AB50-ASA2-AA16,42,151549. Folic acid supplement for adult women with reproductive capacity. AB50-ASA2-AA16,42,161650. Iron deficiency anemia screening for pregnant and lactating women. AB50-ASA2-AA16,42,181751. Preeclampsia preventive medicine for pregnant adult women at high risk 18for preeclampsia. 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 administration’s 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 policy’s or self-insured health plan’s 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 14policy’s or self-insured health plan’s network of providers because there is no 15available health care provider in the policy’s or plan’s 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-AA16,45,1510632.895 (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-AA16,45,2117632.895 (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-AA16,46,54632.895 (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 insured’s or plan participant’s 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-AA16,49,84632.895 (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-AA16,50,716632.895 (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-AA16,50,179632.897 (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-AA16,50,2019(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-AA16,51,2115(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-AA16,52,4
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-AA16,52,8715.07 (3) (bm) 7. The prescription drug affordability review board shall meet 8at least 4 times each year. 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 individual’s 8decision in matters related to the board or the conduct of the board’s activities shall 9be considered and disclosed when appointing that individual to the board under 10sub. (1).
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