Amendment AA8-ASA2-AB50

AB50-ASA2-AA8,174,17 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.

AB50-ASA2-AA8,174,22 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.”.

AB50-ASA2-AA8,174,23 65. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,175,1 “Section 315. 609.74 of the statutes is created to read:

AB50-ASA2-AA8,175,3 609.74 Coverage of infertility services. Defined network plans and preferred provider plans are subject to s. 632.895 (15m).

AB50-ASA2-AA8,316 Section 316. 632.895 (15m) of the statutes is created to read:

AB50-ASA2-AA8,175,5 632.895 (15m) Coverage of infertility services. (a) In this subsection:

AB50-ASA2-AA8,175,11 1. “Diagnosis of and treatment for infertility” means any recommended procedure or medication to treat infertility at the direction of a physician that is consistent with established, published, or approved medical practices or professional guidelines from the American College of Obstetricians and Gynecologists, or its successor organization, or the American Society for Reproductive Medicine, or its successor organization.

AB50-ASA2-AA8,175,13 2. “Infertility” means a disease, condition, or status characterized by any of the following:

AB50-ASA2-AA8,175,18 a. The failure to establish a pregnancy or carry a pregnancy to a live birth after regular, unprotected sexual intercourse for, if the woman is under the age of 35, no longer than 12 months or, if the woman is 35 years of age or older, no longer than 6 months, including any time during those 12 months or 6 months that the woman has a pregnancy that results in a miscarriage.

AB50-ASA2-AA8,175,20 b. An individual’s inability to reproduce either as a single individual or with a partner without medical intervention.

AB50-ASA2-AA8,175,22 c. A physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.

AB50-ASA2-AA8,176,2 3. “Self-insured health plan” means a self-insured health plan of the state or a county, city, village, town, or school district.

AB50-ASA2-AA8,176,9 4. “Standard fertility preservation service” means a procedure that is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine, or its successor organization, or the American Society of Clinical Oncology, or its successor organization, for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

AB50-ASA2-AA8,176,17 (b) Subject to pars. (c) to (e), every disability insurance policy and self-insured health plan that provides coverage for medical or hospital expenses shall cover diagnosis of and treatment for infertility and standard fertility preservation services. Coverage required under this paragraph includes at least 4 completed oocyte retrievals with unlimited embryo transfers, in accordance with the guidelines of the American Society for Reproductive Medicine, or its successor organization, and single embryo transfer when recommended and medically appropriate.

AB50-ASA2-AA8,176,19 (c) 1. A disability insurance policy or self-insured health plan may not do any of the following:

AB50-ASA2-AA8,176,22 a. Impose any exclusion, limitation, or other restriction on coverage required under par. (b) based on a covered individual’s participation in fertility services provided by or to a 3rd party.

AB50-ASA2-AA8,177,3 b. Impose any exclusion, limitation, or other restriction on coverage of medications that are required to be covered under par. (b) that are different from those imposed on any other prescription medications covered under the policy or plan.

AB50-ASA2-AA8,177,10 c. Impose any exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction on coverage that is required under par. (b) of diagnosis of and treatment for infertility and standard fertility preservation services that is different from an exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction imposed on benefits for services that are covered by the policy or plan and that are not related to infertility.

AB50-ASA2-AA8,177,14 2. A disability insurance policy or self-insured health plan shall provide coverage required under par. (b) to any covered individual under the policy or plan, including any covered spouse or nonspouse dependent, to the same extent as other pregnancy-related benefits covered under the policy or plan.

AB50-ASA2-AA8,177,20 (d) The commissioner, after consulting with the department of health services on appropriate treatment for infertility, shall promulgate any rules necessary to implement this subsection. Before the promulgation of rules, disability insurance policies and self-insured health plans are considered to comply with the coverage requirements of par. (b) if the coverage conforms to the standards of the American Society for Reproductive Medicine.

AB50-ASA2-AA8,177,22 (e) This subsection does not apply to a disability insurance policy that is described under s. 632.745 (11) (b) 1. to 12.

AB50-ASA2-AA8,9323 Section 9323. Initial applicability; Insurance.

AB50-ASA2-AA8,178,1 (1) Coverage of infertility services.

