Amendment SSA1-AB68

AB68-SSA1,1376,12 (a) Reimburse a covered entity for a drug that is subject to an agreement under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies that are not covered entities and are similar in prescription volume to the covered entity.

AB68-SSA1,1376,15 (b) Assess a covered entity any fee, charge back, or other adjustment on the basis of the covered entity's participation in the federal drug pricing program under 42 USC 256b.

AB68-SSA1,3003 Section 3003 . 632.87 (4) of the statutes is amended to read:

AB68-SSA1,1376,21 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed dentist or dental therapist within the scope of the dentist's or dental therapist's license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by another health care provider, as defined in s. 146.81 (1) (a) to (p).

AB68-SSA1,3004 Section 3004. 632.871 of the statutes is created to read:

AB68-SSA1,1376,23 632.871 Telehealth services. (1) Definitions. In this section:

AB68-SSA1,1376,24 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).

AB68-SSA1,1376,25 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB68-SSA1,1377,6 (c) “Telehealth" means 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. “Telehealth" does not include communications delivered solely by audio-only telephone, facsimile machine, or e-mail unless specified otherwise by rule.

AB68-SSA1,1377,13 (2) Coverage denial prohibited. No disability insurance policy or self-insured health plan may deny coverage for a treatment or service provided through telehealth on the basis that the treatment or service is provided through telehealth if that treatment or service is covered by the policy or plan when provided in person. A disability insurance policy or self-insured health plan may limit coverage of treatments or services provided through telehealth to those treatments or services that are medically necessary.

AB68-SSA1,1377,17 (3) Certain limitations on telehealth prohibited. A disability insurance policy or self-insured health plan may not subject a treatment or service provided through telehealth for which coverage is required under sub. (2) to any of the following:

AB68-SSA1,1377,19 (a) Any greater deductible, copayment, or coinsurance amount than would be applicable if the treatment or service is provided in person.

AB68-SSA1,1377,22 (b) Any policy or calendar year or lifetime benefit limit or other maximum limitation that is not imposed on other treatments or services covered by the plan that are not provided through telehealth.

AB68-SSA1,1377,24 (c) Prior authorization requirements that are not required for the same treatment or service when provided in person.

AB68-SSA1,1377,25 (d) Unique location requirements.

AB68-SSA1,1378,5 (4) Disclosure of coverage of certain telehealth services. A disability insurance policy or self-insured health plan that covers a telehealth treatment or service that has no equivalent in-person treatment or service, such as remote patient monitoring, shall specify in policy or plan materials the coverage of that telehealth treatment or service.

AB68-SSA1,3005 Section 3005. 632.895 (6) (title) of the statutes is amended to read:

AB68-SSA1,1378,7 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.

AB68-SSA1,3006 Section 3006 . 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and amended to read:

AB68-SSA1,1378,20 632.895 (6) (a) Every disability insurance policy which that provides coverage of expenses incurred for treatment of diabetes shall provide coverage for expenses incurred by the installation and use of an insulin infusion pump, coverage for all other equipment and supplies, including insulin or any other prescription medication, used in the treatment of diabetes, and coverage of diabetic self-management education programs. Coverage Except as provided in par. (b), coverage required under this subsection shall be subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy as other covered expenses, except that insulin infusion pump coverage may be limited to the purchase of one pump per year and the insurer may require the insured to use a pump for 30 days before purchase.

AB68-SSA1,3007 Section 3007 . 632.895 (6) (b) of the statutes is created to read:

AB68-SSA1,1378,22 632.895 (6) (b) 1. In this paragraph:

AB68-SSA1,1378,24 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance amounts imposed on a person covered under a policy or plan.

AB68-SSA1,1378,25 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB68-SSA1,1379,3 2. Every disability insurance policy and self-insured health plan that covers insulin and imposes cost sharing on prescription drugs may not impose cost sharing on insulin in an amount that exceeds $50 for a one-month supply of insulin.

AB68-SSA1,1379,8 3. Nothing in this paragraph prohibits a disability insurance policy or self-insured health plan from imposing cost sharing on insulin in an amount less than the amount specified under subd. 2. Nothing in this paragraph requires a disability insurance policy or self-insured health plan to impose any cost sharing on insulin.

AB68-SSA1,3008 Section 3008. 632.895 (8) (d) of the statutes is amended to read:

AB68-SSA1,1379,16 632.895 (8) (d) Coverage is required under this subsection despite whether the woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and (e), coverage under this subsection may only be subject to exclusions and limitations, including deductibles, copayments and restrictions on excessive charges, that are applied to other radiological examinations covered under the disability insurance policy. Coverage under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB68-SSA1,3009 Section 3009. 632.895 (13m) of the statutes is created to read:

AB68-SSA1,1379,19 632.895 (13m) Preventive services. (a) In this section, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB68-SSA1,1379,22 (b) Every disability insurance policy, except any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall provide coverage for all of the following preventive services:

AB68-SSA1,1379,23 1. Mammography in accordance with sub. (8).

AB68-SSA1,1379,25 2. Genetic breast cancer screening and counseling and preventive medication for adult women at high risk for breast cancer.

AB68-SSA1,1380,2 3. Papanicolaou test for cancer screening for women 21 years of age or older with an intact cervix.

AB68-SSA1,1380,4 4. Human papillomavirus testing for women who have attained the age of 30 years but have not attained the age of 66 years.

AB68-SSA1,1380,5 5. Colorectal cancer screening in accordance with sub. (16m).

AB68-SSA1,1380,8 6. Annual tomography for lung cancer screening for adults who have attained the age of 55 years but have not attained the age of 80 years and who have health histories demonstrating a risk for lung cancer.

