwise provided in this subdivision, if a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers, the policy or plan may apply deductibles to and impose copayments or coinsurance on the office visit and the preventive service. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers because there is no available health care provider in the policy's or plan's network of providers that provides the preventive service, the policy or plan may not apply deductibles to or impose copayments or coinsurance on the preventive service.

AB56-SA2,82,18 4. If multiple well-woman visits described under par. (b) 47. are required to fulfill all necessary preventive services and are in accordance with clinical recommendations, the disability insurance policy or self-insured health plan may not apply a deductible to or impose a copayment or coinsurance on any of those well-woman visits.

AB56-SA2,2099i Section 2099i. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB56-SA2,82,20 632.895 (14) (a) 1. i. Hepatitis A and B.

AB56-SA2,82,21 j. Varicella and herpes zoster.

AB56-SA2,2100i Section 2100i. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB56-SA2,82,23 632.895 (14) (a) 1. k. Human papillomavirus.

AB56-SA2,82,24 L. Meningococcal meningitis.

AB56-SA2,82,25 m. Pneumococcal pneumonia.

AB56-SA2,83,1 n. Influenza.

AB56-SA2,83,2 o. Rotavirus.

AB56-SA2,2101i Section 2101i. 632.895 (14) (b) of the statutes is amended to read:

AB56-SA2,83,9 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for an insured or plan participant, including a dependent who is a child of the insured or plan participant.

AB56-SA2,2102i Section 2102i. 632.895 (14) (c) of the statutes is amended to read:

AB56-SA2,83,15 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

AB56-SA2,2103i Section 2103i. 632.895 (14) (d) 3. of the statutes is amended to read:

AB56-SA2,83,19 632.895 (14) (d) 3. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

AB56-SA2,2104i Section 2104i. 632.895 (14m) of the statutes is created to read:

AB56-SA2,83,22 632.895 (14m) Essential health benefits. (a) In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB56-SA2,84,2 (b) On a date specified by the commissioner, by rule, every disability insurance policy, except as provided in par. (g), and every self-insured health plan shall provide coverage for essential health benefits as determined by the commissioner, by rule, subject to par. (c).

AB56-SA2,84,4 (c) In determining the essential health benefits for which coverage is required under par. (b), the commissioner shall do all of the following:

AB56-SA2,84,6 1. Include benefits, items, and services in, at least, all of the following categories:

AB56-SA2,84,7 a. Ambulatory patient services.

AB56-SA2,84,8 b. Emergency services.

AB56-SA2,84,9 c. Hospitalization.

AB56-SA2,84,10 d. Maternity and newborn care.

AB56-SA2,84,12 e. Mental health and substance use disorder services, including behavioral health treatment.

AB56-SA2,84,13 f. Prescription drugs.

AB56-SA2,84,14 g. Rehabilitative and habilitative services and devices.

AB56-SA2,84,15 h. Laboratory services.

AB56-SA2,84,16 i. Preventive and wellness services and chronic disease management.

AB56-SA2,84,17 j. Pediatric services, including oral and vision care.

AB56-SA2,84,22 2. Conduct a survey of employer-sponsored coverage to determine benefits typically covered by employers and ensure that the scope of essential health benefits for which coverage is required under this subsection is equal to the scope of benefits covered under a typical disability insurance policy offered by an employer to its employees.

AB56-SA2,84,24 3. Ensure that essential health benefits reflect a balance among the categories described in subd. 1. such that benefits are not unduly weighted toward one category.

AB56-SA2,85,2 4. Ensure that essential health benefit coverage is provided with no or limited cost-sharing requirements.

AB56-SA2,85,6 5. Require that disability insurance policies and self-insured health plans do not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.

AB56-SA2,85,9 6. Establish essential health benefits in a way that takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.

AB56-SA2,85,13 7. Ensure that essential health benefits established under this subsection are not subject to a coverage denial based on an insured's or plan participant's age, expected length of life, present or predicted disability, degree of dependency on medical care, or quality of life.

AB56-SA2,85,20 8. Require that disability insurance policies and self-insured health plans cover emergency department services that are essential health benefits without imposing any requirement to obtain prior authorization for those services and without limiting coverage for services provided by an emergency services provider that is not in the provider network of a policy or plan in a way that is more restrictive than requirements or limitations that apply to emergency services provided by a provider that is in the provider network of the policy or plan.

AB56-SA2,85,25 9. Require a disability insurance policy or self-insured health plan to apply to emergency department services that are essential health benefits provided by an emergency department provider that is not in the provider network of the policy or plan the same copayment amount or coinsurance rate that applies if those services are provided by a provider that is in the provider network of the policy or plan.

AB56-SA2,86,2 (d) The commissioner shall periodically update, by rule, the essential health benefits under this subsection to address any gaps in access to coverage.

AB56-SA2,86,7 (e) If an essential health benefit is also subject to mandated coverage elsewhere under this section and the coverage requirements are not identical, the disability insurance policy or self-insured health plan shall provide coverage under whichever subsection provides the insured or plan participant with more comprehensive coverage of the medical condition, item, or service.

AB56-SA2,86,11 (f) Nothing in this subsection or rules promulgated under this subsection prohibits a disability insurance policy or a self-insured health plan from providing benefits in excess of the essential health benefit coverage required under this subsection.

AB56-SA2,86,13 (g) This subsection does not apply to any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12.

AB56-SA2,2105i Section 2105i. 632.895 (16m) (b) of the statutes is amended to read:

AB56-SA2,86,19 632.895 (16m) (b) The coverage required under this subsection may be subject to any limitations, or exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. The coverage required under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB56-SA2,2106i Section 2106i. 632.895 (17) (b) 2. of the statutes is amended to read:

AB56-SA2,86,25 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan sterilization procedures, and patient education and counseling for all females with reproductive capacity.

