The bill requires certain health insurance policies, known in the bill as
disability insurance policies, and self-insured governmental health plans to cover
essential health benefits that will be specified by the commissioner of insurance by
rule. The bill specifies a list of requirements that the commissioner must follow when
establishing the essential health benefits including certain limitations on
cost-sharing and the following general categories of benefits, items, or services in
which the commissioner must require coverage: ambulatory patient services,
emergency services, hospitalization, maternity and newborn care, mental health
and substance use disorder services, prescription drugs, rehabilitative and
habilitative services and devices, laboratory services, preventive and wellness
services and chronic disease management, and pediatric services. If an essential
health benefit specified by the commissioner is also subject to its own mandated
coverage requirement, the bill requires the disability insurance policy or
self-insured health plan to provide coverage under whichever requirement provides
the insured or plan participant with more comprehensive coverage.
The bill requires health insurance policies and self-insured governmental
health plans to cover certain preventive services and to provide coverage of those
preventive services without subjecting that coverage to deductibles, copayments, or
coinsurance. The preventive services for which coverage is required are specified in
the bill. The bill also specifies certain instances when cost-sharing amounts may be
charged for an office visit associated with a preventive service.
Short-term plan coverage requirements
The bill generally sets certain coverage requirements on health plans that are
short-term limited duration health plans. Under current law, short-term plans may
have an initial term of no longer than 12 months and may have an aggregate duration
of no longer than 18 months. The bill shortens the initial term to no longer than three
months and the aggregate duration to no longer than six months.
The bill requires every short-term, limited duration plan to accept every
individual who applies for coverage, whether the individual has a preexisting
condition. Current law allows short-term limited duration plans to impose a
preexisting condition exclusion but requires the plan to reduce the length of time of
the exclusion by the aggregate duration of the insured's consecutive periods of
coverage. A preexisting condition exclusion is a period of time during which a plan
will not cover a medical condition for which the insured received some medical
attention before the effective date of coverage. The bill, however, prohibits
short-term, limited duration plans from imposing any preexisting condition
exclusion.
A short-term, limited duration plan may not vary premium rates for a specific
plan except on the basis of whether the plan covers an individual or family, area in
the state, age, and tobacco use as specified in the bill. A short-term, limited duration
plan is prohibited under the bill from establishing rules for the eligibility of any
individual to enroll based on health status-related factors, which are specified in the
bill, and from requiring an enrollee to pay a greater premium, contribution,
deductible, copayment, or coinsurance amount than is required of a similarly
situated enrollee based on a health status-related factor. Under the bill, a
short-term, limited duration plan may not establish lifetime or limits for the
duration of the coverage on the dollar value of benefits for an enrollee or a dependent
of an enrollee under the plan.
Balance billing for emergency medical services and other items and services
The bill requires defined network plans, such as health maintenance
organizations, and certain preferred provider plans and self-insured governmental
plans that cover benefits or services provided in either an emergency department of
a hospital or independent freestanding emergency department to cover emergency
benefits without requiring a prior authorization determination and without regard
to whether or not the health care provider providing the emergency medical services
is a participating provider or facility. If the emergency medical services for which
coverage is required are provided by a nonparticipating provider, the plan must 1)
not impose a prior authorization requirement or other limitation that is more
restrictive than if the service was provided by a participating provider, 2) not impose
cost-sharing on the enrollee that is greater than the cost-sharing required if the
service was provided by a participating provider, 3) calculate the cost-sharing
amount to be equal to the amount that would have been charged if the service was
provided by a participating provider, 4) provide, within 30 days of the provider's or
facility's bill, an initial payment or denial notice to the provider or facility and then
pay a total amount to the provider or facility that is equal to the amount by which
the provider's or facility's rate exceeds the amount it received in cost-sharing from
the enrollee, and 5) count any cost-sharing payment made by the enrollee for the
emergency medical services toward any in-network deductible or out-of-pocket
maximum as if the cost-sharing payment were made for services provided by a
participating provider or facility. The provider or facility may not bill or hold liable
an enrollee of the plan for any amount for the emergency medical service that is more
than the cost-sharing amount that is determined as described in the bill for the
emergency medical service.
