Amendment AA2-ASA2-AB68

AB68-ASA2-AA2,111,11 58. All contraceptives and services in accordance with sub. (17).

AB68-ASA2-AA2,111,13 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. preventive services task force.

AB68-ASA2-AA2,111,16 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration's Bright Futures project.

AB68-ASA2-AA2,111,19 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the federal advisory committee on immunization practices.

AB68-ASA2-AA2,111,22 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB68-ASA2-AA2,112,2 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB68-ASA2-AA2,112,5 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB68-ASA2-AA2,112,15 3. Except as otherwise provided in this subdivision, if a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers, the policy or plan may apply deductibles to and impose copayments or coinsurance on the office visit and the preventive service. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers because there is no available health care provider in the policy's or plan's network of providers that provides the preventive service, the policy or plan may not apply deductibles to or impose copayments or coinsurance on the preventive service.

AB68-ASA2-AA2,112,20 4. If multiple well-woman visits described under par. (b) 47. are required to fulfill all necessary preventive services and are in accordance with clinical recommendations, the disability insurance policy or self-insured health plan may not apply a deductible to or impose a copayment or coinsurance on any of those well-woman visits.

AB68-ASA2-AA2,412zn Section 412zn. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB68-ASA2-AA2,112,22 632.895 (14) (a) 1. i. Hepatitis A and B.

AB68-ASA2-AA2,112,23 j. Varicella and herpes zoster.

AB68-ASA2-AA2,412zp Section 412zp. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB68-ASA2-AA2,112,25 632.895 (14) (a) 1. k. Human papillomavirus.

AB68-ASA2-AA2,113,1 L. Meningococcal meningitis.

AB68-ASA2-AA2,113,2 m. Pneumococcal pneumonia.

AB68-ASA2-AA2,113,3 n. Influenza.

AB68-ASA2-AA2,113,4 o. Rotavirus.

AB68-ASA2-AA2,412zq Section 412zq. 632.895 (14) (b) of the statutes is amended to read:

AB68-ASA2-AA2,113,11 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for an insured or plan participant, including a dependent who is a child of the insured or plan participant.

AB68-ASA2-AA2,412zr Section 412zr. 632.895 (14) (c) of the statutes is amended to read:

AB68-ASA2-AA2,113,17 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

AB68-ASA2-AA2,412zs Section 412zs. 632.895 (14) (d) 3. of the statutes is amended to read:

AB68-ASA2-AA2,113,21 632.895 (14) (d) 3. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

AB68-ASA2-AA2,412zt Section 412zt. 632.895 (14m) of the statutes is created to read:

AB68-ASA2-AA2,113,24 632.895 (14m) Essential health benefits. (a) In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB68-ASA2-AA2,114,4 (b) On a date specified by the commissioner, by rule, every disability insurance policy, except as provided in par. (g), and every self-insured health plan shall provide coverage for essential health benefits as determined by the commissioner, by rule, subject to par. (c).

AB68-ASA2-AA2,114,6 (c) In determining the essential health benefits for which coverage is required under par. (b), the commissioner shall do all of the following:

AB68-ASA2-AA2,114,8 1. Include benefits, items, and services in, at least, all of the following categories:

AB68-ASA2-AA2,114,9 a. Ambulatory patient services.

AB68-ASA2-AA2,114,10 b. Emergency services.

AB68-ASA2-AA2,114,11 c. Hospitalization.

AB68-ASA2-AA2,114,12 d. Maternity and newborn care.

AB68-ASA2-AA2,114,14 e. Mental health and substance use disorder services, including behavioral health treatment.

AB68-ASA2-AA2,114,15 f. Prescription drugs.

AB68-ASA2-AA2,114,16 g. Rehabilitative and habilitative services and devices.

AB68-ASA2-AA2,114,17 h. Laboratory services.

AB68-ASA2-AA2,114,18 i. Preventive and wellness services and chronic disease management.

AB68-ASA2-AA2,114,19 j. Pediatric services, including oral and vision care.

AB68-ASA2-AA2,114,24 2. Conduct a survey of employer-sponsored coverage to determine benefits typically covered by employers and ensure that the scope of essential health benefits for which coverage is required under this subsection is equal to the scope of benefits covered under a typical disability insurance policy offered by an employer to its employees.

AB68-ASA2-AA2,115,2 3. Ensure that essential health benefits reflect a balance among the categories described in subd. 1. such that benefits are not unduly weighted toward one category.

