AB1038,55,8
1(a) The plan may not require an enrollee to pay, including cost sharing, for a
2service, treatment, or supply provided by a provider that is not a participating
3provider in the plan's network of providers more than the enrollee would pay if the
4service, treatment, or supply is provided by a provider that is a participating
5provider. This subsection applies to any service, treatment, or supply that is related
6to diagnosis or treatment for COVID-19 and to any service, treatment, or supply that
7is provided by a provider that is not a participating provider because a participating
8provider is unavailable due to the public health emergency.
AB1038,55,139
(b) The plan shall reimburse a provider that is not a participating provider for
10a service, treatment, or supply provided under the circumstances described under
11par. (a) at 225 percent of the rate the federal Medicare program reimburses the
12provider for the same or a similar service, treatment, or supply in the same
13geographic area.
AB1038,55,20
14(3) During the state of emergency related to public health declared under s.
15323.10 on March 12, 2020, by executive order 72, or during the public health
16emergency declared under
42 USC 247d by the secretary of the federal department
17of health and human services in response to the COVID-19 pandemic, all of the
18following apply to any health care provider or health care facility that provides a
19service, treatment, or supply to an enrollee of a defined network plan or preferred
20provider plan but is not a participating provider of that plan:
AB1038,55,2421
(a) The health care provider or facility shall accept as payment in full any
22payment by a defined network plan or preferred provider plan that is at least 225
23percent of the rate the federal Medicare program reimburses the provider for the
24same or a similar service, treatment, or supply in the same geographic area.
AB1038,56,3
1(b) The health care provider or facility may not charge the enrollee for the
2service, treatment, or supply an amount that exceeds the amount the provider or
3facility is reimbursed by the defined network plan or preferred provider plan.
AB1038,56,5
4(4) The commissioner may promulgate any rules necessary to implement this
5section.
AB1038,90
6Section 90
. 609.83 of the statutes is amended to read:
AB1038,56,9
7609.83 Coverage of drugs and devices. Limited service health
8organizations, preferred provider plans, and defined network plans are subject to ss.
9632.853 and 632.895 (16t)
and (16v).
AB1038,91
10Section 91
. 609.846 of the statutes is created to read:
AB1038,56,13
11609.846 Discrimination based on COVID-19 prohibited. Limited service
12health organizations, preferred provider plans, and defined network plans are
13subject to s. 632.729.
AB1038,92
14Section 92
. 609.885 of the statutes is created to read:
AB1038,56,17
15609.885 Coverage of COVID-19 testing. Defined network plans, preferred
16provider plans, and limited service health organizations are subject to s. 632.895
17(14g).
AB1038,93
18Section 93
. 625.12 (2) of the statutes is amended to read:
AB1038,57,219
625.12
(2) Classification.
Risks Except as provided in s. 632.729, risks may
20be classified in any reasonable way for the establishment of rates and minimum
21premiums, except that no classifications may be based on race, color, creed or
22national origin, and classifications in automobile insurance may not be based on
23physical condition or developmental disability as defined in s. 51.01 (5). Subject to
24s. ss. 632.365
and 632.729, rates thus produced may be modified for individual risks
25in accordance with rating plans or schedules that establish reasonable standards for
1measuring probable variations in hazards, expenses, or both. Rates may also be
2modified for individual risks under s. 625.13 (2).
AB1038,94
3Section 94
. 628.34 (3) (a) of the statutes is amended to read:
AB1038,57,104
628.34
(3) (a) No insurer may unfairly discriminate among policyholders by
5charging different premiums or by offering different terms of coverage except on the
6basis of classifications related to the nature and the degree of the risk covered or the
7expenses involved, subject to ss. 632.365,
632.729, 632.746 and 632.748. Rates are
8not unfairly discriminatory if they are averaged broadly among persons insured
9under a group, blanket or franchise policy, and terms are not unfairly discriminatory
10merely because they are more favorable than in a similar individual policy.
AB1038,95
11Section 95
. 632.729 of the statutes is created to read:
AB1038,57,13
12632.729 Prohibiting discrimination based on COVID-19. (1) 13Definitions. In this section:
AB1038,57,1414
(a) “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.
