Amendment AA3-SB70

SB70-AA3,29,18 46.40 (8) Alzheimer's family and caregiver support allocation. Subject to sub. (9), for services to persons with Alzheimer's disease and their caregivers under s. 46.87, the department shall distribute not more than $2,808,900 $3,308,900 in each fiscal year.”.

SB70-AA3,29,19 171. Page 318, line 5: delete lines 5 to 15.

SB70-AA3,29,21 172. Page 318, line 18: delete the material beginning with that line and ending with page 319, line 12.

SB70-AA3,29,22 173. Page 365, line 11: after that line insert:

SB70-AA3,29,23 “ Section 438m. 250.15 (2) (d) of the statutes is amended to read:

SB70-AA3,29,24 250.15 (2) (d) To free and charitable clinics, $1,500,000 $2,000,000.”.

SB70-AA3,30,1 174. Page 365, line 12: delete lines 12 to 14.

SB70-AA3,30,2 175. Page 373, line 20: after that line insert:

SB70-AA3,30,3 “ Section 470n. 939.75 (2) (b) 1. of the statutes is amended to read:

SB70-AA3,30,6 939.75 (2) (b) 1. An act committed during an induced abortion. This subdivision does not limit the applicability of ss. 940.04, 940.13, 940.15 and 940.16 to an induced abortion.

SB70-AA3,470p Section 470p. 940.04 of the statutes is repealed.

SB70-AA3,470q Section 470q. 968.26 (1b) (a) 2. a. of the statutes is amended to read:

SB70-AA3,30,15 968.26 (1b) (a) 2. a. Section 940.04, 940.11, 940.19 (2), (4), (5), or (6), 940.195 (2), (4), (5), or (6), 940.198 (2) (b) or (c) or (3), 940.20, 940.201, 940.203, 940.204, 940.205, 940.207, 940.208, 940.22 (2), 940.225 (3), 940.29, 940.302 (2) (c), 940.32, 941.32, 941.38 (2), 942.09 (2), 943.10, 943.205, 943.32 (1), 946.43, 946.44, 946.47, 946.48, 948.02 (3), 948.03 (2) (b) or (c), (3), or (4), 948.04, 948.055, 948.095, 948.10 (1) (a), 948.11, 948.13 (2) (a), 948.14, 948.20, 948.23 (1), (2), or (3) (c) 2. or 3., or 948.30 (1).”.

SB70-AA3,30,16 176. Page 374, line 11: after that line insert:

SB70-AA3,30,17 “ Section 1. 51.042 (3m) of the statutes is created to read:

SB70-AA3,30,20 51.042 (3m) Grants. From the appropriation under s. 20.435 (5) (cc), the department shall award grants to organizations to develop and support youth crisis stabilization facilities.”.

SB70-AA3,30,21 177. Page 374, line 11: after that line insert:

SB70-AA3,30,22 “ Section 2. 632.865 (2m) of the statutes is created to read:

SB70-AA3,31,2 632.865 (2m) Fiduciary duty and disclosures to health benefit plan sponsors. (a) A pharmacy benefit manager owes a fiduciary duty to the health benefit plan sponsor to act according to the health benefit plan sponsor's instructions and in the best interests of the health benefit plan sponsor.

SB70-AA3,31,5 (b) A pharmacy benefit manager shall annually provide, no later than the date and using the method prescribed by the commissioner by rule, the health benefit plan sponsor all of the following information from the previous calendar year:

SB70-AA3,31,7 1. The indirect profit received by the pharmacy benefit manager from owning any interest in a pharmacy or service provider.

SB70-AA3,31,9 2. Any payment made by the pharmacy benefit manager to a consultant or broker who works on behalf of the health benefit plan sponsor.

SB70-AA3,31,13 3. From the amounts received from all drug manufacturers, the amounts retained by the pharmacy benefit manager, and not passed through to the health benefit plan sponsor, that are related to the health benefit plan sponsor's claims or bona fide service fees.