AB68-ASA2-AA2,115,4 4. Ensure that essential health benefit coverage is provided with no or limited cost-sharing requirements.

AB68-ASA2-AA2,115,8 5. Require that disability insurance policies and self-insured health plans do not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.

AB68-ASA2-AA2,115,11 6. Establish essential health benefits in a way that takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.

AB68-ASA2-AA2,115,15 7. Ensure that essential health benefits established under this subsection are not subject to a coverage denial based on an insured's or plan participant's age, expected length of life, present or predicted disability, degree of dependency on medical care, or quality of life.

AB68-ASA2-AA2,115,22 8. Require that disability insurance policies and self-insured health plans cover emergency department services that are essential health benefits without imposing any requirement to obtain prior authorization for those services and without limiting coverage for services provided by an emergency services provider that is not in the provider network of a policy or plan in a way that is more restrictive than requirements or limitations that apply to emergency services provided by a provider that is in the provider network of the policy or plan.

AB68-ASA2-AA2,116,2 9. Require a disability insurance policy or self-insured health plan to apply to emergency department services that are essential health benefits provided by an emergency department provider that is not in the provider network of the policy or plan the same copayment amount or coinsurance rate that applies if those services are provided by a provider that is in the provider network of the policy or plan.

AB68-ASA2-AA2,116,4 (d) The commissioner shall periodically update, by rule, the essential health benefits under this subsection to address any gaps in access to coverage.

AB68-ASA2-AA2,116,9 (e) If an essential health benefit is also subject to mandated coverage elsewhere under this section and the coverage requirements are not identical, the disability insurance policy or self-insured health plan shall provide coverage under whichever subsection provides the insured or plan participant with more comprehensive coverage of the medical condition, item, or service.

AB68-ASA2-AA2,116,13 (f) Nothing in this subsection or rules promulgated under this subsection prohibits a disability insurance policy or a self-insured health plan from providing benefits in excess of the essential health benefit coverage required under this subsection.

AB68-ASA2-AA2,116,15 (g) This subsection does not apply to any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12.

AB68-ASA2-AA2,412zu Section 412zu. 632.895 (16m) (b) of the statutes is amended to read:

AB68-ASA2-AA2,116,21 632.895 (16m) (b) The coverage required under this subsection may be subject to any limitations, or exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. The coverage required under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB68-ASA2-AA2,412zv Section 412zv. 632.895 (17) (b) 2. of the statutes is amended to read:

AB68-ASA2-AA2,117,2 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan sterilization procedures, and patient education and counseling for all females with reproductive capacity.

AB68-ASA2-AA2,412zw Section 412zw. 632.895 (17) (c) of the statutes is amended to read:

AB68-ASA2-AA2,117,18 632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions, and limitations, or cost-sharing provisions that apply generally to the coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices that is provided under the policy or self-insured health plan. A disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to at least one of each type of contraceptive method approved by the federal food and drug administration for which coverage is required under this subsection. The disability insurance policy or self-insured health plan may apply reasonable medical management to a method of contraception to limit coverage under this subsection that is provided without being subject to a deductible, copayment, or coinsurance to prescription drugs without a brand name. The disability insurance policy or self-insured health plan may apply a deductible or impose a copayment or coinsurance for coverage of a contraceptive that is prescribed for a medical need if the services for the medical need would otherwise be subject to a deductible, copayment, or coinsurance.

AB68-ASA2-AA2,412zx Section 412zx. 632.897 (11) (a) of the statutes is amended to read:

AB68-ASA2-AA2,118,3 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.

AB68-ASA2-AA2,118,4 101. Page 355, line 20: after that line insert:

AB68-ASA2-AA2,118,5 “ Section 417h. 2017 Wisconsin Act 370, section 44 (5) is repealed.”.

AB68-ASA2-AA2,118,6 102. Page 388, line 14: delete “$20,000,000" and substitute “$15,000,000".

AB68-ASA2-AA2,118,7 103. Page 388, line 16: delete “$20,000,000" and substitute “$15,000,000".

AB68-ASA2-AA2,118,8 104. Page 389, line 6: delete “$7,584,400" and substitute “$4,740,300".

AB68-ASA2-AA2,118,9 105. Page 389, line 8: delete “$23,557,700" and substitute “$14,875,100".

