Amendment ASA1-AB1

Out-of-network costs related to health coverage

The bill prohibits, through December 31, 2021, a defined network plan, including a health maintenance organization, or preferred provider plan from requiring an enrollee of the plan to pay more for a service, treatment, or supply provided by an out-of-network provider than if the service, treatment, or supply is provided by an in-network provider. This prohibition applies to any service, treatment, or supply that is related to the diagnosis of or treatment for COVID-19 and that is provided by an out-of-network provider because a participating provider is unavailable due to the COVID-19 pandemic. For a service, treatment, or supply provided under those circumstances, the bill requires the plan to reimburse the out-of-network provider at 250 percent of the federal Medicare program rate. Also, under those circumstances, any health care provider or facility that provides a service, treatment, or supply to an enrollee of a plan but is not a participating provider of that plan shall accept as payment in full any payment by a plan that is at least 250 percent of the federal Medicare program rate and may not charge the enrollee an amount that exceeds the amount that the provider or facility is reimbursed by the plan. Similar prohibitions and requirements were created in 2019 Wisconsin Act 185, except that the reimbursement rate in Act 185 for an out-of-network provider was 225 percent of the federal Medicare program rate. The Act 185 prohibitions and requirements applied only during the state of emergency related to public health declared on March 12, 2020, and for 60 days following the termination of that state of emergency.

Coverage of COVID-19 related costs without cost sharing

The bill requires every health insurance policy and every self-insured governmental health plan that generally covers testing for and treatment of infectious disease to provide coverage of testing for, diagnosis and treatment of, and administration of any vaccination developed to prevent COVID-19 without imposing any copayment or coinsurance. This requirement applies through December 31, 2021. A health insurance policy is referred to in the bill as a disability insurance policy. Current law requires health insurance policies and self-insured governmental health plans to cover, until March 13, 2021, testing for COVID-19 without imposing any copayment or coinsurance.

Insurance coverage for health care workers

The bill requires every health insurance policy and every self-insured governmental health plan that generally covers testing for and treatment of infectious disease to provide coverage of testing for and treatment of COVID-19 or any other communicable disease for a frontline health care worker who has been diagnosed with or is under investigation of having COVID-19 or any other communicable disease without imposing any copayment or coinsurance. A health insurance policy is referred to in the bill as a disability insurance policy. For purposes of required insurance coverage, the treatment that must be covered is any treatment that is medically necessary and reasonably related to COVID-19 or any other communicable disease or complications from COVID-19 or other communicable disease.

Coverage parity for telehealth services

The bill prohibits a health insurance policy or a self-insured health plan of the state or a county, city, village, town, or school district from denying coverage for a treatment or service provided through telehealth if that treatment or service is covered under the policy or plan when provided in person by a health care provider. This prohibition applies through December 31, 2021. Health insurance policies are known as disability insurance policies in the bill. Telehealth is a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or a consultation or are used to transfer medically relevant data about a patient.

safety and professional services

Optional licensure of third-party logistics providers

The bill creates an optional license for third-party logistics providers that are located in the state or are located outside the state but provide third-party logistics provider services in the state. A third-party logistics provider is defined under current law as a person that contracts with a prescription drug manufacturer to provide or coordinate warehousing, distribution, or other services on behalf of the manufacturer but that does not take title to the manufacturer's prescription drug or have general responsibility to direct the prescription drug's sale or disposition.

The bill requires an applicant for a third-party logistics provider license to submit certain information prior to licensure, including proof of a recent facility inspection, and a personal statement relating to a designated representative of the facility. The license created by the bill will no longer apply if the federal Food and Drug Administration establishes a licensing program for third-party logistics providers under federal law and the Pharmacy Examining Board determines that state licensure is not required for a resident third-party logistics provider to provide third-party logistics services in another state.

The bill also directs the Pharmacy Examining Board to promulgate rules that regulate third-party logistics providers and out-of-state third-party logistics providers consistent with federal law. The authority of the Pharmacy Examining Board to promulgate rules is restricted to only rules that are equivalent to requirements under federal law and only rules that do not mandate licensing under state law.