For coverage of an item or service that is provided by a nonparticipating
provider in a participating facility, a plan must 1) not impose a cost-sharing
requirement for the item or service that is greater than the cost-sharing
requirement that would have been imposed if the item or service was provided by a
participating provider, 2) calculate the cost-sharing amount to be equal to the
amount that would have been charged if the service was provided by a participating
provider, 3) provide, within 30 days of the provider's bill, an initial payment or denial
notice to the provider and then pay a total amount to the provider that is equal to the
amount by which the provider's rate exceeds the amount it received in cost-sharing
from the enrollee, and 4) count any cost-sharing payment made by the enrollee for
the emergency medical services toward any in-network deductible or out-of-pocket
maximum as if the cost-sharing payment were made for services provided by a
participating provider. A nonparticipating provider providing an item or service in
a participating facility may not bill or hold liable an enrollee for more than the
cost-sharing amount unless the provider provides notice and obtains consent as
described in the bill. However, if the nonparticipating provider is providing an
ancillary item or service that is specified in the bill and the commissioner of
insurance has not specifically allowed balance billing for that item or service by rule,
the nonparticipating provider providing the ancillary item or service in a
participating facility may not bill or hold liable an enrollee for more than the
cost-sharing amount.
A provider or facility that is entitled to a payment under the bill for an
emergency medical service or other item or service may initiate open negotiations
with the plan to determine the amount of payment. If the open negotiation period
terminates without determination of the payment amount, the provider, facility, or
plan may initiate the independent dispute resolution process as specified by the
commissioner of insurance. If an enrollee of a plan is a continuing care patient, as
defined in the bill, and is obtaining services from a participating provider or facility
and the contract is terminated or the coverage of benefits is going to be terminated,
the plan must notify an enrollee of the enrollee's right to elect to continue transitional
care, provide the enrollee an opportunity to notify the plan of the need for
transitional care, and allow the enrollee to continue to have the benefits provided
under the plan under the same terms and conditions as would have applied without
the termination until either 90 days after the termination notice date or the date on
which the enrollee is no longer a continuing care patient, whichever is earlier.
Telehealth parity
The bill requires health insurance policies and self-insured governmental
health plans to cover a treatment or service that is provided through telehealth if the
treatment or service is covered by the policy or plan when provided in person. A
policy or plan may limit its coverage to those treatments or services that are
medically necessary. “Telehealth” is defined in the bill as 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 consultation or are used to transfer medically relevant data about a
patient. Health insurance policies are referred to as disability insurance policies in
the bill, and a self-insured governmental health plan is a self-funded health plan
of the state or a county, city, village, town, or school district.
The bill also sets parameters on the coverage of telehealth treatments and
services that is required in the bill. A policy or plan may not subject a telehealth
treatment or service to a greater deductible, copayment, or coinsurance than if
provided in person. Similarly, a policy or plan may not impose a policy or calendar
year or a lifetime benefit limit or other maximum limitation or a prior authorization
requirement on a telehealth treatment or service that is not imposed on treatments
or services provided through manners other than telehealth. A policy or plan also
may not place unique location requirements on telehealth treatment or services. If
a policy or plan covers a telehealth treatment or service that has no in-person
equivalent, the policy or plan must disclose this in the policy or plan materials.
Participation by school districts in state group health insurance plan
The bill requires the commissioner of insurance to create a task force to develop
an implementation plan for participation by school districts in a group health
insurance plan offered by the Group Insurance Board. The task force consists of 13
members appointed by the governor, including a representative from each of the
following entities: OCI, DOA, DPI, and ETF. The task force also includes one
administrator of a school district, one business official of a school district, one
member of a school board, one official of a public employee union, three employees
of public schools, and one representative of a health plan. Under the bill, the
commissioner of insurance and the secretary of employee trust funds are required
to consult with the task force and review an actuarial study conducted by GIB and
develop a plan to implement participation by school districts in a group health
insurance plan offered by GIB, by January 1, 2024. Finally, under the bill, the
commissioner of insurance and the secretary of employee trust funds are required
to provide the implementation plan to the governor and JCF no later than December
31, 2022.
Outreach and education regarding employee misclassification
The bill directs the commissioner of insurance to conduct, on at least an annual
basis, outreach and education to insurers and other persons regulated by the state
insurance laws on how to identify the misclassification of employees and report
suspected misclassifications to the appropriate federal and state agencies.
JUSTICE
Powers of the attorney general
The bill repeals changes made to the powers of the attorney general in
2017
Wisconsin Act 369 relating to the power to compromise or discontinue civil actions
prosecuted by DOJ and the power to compromise and settle actions in cases in which
DOJ is defending the state. The bill reestablishes these settlement powers as they
existed under the law before
2017 Wisconsin Act 369 was enacted.
The bill allows the attorney general to compromise or discontinue actions
prosecuted by DOJ 1) when directed by the officer, department, board, or commission
that directed the prosecution or 2) with the approval of the governor when the action
is prosecuted by DOJ on the initiative of the attorney general or at the request of any
individual. The bill eliminates the requirement for approval of a compromise or
discontinuance from a legislative intervenor or JCF. It also eliminates the
requirement for the attorney general to obtain approval of a compromise or
discontinuance by the Joint Committee on Legislative Organization in certain
circumstances before submitting a proposed plan to JCF.
Under the bill, when DOJ is defending the state, the attorney general may
compromise and settle the action as the attorney general determines to be in the best
interest of the state. The bill eliminates the requirement under current law that, in
actions for injunctive relief or if there is a proposed consent decree, the attorney
general must 1) obtain the approval of any legislative intervenor or 2) if there is no
intervenor, submit a proposed plan to JCF and, in certain circumstances, obtain
approval of JCF. The bill also eliminates the requirement for the attorney general
to obtain approval from JCLO in certain circumstances before submitting a proposed
plan of settlement or compromise to JCF.
Gifts and grants and disposition of settlement funds
The bill repeals certain changes made by
2017 Wisconsin Act 369 relating to
gifts and grants and certain proceeds received by DOJ, specifically reversing
provisions that changed a DOJ gifts and grants appropriation and a DOJ gifts,
grants, and proceeds appropriation from continuing appropriations to annual
appropriations.
Second, the bill repeals the requirement that the attorney general must deposit
all settlement funds into the general fund. The bill restores procedures relating to
discretionary settlement funds under which the attorney general could expend
certain settlement funds not committed under the terms of a settlement after
submitting a plan to JCF for passive review and either 1) the cochairpersons of JCF
do not schedule a meeting; or 2) a meeting is scheduled and JCF approves a plan for
expenditure.
Sexual assault kits
Under current law, there is no statutory procedure for the collection and
processing of sexual assault kits. The bill creates procedures for transmission,
processing, and storage of sexual assault kits. Under the bill, a health care
professional who collects a sexual assault kit must do one of the following: 1) if the
victim wants to report the sexual assault to law enforcement, the health care
professional must notify a law enforcement agency within 24 hours of collecting the
kit; or 2) if the victim does not want to report the sexual assault to law enforcement,
the health care professional must send the kit to the state crime laboratories within
72 hours for storage. Under the bill, if a law enforcement agency has received
notification from a health care professional that a kit has been collected, the law
enforcement agency must take possession of the kit within 72 hours and must send
the kit to the state crime laboratories for processing within 14 days. If the victim
changes his or her mind about wanting to have his or her kit analyzed after it is given
to a law enforcement agency but before the agency sends the kit to the state crime
laboratories for processing, the agency must send the kit to the state crime
laboratories for storage rather than for processing.
Under the bill, once the state crime laboratories takes possession of a sexual
assault kit, it must do one of the following: 1) if it has received the kit of a person who
has not consented to analysis, securely store the kit for a period of 10 years; or 2) if
it has received the kit of a person who has consented to analysis, process the kit and
then send it to a law enforcement agency to store the kit for a period of 50 years, or
until the date of the expiration of the statute of limitations, or until the end of a term
of imprisonment or probation of a person convicted in the sexual assault case,
whichever is longer.
Under current law, local law enforcement agencies report certain crime
statistics to DOJ. The bill requires law enforcement agencies to provide additional
data to DOJ regarding sexual assault kits collected and processed in Wisconsin in
addition to the data currently being reported. The bill also requires DOJ to publish
data on law enforcement agency compliance with DOJ reporting requirements.
