This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
AB50-ASA2-AA16,42,201952. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
20risk for miscarriage, preeclampsia, or clotting disorders.
AB50-ASA2-AA16,42,212153. Screenings for hepatitis B and bacteriuria for pregnant women.
AB50-ASA2-AA16,43,22254. Screening for gonorrhea for pregnant and sexually active females 24 years

1of age or younger and females older than 24 years of age who are at risk for
2infection.
AB50-ASA2-AA16,43,5355. Screening for chlamydia for pregnant and sexually active females 24 years
4of age and younger and females older than 24 years of age who are at risk for
5infection.
AB50-ASA2-AA16,43,7656. Screening for syphilis for pregnant women and adults who are at high risk
7for infection.
AB50-ASA2-AA16,43,10857. Human immunodeficiency virus screening for adults who have attained
9the age of 15 years but have not attained the age of 66 years and individuals at high
10risk of infection who are younger than 15 years of age or older than 65 years of age.
AB50-ASA2-AA16,43,111158. All contraceptives and services in accordance with sub. (17).
AB50-ASA2-AA16,43,131259. Any services not already specified under this paragraph having an A or B
13rating in current recommendations from the U.S. preventive services task force.
AB50-ASA2-AA16,43,161460. Any preventive services not already specified under this paragraph that
15are recommended by the federal health resources and services administrations
16Bright Futures project.
AB50-ASA2-AA16,43,191761. Any immunizations, not already specified under sub. (14), that are
18recommended and determined to be for routine use by the federal advisory
19committee on immunization practices.
AB50-ASA2-AA16,43,2320(c) Subject to par. (d), no disability insurance policy, except any disability
21insurance policy that is described in s. 632.745 (11) (b) 1. to 12., and no self-insured
22health plan may subject the coverage of any of the preventive services under par. (b)
23to any deductibles, copayments, or coinsurance under the policy or plan.
AB50-ASA2-AA16,44,4
1(d) 1. If an office visit and a preventive service specified under par. (b) are
2billed separately by the health care provider, the disability insurance policy or self-
3insured health plan may apply deductibles to and impose copayments or
4coinsurance on the office visit but not on the preventive service.
AB50-ASA2-AA16,44,752. If the primary reason for an office visit is not to obtain a preventive service
6specified under par. (b), the disability insurance policy or self-insured health plan
7may apply deductibles to and impose copayments or coinsurance on the office visit.
AB50-ASA2-AA16,44,1783. Except as otherwise provided in this subdivision, if a preventive service
9specified under par. (b) is provided by a health care provider that is outside the
10disability insurance policys or self-insured health plans network of providers, the
11policy or plan may apply deductibles to and impose copayments or coinsurance on
12the office visit and the preventive service. If a preventive service specified under
13par. (b) is provided by a health care provider that is outside the disability insurance
14policys or self-insured health plans network of providers because there is no
15available health care provider in the policys or plans network of providers that
16provides the preventive service, the policy or plan may not apply deductibles to or
17impose copayments or coinsurance on the preventive service.
AB50-ASA2-AA16,44,22184. If more than one well-woman visit described under par. (b) 47. is necessary
19to provide all necessary preventive services as determined by a qualified health
20care provider and in accordance with applicable recommendations for preventive
21services, the disability insurance policy or self-insured health plan may not apply a
22deductible to or impose a copayment or coinsurance on any such well-woman visit.
AB50-ASA2-AA16,5423Section 54. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB50-ASA2-AA16,45,1
1632.895 (14) (a) 1. i. Hepatitis A and B.
AB50-ASA2-AA16,45,22j. Varicella and herpes zoster.
AB50-ASA2-AA16,553Section 55. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB50-ASA2-AA16,45,44632.895 (14) (a) 1. k. Human papillomavirus.
AB50-ASA2-AA16,45,55L. Meningococcal meningitis.
AB50-ASA2-AA16,45,66m. Pneumococcal pneumonia.
AB50-ASA2-AA16,45,77n. Influenza.
AB50-ASA2-AA16,45,88o. Rotavirus.