AB1038,57,1515
(b) “Health benefit plan” has the meaning given in s. 632.745 (11).
AB1038,57,1616
(c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB1038,57,1717
(d) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB1038,57,22
18(2) Issuance or renewal. (a) An insurer that offers an individual or group
19health benefit plan, a pharmacy benefit manager, or a self-insured health plan may
20not establish rules for the eligibility of any individual to enroll, for the continued
21eligibility of any individual to remain enrolled, or for the renewal of coverage under
22the plan based on a current or past diagnosis or suspected diagnosis of COVID-19.
AB1038,58,323
(b) An insurer that offers a group health benefit plan, a pharmacy benefit
24manager, or a self-insured health plan may not establish rules for the eligibility of
25any employer or other group to enroll, for the continued eligibility of any employer
1or group to remain enrolled, or for the renewal of an employer's or group's coverage
2under the plan based on a current or past diagnosis or suspected diagnosis of
3COVID-19 of any employee or other member of the group.
AB1038,58,7
4(3) Cancellation. An insurer that offers an individual or group health benefit
5plan, a pharmacy benefit manager, or a self-insured health plan may not use as a
6basis for cancellation of coverage during a contract term a current or past diagnosis
7of COVID-19 or suspected diagnosis of COVID-19.
AB1038,58,11
8(4) Rates. An insurer that offers an individual or group health benefit plan,
9a pharmacy benefit manager, or a self-insured health plan may not use as a basis
10for setting rates for coverage a current or past diagnosis of COVID-19 or suspected
11diagnosis of COVID-19.
AB1038,58,17
12(5) Premium grace period. An insurer that offers an individual or group health
13benefit plan, a pharmacy benefit manager, or a self-insured health plan may not
14refuse to grant to an individual, employer, or other group a grace period for the
15payment of a premium based on an individual's, employee's, or group member's
16current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19 if a
17grace period for payment of premium would generally be granted under the plan.
AB1038,96
18Section 96
. 632.895 (14g) of the statutes is created to read:
AB1038,58,2019
632.895
(14g) Coverage of COVID-19
testing. (a) In this subsection,
20“COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.
AB1038,58,2521
(b) Before March 13, 2021, every disability insurance policy, and every
22self-insured health plan of the state or of a county, city, town, village, or school
23district, that generally covers testing for infectious diseases shall provide coverage
24of testing for COVID-19 without imposing any copayment or coinsurance on the
25individual covered under the policy or plan.
AB1038,97
1Section
97. 632.895 (16v) of the statutes is created to read:
AB1038,59,82
632.895
(16v) Prohibiting coverage limitations on prescription drugs. (a)
3During the period covered by the state of emergency related to public health declared
4by the governor on March 12, 2020, by executive order 72, an insurer offering a
5disability insurance policy that covers prescription drugs, a self-insured health plan
6of the state or of a county, city, town, village, or school district that covers prescription
7drugs, or a pharmacy benefit manager acting on behalf of a policy or plan may not
8do any of the following in order to maintain coverage of a prescription drug:
AB1038,59,109
1. Require prior authorization for early refills of a prescription drug or
10otherwise restrict the period of time in which a prescription drug may be refilled.
AB1038,59,1211
2. Impose a limit on the quantity of prescription drugs that may be obtained
12if the quantity is no more than a 90-day supply.
AB1038,59,1413
(b) This subsection does not apply to a prescription drug that is a controlled
14substance, as defined in s. 961.01 (4).
AB1038,98
15Section 98
. 895.4801 of the statutes is created to read:
AB1038,59,17
16895.4801 Immunity for health care providers during COVID-19
17emergency. (1) Definitions. In this section:
AB1038,59,2018
(a) “Health care professional” means an individual licensed, registered, or
19certified by the medical examining board under subch. II of ch. 448 or the board of
20nursing under ch. 441.
AB1038,59,2221
(b) “Health care provider” has the meaning given in s. 146.38 (1) (b) and
22includes an adult family home, as defined in s. 50.01 (1).