Finally, the bill requires the Pharmacy Examining Board to issue interim licenses for third-party logistics providers and out-of-state third-party logistics providers between the date of enactment until permanent or emergency rules take effect, whichever is sooner, if, in the opinion of the board, the applicant is currently in compliance with federal law relating to third-party logistics providers. An interim license to act as a third-party logistics provider or out-of-state third-party logistics provider expires 90 days after the date that emergency rules take effect or 90 days after the date that permanent rules take effect, whichever is sooner. No fee is required for an interim license to act as a third-party logistics provider or an out-of-state third-party logistics provider.

retirement and group insurance

Wisconsin Retirement System annuities for critical workers

Under current law, certain people who receive a retirement or disability annuity from the Wisconsin Retirement System and who are hired by an employer that participates in the WRS must suspend that annuity and may not receive a WRS annuity payment until the person is no longer in a WRS-covered position. This suspension applies to a person who 1) has reached his or her normal retirement date; 2) is appointed to a position with a WRS-participating employer, or provides employee services as a contractor to a WRS-participating employer; and 3) is expected to work at least two-thirds of what is considered full-time employment by the Department of Employee Trust Funds.

The bill creates an exception to this suspension if 1) the person is either hired or provides employee services as a contractor in a critical position during the period beginning on the effective date of the bill and ending on December 31, 2021; 2) at the time the person initially retires from covered employment with a participating employer, the person does not have an agreement with any participating employer to return to employment; and 3) the person elects to not become a participating employee at the time the person is rehired or enters into a contract after retirement. In other words, the bill allows a WRS annuitant who is either hired or provides employee services as a contractor in a critical position during the period beginning on the effective date of the bill and ending on December 31, 2021, to return to work with an employer who participates in the WRS and continue to receive his or her annuity.

State government

Waiving in-person requirements

Current law allows a state entity to waive any requirement that an individual appear in person during the public health emergency declared on March 12, 2020. The bill expands that provision so that a state entity may waive such in-person requirements through December 31, 2021, if enforcing the requirement would increase the public health risk.

Waiver of certain interest, penalties, and payments

Under the bill, each state agency and authority and each local governmental unit may waive any interest, penalty, or payment that accrues or becomes due beginning on the day the bill becomes law and ending on December 31, 2021, with respect to a debt any person owes to the agency, authority, or local unit of government.

COVID-19 testing and surge capacity

The bill requires DOA to do all of the following related to COVID-19:

1. Facilitate COVID-19 testing and diagnosis throughout this state.

2. Operate alternate care facilities staffed by health care professionals for patients diagnosed with COVID-19.

3. Facilitate surge staffing resources for health care facilities throughout the state.

Grants to small businesses

The bill authorizes the Department of Revenue to provide grants to small businesses in the manner to be determined by DOR.

This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB1-ASA1,1 Section 1 . 16.34 of the statutes is created to read:

AB1-ASA1,12,5 16.34 Hazard pay during a public health emergency; paid medical leave for frontline health care workers. (1) Definition. In this section, “frontline health care worker” means an individual who is any of the following, who is not exempt under 29 USC 213, and whose annual pay does not exceed $99,999:

AB1-ASA1,12,7 (a) A provider of direct care to patients in a hospital, nursing home, or residence.

AB1-ASA1,12,9 (b) An employee who works in a patient care area of a facility that provides direct patient care.

AB1-ASA1,12,11 (c) An individual who handles patient specimens within this state within the scope of employment.

AB1-ASA1,13,2 (d) An employee who works in an area where patient specimens are handled at a facility that handles patient specimens within this state.

AB1-ASA1,13,7 (2) Hazard pay grant program for work during a public health emergency. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to employers for the payment of hazard pay to frontline health care workers who work during a public health emergency declared by the governor under s. 323.10 or the secretary of health services under s. 252.02, as set forth in s. 103.025 (3).

AB1-ASA1,13,13 (b) The department shall establish and administer a program to subsidize, as provided in s. 103.025 (3), the hazard pay costs for frontline health care workers. The department shall require, at a minimum, that the employer provide a sworn affidavit of compliance, and payroll records if requested by the department. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB1-ASA1,13,17 (3) Paid medical leave grant program for frontline health care workers. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to employers for the provision of paid medical leave to frontline health care workers who contract a communicable disease, as set forth in s. 103.10 (4m).