AB50-ASA2-AA16,569Section 56. 632.895 (14) (b) of the statutes is amended to read:
AB50-ASA2-AA16,45,1510632.895 (14) (b) Except as provided in par. (d), every disability insurance
11policy, and every self-insured health plan of the state or a county, city, town, village,
12or school district, that provides coverage for a dependent of the insured shall
13provide coverage of appropriate and necessary immunizations, from birth to the age
14of 6 years, for an insured or plan participant, including a dependent who is a child
15of the insured or plan participant.
AB50-ASA2-AA16,5716Section 57. 632.895 (14) (c) of the statutes is amended to read:
AB50-ASA2-AA16,45,2117632.895 (14) (c) The coverage required under par. (b) may not be subject to any
18deductibles, copayments, or coinsurance under the policy or plan. This paragraph
19applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
20appropriate and necessary immunizations provided by providers participating, as
21defined in s. 609.01 (3m), in the plan.
AB50-ASA2-AA16,5822Section 58. 632.895 (14) (d) 3. of the statutes is amended to read:
AB50-ASA2-AA16,46,223632.895 (14) (d) 3. A health care plan offered by a limited service health

1organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
2in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).
AB50-ASA2-AA16,593Section 59. 632.895 (14m) of the statutes is created to read:
AB50-ASA2-AA16,46,54632.895 (14m) Essential health benefits. (a) In this subsection, self-
5insured health plan has the meaning given in s. 632.85 (1) (c).
AB50-ASA2-AA16,46,96(b) On a date specified by the commissioner, by rule, every disability
7insurance policy, except as provided in par. (g), and every self-insured health plan
8shall provide coverage for essential health benefits as determined by the
9commissioner, by rule, subject to par. (c).
AB50-ASA2-AA16,46,1110(c) In determining the essential health benefits for which coverage is required
11under par. (b), the commissioner shall do all of the following:
AB50-ASA2-AA16,46,13121. Include benefits, items, and services in, at least, all of the following
13categories:
AB50-ASA2-AA16,46,1414a. Ambulatory patient services.
AB50-ASA2-AA16,46,1515b. Emergency services.
AB50-ASA2-AA16,46,1616c. Hospitalization.
AB50-ASA2-AA16,46,1717d. Maternity and newborn care.
AB50-ASA2-AA16,46,1918e. Mental health and substance use disorder services, including behavioral
19health treatment.
AB50-ASA2-AA16,46,2020f. Prescription drugs.
AB50-ASA2-AA16,46,2121g. Rehabilitative and habilitative services and devices.
AB50-ASA2-AA16,46,2222h. Laboratory services.
AB50-ASA2-AA16,46,2323i. Preventive and wellness services and chronic disease management.
AB50-ASA2-AA16,47,1
1j. Pediatric services, including oral and vision care.
AB50-ASA2-AA16,47,622. Conduct a survey of employer-sponsored coverage to determine benefits
3typically covered by employers and ensure that the scope of essential health
4benefits for which coverage is required under this subsection is equal to the scope of
5benefits covered under a typical disability insurance policy offered by an employer
6to its employees.
AB50-ASA2-AA16,47,973. Ensure that essential health benefits reflect a balance among the
8categories described in subd. 1. such that benefits are not unduly weighted toward
9one category.
AB50-ASA2-AA16,47,11104. Ensure that essential health benefit coverage is provided with no or limited
11cost-sharing requirements.
AB50-ASA2-AA16,47,15125. Require that disability insurance policies and self-insured health plans do
13not make coverage decisions, determine reimbursement rates, establish incentive
14programs, or design benefits in ways that discriminate against individuals because
15of their age, disability, or expected length of life.
AB50-ASA2-AA16,47,18166. Establish essential health benefits in a way that takes into account the
17health care needs of diverse segments of the population, including women, children,
18persons with disabilities, and other groups.
AB50-ASA2-AA16,47,22197. Ensure that essential health benefits established under this subsection are
20not subject to a coverage denial based on an insureds or plan participants age,
21expected length of life, present or predicted disability, degree of dependency on
22medical care, or quality of life.