AB1038,60,3
23(2) Immunity. Subject to sub. (3), any health care professional, health care
24provider, or employee, agent, or contractor of a health care professional or health care
25provider is immune from civil liability for the death of or injury to any individual or
1any damages caused by actions or omissions taken in providing services to address
2or in response to a 2019 novel coronavirus outbreak under circumstances that satisfy
3all of the following:
AB1038,60,84
(a) The action or omission is committed while the professional, provider,
5employee, agent, or contractor is providing services during the state of emergency
6declared under s. 323.10 on March 12, 2020, by executive order 72, relating to the
72019 novel coronavirus pandemic and for the 60 days following the date that the state
8of emergency terminates.
AB1038,60,119
(b) The actions or omissions occur during the person's good faith response to
10the emergency described under par. (a) or are substantially consistent with any of
11the following:
AB1038,60,1412
1. Any direction, guidance, recommendation, or other statement made by a
13federal, state, or local official to address or in response to the emergency or disaster
14declared as described under par. (a).
AB1038,60,1715
2. Any guidance published by the department of health services, the federal
16department of health and human services, or any divisions or agencies of the federal
17department of health and human services relied upon in good faith.
AB1038,60,1918
(c) The actions or omissions do not involve reckless or wanton conduct or
19intentional misconduct.
AB1038,60,21
20(3) Applicability. This section does not apply if s. 257.03, 257.04, 323.41, or
21323.44 applies.
AB1038,99
22Section 99
. 895.51 (title) of the statutes is amended to read:
AB1038,60,24
23895.51 (title)
Civil liability exemption: food or emergency household
24products; emergency medical supplies; donation, sale, or distribution.
AB1038,100
25Section 100
. 895.51 (1) (bd) of the statutes is created to read:
AB1038,61,2
1895.51
(1) (bd) “Cost of production” means the cost of inputs, wages, operating
2the manufacturing facility, and transporting the product.
AB1038,101
3Section 101
. 895.51 (1) (bg) of the statutes is created to read:
AB1038,61,94
895.51
(1) (bg) “Emergency medical supplies" means any medical equipment
5or supplies necessary to limit the spread of, or provide treatment for, a disease
6associated with the public health emergency related to the 2019 novel coronavirus
7pandemic, including life support devices, personal protective equipment, cleaning
8supplies, and any other items determined to be necessary by the secretary of health
9services.
AB1038,102
10Section 102
. 895.51 (1) (dp) of the statutes is created to read:
AB1038,61,1611
895.51
(1) (dp) “Public health emergency related to the 2019 novel coronavirus
12pandemic” means the period covered by the public health emergency declared under
1342 USC 247d by the secretary of the federal department of health and human
14services on January 31, 2020, in response to the 2019 novel coronavirus or the
15national emergency declared by the U.S. president under
50 USC 1621 on March 13,
162020, in response to the 2019 novel coronavirus.
AB1038,103
17Section 103
. 895.51 (2r) of the statutes is created to read:
AB1038,61,2418
895.51
(2r) Any person engaged in the manufacturing, distribution, or sale of
19emergency medical supplies, who donates or sells, at a price not to exceed the cost
20of production, emergency medical supplies to a charitable organization or
21governmental unit to respond to the public health emergency related to the 2019
22novel coronavirus pandemic is immune from civil liability for the death of or injury
23to an individual caused by the emergency medical supplies donated or sold by the
24person.
AB1038,104
25Section 104
. 895.51 (3r) of the statutes is created to read:
AB1038,62,4
1895.51
(3r) Any charitable organization that distributes free of charge
2emergency medical supplies received under sub. (2r) is immune from civil liability
3for the death of or injury to an individual caused by the emergency medical supplies
4distributed by the charitable organization.
AB1038,105
5Section 105
.
Nonstatutory provisions.
AB1038,62,116
(1)
Enhanced federal medical assistance percentage. If the federal
7government provides an enhanced federal medical assistance percentage during an
8emergency period declared in response to the novel coronavirus pandemic, the
9department of health services may do any of the following during the period to which
10the enhanced federal medical assistance percentage applies in order to satisfy
11criteria to qualify for the enhanced federal medical assistance percentage:
AB1038,62,1312
(a) Suspend the requirement to comply with the premium requirements under
13s. 49.45 (23b) (b) 2. and (c).