Collection of data from traffic stops
The bill requires a law enforcement agency to collect the following information
concerning motor vehicle stops made on or after January 1, 2022: 1) the name,
address, gender, and race of the operator of the motor vehicle, with the officer
subjectively determining the person's race as being Caucasian, Black or African
American, Hispanic, American Indian or Alaska Native, or Asian or Pacific Islander;
2) the reason for the motor vehicle stop; 3) the make and year of the motor vehicle;
4) the date, time, and location of the motor vehicle stop; 5) whether or not a law
enforcement officer conducted a search of the motor vehicle, the operator, or any
passenger and, if so, whether the search was with consent or by other means; 6) the
name, address, gender, and race of any person searched; and 7) the name and badge
number of the officer making the motor vehicle stop.
The information that is collected under the bill concerning motor vehicle stops
is not subject to inspection or copying as a public record. The information, however,
must be forwarded to DOJ, which must then compile and analyze it, along with any
other relevant information, to determine, both for the state as a whole and for each
law enforcement agency, whether the number of stops and searches involving motor
vehicles operated or occupied by members of a racial minority are disproportionate
compared to the number of stops and searches involving motor vehicles operated or
occupied solely by persons who are not members of a racial minority.
Universal background check requirement for all firearm transfers
Current law provides that a federally licensed firearms dealer may not transfer
a handgun after a sale until the dealer has asked DOJ to perform a background check
on the prospective transferee to determine if he or she is prohibited from possessing
a firearm under state or federal law. The bill generally prohibits any person from
transferring any firearm, including the frame or receiver of a firearm, unless the
transfer occurs through a federally licensed firearms dealer and involves a DOJ
background check of the prospective transferee. Under the bill, the following are
excepted from that prohibition: a transfer to a firearms dealer or to a law
enforcement or armed services agency; a transfer of a firearm classified as antique;
or a transfer that is by gift, bequest, or inheritance to a family member. A person who
is convicted of violating the prohibition is guilty of a misdemeanor and must be fined
not less than $500 nor more than $10,000, may be imprisoned for not more than nine
months, and may not possess a firearm for a period of two years.
Treatment alternatives and diversion grant program
Under current law, DOJ, in collaboration with DOC and DHS, awards grants
to counties or tribes that have established qualifying treatment alternatives and
diversion (TAD) programs that offer substance abuse or mental health treatment
services as alternatives to prosecution or incarceration in order to reduce recidivism,
promote public safety, and reduce prison and jail populations.
Under current law, in order to qualify for a TAD grant, a county's or tribe's
program is required to match 25 percent of the grant, and a program is required to
charge participants a fee to participate. A county or tribe that receives a TAD grant
must create an oversight committee to administer and evaluate its program. DOJ
is required to make grants available to any county or tribe on a competitive basis
every five years. At the end of the five-year grant cycle, DOJ is required to prepare
a comprehensive report on the grant program based on annual reports and other data
it collects from the counties and tribes.
The bill makes several changes to the TAD grant program. Under the bill, a
program funded by a TAD grant need not focus solely on alcohol and other drug
treatment, but must employ evidence-based practices targeted to the population
served by the program. The bill changes the match requirement from 25 percent to
10 percent and changes the competitive grant process to a four-year cycle. The bill
allows, but does not require, an eligible program to charge participants a fee for their
treatment. The bill also eliminates certain requirements pertaining to exposure of
genitals during drug testing.
Under current law, when a person pleads or is found guilty of certain drug
offenses, the court is required to order a substance use assessment. Under current
law, the court does not have to order an assessment if the person is already covered
by such an order, has recently completed an assessment under such an order, or is
participating in a TAD program. The bill specifies that if a person is participating
in any evidence-based substance use disorder treatment program as determined by
DOJ, regardless of its status relating to the TAD program, the court does not need
to order an assessment.
Sentencing review council
The bill creates the Sentencing Review Council within DOJ. The council is
charged with studying and making recommendations on 1) criminal penalties and
reforming the Criminal Code; 2) the equitability of sentences; 3) the state's
bifurcated sentencing structure; and 4) sentencing for individuals who were age 18
to 25 at the time the crime was committed. Under the bill, membership of and
appointments to the council are determined by the governor.