AB68-SSA1,1380,10 7. Skin cancer screening for individuals who have attained the age of 10 years but have not attained the age of 22 years.

AB68-SSA1,1380,12 8. Counseling for skin cancer prevention for adults who have attained the age of 18 years but have not attained the age of 25 years.

AB68-SSA1,1380,14 9. Abdominal aortic aneurysm screening for men who have attained the age of 65 years but have not attained the age of 75 years and who have ever smoked.

AB68-SSA1,1380,17 10. Hypertension screening for adults and blood pressure testing for adults, for children under the age of 3 years who are at high risk for hypertension, and for children 3 years of age or older.

AB68-SSA1,1380,19 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years of age or older at high risk for lipid disorders, and all men 35 years of age or older.

AB68-SSA1,1380,22 12. Aspirin therapy for cardiovascular health for adults who have attained the age of 55 years but have not attained the age of 80 years and for men who have attained the age of 45 years but have not attained the age of 55 years.

AB68-SSA1,1380,24 13. Behavioral counseling for cardiovascular health for adults who are overweight or obese and who have risk factors for cardiovascular disease.

AB68-SSA1,1380,25 14. Type II diabetes screening for adults with elevated blood pressure.

AB68-SSA1,1381,2 15. Depression screening for minors 11 years of age or older and for adults when follow-up supports are available.

AB68-SSA1,1381,4 16. Hepatitis B screening for minors at high risk for infection and adults at high risk for infection.

AB68-SSA1,1381,6 17. Hepatitis C screening for adults at high risk for infection and onetime hepatitis C screening for adults born in any year from 1945 to 1965.

AB68-SSA1,1381,10 18. Obesity screening and management for all minors and adults with a body mass index indicating obesity, counseling and behavioral interventions for obese minors who are 6 years of age or older, and referral for intervention for obesity for adults with a body mass index of 30 kilograms per square meter or higher.

AB68-SSA1,1381,12 19. Osteoporosis screening for all women 65 years of age or older and for women at high risk for osteoporosis under the age of 65 years.

AB68-SSA1,1381,13 20. Immunizations in accordance with sub. (14).

AB68-SSA1,1381,16 21. Anemia screening for individuals 6 months of age or older and iron supplements for individuals at high risk for anemia and who have attained the age of 6 months but have not attained the age of 12 months.

AB68-SSA1,1381,18 22. Fluoride varnish for prevention of tooth decay for minors at the age of eruption of their primary teeth.

AB68-SSA1,1381,20 23. Fluoride supplements for prevention of tooth decay for minors 6 months of age or older who do not have fluoride in their water source.

AB68-SSA1,1381,21 24. Gonorrhea prophylaxis treatment for newborns.

AB68-SSA1,1381,22 25. Health history and physical exams for prenatal visits and for minors.

AB68-SSA1,1381,24 26. Length and weight measurements for newborns and height and weight measurements for minors.

AB68-SSA1,1382,2 27. Head circumference and weight-for-length measurements for newborns and minors who have not attained the age of 3 years.

AB68-SSA1,1382,3 28. Body mass index for minors 2 years of age or older.

AB68-SSA1,1382,5 29. Blood pressure measurements for minors 3 years of age or older and a blood pressure risk assessment at birth.

AB68-SSA1,1382,7 30. Risk assessment and referral for oral health issues for minors who have attained the age of 6 months but have not attained the age of 7 years.

AB68-SSA1,1382,9 31. Blood screening for newborns and minors who have not attained the age of 2 months.

AB68-SSA1,1382,10 32. Screening for critical congenital health defects for newborns.

AB68-SSA1,1382,11 33. Lead screenings in accordance with sub. (10).

AB68-SSA1,1382,13 34. Metabolic and hemoglobin screening and screening for phenylketonuria, sickle cell anemia, and congenital hypothyroidism for minors including newborns.

AB68-SSA1,1382,15 35. Tuberculin skin test based on risk assessment for minors one month of age or older.

AB68-SSA1,1382,17 36. Tobacco counseling and cessation interventions for individuals who are 5 years of age or older.

AB68-SSA1,1382,19 37. Vision and hearing screening and assessment for minors including newborns.

AB68-SSA1,1382,21 38. Sexually transmitted infection and human immunodeficiency virus counseling for sexually active minors.

AB68-SSA1,1382,24 39. Risk assessment for sexually transmitted infection for minors who are 10 years of age or older and screening for sexually transmitted infection for minors who are 16 years of age or older.

AB68-SSA1,1382,25 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

AB68-SSA1,1383,2 41. Autism screening for minors who have attained the age of 18 months but have not attained the age of 25 months.

AB68-SSA1,1383,3 42. Developmental screening and surveillance for minors including newborns.

AB68-SSA1,1383,4 43. Psychosocial and behavioral assessment for minors including newborns.

AB68-SSA1,1383,6 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB68-SSA1,1383,8 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB68-SSA1,1383,9 46. Screening and counseling for intimate partner violence for adult women.

AB68-SSA1,1383,12 47. Well-woman visits for women who have attained the age of 18 years but have not attained the age of 65 years and well-woman visits for recommended preventive services, preconception care, and prenatal care.

AB68-SSA1,1383,14 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB68-SSA1,1383,15 49. Folic acid supplement for adult women with reproductive capacity.

AB68-SSA1,1383,16 50. Iron deficiency anemia screening for pregnant and lactating women.

AB68-SSA1,1383,18 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB68-SSA1,1383,20 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB68-SSA1,1383,21 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB68-SSA1,1383,23 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.

AB68-SSA1,1384,3 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.

AB68-SSA1,1384,5 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB68-SSA1,1384,8 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.

AB68-SSA1,1384,9 58. All contraceptives and services in accordance with sub. (17).