AB1038,62,1514
(b) Suspend the requirement to comply with the health risk assessment
15requirement under s. 49.45 (23b) (b) 3.
AB1038,62,2116
(c) Delay implementation of the community engagement requirement under s.
1749.45 (23b) (b) 1. until the date that is 30 days after either the day the federal
18government has approved the community engagement implementation plan or the
19last day of the calendar quarter in which the last day of the emergency period under
2042 USC 1320b-5 (g) (1) that is declared due to the novel coronavirus pandemic
21occurs, whichever is later.
AB1038,62,2522
(d) Notwithstanding any requirement under subch. IV of ch. 49 to disenroll an
23individual to the contrary, maintain continuous enrollment in compliance with
24section 6008 (b) (3) of the federal Families First Coronavirus Response Act, P.L.
25116-127.
AB1038,63,5
1(2)
Liability insurance for physicians and nurse anesthetists. During the
2public health emergency declared on March 12, 2020, by executive order 72, all of the
3following apply to a physician or nurse anesthetist for whom this state is not a
4principal place of practice but who is authorized to practice in this state on a
5temporary basis:
AB1038,63,96
(a) The physician or nurse anesthetist may fulfill the requirements of s. 655.23
7(3) (a) by filing with the commissioner of insurance a certificate of insurance for a
8policy of health care liability insurance issued by an insurer that is authorized in a
9jurisdiction accredited by the National Association of Insurance Commissioners.
AB1038,63,1110
(b) The physician or nurse anesthetist may elect, in the manner designated by
11the commissioner of insurance by rule under s. 655.004, to be subject to ch. 655.
AB1038,63,1212
(3)
Virtual instruction; reports and guidance.
AB1038,63,1313
(a)
Definitions. In this subsection:
AB1038,63,14
141. “Department” means the department of public instruction.
AB1038,63,16
152. “Public health emergency” means the period during the 2019-20 school year
16when schools are closed by the department of health services under s. 252.02 (3).
AB1038,63,19
173. “Virtual instruction” means instruction provided through means of the
18Internet if the pupils participating in and instructional staff providing the
19instruction are geographically remote from each other.
AB1038,63,2120
(b)
School board reports. By November 1, 2020, each school board shall report
21to the department all of the following:
AB1038,63,24
221. Whether or not virtual instruction was implemented in the school district
23during the public health emergency and, if implemented, in which grades it was
24implemented.
AB1038,64,2
12. If virtual instruction was implemented in the school district during the
2public health emergency, the process for implementing the virtual instruction.
AB1038,64,5
33. For each grade level, the average percentage of the 2019-20 school year
4curriculum provided to pupils, including curriculum provided in-person and
5virtually.
AB1038,64,8
64. Whether anything was provided to pupils during the 2020 summer to help
7pupils learn content that pupils missed because of the public health emergency and,
8if so, what was provided to pupils.
AB1038,64,10
95. Recommendations for best practices for transitioning to and providing
10virtual instruction when schools are closed.
AB1038,64,12
116. Any challenges or barriers the school board faced related to implementing
12virtual instruction during the public health emergency.
AB1038,64,14
137. By position type, the number of staff members who were laid off during the
14public health emergency.
AB1038,64,16
158. The number of lunches the school board provided during the public health
16emergency.
AB1038,64,18
179. The total amount by which the school board reduced expenditures during,
18or because of, the public health emergency in each of the following categories:
AB1038,64,19
19a. Utilities.
AB1038,64,20
20b. Transportation.
AB1038,64,21
21c. Food service.
AB1038,64,23
22d. Personnel. This category includes expenditure reductions that result from
23layoffs.
AB1038,64,24
24e. Contract terminations.
AB1038,65,3
1(c)
Report to the legislature. By January 1, 2021, the department shall compile
2and submit the information it received under par. (b
) to the appropriate standing
3committees of the legislature in the manner provided under s. 13.172 (3).
AB1038,65,64
(d)
DPI guidance on returning to in-person instruction. By June 30, 2020, the
5department shall post on its Internet site guidance to schools on best practices
6related to transitioning from virtual instruction to in-person instruction.