AB50-ASA2-AA16,48,6238. Require that disability insurance policies and self-insured health plans

1cover emergency department services that are essential health benefits without
2imposing any requirement to obtain prior authorization for those services and
3without limiting coverage for services provided by an emergency services provider
4that is not in the provider network of a policy or plan in a way that is more
5restrictive than requirements or limitations that apply to emergency services
6provided by a provider that is in the provider network of the policy or plan.
AB50-ASA2-AA16,48,1179. Require a disability insurance policy or self-insured health plan to apply to
8emergency department services that are essential health benefits provided by an
9emergency department provider that is not in the provider network of the policy or
10plan the same copayment amount or coinsurance rate that applies if those services
11are provided by a provider that is in the provider network of the policy or plan.
AB50-ASA2-AA16,48,1312(d) The commissioner shall periodically update, by rule, the essential health
13benefits under this subsection to address any gaps in access to coverage.
AB50-ASA2-AA16,48,1814(e) If an essential health benefit is also subject to mandated coverage
15elsewhere under this section and the coverage requirements are not identical, the
16disability insurance policy or self-insured health plan shall provide coverage under
17whichever subsection provides the insured or plan participant with more
18comprehensive coverage of the medical condition, item, or service.
AB50-ASA2-AA16,48,2219(f) Nothing in this subsection or rules promulgated under this subsection
20prohibits a disability insurance policy or a self-insured health plan from providing
21benefits in excess of the essential health benefit coverage required under this
22subsection.
AB50-ASA2-AA16,49,2
1(g) This subsection does not apply to any disability insurance policy that is
2described in s. 632.745 (11) (b) 1. to 12.
AB50-ASA2-AA16,603Section 60. 632.895 (16m) (b) of the statutes is amended to read:
AB50-ASA2-AA16,49,84632.895 (16m) (b) The coverage required under this subsection may be subject
5to any limitations, or exclusions, or cost-sharing provisions that apply generally
6under the disability insurance policy or self-insured health plan. The coverage
7required under this subsection may not be subject to any deductibles, copayments,
8or coinsurance.
AB50-ASA2-AA16,619Section 61. 632.895 (17) (b) 2. of the statutes is amended to read:
AB50-ASA2-AA16,49,1410632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and
11medical services that are necessary to prescribe, administer, maintain, or remove a
12contraceptive, if covered for any other drug benefits under the policy or plan
13sterilization procedures, and patient education and counseling for all females with
14reproductive capacity.
AB50-ASA2-AA16,6215Section 62. 632.895 (17) (c) of the statutes is amended to read:
AB50-ASA2-AA16,50,716632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions,
17and limitations, or cost-sharing provisions that apply generally to the coverage of
18outpatient health care services, preventive treatments and services, or prescription
19drugs and devices that is provided under the policy or self-insured health plan. A
20disability insurance policy or self-insured health plan may not apply a deductible or
21impose a copayment or coinsurance to at least one of each type of contraceptive
22method approved by the federal food and drug administration for which coverage is
23required under this subsection. The disability insurance policy or self-insured

1health plan may apply reasonable medical management to a method of
2contraception to limit coverage under this subsection that is provided without being
3subject to a deductible, copayment, or coinsurance to prescription drugs without a
4brand name. The disability insurance policy or self-insured health plan may apply
5a deductible or impose a copayment or coinsurance for coverage of a contraceptive
6that is prescribed for a medical need if the services for the medical need would
7otherwise be subject to a deductible, copayment, or coinsurance.
AB50-ASA2-AA16,638Section 63. 632.897 (11) (a) of the statutes is amended to read:
AB50-ASA2-AA16,50,179632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
10promulgate rules establishing standards requiring insurers to provide continuation
11of coverage for any individual covered at any time under a group policy who is a
12terminated insured or an eligible individual under any federal program that
13provides for a federal premium subsidy for individuals covered under continuation
14of coverage under a group policy, including rules governing election or extension of
15election periods, notice, rates, premiums, premium payment, application of
16preexisting condition exclusions, election of alternative coverage, and status as an
17eligible individual, as defined in s. 149.10 (2t), 2011 stats.
AB50-ASA2-AA16,932318Section 9323. Initial applicability; Insurance.
