Amendment SA4-SSA2-SB45

SB45-SSA2-SA4,88,8 (10) Falls prevention funding. From the appropriation under s. 20.435 (1) (b), the department of health services shall award a grant of $450,000 in each of fiscal years 2025-26 and 2026-27 to an organization committed to reducing falls among older adults in this state for the purpose of statewide falls prevention awareness and initiatives.

SB45-SSA2-SA4,88,11 (11) Reference changes. Wherever a reference to s. 253.10 (2) (a) appears in the statutes, the legislative reference bureau shall substitute a reference to s. 69.01 (13m), as it defines the term “induced abortion.”

SB45-SSA2-SA4,88,13 (12) Positions. The authorized positions for the department of health services are increased as provided in 2025 Senate Bill 45.

SB45-SSA2-SA4,88,16 (13) Funding At the appropriate place, replace the schedule for s. 20.435 with the schedule for 2025 Senate Bill 45 covering the department of health services.

SB45-SSA2-SA4,9123 Section 9123. Nonstatutory provisions; Insurance.

SB45-SSA2-SA4,88,19 (1) Positions. The authorized positions for office of the commissioner of insurance are increased as provided in 2025 Senate Bill 45.

SB45-SSA2-SA4,88,22 (2) Funding. At the appropriate place, replace the schedule for s. 20.145 with the schedule for 2025 Senate Bill 45 covering the office of the commissioner of insurance.

SB45-SSA2-SA4,9147 Section 9147. Nonstatutory provisions; University of Wisconsin System.

SB45-SSA2-SA4,89,5 (1) Funding allocation for a statewide Parkinson’s disease registry. From the appropriation under s. 20.285 (1) (a), the Board of Regents of the University of Wisconsin System shall allocate in fiscal year 2025-26, at least $3,900,000, and in fiscal year 2026-27, at least $2,400,000, to establish the statewide Parkinson’s disease registry under s. 36.47.

SB45-SSA2-SA4,9219 Section 9219. Fiscal changes; Health Services.

SB45-SSA2-SA4,89,9 (1) Extended intensive treatment surcharge balance transfer. The unencumbered balance in the appropriation account under s. 20.435 (2) (gL), 2023 stats., is transferred to the appropriation account under s. 20.435 (2) (g).

SB45-SSA2-SA4,89,13 (2) Winnebago Mental Health Institute. There is transferred from the general fund to the appropriation account under s. 20.435 (2) (gk) $18,599,500 in fiscal year 2025-26 and $15,251,000 in fiscal year 2026-27 to support the operations of Winnebago Mental Health Institute.

SB45-SSA2-SA4,9319 Section 9319. Initial applicability; Health Services.

SB45-SSA2-SA4,89,17 (1) Support and improvement of emergency medical services. The treatment of s. 256.12 (4) (a) and (c) of this act first applies to funds distributed under s. 256.12 (4) (a) on the effective date of this subsection.

SB45-SSA2-SA4,89,20 (2) Emergency medical services training and examination aid. The treatment of s. 256.12 (5) (a) and (am) first applies to funds distributed under s. 256.12 (5) (a) on the effective date of this subsection.

SB45-SSA2-SA4,89,22 (3) Medicaid school-based services. The treatment of s. 49.45 (39) (b) 1. and 2. first applies to claims for reimbursement submitted on July 1, 2026.

SB45-SSA2-SA4,90,2 (4) Determination of Medical Assistance eligibility by indicating interest on an individual income tax return. The treatment of ss. 71.03 (9) and 71.78 (4) (w) first applies to taxable years beginning after December 31, 2025.

SB45-SSA2-SA4,90,3 (5) Abortion coverage.

SB45-SSA2-SA4,90,6 (a) For policies and plans containing provisions inconsistent with s. 40.51 (9m), s. 40.51 (9m) first applies to policy or plan years beginning on the effective date of this subsection, except as provided in par. (b).

SB45-SSA2-SA4,90,11 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with s. 40.51 (9m), s. 40.51 (9m) first applies to policy or plan years beginning on the effective date of this subsection or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

SB45-SSA2-SA4,9323 Section 9323. Initial applicability; Insurance.

