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AB56-SA2,82,2525 m. Pneumococcal pneumonia.
AB56-SA2,83,1
1n. Influenza.
AB56-SA2,83,22 o. Rotavirus.
AB56-SA2,2101i 3Section 2101i. 632.895 (14) (b) of the statutes is amended to read:
AB56-SA2,83,94 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
5and every self-insured health plan of the state or a county, city, town, village, or
6school district, that provides coverage for a dependent of the insured shall provide
7coverage of appropriate and necessary immunizations, from birth to the age of 6
8years,
for an insured or plan participant, including a dependent who is a child of the
9insured or plan participant.
AB56-SA2,2102i 10Section 2102i. 632.895 (14) (c) of the statutes is amended to read:
AB56-SA2,83,1511 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
12deductibles, copayments, or coinsurance under the policy or plan. This paragraph
13applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
14appropriate and necessary immunizations provided by providers participating, as
15defined in s. 609.01 (3m), in the plan.
AB56-SA2,2103i 16Section 2103i. 632.895 (14) (d) 3. of the statutes is amended to read:
AB56-SA2,83,1917 632.895 (14) (d) 3. A health care plan offered by a limited service health
18organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
19in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
AB56-SA2,2104i 20Section 2104i. 632.895 (14m) of the statutes is created to read:
AB56-SA2,83,2221 632.895 (14m) Essential health benefits. (a) In this subsection,
22“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB56-SA2,84,223 (b) On a date specified by the commissioner, by rule, every disability insurance
24policy, except as provided in par. (g), and every self-insured health plan shall provide

1coverage for essential health benefits as determined by the commissioner, by rule,
2subject to par. (c).
AB56-SA2,84,43 (c) In determining the essential health benefits for which coverage is required
4under par. (b), the commissioner shall do all of the following:
AB56-SA2,84,65 1. Include benefits, items, and services in, at least, all of the following
6categories:
AB56-SA2,84,77 a. Ambulatory patient services.
AB56-SA2,84,88 b. Emergency services.
AB56-SA2,84,99 c. Hospitalization.
AB56-SA2,84,1010 d. Maternity and newborn care.
AB56-SA2,84,1211 e. Mental health and substance use disorder services, including behavioral
12health treatment.
AB56-SA2,84,1313 f. Prescription drugs.
AB56-SA2,84,1414 g. Rehabilitative and habilitative services and devices.
AB56-SA2,84,1515 h. Laboratory services.
AB56-SA2,84,1616 i. Preventive and wellness services and chronic disease management.
AB56-SA2,84,1717 j. Pediatric services, including oral and vision care.
AB56-SA2,84,2218 2. Conduct a survey of employer-sponsored coverage to determine benefits
19typically covered by employers and ensure that the scope of essential health benefits
20for which coverage is required under this subsection is equal to the scope of benefits
21covered under a typical disability insurance policy offered by an employer to its
22employees.
AB56-SA2,84,2423 3. Ensure that essential health benefits reflect a balance among the categories
24described in subd. 1. such that benefits are not unduly weighted toward one category.
AB56-SA2,85,2
14. Ensure that essential health benefit coverage is provided with no or limited
2cost-sharing requirements.
AB56-SA2,85,63 5. Require that disability insurance policies and self-insured health plans do
4not make coverage decisions, determine reimbursement rates, establish incentive
5programs, or design benefits in ways that discriminate against individuals because
6of their age, disability, or expected length of life.
AB56-SA2,85,97 6. Establish essential health benefits in a way that takes into account the
8health care needs of diverse segments of the population, including women, children,
9persons with disabilities, and other groups.
AB56-SA2,85,1310 7. Ensure that essential health benefits established under this subsection are
11not subject to a coverage denial based on an insured's or plan participant's age,
12expected length of life, present or predicted disability, degree of dependency on
13medical care, or quality of life.
AB56-SA2,85,2014 8. Require that disability insurance policies and self-insured health plans
15cover emergency department services that are essential health benefits without
16imposing any requirement to obtain prior authorization for those services and
17without limiting coverage for services provided by an emergency services provider
18that is not in the provider network of a policy or plan in a way that is more restrictive
19than requirements or limitations that apply to emergency services provided by a
20provider that is in the provider network of the policy or plan.
AB56-SA2,85,2521 9. Require a disability insurance policy or self-insured health plan to apply to
22emergency department services that are essential health benefits provided by an
23emergency department provider that is not in the provider network of the policy or
24plan the same copayment amount or coinsurance rate that applies if those services
25are provided by a provider that is in the provider network of the policy or plan.
AB56-SA2,86,2
1(d) The commissioner shall periodically update, by rule, the essential health
2benefits under this subsection to address any gaps in access to coverage.
AB56-SA2,86,73 (e) If an essential health benefit is also subject to mandated coverage elsewhere
4under this section and the coverage requirements are not identical, the disability
5insurance policy or self-insured health plan shall provide coverage under whichever
6subsection provides the insured or plan participant with more comprehensive
7coverage of the medical condition, item, or service.
AB56-SA2,86,118 (f) Nothing in this subsection or rules promulgated under this subsection
9prohibits a disability insurance policy or a self-insured health plan from providing
10benefits in excess of the essential health benefit coverage required under this
11subsection.
AB56-SA2,86,1312 (g) This subsection does not apply to any disability insurance policy that is
13described in s. 632.745 (11) (b) 1. to 12.
AB56-SA2,2105i 14Section 2105i. 632.895 (16m) (b) of the statutes is amended to read:
AB56-SA2,86,1915 632.895 (16m) (b) The coverage required under this subsection may be subject
16to any limitations, or exclusions, or cost-sharing provisions that apply generally
17under the disability insurance policy or self-insured health plan. The coverage
18required under this subsection may not be subject to any deductibles, copayments,
19or coinsurance.
AB56-SA2,2106i 20Section 2106i. 632.895 (17) (b) 2. of the statutes is amended to read:
AB56-SA2,86,2521 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and
22medical services that are necessary to prescribe, administer, maintain, or remove a
23contraceptive, if covered for any other drug benefits under the policy or plan
24sterilization procedures, and patient education and counseling for all females with
25reproductive capacity
.
AB56-SA2,2107i
1Section 2107i. 632.895 (17) (c) of the statutes is amended to read:
AB56-SA2,87,162 632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions,
3and limitations, or cost-sharing provisions that apply generally to the coverage of
4outpatient health care services, preventive treatments and services, or prescription
5drugs and devices that is provided under the policy or self-insured health plan. A
6disability insurance policy or self-insured health plan may not apply a deductible or
7impose a copayment or coinsurance to at least one of each type of contraceptive
8method approved by the federal food and drug administration for which coverage is
9required under this subsection. The disability insurance policy or self-insured
10health plan may apply reasonable medical management to a method of contraception
11to limit coverage under this subsection that is provided without being subject to a
12deductible, copayment, or coinsurance to prescription drugs without a brand name.
13The disability insurance policy or self-insured health plan may apply a deductible
14or impose a copayment or coinsurance for coverage of a contraceptive that is
15prescribed for a medical need if the services for the medical need would otherwise be
16subject to a deductible, copayment, or coinsurance.
AB56-SA2,2108i 17Section 2108i. 632.897 (11) (a) of the statutes is amended to read:
AB56-SA2,88,218 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
19promulgate rules establishing standards requiring insurers to provide continuation
20of coverage for any individual covered at any time under a group policy who is a
21terminated insured or an eligible individual under any federal program that
22provides for a federal premium subsidy for individuals covered under continuation
23of coverage under a group policy, including rules governing election or extension of
24election periods, notice, rates, premiums, premium payment, application of

1preexisting condition exclusions,
election of alternative coverage, and status as an
2eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.
AB56-SA2,88,3 3105. Page 455, line 18: after that line insert:
AB56-SA2,88,4 4 Section 2118m. 767.805 (4) (d) of the statutes is repealed.
AB56-SA2,2119m 5Section 2119m. 767.89 (3) (e) of the statutes is repealed.”.
AB56-SA2,88,6 6106. Page 460, line 2: after that line insert:
AB56-SA2,88,7 7 Section 2264g. 2017 Wisconsin Act 370, Section 44 (2) and (3) are repealed.”.
AB56-SA2,88,8 8107. Page 488, line 8: after that line insert:
AB56-SA2,88,16 9“(1) Prescription drug pooling study. The department of employee trust
10funds, in consultation with the department of corrections, the department of health
11services, and the department of veterans affairs, shall study the options and
12opportunities for cost savings to state agencies through prescription drug pooling.
13No later than January 1, 2020, the department of employee trust funds shall submit
14a report of the study to the governor and the appropriate standing committees of the
15legislature, as determined by the speaker of the assembly and the president of the
16senate, in the manner provided under s. 13.172 (3).”.
AB56-SA2,88,17 17108. Page 488, line 16: after that line insert:
AB56-SA2,88,22 18(1s) Forensic unit expansion at Sand Ridge Secure Treatment Center. From
19the appropriation under s. 20.435 (2) (bm), the department of health services shall
20allocate $3,430,900 in fiscal year 2020-21 and create 36.50 FTE GPR positions to
21operate a 20-bed unit for forensic patients at the Sand Ridge Secure Treatment
22Center.
AB56-SA2,89,2 23(1t) Youth crisis stabilization facilities and peer-run respite centers for
24veterans.
The department of health services shall award in each fiscal year $996,400