SB70-AA3,31,18 4. The amounts, including pharmacy access and audit recovery fees, received from all pharmacies that are in the pharmacy benefit manager's network or have a contract to be in the network and, from these amounts, the amount retained by the pharmacy benefit manager and not passed through to the health benefit plan sponsor.”.

SB70-AA3,31,19 178. Page 374, line 11: after that line insert:

SB70-AA3,31,20 “ Section 3. 632.869 of the statutes is created to read:

SB70-AA3,31,22 632.869 Reimbursement to federal drug pricing program participants. (1) In this section:

SB70-AA3,32,2 (a) “Covered entity” means an entity described in 42 USC 256b (a) (4) (A), (D), (E), (J), or (N) that participates in the federal drug pricing program under 42 USC 256b, a pharmacy of the entity, or a pharmacy contracted with the entity to dispense drugs purchased through the federal drug pricing program under 42 USC 256b.

SB70-AA3,32,3 (b) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

SB70-AA3,32,5 (2) No person, including a pharmacy benefit manager and 3rd-party payer, may do any of the following:

SB70-AA3,32,9 (a) Reimburse a covered entity for a drug that is subject to an agreement under 42 USC 256b at a rate lower than that paid for the same drug to pharmacies that are not covered entities and have a similar prescription volume to that of the covered entity.

SB70-AA3,32,12 (b) Assess a covered entity any fee, charge back, or other adjustment on the basis of the covered entity's participation in the federal drug pricing program under 42 USC 256b.

SB70-AA3,32,15 (3) The commissioner may promulgate rules to implement this section and to establish a minimum reimbursement rate for covered entities and any other entity described under 42 USC 256b (a) (4).”.

SB70-AA3,32,16 179. Page 374, line 11: after that line insert:

SB70-AA3,32,17 “ Section 4. 609.712 of the statutes is created to read:

SB70-AA3,32,19 609.712 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

SB70-AA3,5 Section 5. 609.847 of the statutes is created to read:

SB70-AA3,32,23 609.847 Preexisting condition discrimination and certain benefit limits prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.728.

SB70-AA3,6 Section 6. 625.12 (1) (a) of the statutes is amended to read:

SB70-AA3,33,2 625.12 (1) (a) Past and prospective loss and expense experience within and outside of this state, except as provided in s. 632.728.

SB70-AA3,7 Section 7. 625.12 (1) (e) of the statutes is amended to read:

SB70-AA3,33,5 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, including the judgment of technical personnel.

SB70-AA3,8 Section 8. 625.12 (2) of the statutes is amended to read:

SB70-AA3,33,15 625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

SB70-AA3,9 Section 9. 625.15 (1) of the statutes is amended to read:

SB70-AA3,33,24 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may itself establish rates and supplementary rate information for one or more market segments based on the factors in s. 625.12 and, if the rates are for motor vehicle liability insurance, subject to s. 632.365, or the insurer may use rates and supplementary rate information prepared by a rate service organization, with average expense factors determined by the rate service organization or with such modification for its own expense and loss experience as the credibility of that experience allows.

SB70-AA3,10 Section 10. 628.34 (3) (a) of the statutes is amended to read:

SB70-AA3,34,8 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746 and, 632.748, and 632.7496. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

SB70-AA3,11 Section 11. 632.728 of the statutes is created to read:

SB70-AA3,34,11 632.728 Coverage of persons with preexisting conditions; guaranteed issue; benefit limits. (1) Definitions. In this section:

SB70-AA3,34,13 (a) “Cost sharing” includes deductibles, coinsurance, copayments, or similar charges.

SB70-AA3,34,14 (b) “Health benefit plan” has the meaning given in s. 632.745 (11).

SB70-AA3,34,15 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

SB70-AA3,34,21 (2) Guaranteed issue. (a) Every individual health benefit plan shall accept every individual in this state who, and every group health benefit plan shall accept every employer in this state that, applies for coverage, regardless of sexual orientation, gender identity, or whether or not any employee or individual has a preexisting condition. A health benefit plan may restrict enrollment in coverage described in this paragraph to open or special enrollment periods.

SB70-AA3,34,24 (b) The commissioner shall establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan to allow individuals, including individuals who do not have coverage, to enroll in coverage.

SB70-AA3,35,5 (3) Prohibiting discrimination based on health status. (a) An individual health benefit plan or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

SB70-AA3,35,6 1. Health status.

SB70-AA3,35,7 2. Medical condition, including both physical and mental illnesses.

SB70-AA3,35,8 3. Claims experience.

SB70-AA3,35,9 4. Receipt of health care.

SB70-AA3,35,10 5. Medical history.

SB70-AA3,35,11 6. Genetic information.

SB70-AA3,35,13 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

SB70-AA3,35,14 8. Disability.

SB70-AA3,35,21 (b) An insurer offering an individual health benefit plan or a self-insured health plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor under par. (a) with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the plan.

SB70-AA3,35,25 (c) Nothing in this subsection prevents an insurer offering an individual health benefit plan or a self-insured health plan from establishing premium discounts or rebates or modifying otherwise applicable cost sharing in return for adherence to programs of health promotion and disease prevention.

SB70-AA3,36,3 (4) Premium rate variation. A health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific plan based only on the following considerations:

SB70-AA3,36,4 (a) Whether the policy or plan covers an individual or a family.

SB70-AA3,36,5 (b) Rating area in the state, as established by the commissioner.

SB70-AA3,36,8 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

SB70-AA3,36,9 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

SB70-AA3,36,14 (5) Statewide risk pool. An insurer offering a health benefit plan may not segregate enrollees into risk pools other than a single statewide risk pool for the individual market and a single statewide risk pool for the small employer market or a single statewide risk pool that combines the individual and small employer markets.

SB70-AA3,36,16 (6) Annual and lifetime limits. An individual or group health benefit plan or a self-insured health plan may not establish any of the following:

SB70-AA3,36,18 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

SB70-AA3,36,20 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

SB70-AA3,36,24 (7) Cost sharing maximum. A health benefit plan offered on the individual or small employer market may not require an enrollee under the plan to pay more in cost sharing than the maximum amount calculated under 42 USC 18022 (c), including the annual indexing of the limits.

SB70-AA3,37,3 (8) Medical loss ratio. (a) In this subsection, “medical loss ratio” means the proportion, expressed as a percentage, of premium revenues spent by a health benefit plan on clinical services and quality improvement.

SB70-AA3,37,5 (b) A health benefit plan on the individual or small employer market shall have a medical loss ratio of at least 80 percent.

SB70-AA3,37,7 (c) A group health benefit plan other than one described under par. (b) shall have a medical loss ratio of at least 85 percent.

SB70-AA3,37,11 (9) Actuarial values of plan tiers. Any health benefit plan offered on the individual or small employer market shall 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.

SB70-AA3,12 Section 12. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and amended to read:

SB70-AA3,37,20 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health benefit plan may, with respect to a participant or beneficiary under the plan, not impose a preexisting condition exclusion only if the exclusion relates to a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on the participant's or beneficiary's enrollment date under the plan on a participant or beneficiary under the plan.

SB70-AA3,13 Section 13. 632.746 (1) (b) of the statutes is repealed.

SB70-AA3,14 Section 14. 632.746 (2) (a) of the statutes is amended to read:

SB70-AA3,38,2 632.746 (2) (a) An insurer offering a group health benefit plan may not treat impose a preexisting condition exclusion based on genetic information as a preexisting condition under sub. (1) without a diagnosis of a condition related to the information.

SB70-AA3,15 Section 15. 632.746 (2) (c), (d) and (e) of the statutes are repealed.

SB70-AA3,16 Section 16. 632.746 (3) (a) of the statutes is repealed.

SB70-AA3,17 Section 17. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).

SB70-AA3,18 Section 18. 632.746 (3) (d) 2. and 3. of the statutes are repealed.