SB45-SSA2-SA4,90,13 (1) Coverage of asthma drugs and supplies.

SB45-SSA2-SA4,90,17 (a) For policies and plans containing provisions inconsistent with this act, the treatment of ss. 609.835 and 632.895 (16g) first applies to policy or plan years beginning on the effective paragraph of this subsection, except as provided in par. (b).

SB45-SSA2-SA4,90,22 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with this act, the treatment of ss. 609.835 and 632.895 (16g) first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

SB45-SSA2-SA4,9419 Section 9419. Effective dates; Health Services.

SB45-SSA2-SA4,91,2 (1) Medicaid expansion. The treatment of ss. 20.435 (4) (jw), 49.45 (23) and (23b), 49.471 (1) (cr), (4) (a) 4. b. and 8., and (4g), and 49.686 (3) (d) and Section 9119 (1) of this act take effect on July 1, 2025.

SB45-SSA2-SA4,91,4 (2) Healthcare ownership and transparency. The creation of subch. IX of ch. 150, ss. 150.99, 150.992, 150.994, and 150.996 takes effect on January 1, 2027.

SB45-SSA2-SA4,91,6 (3) Trauma resilience grant. The repeal of s. 46.48 (21) takes effect on July 1, 2027.

SB45-SSA2-SA4,91,8 (4) Medical examining board authority. The repeal and recreation of s. 448.02 (3) (a) takes effect on March 1, 2026.

SB45-SSA2-SA4,9423 Section 9423. Effective dates; Insurance.

SB45-SSA2-SA4,91,12 (1) Coverage of asthma drugs and supplies. The treatment of ss. 609.835 and 632.895 (16g) takes effect on the first day of the 4th month beginning after publication.

SB45-SSA2-SA4,9437 Section 9437. Effective dates; Revenue.

SB45-SSA2-SA4,91,15 (1) Over-the-counter drugs. The treatment of ss. 77.51 (9rm) and 77.54 (14) (g) takes effect on the first day of the 3rd month beginning after publication.”.

SB45-SSA2-SA4,91,16 2. At the appropriate places, insert all of the following:

SB45-SSA2-SA4,91,17 “Section 169. 15.07 (3) (bm) 7. of the statutes is created to read:

SB45-SSA2-SA4,91,19 15.07 (3) (bm) 7. The prescription drug affordability review board shall meet at least 4 times each year.

SB45-SSA2-SA4,170 Section 170. 15.732 of the statutes is created to read:

SB45-SSA2-SA4,91,23 15.732 Same; attached office. (1) Office of the public intervenor. There is created an office of the public intervenor which is attached to the office of the commissioner of insurance.

SB45-SSA2-SA4,171 Section 171. 15.735 of the statutes is created to read:

SB45-SSA2-SA4,92,3 15.735 Same; attached board. (1) There is created a prescription drug affordability review board attached to the office of the commissioner of insurance under s. 15.03. The board shall consist of the following members:

SB45-SSA2-SA4,92,4 (a) The commissioner of insurance or his or her designee.

SB45-SSA2-SA4,92,8 (b) Two members appointed for 4-year terms who represent the pharmaceutical drug industry, including pharmaceutical drug manufacturers and wholesalers. At least one of the members appointed under this paragraph shall be a licensed pharmacist.

SB45-SSA2-SA4,92,10 (c) Two members appointed for 4-year terms who represent the health insurance industry, including insurers and pharmacy benefit managers.

SB45-SSA2-SA4,92,14 (d) Two members appointed for 4-year terms who represent the health care industry, including hospitals, physicians, pharmacies, and pharmacists. At least one of the members appointed under this paragraph shall be a licensed practitioner.

SB45-SSA2-SA4,92,16 (e) Two members appointed for 4-year terms who represent the interests of the public.

SB45-SSA2-SA4,92,19 (2) A member appointed under sub. (1), except for a member appointed under sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug manufacturer or trade association for drug manufacturers.