AB56-SA2,2107i Section 2107i. 632.895 (17) (c) of the statutes is amended to read:

AB56-SA2,87,16 632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions, and limitations, or cost-sharing provisions that apply generally to the coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices that is provided under the policy or self-insured health plan. A disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to at least one of each type of contraceptive method approved by the federal food and drug administration for which coverage is required under this subsection. The disability insurance policy or self-insured health plan may apply reasonable medical management to a method of contraception to limit coverage under this subsection that is provided without being subject to a deductible, copayment, or coinsurance to prescription drugs without a brand name. The disability insurance policy or self-insured health plan may apply a deductible or impose a copayment or coinsurance for coverage of a contraceptive that is prescribed for a medical need if the services for the medical need would otherwise be subject to a deductible, copayment, or coinsurance.

AB56-SA2,2108i Section 2108i. 632.897 (11) (a) of the statutes is amended to read:

AB56-SA2,88,2 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.

AB56-SA2,88,3 105. Page 455, line 18: after that line insert:

AB56-SA2,88,4 “ Section 2118m. 767.805 (4) (d) of the statutes is repealed.

AB56-SA2,2119m Section 2119m. 767.89 (3) (e) of the statutes is repealed.”.

AB56-SA2,88,6 106. Page 460, line 2: after that line insert:

AB56-SA2,88,7 “ Section 2264g. 2017 Wisconsin Act 370, Section 44 (2) and (3) are repealed.”.

AB56-SA2,88,8 107. Page 488, line 8: after that line insert:

AB56-SA2,88,16 “(1) Prescription drug pooling study. The department of employee trust funds, in consultation with the department of corrections, the department of health services, and the department of veterans affairs, shall study the options and opportunities for cost savings to state agencies through prescription drug pooling. No later than January 1, 2020, the department of employee trust funds shall submit a report of the study to the governor and the appropriate standing committees of the legislature, as determined by the speaker of the assembly and the president of the senate, in the manner provided under s. 13.172 (3).”.

AB56-SA2,88,17 108. Page 488, line 16: after that line insert:

AB56-SA2,88,22 “(1s) Forensic unit expansion at Sand Ridge Secure Treatment Center. From the appropriation under s. 20.435 (2) (bm), the department of health services shall allocate $3,430,900 in fiscal year 2020-21 and create 36.50 FTE GPR positions to operate a 20-bed unit for forensic patients at the Sand Ridge Secure Treatment Center.

AB56-SA2,89,2 (1t) Youth crisis stabilization facilities and peer-run respite centers for veterans. The department of health services shall award in each fiscal year $996,400 in grants to youth crisis stabilization facilities and $450,000 in grants to a peer-run respite center for veterans.”.

AB56-SA2,89,4 109. Page 488, line 17: delete the material beginning with that line and ending with page 489, line 3, and substitute:

AB56-SA2,89,9 “(2b) Medical Assistance reimbursement for services provided through telehealth. The department of health services shall develop, by rule, a method of reimbursing providers under the Medical Assistance program for a service that is covered by the Medical Assistance program under subch. IV of ch. 49 and that satisfies any of the following:

AB56-SA2,89,12 (a) The service is a consultation between a provider at an originating site and a provider at a remote location using a combination of interactive video, audio, and externally acquired images through a networking environment.

AB56-SA2,89,15 (b) The service is an asynchronous transmission of digital clinical information through a secure electronic system from a Medical Assistance recipient or provider to a provider.”.

AB56-SA2,89,16 110. Page 489, line 3: after that line insert:

AB56-SA2,89,20 “(2g) Childless adults demonstration project reform waiver. The department of health services may submit a request to the federal department of health and human services to modify or withdraw the waiver granted under s. 49.45 (23) (g), 2017 stats.

AB56-SA2,89,21 (3g) Academic detailing training program.

AB56-SA2,90,2 (a) In this subsection, “academic detailing” means a teaching model under which health care experts are taught techniques for engaging in interactional educational outreach to other health care providers and clinical staff to provide information on evidence-based practices and successful therapeutic interventions with the goal of improving patient care.

AB56-SA2,90,5 (b) The department of health services shall establish and implement a 2-year academic detailing primary care clinic dementia training program in 10 primary care clinics in the state through a contract with the Wisconsin Alzheimer's Institute.

AB56-SA2,90,10 (c) The department shall, as part of the training program, provide primary care providers with clinical training and access to educational resources on best practices for diagnosis and management of common cognitive disorders, and referral strategies to dementia specialists for complicated or rare cognitive or behavioral disorders.

AB56-SA2,90,12 (d) The department shall ensure that the training program under this subsection includes at least the following three components:

AB56-SA2,90,14 1. The most current research on effective clinical treatments and practices is systematically evaluated by the academic detailing team.

AB56-SA2,90,17 2. Information gathered and evaluated under subd. 1. is packaged into an easily accessible format that is clinically relevant, rigorously sourced, and compellingly formatted.

AB56-SA2,90,21 3. Training is provided for clinicians to serve as academic detailers that equips them with clinical expertise and proficiency in conducting an interactive educational exchange to facilitate individualized learning among participating primary care practitioners in the target clinics.”.

AB56-SA2,90,22 111. Page 489, line 14: after that line insert:

AB56-SA2,91,6 “(4c) Childless adults demonstration project. The department of health services shall submit any necessary request to the federal department of health and human services for a state plan amendment or waiver of federal Medicaid law or to modify or withdraw from any waiver of federal Medicaid law relating to the childless adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the incorporation of recipients of Medical Assistance under the demonstration project into the BadgerCare Plus program under s. 49.471 and the termination of the demonstration project.”.