1in grants to youth crisis stabilization facilities and $450,000 in grants to a peer-run
2respite center for veterans.”.
AB56-SA2,89,4 3109. Page 488, line 17: delete the material beginning with that line and
4ending with page 489, line 3, and substitute:
AB56-SA2,89,9 5“(2b) Medical Assistance reimbursement for services provided through
6telehealth.
The department of health services shall develop, by rule, a method of
7reimbursing providers under the Medical Assistance program for a service that is
8covered by the Medical Assistance program under subch. IV of ch. 49 and that
9satisfies any of the following:
AB56-SA2,89,1210 (a) The service is a consultation between a provider at an originating site and
11a provider at a remote location using a combination of interactive video, audio, and
12externally acquired images through a networking environment.
AB56-SA2,89,1513 (b) The service is an asynchronous transmission of digital clinical information
14through a secure electronic system from a Medical Assistance recipient or provider
15to a provider.”.
AB56-SA2,89,16 16110. Page 489, line 3: after that line insert:
AB56-SA2,89,20 17“(2g) Childless adults demonstration project reform waiver. The
18department of health services may submit a request to the federal department of
19health and human services to modify or withdraw the waiver granted under s. 49.45
20(23) (g), 2017 stats.
AB56-SA2,89,2121 (3g) Academic detailing training program.
AB56-SA2,90,222 (a) In this subsection, “academic detailing” means a teaching model under
23which health care experts are taught techniques for engaging in interactional
24educational outreach to other health care providers and clinical staff to provide

1information on evidence-based practices and successful therapeutic interventions
2with the goal of improving patient care.
AB56-SA2,90,53 (b) The department of health services shall establish and implement a 2-year
4academic detailing primary care clinic dementia training program in 10 primary
5care clinics in the state through a contract with the Wisconsin Alzheimer's Institute.
AB56-SA2,90,106 (c) The department shall, as part of the training program, provide primary care
7providers with clinical training and access to educational resources on best practices
8for diagnosis and management of common cognitive disorders, and referral
9strategies to dementia specialists for complicated or rare cognitive or behavioral
10disorders.
AB56-SA2,90,1211 (d) The department shall ensure that the training program under this
12subsection includes at least the following three components:
AB56-SA2,90,14 131. The most current research on effective clinical treatments and practices is
14systematically evaluated by the academic detailing team.
AB56-SA2,90,17 152. Information gathered and evaluated under subd. 1. is packaged into an
16easily accessible format that is clinically relevant, rigorously sourced, and
17compellingly formatted.
AB56-SA2,90,21 183. Training is provided for clinicians to serve as academic detailers that equips
19them with clinical expertise and proficiency in conducting an interactive educational
20exchange to facilitate individualized learning among participating primary care
21practitioners in the target clinics.”.
AB56-SA2,90,22 22111. Page 489, line 14: after that line insert:
AB56-SA2,91,6 23“(4c) Childless adults demonstration project. The department of health
24services shall submit any necessary request to the federal department of health and

1human services for a state plan amendment or waiver of federal Medicaid law or to
2modify or withdraw from any waiver of federal Medicaid law relating to the childless
3adults demonstration project under s. 49.45 (23), 2017 stats., to reflect the
4incorporation of recipients of Medical Assistance under the demonstration project
5into the BadgerCare Plus program under s. 49.471 and the termination of the
6demonstration project.”.
AB56-SA2,91,7 7112. Page 489, line 15: delete lines 15 to 20 and substitute:
AB56-SA2,91,13 8“(6b) Evidence-based oral health grants and Seal-A-Smile program.
9Notwithstanding s. 250.10 (1m) (b), in fiscal year 2019-20, the department of health
10services shall, from the appropriation under s. 20.435 (1) (de), award to qualified
11applicants grants totaling $50,000 for fluoride varnish and other evidence-based
12oral health activities, $525,000 for school-based preventive dental services, and
13$100,000 for school-based restorative dental services.”.
AB56-SA2,91,14 14113. Page 489, line 20: after that line insert:
AB56-SA2,91,21 15“(6d) Prescription drug importation program. The department of health
16services shall submit the first report required under s. 250.048 (5) by the next
17January 1 or July 1, whichever is earliest, that is at least 180 days after the date the
18prescription drug importation program is fully operational under s. 250.048 (4). The
19department of health services shall include in the first 3 reports submitted under s.
20250.048 (5) information on the implementation of the audit functions under s.
21250.048 (1) (n).”.
AB56-SA2,91,22 22114. Page 490, line 5: after that line insert:
AB56-SA2,92,4 23“(8m) Community-based doulas. From the appropriation under s. 20.435 (4)
24(bm), the department of health services shall in fiscal year 2019-20 allocate $192,000