SB45-SSA2-SA4,93,2 (3) Any conflict of interest, including any financial or personal association, that has the potential to bias or has the appearance of biasing an individual’s decision in matters related to the board or the conduct of the board’s activities shall be considered and disclosed when appointing that individual to the board under sub. (1).

SB45-SSA2-SA4,172 Section 172. 20.145 (1) (a) of the statutes is created to read:

SB45-SSA2-SA4,93,5 20.145 (1) (a) State operations. The amounts in the schedule for general program operations.

SB45-SSA2-SA4,173 Section 173. 20.145 (1) (g) (intro.) of the statutes is amended to read:

SB45-SSA2-SA4,93,16 20.145 (1) (g) General program operations. (intro.) The amounts in the schedule for general program operations, including organizational support services and, oversight of care management organizations, development of a public option health insurance plan, and operation of a state-based exchange under s. 601.59, and for transferring to the appropriation account under s. 20.435 (4) (kv) the amount allocated by the commissioner of insurance. Notwithstanding s. 20.001 (3) (a), at the end of each fiscal year, the unencumbered balance in this appropriation account that exceeds 10 percent of that fiscal year’s expenditure under this appropriation shall lapse to the general fund. All of the following shall be credited to this appropriation account:

SB45-SSA2-SA4,174 Section 174. 20.145 (1) (g) 1. of the statutes is amended to read:

SB45-SSA2-SA4,93,20 20.145 (1) (g) 1. All moneys received under ss. 601.25 (2), 601.31, 601.32, 601.42 (7), 601.45, and 601.47 and by the commissioner for expenses related to insurance company restructurings, except for restructurings specified in par. (h).

SB45-SSA2-SA4,175 Section 175. 20.145 (1) (g) 4. of the statutes is created to read:

SB45-SSA2-SA4,93,22 20.145 (1) (g) 4. All moneys received under s. 601.59.

SB45-SSA2-SA4,176 Section 176. 20.145 (1) (g) 5. of the statutes is created to read:

SB45-SSA2-SA4,94,4 20.145 (1) (g) 5. All moneys received from the regulation of pharmacy benefit managers, pharmacy benefit management brokers, pharmacy benefit management consultants, pharmacy services administration organizations, and pharmaceutical representatives.

SB45-SSA2-SA4,177 Section 177. 40.51 (8) of the statutes is amended to read:

SB45-SSA2-SA4,94,11 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.7498, 632.798, 632.83, 632.835, 632.848, 632.85, 632.851, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (3) to (6) (8), 632.871, 632.885, 632.89, 632.891, 632.895 (5m) and (8) to (17), and 632.896.

SB45-SSA2-SA4,178 Section 178. 40.51 (8m) of the statutes is amended to read:

SB45-SSA2-SA4,94,17 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.7498, 632.798, 632.83, 632.835, 632.848, 632.85, 632.851, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4e), (7), and (8), 632.871, 632.885, 632.89, 632.891, and 632.895 (11) to (17).

SB45-SSA2-SA4,179 Section 179. 66.0137 (4) of the statutes is amended to read:

SB45-SSA2-SA4,95,2 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.7498, 632.798, 632.848, 632.85, 632.851, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4) to (6) (8), 632.871, 632.885, 632.89, 632.891, 632.895 (9) to (17), 632.896, and 767.513 (4).

SB45-SSA2-SA4,180 Section 180. 120.13 (2) (g) of the statutes is amended to read:

SB45-SSA2-SA4,95,8 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.7498, 632.798, 632.848, 632.85, 632.851, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4) to (6) (8), 632.871, 632.885, 632.89, 632.891, 632.895 (9) to (17), 632.896, and 767.513 (4).

SB45-SSA2-SA4,181 Section 181. 185.983 (1) (intro.) of the statutes is amended to read:

SB45-SSA2-SA4,95,18 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.7498, 632.775, 632.79, 632.795, 632.798, 632.848, 632.85, 632.851, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (2) to (6) (8), 632.871, 632.885, 632.89, 632.891, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but the sponsoring association shall:

SB45-SSA2-SA4,182 Section 182. 601.25 of the statutes is created to read:

SB45-SSA2-SA4,95,23 601.25 Office of the public intervenor. (1) The office of the public intervenor shall assist individuals with insurance claims, policies, appeals, and other legal actions to pursue insurance coverage for medical procedures, prescription medications, and other health care services.