AB1-ASA1,13,23 (b) The department shall establish and administer a program to subsidize, as provided in s. 103.10 (4m), the paid medical leave costs for frontline health care workers. The department shall require, at a minimum, that the employer provide a sworn affidavit of compliance, and payroll records if requested by the department. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB1-ASA1,14,2 (4) Coverage of COVID-19 for health care workers. (a) From the appropriation under s. 20.505 (1) (ft), the department shall award grants to insurers for the provision of health insurance coverage to frontline health care workers as set forth in s. 632.895 (14f).

AB1-ASA1,14,7 (b) The department shall establish and administer a program to subsidize, as provided in s. 632.895 (14f), the costs of providing coverage for frontline health care workers at no additional cost to the covered individuals. The governor or his or her designee within the department may determine the period of applicability of this subsection.

AB1-ASA1,2 Section 2 . 20.005 (3) (schedule) of the statutes: at the appropriate place, insert the following amounts for the purposes indicated: - See PDF for table - See PDF for table - See PDF for table

AB1-ASA1,3 Section 3 . 20.115 (3) (b) of the statutes is created to read:

AB1-ASA1,15,3 20.115 (3) (b) Food security initiative grants. The amounts in the schedule to provide grants under s. 93.485.

AB1-ASA1,4 Section 4 . 20.435 (1) (dw) of the statutes is created to read:

AB1-ASA1,15,7 20.435 (1) (dw) Coronavirus pandemic. The amounts in the schedule for community testing, contact tracing, vaccinations, and public awareness related to the infection caused by the SARS-CoV-2 coronavirus, known as COVID-19.

AB1-ASA1,5 Section 5 . 20.435 (4) (bu) of the statutes is created to read:

AB1-ASA1,15,13 20.435 (4) (bu) COVID-19 and other communicable disease aids for frontline health care workers. A sum sufficient not to exceed in each fiscal year the difference between $165,011,600 per fiscal year and the amount after payments have been made under s. 16.34, for testing and treatment of frontline health care workers under s. 49.681.

AB1-ASA1,6 Section 6 . 20.435 (4) (jw) of the statutes is amended to read:

AB1-ASA1,16,2 20.435 (4) (jw) BadgerCare Plus and hospital assessment. All moneys received from payment of enrollment fees under the program under s. 49.45 (23), all moneys transferred under s. 50.38 (9), all moneys transferred from the appropriation account under par. (jz), and 10 percent of all moneys received from penalty assessments under s. 49.471 (9) (c), for administration of the program under s. 49.45 (23), to provide a portion of the state share of administrative costs for the BadgerCare Plus Medical Assistance program under s. 49.471, and for administration of the hospital assessment under s. 50.38.

AB1-ASA1,7 Section 7 . 20.505 (1) (bk) of the statutes is created to read:

AB1-ASA1,16,6 20.505 (1) (bk) COVID-19 testing and surge capacity. The amounts in the schedule for the purposes specified in 2021 Wisconsin Act .... (this act), section 9101 (1).

AB1-ASA1,8 Section 8 . 20.505 (1) (ft) of the statutes is created to read:

AB1-ASA1,16,10 20.505 (1) (ft) Health care coverage and employee benefits relating to COVID-19 and other communicable diseases. A sum sufficient not to exceed in each fiscal year $165,011,600 for payments under s. 16.34 (2), (3), and (4).

AB1-ASA1,9 Section 9 . 20.835 (2) (an) of the statutes is created to read:

AB1-ASA1,16,13 20.835 (2) (an) Grants to small businesses. The amounts in the schedule to provide grants to small businesses under s. 73.03 (75).

AB1-ASA1,10 Section 10 . 40.22 (1) of the statutes is amended to read:

AB1-ASA1,16,19 40.22 (1) Except as otherwise provided in sub. (2) and s. 40.26 (6) and (7), each employee currently in the service of, and receiving earnings from, a state agency or other participating employer shall be included within the provisions of the Wisconsin retirement system as a participating employee of that state agency or participating employer.