1to public or private entities, American Indian tribes or tribal organizations, or
2community-based organizations for grants for community-based doulas. The
3recipients of the grants shall use the moneys to identify and train local community
4workers to mentor pregnant women.”.
AB56-SA2,92,5 5115. Page 490, line 6: delete lines 6 to 11 and substitute:
AB56-SA2,92,11 6“(9b) Dental services under Medical Assistance. During the 2019-21 fiscal
7biennium, the department of health services shall allocate a total of $2,000,000 in the
82019-20 fiscal year and $3,000,000 in the 2020-21 fiscal year from all funding
9sources to increase reimbursement rates for dental services that are covered under
10the Medical Assistance program under subch. IV of ch. 49 and that are provided to
11recipients of Medical Assistance who have disabilities.”.
AB56-SA2,92,12 12116. Page 490, line 11: after that line insert:
AB56-SA2,92,20 13(9r) Wisconsin chronic disease program. In fiscal year 2019-20, the
14department of health services shall allocate $3,782,200 from the appropriation
15under s. 20.435 (4) (e) and $983,500 from the appropriation under s. 20.435 (4) (je)
16to fund the Wisconsin Chronic Disease Program as provided under ss. 49.68, 49.683,
17and 49.685. In fiscal year 2020-21, the department of health services shall allocate
18$3,939,300 from the appropriation under s. 20.435 (4) (e) and $1,027,300 from the
19appropriation under s. 20.435 (4) (je) to fund the Wisconsin Chronic Disease Program
20as provided under ss. 49.68, 49.683, and 49.685.”.
AB56-SA2,92,21 21117. Page 490, line 12: delete lines 12 to 16 and substitute:
AB56-SA2,93,2 22“(10c) Infant mortality prevention program. The department of health
23services shall allocate 5.0 FTE positions that are authorized for the department of
24health services to staff an infant mortality prevention program. The department of

1health services shall report in its 2021-23 budget request any necessary budget
2adjustments to reflect this allocation of positions.”.
AB56-SA2,93,3 3118. Page 490, line 16: after that line insert:
AB56-SA2,93,13 4(10d) Dispatcher assisted cardiopulmonary resuscitation. Beginning in
5fiscal year 2019-20, the department of health services shall allocate $105,900 each
6fiscal year to assist public safety answering points in complying with dispatcher
7training requirements on telephonic assistance on administering cardiopulmonary
8resuscitation enacted in 2017 Wisconsin Act 296, including $75,900 under 20.435 (1)
9(cj) for the department of health services to distribute, either as grants to public
10safety answering points or by contracting with an entity to provide training to public
11safety answering points, and $30,000 to fund supplies and services for the program
12under the department of health services general program operations appropriation
13under s. 20.435 (1) (a).”.
AB56-SA2,93,14 14119. Page 491, line 3: delete lines 3 to 15.
AB56-SA2,93,15 15120. Page 491, line 15: after that line insert:
AB56-SA2,93,20 16(10s) One-time funding for information technology infrastructure
17improvements.
In fiscal year 2019-20, the department of health services shall
18allocate $500,000 on a one-time basis to fund information technology infrastructure
19improvements as part of an automated licensing project and to enable assisted living
20providers to enter reports online.”.
AB56-SA2,93,24 21121. Page 491, line 20: delete the material beginning with “facilities;" and
22ending with “2020-21" on line 23 and substitute “facilities and an additional
23$15,000,000, as the state share of payments, and the matching federal share of
24payments in each of fiscal years 2019-20 and 2020-21”.
AB56-SA2,94,1
1122. Page 492, line 1: delete lines 1 to 7 and substitute:
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