AB68-ASA2-AA2,118,10 106. Page 387, line 14: delete lines 14 to 19 and substitute:

AB68-ASA2-AA2,118,16 “(2) Surgical quality improvement grant. From the appropriation under s. 20.435 (1) (b), the department of health services may award a onetime grant of $335,000 in fiscal year 2021-22 to support surgical quality improvement activities. Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department of health services may transfer moneys appropriated for the purpose described under this subsection from fiscal year 2021-22 to fiscal year 2022-23.”.

AB68-ASA2-AA2,118,17 107. Page 389, line 10: after that line insert:

AB68-ASA2-AA2,118,20 “(7h) Behavioral treatment rate increase. The department of health services shall increase reimbursement rates for behavioral treatment services related to autism under the Medical Assistance program by 25 percent.

AB68-ASA2-AA2,119,2 (7i) Nursing home grant program. The authorized FTE positions for the department of health services are increased by 1.0 PR position on July 1, 2021, to be funded from the appropriation under s. 20.435 (6) (g), for the purposes of managing the civil money penalties grant program.

AB68-ASA2-AA2,119,9 (8h) Community-based psychosocial services. The department of health services may promulgate rules, including amending rules promulgated under s. 49.45 (30e) (b), update Medical Assistance program policies, and request any state plan amendment or waiver of federal Medicaid law from the federal government necessary to provide reimbursement to providers who are not county-based providers for psychosocial services provided to Medical Assistance recipients under s. 49.45 (30e).

AB68-ASA2-AA2,119,13 (9h) Tailored caregiver assessment and referral pilot program. During fiscal year 2021-22, the department of health services shall conduct a one-year tailored caregiver assessment and referral pilot program as described in the September 2020 report of the governor's task force on caregiving.

AB68-ASA2-AA2,119,18 (10h) Initial training for guardians. The grantee selected under s. 46.977 to administer and conduct training shall, no later than one year after the effective date of this subsection and in coordination with the department of health services, develop the content for the initial training to be provided to guardians under s. 54.26 and implement the program.

AB68-ASA2-AA2,120,2 (11h) Health information exchange. From the appropriation under s. 20.435 (1) (b), the department of health services shall provide a grant of $655,000 in fiscal year 2021-22 and a grant of $655,000 in fiscal year 2022-23 to support health information exchange activities. The department of health services may not encumber moneys from the appropriation under s. 20.435 (1) (b) for a grant under this subsection after June 30, 2023. Notwithstanding ss. 20.001 (3) (a) and 20.002 (1), the department may transfer moneys appropriated for the purpose described under this subsection between fiscal years.

AB68-ASA2-AA2,120,5 (12h) Spinal cord injury council; initial appointments. Notwithstanding the length of terms specified for the members of the spinal cord injury council under s. 15.197 (20) (a) (intro.), initial appointments to the council shall be made as follows:

AB68-ASA2-AA2,120,8 (a) The members appointed under s. 15.197 (20) (a) 1., 3., 5., and 7., or in lieu of those members under s. 15.197 (20) (b), shall be appointed for terms expiring on July 1, 2024.

AB68-ASA2-AA2,120,11 (b) The members appointed under s. 15.197 (20) (a) 2., 4., 6., and 8., or in lieu of those members under s. 15.197 (20) (b), shall be appointed for terms expiring on July 1, 2025.

AB68-ASA2-AA2,120,18 (13h) Black women's health. The department of health services shall award a grant of $500,000 in fiscal year 2021-22 and a grant of $500,000 in fiscal year 2022-23 to an entity to connect and convene efforts between state agencies, public and private sector organizations, and community organizations to support a statewide public health strategy to advance Black women's health. The department of health services may award the grants from the appropriation under s. 20.435 (1) (b).

AB68-ASA2-AA2,121,2 (14h) Crisis urgent care and observation center emergency rules. The department of health services may promulgate rules allowed under s. 51.036 related to crisis urgent care and observation centers as emergency rules under s. 227.24. Notwithstanding s. 227.24 (1) (a) and (3), the department of health services is not required to provide evidence that promulgating a rule under this subsection as an emergency rule is necessary for the preservation of the public peace, health, safety, or welfare and is not required to provide a finding of emergency for a rule promulgated under this subsection.

AB68-ASA2-AA2,121,11 (15h) Childless adults demonstration project. The department of health services shall submit any necessary request to the federal department of health and human services for a state plan amendment or waiver of federal Medicaid law or to modify or withdraw from any waiver of federal Medicaid law relating to the childless adults demonstration project under s. 49.45 (23), 2019 stats., to reflect the incorporation of recipients of Medical Assistance under the demonstration project into the BadgerCare Plus program under s. 49.471 and the termination of the demonstration project. Sections 20.940 and 49.45 (2t) do not apply to a submission to the federal government under this subsection.

AB68-ASA2-AA2,121,15 (16h) Medical Assistance reimbursement rate; emergency physician. For dates of service beginning on January 1, 2022, the department of health services shall increase by 36 percent the rates for emergency physician services under the Medical Assistance program.

AB68-ASA2-AA2,122,15 (17h) Option to purchase publicly administered coverage. During the 2021-23 fiscal biennium, the department of health services, the office of the commissioner of insurance, or the department of health services in consultation with the office of the commissioner of insurance shall conduct an analysis and actuarial study of the creation of an option for individuals to purchase health coverage that is publicly provided or administered. The analysis under this subsection shall incorporate input from a variety of persons and entities, including consumers, that have an interest in health insurance and health coverage, including Medical Assistance program coverage, and an analysis of any other health care affordability initiatives. If the department of health services or the office of the commissioner of insurance determines that the option to purchase public coverage or any other health care affordability initiatives are feasible, the department or office may submit to the federal government any requests for a waiver of federal law or other federal approval necessary to implement the public coverage option or any other health care affordability initiatives. If the department of health services or office of the commissioner of insurance obtains the necessary federal approval or determines that no federal approval is necessary and if the department or office continues to determine that the option to purchase public coverage or any other health care affordability initiative is feasible, the department or office shall implement the option to purchase public coverage or other health care affordability initiative by January 1, 2025, or earlier if possible, except that if the commissioner of insurance determines the provisions of title I of the federal Patient Protection and Affordable Care Act, P.L. 111-148, are no longer enforceable, the department or office shall implement the public option or other affordability initiatives by January 1, 2022, or as soon as possible.

AB68-ASA2-AA2,122,21 (18h) Addiction treatment platform. From the appropriation under s. 20.435 (5) (a), the department of health services shall contract in fiscal year 2022-23 for the development of a substance use disorder treatment platform that allows for the comparison of substance use disorder treatment programs in the state. The department of health services may expend no more than $300,000 in fiscal year 2022-23 under this subsection.

AB68-ASA2-AA2,9123 Section 9123. Nonstatutory provisions; Insurance.

AB68-ASA2-AA2,123,2 (1h) Prescription drug cost survey. The commissioner of insurance shall conduct a statistically valid survey of pharmacies in this state regarding whether the pharmacy agreed to not disclose that customer drug benefit cost sharing exceeds the cost of the dispensed drug.

AB68-ASA2-AA2,123,6 (2h) Public option health insurance plan. The office of the commissioner of insurance may expend from the appropriation under s. 20.145 (1) (a) in fiscal year 2021-22 not more than $900,000 for the development of a public option health insurance plan.

AB68-ASA2-AA2,123,20 (3h) Health insurance premium assistance program. The commissioner of insurance shall develop a program to provide, beginning no later than plan year 2024, health insurance premium assistance to any resident of this state who purchases a silver level plan on the exchange, as defined in s. 628.90 (1), and whose household income exceeds 133 percent of the poverty line before application of the 5 percent income disregard as described in 42 CFR 435.603 (d), but does not exceed 250 percent of the poverty line. The assistance shall equal the difference between the lowest-cost silver level plan and lowest-cost bronze level plan in the individual's county of residence. The commissioner of insurance shall include a cost estimate of the program with the 2023-24 biennial budget submission for the office of the commissioner of insurance. In this subsection, “bronze level plan” means a plan described in 42 USC 18022 (d) (1) (A), “poverty line” means the poverty line as defined and revised annually under 42 USC 9902 (2) for a family the size of the individual's family, and “silver level plan” means a plan described in 42 USC 18022 (d) (1) (B).

AB68-ASA2-AA2,123,23 (4h) Prescription drug purchasing entity. During the 2021-2023 fiscal biennium, the office of the commissioner of insurance shall conduct a study on the viability of creating or implementing a state prescription drug purchasing entity.

AB68-ASA2-AA2,123,24 (5h) School district group health insurance task force.