AB50-ASA2-AA16,50,2019(1) Coverage of individuals with preexisting conditions, essential
20health benefits, and preventive services.
AB50-ASA2-AA16,51,421(a) For policies and plans containing provisions inconsistent with these
22sections, the treatment of ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e),
23(3) (a) and (d) 1., 2., and 3., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac)

11. and 2., 632.795 (4) (a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c),
2and (d) 3., (14m), (16m) (b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies
3to policy or plan years beginning on January 1 of the year following the year in
4which this paragraph takes effect, except as provided in par. (b).
AB50-ASA2-AA16,51,135(b) For policies and plans that are affected by a collective bargaining
6agreement containing provisions inconsistent with these sections, the treatment of
7ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and
83., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4)
9(a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m)
10(b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies to policy or plan years
11beginning on the effective date of this paragraph or on the day on which the
12collective bargaining agreement is entered into, extended, modified, or renewed,
13whichever is later.
AB50-ASA2-AA16,942314Section 9423. Effective dates; Insurance.
AB50-ASA2-AA16,51,2115(1) Coverage of individuals with preexisting conditions, essential
16health benefits, and preventive services. The treatment of ss. 632.728,
17632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and 3., (5), and (8)
18(a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a), 632.895 (8)
19(d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m) (b), and (17) (b)
202. and (c), and 632.897 (11) (a) and Section 9323 (1) of this act take effect on the
21first day of the 4th month beginning after publication..
AB50-ASA2-AA16,51,222220. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,51,2323Section 64. 20.145 (1) (g) 5. of the statutes is created to read:
AB50-ASA2-AA16,52,4
120.145 (1) (g) 5. All moneys received from the regulation of pharmacy benefit
2managers, pharmacy benefit management brokers, pharmacy benefit management
3consultants, pharmacy services administration organizations, and pharmaceutical
4representatives..
AB50-ASA2-AA16,52,5521. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,52,66Section 65. 15.07 (3) (bm) 7. of the statutes is created to read:
AB50-ASA2-AA16,52,8715.07 (3) (bm) 7. The prescription drug affordability review board shall meet
8at least 4 times each year.
AB50-ASA2-AA16,669Section 66. 15.735 of the statutes is created to read:
AB50-ASA2-AA16,52,121015.735 Same; attached board. (1) There is created a prescription drug
11affordability review board attached to the office of the commissioner of insurance
12under s. 15.03. The board shall consist of the following members:
AB50-ASA2-AA16,52,1313(a) The commissioner of insurance or his or her designee.
AB50-ASA2-AA16,52,1714(b) Two members appointed for 4-year terms who represent the
15pharmaceutical drug industry, including pharmaceutical drug manufacturers and
16wholesalers. At least one of the members appointed under this paragraph shall be
17a licensed pharmacist.
AB50-ASA2-AA16,52,1918(c) Two members appointed for 4-year terms who represent the health
19insurance industry, including insurers and pharmacy benefit managers.
AB50-ASA2-AA16,52,2320(d) Two members appointed for 4-year terms who represent the health care
21industry, including hospitals, physicians, pharmacies, and pharmacists. At least
22one of the members appointed under this paragraph shall be a licensed
23practitioner.
AB50-ASA2-AA16,53,2
1(e) Two members appointed for 4-year terms who represent the interests of
2the public.
AB50-ASA2-AA16,53,53(2) A member appointed under sub. (1), except for a member appointed under
4sub. (1) (b), may not be an employee of, a board member of, or a consultant to a drug
5manufacturer or trade association for drug manufacturers.
AB50-ASA2-AA16,53,106(3) Any conflict of interest, including any financial or personal association,
7that has the potential to bias or has the appearance of biasing an individuals
8decision in matters related to the board or the conduct of the boards activities shall
9be considered and disclosed when appointing that individual to the board under
10sub. (1).
AB50-ASA2-AA16,6711Section 67. Subchapter VI (title) of chapter 601 [precedes 601.78] of the
12statutes is created to read:
AB50-ASA2-AA16,53,1414SUBCHAPTER VI
Loading...
Loading...