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25 14. Type II diabetes screening for adults with elevated blood pressure.

115. Depression screening for minors 11 years of age or older and for adults when
2follow-up supports are available.
3 16. Hepatitis B screening for minors at high risk for infection and adults at high
4risk for infection.
5 17. Hepatitis C screening for adults at high risk for infection and onetime
6hepatitis C screening for adults born in any year from 1945 to 1965.
7 18. Obesity screening and management for all minors and adults with a body
8mass index indicating obesity, counseling and behavioral interventions for obese
9minors who are 6 years of age or older, and referral for intervention for obesity for
10adults with a body mass index of 30 kilograms per square meter or higher.
11 19. Osteoporosis screening for all women 65 years of age or older and for women
12at high risk for osteoporosis under the age of 65 years.
13 20. Immunizations in accordance with sub. (14).
14 21. Anemia screening for individuals 6 months of age or older and iron
15supplements for individuals at high risk for anemia and who have attained the age
16of 6 months but have not attained the age of 12 months.
17 22. Fluoride varnish for prevention of tooth decay for minors at the age of
18eruption of their primary teeth.
19 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
20age or older who do not have fluoride in their water source.
21 24. Gonorrhea prophylaxis treatment for newborns.
22 25. Health history and physical exams for prenatal visits and for minors.
23 26. Length and weight measurements for newborns and height and weight
24measurements for minors.

127. Head circumference and weight-for-length measurements for newborns
2and minors who have not attained the age of 3 years.
3 28. Body mass index for minors 2 years of age or older.
4 29. Blood pressure measurements for minors 3 years of age or older and a blood
5pressure risk assessment at birth.
6 30. Risk assessment and referral for oral health issues for minors who have
7attained the age of 6 months but have not attained the age of 7 years.
8 31. Blood screening for newborns and minors who have not attained the age of
92 months.
10 32. Screening for critical congenital health defects for newborns.
11 33. Lead screenings in accordance with sub. (10).
12 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
13sickle cell anemia, and congenital hypothyroidism for minors including newborns.
14 35. Tuberculin skin test based on risk assessment for minors one month of age
15or older.
16 36. Tobacco counseling and cessation interventions for individuals who are 5
17years of age or older.
18 37. Vision and hearing screening and assessment for minors including
19newborns.
20 38. Sexually transmitted infection and human immunodeficiency virus
21counseling for sexually active minors.
22 39. Risk assessment for sexually transmitted infection for minors who are 10
23years of age or older and screening for sexually transmitted infection for minors who
24are 16 years of age or older.
25 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

141. Autism screening for minors who have attained the age of 18 months but
2have not attained the age of 25 months.
3 42. Developmental screening and surveillance for minors including newborns.
4 43. Psychosocial and behavioral assessment for minors including newborns.
5 44. Alcohol misuse screening and counseling for pregnant adults and a risk
6assessment for all adults.
7 45. Fall prevention and counseling and preventive medication for fall
8prevention for community-dwelling adults 65 years of age or older.
9 46. Screening and counseling for intimate partner violence for adult women.
10 47. Well-woman visits for women who have attained the age of 18 years but
11have not attained the age of 65 years and well-woman visits for recommended
12preventive services, preconception care, and prenatal care.
13 48. Counseling on, consultations with a trained provider on, and equipment
14rental for breastfeeding for pregnant and lactating women.
15 49. Folic acid supplement for adult women with reproductive capacity.
16 50. Iron deficiency anemia screening for pregnant and lactating women.
17 51. Preeclampsia preventive medicine for pregnant adult women at high risk
18for preeclampsia.
19 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
20risk for miscarriage, preeclampsia, or clotting disorders.
21 53. Screenings for hepatitis B and bacteriuria for pregnant women.
22 54. Screening for gonorrhea for pregnant and sexually active females 24 years
23of age or younger and females older than 24 years of age who are at risk for infection.

155. Screening for chlamydia for pregnant and sexually active females 24 years
2of age and younger and females older than 24 years of age who are at risk for
3infection.
4 56. Screening for syphilis for pregnant women and adults who are at high risk
5for infection.
6 57. Human immunodeficiency virus screening for adults who have attained the
7age of 15 years but have not attained the age of 66 years and individuals at high risk
8of infection who are younger than 15 years of age or older than 65 years of age.
9 58. All contraceptives and services in accordance with sub. (17).
10 59. Any services not already specified under this paragraph having an A or B
11rating in current recommendations from the U.S. preventive services task force.
12 60. Any preventive services not already specified under this paragraph that are
13recommended by the federal health resources and services administration's Bright
14Futures project.
15 61. Any immunizations, not already specified under sub. (14), that are
16recommended and determined to be for routine use by the federal advisory
17committee on immunization practices.
18 (c) Subject to par. (d), no disability insurance policy and no self-insured health
19plan may subject the coverage of any of the preventive services under par. (b) to any
20deductibles, copayments, or coinsurance under the policy or plan.
21 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
22separately by the health care provider, the disability insurance policy or self-insured
23health plan may apply deductibles to and impose copayments or coinsurance on the
24office visit but not on the preventive service.