AB1-ASA1,11 Section 11 . 40.22 (2m) (intro.) of the statutes is amended to read:

AB1-ASA1,17,2 40.22 (2m) (intro.) Except as otherwise provided in s. 40.26 (6) and (7), an employee who was a participating employee before July 1, 2011, who is not expected to work at least one-third of what is considered full-time employment by the department, as determined by rule, and who is not otherwise excluded under sub. (2) from becoming a participating employee shall become a participating employee if he or she is subsequently employed by the state agency or other participating employer for either of the following periods:

AB1-ASA1,12 Section 12 . 40.22 (2r) (intro.) of the statutes is amended to read:

AB1-ASA1,17,10 40.22 (2r) (intro.) Except as otherwise provided in s. 40.26 (6) and (7), an employee who was not a participating employee before July 1, 2011, who is not expected to work at least two-thirds of what is considered full-time employment by the department, as determined by rule, and who is not otherwise excluded under sub. (2) from becoming a participating employee shall become a participating employee if he or she is subsequently employed by the state agency or other participating employer for either of the following periods:

AB1-ASA1,13 Section 13 . 40.22 (3) (intro.) of the statutes is amended to read:

AB1-ASA1,17,14 40.22 (3) (intro.) Except as otherwise provided in s. 40.26 (6) and (7), a person who qualifies as a participating employee shall be included within, and shall be subject to, the Wisconsin retirement system effective on one of the following dates:

AB1-ASA1,14 Section 14 . 40.26 (1m) (a) of the statutes is amended to read:

AB1-ASA1,17,22 40.26 (1m) (a) Except as otherwise provided in sub. subs. (6) and (7), if a participant receiving a retirement annuity, or a disability annuitant who has attained his or her normal retirement date, is employed in a position in covered employment in which he or she is expected to work at least two-thirds of what is considered full-time employment by the department, as determined under s. 40.22 (2r), the participant's annuity shall be suspended and no annuity payment shall be payable until after the participant terminates covered employment.

AB1-ASA1,15 Section 15 . 40.26 (1m) (b) of the statutes is amended to read:

AB1-ASA1,18,6 40.26 (1m) (b) Except as otherwise provided in sub. subs. (6) and (7), if a participant receiving a retirement annuity, or a disability annuitant who has attained his or her normal retirement date, enters into a contract to provide employee services with a participating employer and he or she is expected to work at least two-thirds of what is considered full-time employment by the department, as determined under s. 40.22 (2r), the participant's annuity shall be suspended and no annuity payment shall be payable until after the participant no longer provides employee services under the contract.

AB1-ASA1,16 Section 16 . 40.26 (5m) of the statutes is amended to read:

AB1-ASA1,18,14 40.26 (5m) During the public health emergency declared on March 12, 2020, by executive order 72, or during the period beginning on the effective date of this subsection .... [LRB inserts date], and ending on December 31, 2021, sub. (5) does not apply if at least 15 days have elapsed between the termination of employment with a participating employer and becoming a participating employee if the position for which the participant is hired is a critical position, as determined by the secretary of health services under s. 323.19 (3).

AB1-ASA1,17 Section 17 . 40.26 (7) of the statutes is created to read:

AB1-ASA1,18,20 40.26 (7) (intro.) During the period beginning on the effective date of this subsection .... [LRB inserts date], and ending on December 31, 2021, a participant who is hired during the period may elect to not suspend his or her retirement annuity or disability annuity under sub. (1m) for the duration of the period if all of the following conditions are met:

AB1-ASA1,18,24 (a) At the time the participant terminates his or her employment with a participating employer, the participant does not have an agreement with any participating employer to return to employment or enter into a contract to provide employee services for the employer.

AB1-ASA1,19,2 (b) The participant is hired to a critical position, as determined under s. 323.19 (3m).

AB1-ASA1,18 Section 18 . 40.51 (8) of the statutes is amended to read:

AB1-ASA1,19,8 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.87 (3) to (6), 632.871, 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB1-ASA1,19 Section 19 . 40.51 (8m) of the statutes is amended to read:

AB1-ASA1,19,13 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.871, 632.885, 632.89, and 632.895 (11) to (17).

AB1-ASA1,20 Section 20 . 49.45 (2p) of the statutes is repealed.

AB1-ASA1,21 Section 21 . 49.45 (23) of the statutes is repealed.

AB1-ASA1,22 Section 22 . 49.45 (23b) (title) of the statutes is amended to read:

AB1-ASA1,19,18 49.45 (23b) (title) Childless adults demonstration project reform waiver implementation required.

AB1-ASA1,23 Section 23 . 49.45 (23b) (b) of the statutes is amended to read:

AB1-ASA1,19,23 49.45 (23b) (b) Beginning as soon as practicable after October 31, 2018, and ending no sooner than December 31, 2023, the department shall do all of the following with regard to the childless adults demonstration project under sub. (23) s. 49.471 (4) (a) 8.: