The bill requires DOA to award grants to each continuum of care organization
in this state for the purpose of providing tenant-based rental assistance to homeless
veterans. A continuum of care organization is an organization designated by the
federal Department of Housing and Urban Development that provides funding and
services to alleviate homelessness.
Homeless case management services grants
Under current law, DOA may award up to 10 grants of up to $50,000 each year
to shelter facilities for case management services provided to homeless families. The
bill eliminates the limit on the number of grants that may be awarded and raises the
grant limit to $75,000.
Whole-home upgrade grants
The bill establishes a pilot program under which DOA must award one or more
grants to the Walnut Way Conservation Corporation and Elevate, Inc., for the
purpose of funding home improvements in low-income households in a first class city
(presently only Milwaukee). The grants must have one or more of the following goals:
1) reducing carbon emissions, 2) reducing energy burdens, 3) creating cost savings,
or 4) creating healthier living environments.
The bill authorizes DOA to establish eligibility requirements and other
program guidelines for the grant program. Under the bill, the grant program sunsets
on July 1, 2025.
Affordable housing grants
The bill requires DOA to award grants to municipalities for the purpose of
increasing the availability of affordable workforce housing within the
municipalities.
Water utility assistance program for low-income households
The bill creates a water utility assistance program for low-income households
that is administered by DOA. Under the program, low-income households may
apply for assistance from the state to help pay the cost of their water utility bills.
Although the program is administered by DOA, DOA may contract with a county
department or other local governmental agency or a private nonprofit organization
to process applications and make assistance payments. DOA must establish a
payments schedule for the program. If the number of household applicants exceeds
the number anticipated to apply, payments to households may be reduced and DOA
may suspend additional applications for assistance. Under the bill, a household
eligible for water utility assistance may also be eligible for a crisis assistance
payment if the household is experiencing or at risk of experiencing a water
utility-related emergency, as defined by DOA.
Municipal home rehabilitation grants
The bill requires DOA to award grants to municipalities to fund initiatives to
rehabilitate and restore blighted residential properties within the municipality. The
bill authorizes DOA to establish eligibility requirements and other program
guidelines for the grant program.
Housing quality standards grants
The bill requires DOA to award grants to owners of rental housing units in
Wisconsin for purposes of satisfying applicable housing quality standards.
insurance
Coverage of individuals with preexisting conditions and other insurance
market regulations
The bill requires certain health plans to guarantee access to coverage; prohibits
plans from imposing preexisting condition exclusions; prohibits plans from setting
premiums or cost-sharing amounts based on health status-related factors; prohibits
plans from setting lifetime or annual limits on benefits; requires plans to cover
certain essential health benefits; requires coverage of certain preventive services by
plans without a cost-sharing contribution by an enrollee; sets a maximum annual
amount of cost sharing for enrollees; and designates risk pool, medical loss ratio, and
actuarial value requirements.
The bill requires every individual health insurance policy, known in the bill as
a health benefit plan, to accept every individual who applies for coverage and
requires every group health insurance policy to accept every employer that applies
for coverage, regardless of the individual's or any employee's sexual orientation or
gender identity and regardless of whether the individual or any employee has a
preexisting condition. The bill allows health benefit plans to restrict enrollment in
coverage to open or special enrollment periods and requires the commissioner of
insurance to establish a statewide open enrollment period of no shorter than 30 days
for every individual health benefit plan. The bill prohibits a group health insurance
policy, including a self-insured governmental health plan, from imposing a
preexisting condition exclusion. The bill also prohibits an individual health
insurance policy from reducing or denying a claim or loss incurred or disability
commencing under the policy on the ground that a disease or physical condition
existed prior to the effective date of coverage.
A health benefit plan offered on the individual or small employer market or a
self-insured governmental health 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. An individual health benefit
plan or self-insured health 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. A self-insured health plan or an insurer offering an
individual health benefit plan is also prohibited 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.
Current state law prohibits group health benefit plans from establishing rules of
eligibility or requiring greater premium or contribution amounts based on a health
status-related factor. The bill adds to these current law requirements for group
health benefit plans that the plan may not require a greater deductible, copayment,
or coinsurance amount based on a health status-related factor.
Under the bill, an individual or group health benefit plan or a self-insured
governmental health plan may not establish lifetime or annual limits on the dollar
value of benefits for an enrollee or a dependent of an enrollee under the plan. The
bill specifies a maximum amount of cost sharing that a plan may impose as the
amount calculated under the federal Patient Protection and Affordable Care Act
(ACA).
The bill requires individual and small employer plans to have either a single
statewide risk pool for the individual market and a single pool for the small employer
market or a single statewide risk pool for a combination of the individual and small
employer markets. The bill requires individual and small employer plans to have a
medical loss ratio of at least 80 percent and larger group plans to have a medical loss
ratio of at least 85 percent. The medical loss ratio is the proportion of premium
revenues that the plan spends on clinical services and quality improvement. The bill
also requires individual and small employer plans to provide a level of coverage that
is designed to provide benefits that are actuarially equivalent to at least 60 percent
of the full actuarial value of the benefits provided under the plan. An actuarial value
of 60 percent corresponds to a bronze tier plan under the ACA.
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 requires certain health
insurance policies and governmental self-insured 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 governmental self-insured
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.
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
medical services without requiring a prior authorization determination and without
regard to whether 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 an 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 recognized amount specified under federal law; 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 an out-of-network 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 was made for
services provided by a participating provider or facility.
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
recognized amount specified under federal law; 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 out-of-network 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 items or services toward any
in-network deductible or out-of-pocket maximum as if the cost-sharing payment
was made for items or 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.
Under the bill, a provider or facility that is entitled to a payment for an
emergency medical service or other item or service may initiate open negotiations
with the defined network plan, preferred provider plan, or self-insured
governmental health 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 because of a change in the terms of the participation of the provider or
facility in the plan or the contract is terminated resulting in a loss of benefits under
the plan, the plan must notify the 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.
Fiduciary duty of pharmacy benefit managers
The bill imposes fiduciary and disclosure requirements on pharmacy benefit
managers. Pharmacy benefit managers contract with health plans that provide
prescription drug benefits to administer those benefits for the plans. Pharmacy
benefit managers also have contracts with pharmacies and pay the pharmacies for
providing the drugs to the plan beneficiaries.
The bill provides that a pharmacy benefit manager owes a fiduciary duty to a
plan sponsor. The bill also requires that a pharmacy benefit manager annually
disclose all of the following information to the plan sponsor:
1. The indirect profit received by the pharmacy benefit manager from owning
a pharmacy or service provider.
2. Any payments made to a consultant or broker who works on behalf of the plan
sponsor.
3. From the amounts received from drug manufacturers, the amounts retained
by the pharmacy benefit manager that are related to the plan sponsor's claims or
bona fide service fees.
4. The amounts received from network pharmacies and the amount retained
by the pharmacy benefit manager.
Licensure of pharmacy benefit management brokers and consultants
The bill requires an individual who is acting as a pharmacy benefit
management broker or consultant or any other individual who procures the services
of a pharmacy benefit manager on behalf of a client to be licensed by OCI. The bill
allows OCI to promulgate administrative rules to establish criteria, procedures, and
fees for licensure. A pharmacy benefit manager, as defined under current law, is an
entity that contracts to administer or manage prescription drug benefits on behalf
of an insurer or other entity that provides prescription drug benefits.
Prescription drug affordability review board
The bill creates a prescription drug affordability review board, whose purpose
is to protect Wisconsin residents and other stakeholders from the high costs of
prescription drugs. The board consists of the commissioner of insurance and the
following members, all of whom are appointed by the governor for four-year terms:
1. Two members who represent the pharmaceutical drug industry, at least one
of whom is a licensed pharmacist.
2. Two members who represent the health insurance industry.
3. Two members who represent the health care industry, at least one of whom
is a licensed practitioner.
4. Two members who represent the interests of the public.
The bill requires the board to meet in open session at least four times per year
to review prescription drug pricing information. The board must provide at least two
weeks' public notice of its meetings, make the meeting's materials publicly available
at least one week prior to meeting, and provide the opportunity for public comment.
The bill imposes conflict of interest requirements for the board relating to recusal
and public disclosure of certain conflicts. The bill directs the board to access and
assess drug pricing information, to the extent practicable, by accessing and assessing
information from other states, by assessing spending for the drug in Wisconsin, and
by accessing other available pricing information.
Under the bill, the board must conduct drug cost affordability reviews. The first
step in the reviews is for the board to identify prescription drugs whose launch
wholesale acquisition cost exceeds specified thresholds, prescription drugs whose
increase in wholesale acquisition cost exceeds specified thresholds, and other
prescription drugs that may create affordability challenges for the health care
system in Wisconsin. For each identified prescription drug, the board must
determine whether to conduct an affordability review by seeking stakeholder input
and by considering the average patient cost share for the drug. During an
affordability review, the board must determine whether use of the prescription drug
that is fully consistent with the labeling approved by the federal Food and Drug
Administration or standard medical practice has led or will lead to an affordability
challenge for the health care system in Wisconsin. In making this determination, the
bill requires the board to consider a variety of factors, which include the following:
1. The drug's wholesale acquisition cost.
2. The average monetary price concession, discount, or rebate the
manufacturer provides, or is expected to provide, for the drug to health plans.
3. The total amount of price concessions, discounts, and rebates the
manufacturer provides to each pharmacy benefit manager for the drug.
4. The price at which therapeutic alternatives have been sold and the average
monetary concession, discount, or rebate the manufacturer provides, or is expected
to provide, to health plan payors and pharmacy benefit managers for therapeutic
alternatives.
5. The costs to health plans based on patient access consistent with federal
labeled indications and recognized standard medical practice.
6. The impact on patient access resulting from the drug's cost relative to
insurance benefit design.
7. The current or expected dollar value of drug-specific patient access
programs that are supported by the manufacturer.
8. The relative financial impacts to health, medical, or social services costs that
can be quantified and compared to baseline effects of existing therapeutic
alternatives.
9. The average patient copay or other cost sharing for the drug.
If the board determines that a prescription drug will lead to an affordability
challenge, the bill directs the board to establish an upper payment limit for that drug
that applies to all purchases and payor reimbursements of the drug dispensed or
administered to individuals in this state. In establishing the upper payment limit,
the board must consider the cost of administering the drug, the cost of delivering it
to consumers, and other relevant administrative costs. For certain drugs, the board
must solicit information from the manufacturer regarding the price increase and, if
the board determines that the price increase is not a result of the need for increased
manufacturing capacity or other effort to improve patient access during a public
health emergency, the board must establish an upper payment limit equal to the
drug's cost prior to the price increase.
Cost-sharing cap on insulin
The bill prohibits each health insurance policy and governmental self-insured
health plan that covers insulin and imposes cost sharing on prescription drugs from
imposing cost sharing on insulin in an amount that exceeds $35 for a one-month
supply. Current law requires each health insurance policy that provides coverage of
expenses incurred for treatment of diabetes to provide coverage for specified
expenses and items, including insulin. The required coverage under current law for
certain diabetes treatments other than insulin infusion pumps is subject to the same
exclusions, limitations, deductibles, and coinsurance provisions of the policy as other
covered expenses. The bill's cost-sharing limitation on insulin supersedes the
specification that the exclusions, limitations, deductibles, and coinsurance are the
same as for other coverage.
Insulin safety net programs
The bill requires insulin manufacturers to establish a program under which
qualifying residents of this state who are in urgent need of insulin and are uninsured
or have limited insurance coverage can be dispensed insulin at a pharmacy. Under
the program, if a qualifying individual in urgent need of insulin provides a pharmacy
with a form attesting that the individual meets the program's eligibility
requirements, specified proof of residency, and a valid insulin prescription, the
pharmacy must dispense a 30-day supply of insulin to the individual and may charge
the individual a copayment of no more than $35. The pharmacy may submit an
electronic payment claim for the insulin's acquisition cost to the manufacturer or
agree to receive a replacement of the same insulin in the amount dispensed.
The bill also requires that each insulin manufacturer establish a patient
assistance program to make insulin available to any qualifying resident of this state
who, among other requirements, is uninsured or has limited insurance coverage and
whose family income does not exceed 400 percent of the federal poverty line. Under
the bill, an individual must apply to participate in a manufacturer's program. If the
manufacturer determines that the individual meets the program's eligibility
requirements, the manufacturer must issue the individual a statement of eligibility,
which is valid for 12 months and may be renewed. Under the bill, if an individual
with a statement of eligibility and valid insulin prescription requests insulin from
a pharmacy, the pharmacy must submit an order to the manufacturer, who must then
provide a 90-day supply of insulin at no charge to the individual or pharmacy. The
pharmacy may charge the individual a copayment of no more than $50. Under the
bill, a manufacturer is not required to issue a statement of eligibility if the individual
has prescription drug coverage through an individual or group health plan and the
manufacturer determines that the individual's insulin needs are better addressed
through the manufacturer's copayment assistance program. In such case, the
manufacturer must provide the individual with the necessary drug coupons, and the
individual may not be required to pay more than a $50 copayment for a 90-day
supply of insulin.
Under the bill, if the manufacturer determines that an individual is not eligible
for the patient assistance program, the individual may file an appeal with OCI. The
bill directs OCI to establish procedures for deciding appeals. Under the bill, OCI
must issue a decision within 10 days, and that decision is final.
The bill requires that insulin manufacturers annually report to OCI certain
information, including the number of individuals served and the cost of insulin
dispensed under the programs, and that OCI annually report to the governor and the
legislature on the programs. The bill also directs OCI to conduct public outreach and
develop an information sheet about the programs, conduct satisfaction surveys of
individuals and pharmacies that participate in the programs, and report to the
governor and the legislature on the surveys by July 1, 2026. Additionally, the bill
requires that OCI develop a training program for health care navigators to assist
individuals in accessing appropriate long-term insulin options and maintain a list
of trained navigators.
The bill provides that a manufacturer that violates the bill's provisions may be
required to forfeit not more than $200,000 per month of violation, which increases
to $400,000 per month if the manufacturer continues to be in violation after six
months and to $600,000 per month if the manufacturer continues to be in violation
after one year. The bill's requirements do not apply to manufacturers with annual
insulin sales revenue in this state of no more than $2,000,000 or to insulin that costs
less than a specified dollar amount.
Application of manufacturer discounts
Health insurance policies and plans often apply deductibles and out-of-pocket
maximum amounts to the benefits covered by the policy or plan. A deductible is an
amount that an enrollee in a policy or plan must pay out of pocket before attaining
the full benefits of the policy or plan. An out-of-pocket maximum amount is a limit
specified by a policy or plan on the amount that an enrollee pays, and once that limit
is reached, the policy or plan covers the benefit entirely. The bill requires health
insurance policies that offer prescription drug benefits and self-insured health plans
to apply the amount of any discounts that a manufacturer of a brand name drug
provides to reduce the amount of cost sharing that is charged to an enrollee for those
brand name drugs to the enrollee's deductible and out-of-pocket maximum amount.
That requirement applies for brand name drugs that have no generic equivalent and
for brand name drugs that have a generic equivalent but that the enrollee has prior
authorization or physician approval to obtain.
Reimbursement to federal drug pricing program participants
The bill prohibits any person from reimbursing certain entities that participate
in the federal drug pricing program, known as the 340B program, for a drug subject
to an agreement under the program at a rate lower than that paid for the same drug
to pharmacies that have a similar prescription volume. The bill also prohibits a
person from imposing any fee, charge back, or other adjustment on the basis of the
entity's participation in the 340B program. The entities covered by the prohibitions
under the bill are federally qualified health centers, critical access hospitals, and
grantees under the federal Ryan White HIV/AIDS program, as well as these entities'
pharmacies and any pharmacy with which any of the entities have contracted to
dispense drugs through the 340B program. The bill allows the commissioner to
promulgate administrative rules to establish a minimum reimbursement rate for
entities that participate in the 340B program.
Value-based diabetes medication pilot project
The bill directs OCI to develop a pilot project under which a pharmacy benefit
manager and a pharmaceutical manufacturer are directed to create a value-based,
sole-source arrangement to reduce the costs of prescription diabetes medication.
The bill allows OCI to promulgate administrative rules to implement the pilot
project.
Pharmacy services administrative organizations
The bill requires that a pharmacy services administrative organization (PSAO)
be licensed by OCI. Under the bill, a PSAO is an entity operating in Wisconsin that
does all of the following:
1. Contracts with an independent pharmacy to conduct business on the
pharmacy's behalf with a third-party payer.
2. Provides at least one administrative service to an independent pharmacy
and negotiates and enters into a contract with a third-party payer or pharmacy
benefit manager on the pharmacy's behalf.