12. If the primary reason for an office visit is not to obtain a preventive service,
2the disability insurance policy or self-insured health plan may apply deductibles to
3and impose copayments or coinsurance on the office visit.
4 3. Except as otherwise provided in this subdivision, if a preventive service
5specified under par. (b) is provided by a health care provider that is outside the
6disability insurance policy's or self-insured health plan's network of providers, the
7policy or plan may apply deductibles to and impose copayments or coinsurance on the
8office visit and the preventive service. If a preventive service specified under par. (b)
9is provided by a health care provider that is outside the disability insurance policy's
10or self-insured health plan's network of providers because there is no available
11health care provider in the policy's or plan's network of providers that provides the
12preventive service, the policy or plan may not apply deductibles to or impose
13copayments or coinsurance on the preventive service.
14 4. If multiple well-woman visits described under par. (b) 47. are required to
15fulfill all necessary preventive services and are in accordance with clinical
16recommendations, the disability insurance policy or self-insured health plan may
17not apply a deductible to or impose a copayment or coinsurance on any of those
18well-woman visits.
19Section 3010. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
20 632.895 (14) (a) 1. i. Hepatitis A and B.
21 j. Varicella and herpes zoster.
22Section 3011. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
23 632.895 (14) (a) 1. k. Human papillomavirus.
24 L. Meningococcal meningitis.
25 m. Pneumococcal pneumonia.

1n. Influenza.
2 o. Rotavirus.
3Section 3012. 632.895 (14) (b) of the statutes is amended to read:
4 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
5and every self-insured health plan of the state or a county, city, town, village, or
6school district, that provides coverage for a dependent of the insured shall provide
7coverage of appropriate and necessary immunizations, from birth to the age of 6
8years,
for an insured or plan participant, including a dependent who is a child of the
9insured or plan participant.
10Section 3013. 632.895 (14) (c) of the statutes is amended to read:
11 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
12deductibles, copayments, or coinsurance under the policy or plan. This paragraph
13applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
14appropriate and necessary immunizations provided by providers participating, as
15defined in s. 609.01 (3m), in the plan.
16Section 3014. 632.895 (14) (d) 3. of the statutes is amended to read:
17 632.895 (14) (d) 3. A health care plan offered by a limited service health
18organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
19in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
20Section 3015. 632.895 (14m) of the statutes is created to read:
21 632.895 (14m) Essential health benefits. (a) In this subsection,
22“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
23 (b) On a date specified by the commissioner, by rule, every disability insurance
24policy, except as provided in par. (g), and every self-insured health plan shall provide

1coverage for essential health benefits as determined by the commissioner, by rule,
2subject to par. (c).
3 (c) In determining the essential health benefits for which coverage is required
4under par. (b), the commissioner shall do all of the following:
5 1. Include benefits, items, and services in, at least, all of the following
6categories:
7 a. Ambulatory patient services.
8 b. Emergency services.
9 c. Hospitalization.
10 d. Maternity and newborn care.
11 e. Mental health and substance use disorder services, including behavioral
12health treatment.
13 f. Prescription drugs.
14 g. Rehabilitative and habilitative services and devices.
15 h. Laboratory services.
16 i. Preventive and wellness services and chronic disease management.
17 j. Pediatric services, including oral and vision care.
18 2. Conduct a survey of employer-sponsored coverage to determine benefits
19typically covered by employers and ensure that the scope of essential health benefits
20for which coverage is required under this subsection is equal to the scope of benefits
21covered under a typical disability insurance policy offered by an employer to its
22employees.
23 3. Ensure that essential health benefits reflect a balance among the categories
24described in subd. 1. such that benefits are not unduly weighted toward one category.

14. Ensure that essential health benefit coverage is provided with no or limited
2cost-sharing requirements.
3 5. Require that disability insurance policies and self-insured health plans do
4not make coverage decisions, determine reimbursement rates, establish incentive
5programs, or design benefits in ways that discriminate against individuals because
6of their age, disability, or expected length of life.
7 6. Establish essential health benefits in a way that takes into account the
8health care needs of diverse segments of the population, including women, children,
9persons with disabilities, and other groups.
10 7. Ensure that essential health benefits established under this subsection are
11not subject to a coverage denial based on an insured's or plan participant's age,
12expected length of life, present or predicted disability, degree of dependency on
13medical care, or quality of life.
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