Grants for alternative emergency response and 911 diversion
The bill creates a grant program within DOJ for alternative emergency
response and 911 diversion. Under the bill, DOJ must issue grants to counties with
a population of 750,000 or more to facilitate contracts between local health
departments and behavioral crisis support service providers and to support
research, design, and personnel costs associated with creating programs to divert
behavioral health situations in 911 call centers.
Sexual assault victim services grants for the Wisconsin Coalition Against
Sexual Assault
Under current law, DOJ administers a grant program to provide grants to
organizations that provide services to victims of sexual assault. The bill requires
that, in addition to the other grants under the program, DOJ must provide an annual
grant of $100,000 to the Wisconsin Coalition Against Sexual Assault. Under the bill,
the Wisconsin Coalition Against Sexual Assault may also apply for additional grants
under the program.
Youth diversion services
Under current law, DOJ allocates $1,050,000 to contract with organizations to
provide services in Milwaukee, Racine, Kenosha, and Brown Counties for the
diversion of youths from gang activities into productive activities such as
educational, recreational, and employment programs. Under current law, these
contracts are funded by a penalty surcharge on court fines and forfeitures. The bill
creates a GPR appropriation account from which funding for these services may be
provided.
County Victim Witness Reimbursement
Under current law, there are three program revenue appropriations from which
DOJ is required to reimburse counties for services provided to victims and witnesses
of crime. The bill creates an additional general purpose revenue annual
appropriation from which DOJ is required to reimburse counties for services
provided to victims and witnesses of crime.
Nonviolent offender diversion program
The 2019 biennial budget created a diversion pilot program for nonviolent
criminal offenders to be diverted to a treatment option. Under current law, the pilot
program sunsets on July 1, 2021. The bill repeals that sunset so that the diversion
program remains in place beyond July 1, 2021.
Ongoing transfer for investigation of crimes against children
The bill creates an ongoing transfer of moneys collected from crime laboratory,
DNA analysis, and drug law enforcement surcharges to an appropriation to be used
for investigation and prosecution of internet crimes against children.
Relator appropriation
The bill creates a continuing appropriation to hold all money received by DOJ
that is owed to a relator, to provide payments to relators. A relator is a type of party
in a legal action in whose name an action is brought by a state.
Law enforcement
Use of force policies
Under current law, each law enforcement agency must have a written public
policy that regulates the use of force by law enforcement officers. The bill makes
several changes that affect this requirement.
First, the bill requires the law enforcement agency to post its policy on the law
enforcement agency website or, if the agency does not have one, on a website
maintained by the municipality over which the law enforcement agency has
jurisdiction.
Second, the bill requires each law enforcement agency to ensure that its use of
force policy incorporates the following principles: that the primary duty of all law
enforcement is to preserve the life of all individuals; that deadly force is to be used
only as the last resort; that chokeholds are banned; that officers should use skills and
tactics that minimize the likelihood that force will become necessary; that, if officers
must use physical force, it should be the least amount of force necessary to safely
address the threat; and that law enforcement officers must take reasonable action
to stop or prevent any unreasonable use of force by their colleagues.
Third, under the bill, each law enforcement officer must annually complete at
least eight hours of training on use-of-force options and techniques a law
enforcement officer may use to de-escalate a potentially unstable situation.
Fourth, the bill prohibits disciplining a law enforcement officer for reporting a
violation of a law enforcement agency's use of force policy.
Finally, the bill requires the Law Enforcement Standards Board to develop a
model use of force policy for law enforcement agencies. The model policy must
address interactions with individuals with mental disorders, alcohol or drug
problems, dementia disorders, and developmental disabilities; limit the use of force
against vulnerable populations; and include other best practices that LESB
identifies.
Reports on use of force incidents
Current law requires DOJ to collect certain information concerning criminal
offenses committed in Wisconsin. The bill requires DOJ to collect data and publish
an annual report on law enforcement use of force incidents, including incidents in
which there was a shooting, in which a firearm was discharged in the direction of a
person (even if there was no injury), and in which other serious bodily harm resulted
from the incident. The bill requires certain demographic information to be collected
about each such incident, and reported annually by DOJ on its website.