The bill defines “independent pharmacy" to mean a licensed pharmacy
operating in this state that is under common ownership with no more than two other
pharmacies. “Administrative service” is defined to mean assisting with claims or
audits, providing centralized payment, performing certification in a specialized care
program, providing compliance support, setting flat fees for generic drugs, assisting
with store layout, managing inventory, providing marketing support, providing
management and analysis of payment and drug dispensing data, or providing
resources for retail cash cards. The bill defines “third-party payer” to mean an entity
operating in this state that pays or insures health, medical, or prescription drug
expenses on behalf of beneficiaries. The bill uses the current law definition of
“pharmacy benefit manager," which is an entity doing business in this state that
contracts to administer or manage prescription drug benefits on behalf of an insurer
or other entity that provides prescription drug benefits to Wisconsin residents.
To obtain the license required by the bill, a person must apply to OCI and
provide the contact information for the applicant and a contact person, evidence of
financial responsibility of at least $1,000,000, and any other information required by
the commissioner. Under the bill, the license fee is set by the commissioner, and the
term of a license is two years.
The bill also requires that a PSAO disclose to OCI the extent of any ownership
or control by an entity that provides pharmacy services; provides prescription drug
or device services; or manufactures, sells, or distributes prescription drugs,
biologicals, or medical devices. The PSAO must notify OCI within five days of any
material change in its ownership or control related to such an entity.
Licensure of pharmaceutical representatives
The bill requires a pharmaceutical representative to be licensed by OCI and to
display the pharmaceutical representative's license during each visit with a health
care professional. The bill defines “pharmaceutical representative” to mean an
individual who markets or promotes pharmaceuticals to health care professionals on
behalf of a pharmaceutical manufacturer for compensation. The term of a license
issued under the bill is one year, and the license is renewable. Under the bill, the
license fee is set by the commissioner of insurance. The bill directs the commissioner
to promulgate administrative rules to implement the bill's requirements, including
rules that require pharmaceutical representatives to complete continuing
educational coursework as a condition of licensure. An individual who violates any
of the requirements under the bill is subject to a fine, and the individual's license may
be suspended or revoked.
Moneys from professional regulation used for general program operations
The bill credits to the appropriation account for OCI's general program
operations all moneys received from the regulation of pharmacy benefit managers,
pharmacy benefit management brokers, pharmacy benefit management
consultants, PSAOs, and pharmaceutical representatives.
Coverage of infertility services
The bill requires health insurance policies and self-insured governmental
health plans that cover medical or hospital expenses to cover diagnosis of and
treatment for infertility and standard fertility preservation services. Coverage
required under the bill must include at least four completed egg retrievals with
unlimited embryo transfers, in accordance with certain guidelines, and single
embryo transfer is allowed when recommended and medically appropriate. Policies
and plans are prohibited from imposing an exclusion, limitation, or other restriction
on coverage of medications of which the bill requires coverage that is not imposed on
any other prescription medications covered under the policy or plan. Similarly,
policies and plans may not impose any exclusion, limitation, cost-sharing
requirement, benefit maximum, waiting period, or other restriction on diagnosis,
treatment, or services for which coverage is required under the bill that is different
from any exclusion, limitation, cost-sharing requirement, benefit maximum,
waiting period, or other restriction imposed on benefits for other services. Also,
policies and plans may not impose an exclusion, limitation, or other restriction on
diagnosis, treatment, or services for which coverage is required under the bill on the
basis that an insured person participates in fertility services provided by or to a third
party.
Coverage of treatment or services provided by qualified treatment trainees
The bill prohibits any health insurance plan from excluding coverage for
mental health or behavioral health treatment or services provided by a qualified
treatment trainee within the scope of the qualified treatment trainee's education and
training if the health insurance plan covers the mental health or behavioral health
treatment or services when provided by another health care provider. “Qualified
treatment trainee” is defined under current law to mean either a graduate student
who is enrolled in an accredited institution in psychology, counseling, marriage and
family therapy, social work, nursing, or a closely related field, or a person with a
graduate degree from an accredited institution and course work in psychology,
counseling, marriage and family therapy, social work, nursing, or a closely related
field who has not yet completed the applicable supervised practice requirements
described under the administrative code.
Coverage of treatment or services provided by substance abuse counselors
The bill prohibits any health insurance plan from excluding coverage for
alcoholism or other drug abuse treatment or services provided by a certified
substance abuse counselor within the scope of the substance abuse counselor's
education and training if the health insurance plan covers the alcoholism or other
drug abuse treatment or services when provided by another health care provider.
“Substance abuse counselor” is defined under current law to mean a substance abuse
counselor-in-training, a substance abuse counselor, or a clinical substance abuse
counselor.
Telehealth parity
