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AB68-SSA1,1376,2117 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and
18treatment of a condition or complaint by a licensed dentist or dental therapist within
19the scope of the dentist's or dental therapist's license, if the policy, plan or contract
20covers diagnosis and treatment of the condition or complaint by another health care
21provider, as defined in s. 146.81 (1) (a) to (p).
AB68-SSA1,3004 22Section 3004. 632.871 of the statutes is created to read:
AB68-SSA1,1376,23 23632.871 Telehealth services. (1) Definitions. In this section:
AB68-SSA1,1376,2424 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-SSA1,1376,2525 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1377,6
1(c) “Telehealth" means a practice of health care delivery, diagnosis,
2consultation, treatment, or transfer of medically relevant data by means of audio,
3video, or data communications that are used either during a patient visit or a
4consultation or are used to transfer medically relevant data about a patient.
5“Telehealth" does not include communications delivered solely by audio-only
6telephone, facsimile machine, or e-mail unless specified otherwise by rule.
AB68-SSA1,1377,13 7(2) Coverage denial prohibited. No disability insurance policy or self-insured
8health plan may deny coverage for a treatment or service provided through
9telehealth on the basis that the treatment or service is provided through telehealth
10if that treatment or service is covered by the policy or plan when provided in person.
11A disability insurance policy or self-insured health plan may limit coverage of
12treatments or services provided through telehealth to those treatments or services
13that are medically necessary.
AB68-SSA1,1377,17 14(3) Certain limitations on telehealth prohibited. A disability insurance
15policy or self-insured health plan may not subject a treatment or service provided
16through telehealth for which coverage is required under sub. (2) to any of the
17following:
AB68-SSA1,1377,1918 (a) Any greater deductible, copayment, or coinsurance amount than would be
19applicable if the treatment or service is provided in person.
AB68-SSA1,1377,2220 (b) Any policy or calendar year or lifetime benefit limit or other maximum
21limitation that is not imposed on other treatments or services covered by the plan
22that are not provided through telehealth.
AB68-SSA1,1377,2423 (c) Prior authorization requirements that are not required for the same
24treatment or service when provided in person.
AB68-SSA1,1377,2525 (d) Unique location requirements.
AB68-SSA1,1378,5
1(4) Disclosure of coverage of certain telehealth services. A disability
2insurance policy or self-insured health plan that covers a telehealth treatment or
3service that has no equivalent in-person treatment or service, such as remote patient
4monitoring, shall specify in policy or plan materials the coverage of that telehealth
5treatment or service.
AB68-SSA1,3005 6Section 3005. 632.895 (6) (title) of the statutes is amended to read:
AB68-SSA1,1378,77 632.895 (6) (title) Equipment and supplies for treatment of diabetes; insulin.
AB68-SSA1,3006 8Section 3006 . 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and
9amended to read:
AB68-SSA1,1378,2010 632.895 (6) (a) Every disability insurance policy which that provides coverage
11of expenses incurred for treatment of diabetes shall provide coverage for expenses
12incurred by the installation and use of an insulin infusion pump, coverage for all
13other equipment and supplies, including insulin or any other prescription
14medication, used in the treatment of diabetes, and coverage of diabetic
15self-management education programs. Coverage Except as provided in par. (b),
16coverage
required under this subsection shall be subject to the same exclusions,
17limitations, deductibles, and coinsurance provisions of the policy as other covered
18expenses, except that insulin infusion pump coverage may be limited to the purchase
19of one pump per year and the insurer may require the insured to use a pump for 30
20days before purchase.
AB68-SSA1,3007 21Section 3007 . 632.895 (6) (b) of the statutes is created to read:
AB68-SSA1,1378,2222 632.895 (6) (b) 1. In this paragraph:
AB68-SSA1,1378,2423 a. “Cost sharing” means the total of any deductible, copayment, or coinsurance
24amounts imposed on a person covered under a policy or plan.
AB68-SSA1,1378,2525 b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1379,3
12. Every disability insurance policy and self-insured health plan that covers
2insulin and imposes cost sharing on prescription drugs may not impose cost sharing
3on insulin in an amount that exceeds $50 for a one-month supply of insulin.
AB68-SSA1,1379,84 3. Nothing in this paragraph prohibits a disability insurance policy or
5self-insured health plan from imposing cost sharing on insulin in an amount less
6than the amount specified under subd. 2. Nothing in this paragraph requires a
7disability insurance policy or self-insured health plan to impose any cost sharing on
8insulin.
AB68-SSA1,3008 9Section 3008. 632.895 (8) (d) of the statutes is amended to read:
AB68-SSA1,1379,1610 632.895 (8) (d) Coverage is required under this subsection despite whether the
11woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
12(e), coverage under this subsection may only be subject to exclusions and limitations,
13including deductibles, copayments and restrictions on excessive charges, that are
14applied to other radiological examinations covered under the disability insurance
15policy. Coverage under this subsection may not be subject to any deductibles,
16copayments, or coinsurance.
AB68-SSA1,3009 17Section 3009. 632.895 (13m) of the statutes is created to read:
AB68-SSA1,1379,1918 632.895 (13m) Preventive services. (a) In this section, “self-insured health
19plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1379,2220 (b) Every disability insurance policy, except any disability insurance policy that
21is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
22provide coverage for all of the following preventive services:
AB68-SSA1,1379,2323 1. Mammography in accordance with sub. (8).
AB68-SSA1,1379,2524 2. Genetic breast cancer screening and counseling and preventive medication
25for adult women at high risk for breast cancer.
AB68-SSA1,1380,2
13. Papanicolaou test for cancer screening for women 21 years of age or older
2with an intact cervix.
AB68-SSA1,1380,43 4. Human papillomavirus testing for women who have attained the age of 30
4years but have not attained the age of 66 years.
AB68-SSA1,1380,55 5. Colorectal cancer screening in accordance with sub. (16m).
AB68-SSA1,1380,86 6. Annual tomography for lung cancer screening for adults who have attained
7the age of 55 years but have not attained the age of 80 years and who have health
8histories demonstrating a risk for lung cancer.
AB68-SSA1,1380,109 7. Skin cancer screening for individuals who have attained the age of 10 years
10but have not attained the age of 22 years.
AB68-SSA1,1380,1211 8. Counseling for skin cancer prevention for adults who have attained the age
12of 18 years but have not attained the age of 25 years.
AB68-SSA1,1380,1413 9. Abdominal aortic aneurysm screening for men who have attained the age of
1465 years but have not attained the age of 75 years and who have ever smoked.
AB68-SSA1,1380,1715 10. Hypertension screening for adults and blood pressure testing for adults, for
16children under the age of 3 years who are at high risk for hypertension, and for
17children 3 years of age or older.
AB68-SSA1,1380,1918 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
19of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB68-SSA1,1380,2220 12. Aspirin therapy for cardiovascular health for adults who have attained the
21age of 55 years but have not attained the age of 80 years and for men who have
22attained the age of 45 years but have not attained the age of 55 years.
AB68-SSA1,1380,2423 13. Behavioral counseling for cardiovascular health for adults who are
24overweight or obese and who have risk factors for cardiovascular disease.
AB68-SSA1,1380,2525 14. Type II diabetes screening for adults with elevated blood pressure.
AB68-SSA1,1381,2
115. Depression screening for minors 11 years of age or older and for adults when
2follow-up supports are available.
AB68-SSA1,1381,43 16. Hepatitis B screening for minors at high risk for infection and adults at high
4risk for infection.
AB68-SSA1,1381,65 17. Hepatitis C screening for adults at high risk for infection and onetime
6hepatitis C screening for adults born in any year from 1945 to 1965.
AB68-SSA1,1381,107 18. Obesity screening and management for all minors and adults with a body
8mass index indicating obesity, counseling and behavioral interventions for obese
9minors who are 6 years of age or older, and referral for intervention for obesity for
10adults with a body mass index of 30 kilograms per square meter or higher.
AB68-SSA1,1381,1211 19. Osteoporosis screening for all women 65 years of age or older and for women
12at high risk for osteoporosis under the age of 65 years.
AB68-SSA1,1381,1313 20. Immunizations in accordance with sub. (14).
AB68-SSA1,1381,1614 21. Anemia screening for individuals 6 months of age or older and iron
15supplements for individuals at high risk for anemia and who have attained the age
16of 6 months but have not attained the age of 12 months.
AB68-SSA1,1381,1817 22. Fluoride varnish for prevention of tooth decay for minors at the age of
18eruption of their primary teeth.
AB68-SSA1,1381,2019 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
20age or older who do not have fluoride in their water source.
AB68-SSA1,1381,2121 24. Gonorrhea prophylaxis treatment for newborns.
AB68-SSA1,1381,2222 25. Health history and physical exams for prenatal visits and for minors.