SB45-SSA2-SA4,96,4 (2) The office of the public intervenor may levy an assessment on each insurer that is authorized to engage in the business of insurance in this state. The assessment levied under this subsection shall be based on the insurer’s premium volume for disability insurance policies, as defined in s. 632.895 (1) (a), written in this state.

SB45-SSA2-SA4,96,6 (3) The commissioner may provide by rule for the governance, duties, and administration of the office of the public intervenor.

SB45-SSA2-SA4,183 Section 183. 601.31 (1) (mv) of the statutes is created to read:

SB45-SSA2-SA4,96,10 601.31 (1) (mv) For initial issuance or renewal of a license as a pharmacy benefit management broker or consultant under s. 628.495, amounts set by the commissioner by rule.

SB45-SSA2-SA4,184 Section 184. 601.31 (1) (nv) of the statutes is created to read:

SB45-SSA2-SA4,96,13 601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical representative under s. 632.863, an amount to be set by the commissioner by rule.

SB45-SSA2-SA4,185 Section 185. 601.31 (1) (nw) of the statutes is created to read:

SB45-SSA2-SA4,96,17 601.31 (1) (nw) For issuing or renewing a license as a pharmacy services administrative organization under s. 632.864, an amount to be set by the commissioner by rule.

SB45-SSA2-SA4,186 Section 186. 601.41 (14) of the statutes is created to read:

SB45-SSA2-SA4,96,24 601.41 (14) Value-based diabetes medication pilot project. The commissioner shall develop a pilot project to direct a pharmacy benefit manager, as defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value- based, sole-source arrangement to reduce the costs of prescription medication used to treat diabetes. The commissioner may promulgate rules to implement this subsection.

SB45-SSA2-SA4,187 Section 187. 601.45 (1) of the statutes is amended to read:

SB45-SSA2-SA4,97,10 601.45 (1) Costs to be paid by examinees. The reasonable costs of examinations and audits under ss. 601.43, 601.44, 601.455, and 601.83 (5) (f) shall be paid by examinees except as provided in sub. (4), either on the basis of a system of billing for actual salaries and expenses of examiners and other apportionable expenses, including office overhead, or by a system of regular annual billings to cover the costs relating to a group of companies, or a combination of such systems, as the commissioner may by rule prescribe. Additional funding, if any, shall be governed by s. 601.32. The commissioner shall schedule annual hearings under s. 601.41 (5) to review current problems in the area of examinations.

SB45-SSA2-SA4,188 Section 188. 601.455 of the statutes is created to read:

SB45-SSA2-SA4,97,13 601.455 Fair claims processing, health insurance transparency, and claim denial rate audits. (1) Definitions. In this section:

SB45-SSA2-SA4,97,19 (a) “Claim denial” means the refusal by an insurer to provide payment under a disability insurance policy for a service, treatment, or medication recommended by a health care provider. “Claim denial” includes the prospective refusal to pay for a service, treatment, or medication when a disability insurance policy requires advance approval before a prescribed medical service, treatment, or medication is provided.

SB45-SSA2-SA4,97,20 (b) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).

SB45-SSA2-SA4,97,21 (c) “Health care provider” has the meaning given in s. 146.81 (1) (a) to (p).

SB45-SSA2-SA4,97,24 (2) Claims processing. (a) Insurers shall process each claim for a disability insurance policy within a time frame that is reasonable and prevents an undue delay in an insured’s care, taking into account the medical urgency of the claim.

SB45-SSA2-SA4,98,4 (b) If an insurer determines additional information is needed to process a claim for a disability insurance policy, the insurer shall request the information from the insured within 5 business days of making the determination and shall provide at least 15 days for the insured to respond.

SB45-SSA2-SA4,98,5 (c) All claim denials shall include all of the following: