AB50-ASA2-AA8,174,17143. From the amounts received from all drug manufacturers, the amounts 15retained by the pharmacy benefit manager, and not passed through to the health 16benefit plan sponsor, that are related to the health benefit plan sponsor’s claims or 17bona fide service fees. AB50-ASA2-AA8,174,22184. The amounts, including pharmacy access and audit recovery fees, received 19from all pharmacies that are in the pharmacy benefit manager’s network or have a 20contract to be in the network and, from these amounts, the amount retained by the 21pharmacy benefit manager and not passed through to the health benefit plan 22sponsor.”. AB50-ASA2-AA8,175,32609.74 Coverage of infertility services. Defined network plans and 3preferred provider plans are subject to s. 632.895 (15m). AB50-ASA2-AA8,175,55632.895 (15m) Coverage of infertility services. (a) In this subsection: AB50-ASA2-AA8,175,1161. “Diagnosis of and treatment for infertility” means any recommended 7procedure or medication to treat infertility at the direction of a physician that is 8consistent with established, published, or approved medical practices or 9professional guidelines from the American College of Obstetricians and 10Gynecologists, or its successor organization, or the American Society for 11Reproductive Medicine, or its successor organization. AB50-ASA2-AA8,175,13122. “Infertility” means a disease, condition, or status characterized by any of 13the following: AB50-ASA2-AA8,175,1814a. The failure to establish a pregnancy or carry a pregnancy to a live birth 15after regular, unprotected sexual intercourse for, if the woman is under the age of 1635, no longer than 12 months or, if the woman is 35 years of age or older, no longer 17than 6 months, including any time during those 12 months or 6 months that the 18woman has a pregnancy that results in a miscarriage. AB50-ASA2-AA8,175,2019b. An individual’s inability to reproduce either as a single individual or with a 20partner without medical intervention. AB50-ASA2-AA8,175,2221c. A physician’s findings based on a patient’s medical, sexual, and 22reproductive history, age, physical findings, or diagnostic testing. AB50-ASA2-AA8,176,2
13. “Self-insured health plan” means a self-insured health plan of the state or 2a county, city, village, town, or school district. AB50-ASA2-AA8,176,934. “Standard fertility preservation service” means a procedure that is 4consistent with established medical practices or professional guidelines published 5by the American Society for Reproductive Medicine, or its successor organization, or 6the American Society of Clinical Oncology, or its successor organization, for a 7person who has a medical condition or is expected to undergo medication therapy, 8surgery, radiation, chemotherapy, or other medical treatment that is recognized by 9medical professionals to cause a risk of impairment to fertility. AB50-ASA2-AA8,176,1710(b) Subject to pars. (c) to (e), every disability insurance policy and self-insured 11health plan that provides coverage for medical or hospital expenses shall cover 12diagnosis of and treatment for infertility and standard fertility preservation 13services. Coverage required under this paragraph includes at least 4 completed 14oocyte retrievals with unlimited embryo transfers, in accordance with the 15guidelines of the American Society for Reproductive Medicine, or its successor 16organization, and single embryo transfer when recommended and medically 17appropriate. AB50-ASA2-AA8,176,1918(c) 1. A disability insurance policy or self-insured health plan may not do any 19of the following: AB50-ASA2-AA8,176,2220a. Impose any exclusion, limitation, or other restriction on coverage required 21under par. (b) based on a covered individual’s participation in fertility services 22provided by or to a 3rd party. AB50-ASA2-AA8,177,323b. Impose any exclusion, limitation, or other restriction on coverage of
1medications that are required to be covered under par. (b) that are different from 2those imposed on any other prescription medications covered under the policy or 3plan. AB50-ASA2-AA8,177,104c. Impose any exclusion, limitation, cost-sharing requirement, benefit 5maximum, waiting period, or other restriction on coverage that is required under 6par. (b) of diagnosis of and treatment for infertility and standard fertility 7preservation services that is different from an exclusion, limitation, cost-sharing 8requirement, benefit maximum, waiting period, or other restriction imposed on 9benefits for services that are covered by the policy or plan and that are not related to 10infertility. AB50-ASA2-AA8,177,14112. A disability insurance policy or self-insured health plan shall provide 12coverage required under par. (b) to any covered individual under the policy or plan, 13including any covered spouse or nonspouse dependent, to the same extent as other 14pregnancy-related benefits covered under the policy or plan. AB50-ASA2-AA8,177,2015(d) The commissioner, after consulting with the department of health services 16on appropriate treatment for infertility, shall promulgate any rules necessary to 17implement this subsection. Before the promulgation of rules, disability insurance 18policies and self-insured health plans are considered to comply with the coverage 19requirements of par. (b) if the coverage conforms to the standards of the American 20Society for Reproductive Medicine. AB50-ASA2-AA8,177,2221(e) This subsection does not apply to a disability insurance policy that is 22described under s. 632.745 (11) (b) 1. to 12. AB50-ASA2-AA8,178,1
1(1) Coverage of infertility services. AB50-ASA2-AA8,178,52(a) For policies and plans containing provisions inconsistent with these 3sections, the treatment of ss. 609.74 and 632.895 (15m) first applies to policy or 4plan years beginning on January 1 of the year following the year in which this 5paragraph takes effect, except as provided in pars. (b) and (c). AB50-ASA2-AA8,178,106(b) For policies and plans that have a term greater than one year and contain 7provisions inconsistent with these sections, the treatment of ss. 609.74 and 632.895 8(15m) first applies to policy or plan years beginning on January 1 of the year 9following the year in which the policy or plan is extended, modified, or renewed, 10whichever is later. AB50-ASA2-AA8,178,1511(c) For policies and plans that are affected by a collective bargaining 12agreement containing provisions inconsistent with these sections, the treatment of 13ss. 609.74 and 632.895 (15m) first applies to policy or plan years beginning on the 14effective date of this paragraph or on the day on which the collective bargaining 15agreement is entered into, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,178,1917(1) Coverage of infertility services. The treatment of ss. 609.74 and 18632.895 (15m) and Section 9323 (1) of this act take effect on the first day of the 4th 19month beginning after publication.”. AB50-ASA2-AA8,179,522(1) MyWisconsin ID - IT security. In the schedule under s. 20.005 (3) for the 23appropriation to the department of health services under s. 20.435 (1) (a), the dollar
1amount for fiscal year 2025-26 is increased by $1,432,400 to develop the 2MyWisconsin identification account management system. In the schedule under s. 320.005 (3) for the appropriation to the department of health services under s. 420.435 (1) (a), the dollar amount for fiscal year 2026-27 is increased by $477,500 to 5develop the MyWisconsin identification account management system.”. AB50-ASA2-AA8,179,98632.895 (17) (b) 1m. Oral contraceptives that are lawfully furnished over the 9counter without a prescription. AB50-ASA2-AA8,179,1111(1) Coverage of over-the-counter oral contraceptives. AB50-ASA2-AA8,179,1512(a) For policies and plans containing provisions inconsistent with s. 632.895 13(17) (b) 1m., the treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan 14years beginning on January 1 of the year following the year in which this paragraph 15takes effect, except as provided in par. (b). AB50-ASA2-AA8,179,2016(b) For policies and plans that are affected by a collective bargaining 17agreement containing provisions inconsistent with s. 632.895 (17) (b) 1m., the 18treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan years beginning on 19the effective date of this paragraph or on the day on which the collective bargaining 20agreement is newly established, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,179,2422(1) Coverage of over-the-counter oral contraceptives. The treatment 23of s. 632.895 (17) (b) 1m. and Section 9323 (1) of this act take effect on the first day 24of the 4th month beginning after publication.”. AB50-ASA2-AA8,180,5346.74 Grants for mobile dental clinics. The department shall award 4grants to community health centers, as defined in s. 250.15 (1) (a), to procure and 5operate mobile dental clinics. AB50-ASA2-AA8,180,137(1) Mobile dental clinic grants. In the schedule under s. 20.005 (3) for the 8appropriation to the department of health services under s. 20.435 (4) (b), the dollar 9amount for fiscal year 2026-27 is increased by $1,898,700 to fund grants to 3 10community health centers to enable them to each procure and operate a mobile 11dental clinic, and to reflect an increase in dental services utilization under the 12Medical Assistance program under subch. IV of ch. 49 resulting from the mobile 13dental clinics.”. AB50-ASA2-AA8,180,191640.51 (8m) Every health care coverage plan offered by the group insurance 17board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 18(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 19632.861, 632.867, 632.87 (4e), 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA8,180,2221609.718 Dental therapist coverage. Limited service health organizations, 22preferred provider plans, and defined network plans are subject to s. 632.87 (4e). AB50-ASA2-AA8,181,5
1632.87 (1) No insurer may refuse to provide or pay for benefits for health care 2services provided by a licensed health care professional on the ground that the 3services were not rendered by a physician as defined in s. 990.01 (28), unless the 4contract clearly excludes services by such practitioners, but no contract or plan may 5exclude services in violation of sub. (2), (2m), (3), (4), (4e), (4m), (5), or (6). AB50-ASA2-AA8,181,117632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and 8treatment of a condition or complaint by a licensed dentist or dental therapist 9within the scope of the dentist’s or dental therapist’s license, if the policy, plan or 10contract covers diagnosis and treatment of the condition or complaint by another 11health care provider, as defined in s. 146.81 (1) (a) to (p). AB50-ASA2-AA8,181,1413632.87 (4e) In this subsection, “dental therapist” means an individual 14licensed under s. 447.04 (1m). AB50-ASA2-AA8,181,1915(b) No policy, plan, or contract may exclude coverage for dental services, 16treatments, or procedures provided by a dental therapist within the scope of the 17dental therapist’s license if the policy, plan, or contract covers the dental services, 18treatments, or procedures when provided by another health care provider, as 19defined in s. 146.81 (1) (a) to (hp). AB50-ASA2-AA8,181,2121(1) Dental therapist coverage. AB50-ASA2-AA8,182,222(a) For policies and plans containing provisions inconsistent with ss. 40.51 23(8m), 609.718, and 632.87 (1), (4), and (4e), the treatment of ss. 40.51 (8m), 609.718, 24and 632.87 (1), (4), and (4e) first applies to policy or plan years beginning on
1January 1 of the year following the year in which this paragraph takes effect, except 2as provided in par. (b). AB50-ASA2-AA8,182,83(b) For policies and plans that are affected by a collective bargaining 4agreement containing provisions inconsistent with ss. 40.51 (8m), 609.718, and 5632.87 (1), (4), and (4e), the treatment of ss. 40.51 (8m), 609.718, and 632.87 (1), (4), 6and (4e) first applies to policy or plan years beginning on the effective date of this 7paragraph or on the day on which the collective bargaining agreement is entered 8into, extended, modified, or renewed, whichever is later. AB50-ASA2-AA8,182,1210(1) Dental therapist coverage. The treatment of ss. 40.51 (8m), 609.718, 11and 632.87 (1), (4), and (4e) and Section 9323 (1) of this act take effect on the first 12day of the 4th month beginning after publication.”. AB50-ASA2-AA8,182,2015(1) Alzheimer's disease training and information grants. In the 16schedule under s. 20.005 (3) for the appropriation to the department of health 17services under s. 20.435 (1) (bg), the dollar amount for fiscal year 2025-26 is 18increased by $50,000 and the dollar amount for fiscal year 2026-27 is increased by 19$50,000 to increase funding for the Alzheimer's disease training and information 20grants.”. AB50-ASA2-AA8,183,42340.51 (8) Every health care coverage plan offered by the state under sub. (6)
1shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 2632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 3632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6) (7), 632.885, 632.89, 4632.895 (5m) and (8) to (17), and 632.896. AB50-ASA2-AA8,183,9640.51 (8m) Every health care coverage plan offered by the group insurance 7board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 8(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 9632.861, 632.867, 632.87 (7), 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA8,183,171166.0137 (4) Self-insured health plans. If a city, including a 1st class city, 12or a village provides health care benefits under its home rule power, or if a town 13provides health care benefits, to its officers and employees on a self-insured basis, 14the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 15632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 16632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6) (7), 632.885, 632.89, 632.895 17(9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,183,2219120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 2049.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and 21(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to 22(6) (7), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA8,32823Section 328. 185.983 (1) (intro.) of the statutes is amended to read: AB50-ASA2-AA8,184,724185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
1cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 2646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 3601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 4631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795, 5632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6) (7), 632.885, 6632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 7635, 645, and 646, but the sponsoring association shall: AB50-ASA2-AA8,184,119609.713 Qualified treatment trainee coverage. Limited service health 10organizations, preferred provider plans, and defined network plans are subject to s. 11632.87 (7). AB50-ASA2-AA8,184,1313632.87 (7) (a) In this subsection: AB50-ASA2-AA8,184,14141. “Health care provider” has the meaning given in s. 146.81 (1) (a) to (hp). AB50-ASA2-AA8,184,16152. “Qualified treatment trainee” has the meaning given in s. DHS 35.03 16(17m), Wis. Adm. Code. AB50-ASA2-AA8,184,2117(b) No policy, plan, or contract may exclude coverage for mental health or 18behavioral health treatment or services provided by a qualified treatment trainee 19within the scope of the qualified treatment trainee’s education and training if the 20policy, plan, or contract covers the mental health or behavioral health treatment or 21services when provided by another health care provider. AB50-ASA2-AA8,184,2323(1) Qualified treatment trainee coverage. AB50-ASA2-AA8,185,424(a) For policies and plans containing provisions inconsistent with these
1sections, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 2(1) (intro.), 609.713, and 632.87 (7) first applies to policy or plan years beginning on 3January 1 of the year following the year in which this paragraph takes effect, except 4as provided in par. (b). AB50-ASA2-AA8,185,105(b) For policies and plans that are affected by a collective bargaining 6agreement containing provisions inconsistent with these sections, the treatment of 7ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 8632.87 (7) first applies to policy or plan years beginning on the effective date of this 9paragraph or on the day on which the collective bargaining agreement is entered 10into, extended, modified, or renewed, whichever is later.
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