AB68-SSA1,1381,2423 26. Length and weight measurements for newborns and height and weight
24measurements for minors.
AB68-SSA1,1382,2
127. Head circumference and weight-for-length measurements for newborns
2and minors who have not attained the age of 3 years.
AB68-SSA1,1382,33 28. Body mass index for minors 2 years of age or older.
AB68-SSA1,1382,54 29. Blood pressure measurements for minors 3 years of age or older and a blood
5pressure risk assessment at birth.
AB68-SSA1,1382,76 30. Risk assessment and referral for oral health issues for minors who have
7attained the age of 6 months but have not attained the age of 7 years.
AB68-SSA1,1382,98 31. Blood screening for newborns and minors who have not attained the age of
92 months.
AB68-SSA1,1382,1010 32. Screening for critical congenital health defects for newborns.
AB68-SSA1,1382,1111 33. Lead screenings in accordance with sub. (10).
AB68-SSA1,1382,1312 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
13sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB68-SSA1,1382,1514 35. Tuberculin skin test based on risk assessment for minors one month of age
15or older.
AB68-SSA1,1382,1716 36. Tobacco counseling and cessation interventions for individuals who are 5
17years of age or older.
AB68-SSA1,1382,1918 37. Vision and hearing screening and assessment for minors including
19newborns.
AB68-SSA1,1382,2120 38. Sexually transmitted infection and human immunodeficiency virus
21counseling for sexually active minors.
AB68-SSA1,1382,2422 39. Risk assessment for sexually transmitted infection for minors who are 10
23years of age or older and screening for sexually transmitted infection for minors who
24are 16 years of age or older.
AB68-SSA1,1382,2525 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB68-SSA1,1383,2
141. Autism screening for minors who have attained the age of 18 months but
2have not attained the age of 25 months.
AB68-SSA1,1383,33 42. Developmental screening and surveillance for minors including newborns.
AB68-SSA1,1383,44 43. Psychosocial and behavioral assessment for minors including newborns.
AB68-SSA1,1383,65 44. Alcohol misuse screening and counseling for pregnant adults and a risk
6assessment for all adults.
AB68-SSA1,1383,87 45. Fall prevention and counseling and preventive medication for fall
8prevention for community-dwelling adults 65 years of age or older.
AB68-SSA1,1383,99 46. Screening and counseling for intimate partner violence for adult women.
AB68-SSA1,1383,1210 47. Well-woman visits for women who have attained the age of 18 years but
11have not attained the age of 65 years and well-woman visits for recommended
12preventive services, preconception care, and prenatal care.
AB68-SSA1,1383,1413 48. Counseling on, consultations with a trained provider on, and equipment
14rental for breastfeeding for pregnant and lactating women.
AB68-SSA1,1383,1515 49. Folic acid supplement for adult women with reproductive capacity.
AB68-SSA1,1383,1616 50. Iron deficiency anemia screening for pregnant and lactating women.
AB68-SSA1,1383,1817 51. Preeclampsia preventive medicine for pregnant adult women at high risk
18for preeclampsia.
AB68-SSA1,1383,2019 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
20risk for miscarriage, preeclampsia, or clotting disorders.
AB68-SSA1,1383,2121 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB68-SSA1,1383,2322 54. Screening for gonorrhea for pregnant and sexually active females 24 years
23of age or younger and females older than 24 years of age who are at risk for infection.
AB68-SSA1,1384,3
155. Screening for chlamydia for pregnant and sexually active females 24 years
2of age and younger and females older than 24 years of age who are at risk for
3infection.
AB68-SSA1,1384,54 56. Screening for syphilis for pregnant women and adults who are at high risk
5for infection.
AB68-SSA1,1384,86 57. Human immunodeficiency virus screening for adults who have attained the
7age of 15 years but have not attained the age of 66 years and individuals at high risk
8of infection who are younger than 15 years of age or older than 65 years of age.
AB68-SSA1,1384,99 58. All contraceptives and services in accordance with sub. (17).
AB68-SSA1,1384,1110 59. Any services not already specified under this paragraph having an A or B
11rating in current recommendations from the U.S. preventive services task force.
AB68-SSA1,1384,1412 60. Any preventive services not already specified under this paragraph that are
13recommended by the federal health resources and services administration's Bright
14Futures project.
AB68-SSA1,1384,1715 61. Any immunizations, not already specified under sub. (14), that are
16recommended and determined to be for routine use by the federal advisory
17committee on immunization practices.
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