AB50-ASA2-AA8,178,5 (a) For policies and plans containing provisions inconsistent with these sections, the treatment of ss. 609.74 and 632.895 (15m) first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in pars. (b) and (c).

AB50-ASA2-AA8,178,10 (b) For policies and plans that have a term greater than one year and contain provisions inconsistent with these sections, the treatment of ss. 609.74 and 632.895 (15m) first applies to policy or plan years beginning on January 1 of the year following the year in which the policy or plan is extended, modified, or renewed, whichever is later.

AB50-ASA2-AA8,178,15 (c) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with these sections, the treatment of ss. 609.74 and 632.895 (15m) first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is entered into, extended, modified, or renewed, whichever is later.

AB50-ASA2-AA8,9423 Section 9423. Effective dates; Insurance.

AB50-ASA2-AA8,178,19 (1) Coverage of infertility services. The treatment of ss. 609.74 and 632.895 (15m) and Section 9323 (1) of this act take effect on the first day of the 4th month beginning after publication.”.

AB50-ASA2-AA8,178,20 66. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,178,21 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,179,5 (1) MyWisconsin ID - IT security. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (a), the dollar amount for fiscal year 2025-26 is increased by $1,432,400 to develop the MyWisconsin identification account management system. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (a), the dollar amount for fiscal year 2026-27 is increased by $477,500 to develop the MyWisconsin identification account management system.”.

AB50-ASA2-AA8,179,6 67. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,179,7 “Section 317. 632.895 (17) (b) 1m. of the statutes is created to read:

AB50-ASA2-AA8,179,9 632.895 (17) (b) 1m. Oral contraceptives that are lawfully furnished over the counter without a prescription.

AB50-ASA2-AA8,9323 Section 9323. Initial applicability; Insurance.

AB50-ASA2-AA8,179,11 (1) Coverage of over-the-counter oral contraceptives.

AB50-ASA2-AA8,179,15 (a) For policies and plans containing provisions inconsistent with s. 632.895 (17) (b) 1m., the treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b).

AB50-ASA2-AA8,179,20 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with s. 632.895 (17) (b) 1m., the treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.

AB50-ASA2-AA8,9423 Section 9423. Effective dates; Insurance.

AB50-ASA2-AA8,179,24 (1) Coverage of over-the-counter oral contraceptives. The treatment of s. 632.895 (17) (b) 1m. and Section 9323 (1) of this act take effect on the first day of the 4th month beginning after publication.”.

AB50-ASA2-AA8,180,1 68. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,180,2 “Section 318. 46.74 of the statutes is created to read:

AB50-ASA2-AA8,180,5 46.74 Grants for mobile dental clinics. The department shall award grants to community health centers, as defined in s. 250.15 (1) (a), to procure and operate mobile dental clinics.

AB50-ASA2-AA8,9219 Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,180,13 (1) Mobile dental clinic grants. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (b), the dollar amount for fiscal year 2026-27 is increased by $1,898,700 to fund grants to 3 community health centers to enable them to each procure and operate a mobile dental clinic, and to reflect an increase in dental services utilization under the Medical Assistance program under subch. IV of ch. 49 resulting from the mobile dental clinics.”.

AB50-ASA2-AA8,180,14 69. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,180,15 “Section 319. 40.51 (8m) of the statutes is amended to read:

AB50-ASA2-AA8,180,19 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4e), 632.885, 632.89, and 632.895 (11) to (17).

AB50-ASA2-AA8,320 Section 320. 609.718 of the statutes is created to read:

AB50-ASA2-AA8,180,22 609.718 Dental therapist coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (4e).

AB50-ASA2-AA8,321 Section 321. 632.87 (1) of the statutes is amended to read:

AB50-ASA2-AA8,181,5 632.87 (1) No insurer may refuse to provide or pay for benefits for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the contract clearly excludes services by such practitioners, but no contract or plan may exclude services in violation of sub. (2), (2m), (3), (4), (4e), (4m), (5), or (6).

AB50-ASA2-AA8,322 Section 322. 632.87 (4) of the statutes is amended to read:

AB50-ASA2-AA8,181,11 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed dentist or dental therapist within the scope of the dentist’s or dental therapist’s license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by another health care provider, as defined in s. 146.81 (1) (a) to (p).

AB50-ASA2-AA8,323 Section 323. 632.87 (4e) of the statutes is created to read:

AB50-ASA2-AA8,181,14 632.87 (4e) In this subsection, “dental therapist” means an individual licensed under s. 447.04 (1m).

AB50-ASA2-AA8,181,19 (b) No policy, plan, or contract may exclude coverage for dental services, treatments, or procedures provided by a dental therapist within the scope of the dental therapist’s license if the policy, plan, or contract covers the dental services, treatments, or procedures when provided by another health care provider, as defined in s. 146.81 (1) (a) to (hp).

AB50-ASA2-AA8,9323 Section 9323. Initial applicability; Insurance.

AB50-ASA2-AA8,181,21 (1) Dental therapist coverage.

AB50-ASA2-AA8,182,2 (a) For policies and plans containing provisions inconsistent with ss. 40.51 (8m), 609.718, and 632.87 (1), (4), and (4e), the treatment of ss. 40.51 (8m), 609.718, and 632.87 (1), (4), and (4e) first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b).

AB50-ASA2-AA8,182,8 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with ss. 40.51 (8m), 609.718, and 632.87 (1), (4), and (4e), the treatment of ss. 40.51 (8m), 609.718, and 632.87 (1), (4), and (4e) first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is entered into, extended, modified, or renewed, whichever is later.

AB50-ASA2-AA8,9423 Section 9423. Effective dates; Insurance.

AB50-ASA2-AA8,182,12 (1) Dental therapist coverage. The treatment of ss. 40.51 (8m), 609.718, and 632.87 (1), (4), and (4e) and Section 9323 (1) of this act take effect on the first day of the 4th month beginning after publication.”.

AB50-ASA2-AA8,182,13 70. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,182,14 “Section 9219. Fiscal changes; Health Services.

AB50-ASA2-AA8,182,20 (1) Alzheimer's disease training and information grants. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (1) (bg), the dollar amount for fiscal year 2025-26 is increased by $50,000 and the dollar amount for fiscal year 2026-27 is increased by $50,000 to increase funding for the Alzheimer's disease training and information grants.”.

AB50-ASA2-AA8,182,21 71. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,182,22 “Section 324. 40.51 (8) of the statutes is amended to read:

AB50-ASA2-AA8,183,4 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6) (7), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB50-ASA2-AA8,325 Section 325. 40.51 (8m) of the statutes is amended to read:

AB50-ASA2-AA8,183,9 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (7), 632.885, 632.89, and 632.895 (11) to (17).

AB50-ASA2-AA8,326 Section 326. 66.0137 (4) of the statutes is amended to read:

AB50-ASA2-AA8,183,17 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6) (7), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).

AB50-ASA2-AA8,327 Section 327. 120.13 (2) (g) of the statutes is amended to read:

AB50-ASA2-AA8,183,22 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6) (7), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).

AB50-ASA2-AA8,328 Section 328. 185.983 (1) (intro.) of the statutes is amended to read:

AB50-ASA2-AA8,184,7 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6) (7), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but the sponsoring association shall:

AB50-ASA2-AA8,329 Section 329. 609.713 of the statutes is created to read:

AB50-ASA2-AA8,184,11 609.713 Qualified treatment trainee coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (7).

AB50-ASA2-AA8,330 Section 330. 632.87 (7) of the statutes is created to read:

AB50-ASA2-AA8,184,13 632.87 (7) (a) In this subsection:

AB50-ASA2-AA8,184,14 1. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp).

AB50-ASA2-AA8,184,16 2. “Qualified treatment trainee” has the meaning given in s. DHS 35.03 (17m), Wis. Adm. Code.

AB50-ASA2-AA8,184,21 (b) No policy, plan, or contract may exclude coverage for mental health or behavioral health treatment or services provided by a qualified treatment trainee within the scope of the qualified treatment trainee’s education and training if the policy, plan, or contract covers the mental health or behavioral health treatment or services when provided by another health care provider.

AB50-ASA2-AA8,9323 Section 9323. Initial applicability; Insurance.

AB50-ASA2-AA8,184,23 (1) Qualified treatment trainee coverage.

AB50-ASA2-AA8,185,4 (a) For policies and plans containing provisions inconsistent with these sections, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7) first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in par. (b).

AB50-ASA2-AA8,185,10 (b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with these sections, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7) first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is entered into, extended, modified, or renewed, whichever is later.