Grant program to reduce violence
The bill creates a $1,000,000 grant program, administered by DOJ, to fund
community organizations that are utilizing evidence-based outreach and violence
interruption strategies to mediate conflicts, prevent retaliation and other potentially
violent situations, and connect individuals to community supports.
Cause of action for unnecessarily summoning a law enforcement officer
The bill creates a civil cause of action for unnecessarily summoning a law
enforcement officer. Under the bill, a person may bring an action against another
person who, with the intent to do any of the following, causes a law enforcement
officer to arrive at a location to contact the person: infringe upon a constitutional
right of the person; unlawfully discriminate against the person; cause the person to
feel harassed, humiliated, or embarrassed; cause the person to be expelled from a
place in which the person is lawfully located; damage the person's reputation or
standing within the community; or damage the person's financial, economic,
consumer, or business prospects or interests.
Under the bill, the person may recover the greater of special and general
damages, including damages for emotional distress, or an amount equal to $250 from
each defendant found liable; punitive damages; and costs, including all reasonable
attorney fees and other costs of the investigation and litigation that were reasonably
incurred.
Prohibition on no-knock warrants
Under current law, a law enforcement officer executing a search warrant must
knock and announce before entering unless, at the time the warrant is executed, the
law enforcement officer has a reasonable suspicion that knocking and announcing
will be dangerous or futile or will inhibit the effective investigation of the crime. The
bill requires that a law enforcement officer executing a search warrant must, before
entering the premises, identify himself or herself as a law enforcement officer and
announce the authority and purpose of the entry.
Training and recruiting officers
The bill makes certain changes to the responsibilities of the Law Enforcement
Standards Board. Under current law, LESB regulates the training of law
enforcement officers. The bill requires LESB to also regulate jail and juvenile
detention officer training standards, and to regulate recruitment standards for the
recruiting of new law enforcement, jail, and juvenile detention officers.
The bill also requires each law enforcement agency to maintain an employment
file for each employee. Under the bill, when a law enforcement agency, jail, or
juvenile detention facility is recruiting for new officers, the agency, jail, or facility
must require each candidate that is or has been employed by a different agency, jail,
or facility to authorize that employer to disclose his or her employment files to the
recruiting agency, jail, or facility and to release that employer from any liability
related to the use and disclosure of the files.
Local government
Public contracts
Bidding thresholds
In general, under current law, a second, third, or fourth class city or a village,
town, county, technical college district board, or federated public library system must
let a public contract having an estimated cost of more than $25,000 to the lowest
responsible bidder. Under the bill, the amount above which any of these local
governmental units must let a contract to the lowest responsible bidder is raised to
$50,000.
Levy limits
Levy limits; alternative minimum growth factor increase
Generally under current law, local levy limits are applied to the property tax
levies that are imposed by a city, village, town, or county (political subdivision) in
December of each year. Current law prohibits any political subdivision from
increasing its levy by a percentage that exceeds its “valuation factor," which is
defined as the greater of either 0 percent or the percentage change in the political
subdivision's equalized value due to new construction, less improvements removed.
The bill increases the alternative percentage factor for purposes of the “valuation
factor” to 2 percent.
Levy limit reduction for service transfer
Under current law, if a political subdivision transfers to another governmental
unit the responsibility to provide a service that it provided in the previous year, the
levy limit otherwise applicable in the current year is decreased to reflect the cost that
the political subdivision would have incurred to provide that service. The bill repeals
that provision.
Levy limit negative adjustment for certain service revenues
Under current law, a political subdivision must reduce its allowable levy by the
estimated amount of any revenue from fees or payments in lieu of taxes if the revenue
is received for providing certain “covered services" that were funded with property
tax revenues in calendar year 2013. The “covered services" are certain garbage
collection, fire protection, snow plowing, street sweeping, and storm water
management.
The bill repeals the requirement that a political subdivision must reduce its
allowable levy by the estimated amount of revenues received for providing covered
services that were funded with property tax revenues in calendar year 2013.
Levy limit exclusion for cross-municipality transit routes
