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AB50-ASA2-AA8,196,1918(i) Apply different medical necessity criteria based on financial interests
19rather than patient needs.
AB50-ASA2-AA8,196,2120(j) Disregard a treating health care providers medical assessment without a
21valid clinical reason.
AB50-ASA2-AA8,196,2322(k) Mandate prior approval for routine or urgent procedures in a manner that
23causes harmful delays.
AB50-ASA2-AA8,197,224(L) For a disability insurance policy that provides coverage of emergency

1medical services, refuse to cover emergency medical services provided by out-of-
2network providers.
AB50-ASA2-AA8,197,43(m) List a health care provider as in-network on a provider directory and then
4deny a claim by stating the health care provider is out-of-network.
AB50-ASA2-AA8,197,65(n) Deny coverage based on age, gender, disability, or a chronic condition
6rather than medical necessity.
AB50-ASA2-AA8,197,87(o) Apply stricter standards in reviewing claims related to mental health
8conditions than claims related to physical health conditions.
AB50-ASA2-AA8,197,109(p) Perform a blanket denial of claims for high-cost conditions without an
10individualized review of each claim.
AB50-ASA2-AA8,197,1111(r) Reclassify a claim to a lower-cost treatment to reduce insurer payout.
AB50-ASA2-AA8,197,1312(s) Require an insured to fail a cheaper treatment before approving coverage
13for necessary care.
AB50-ASA2-AA8,197,1414(t) Manipulate cost-sharing rules to shift higher costs to insureds.
AB50-ASA2-AA8,197,1915(5) Transparency and reporting. (a) Beginning on January 1, 2027, an
16insurer shall annually publish a report detailing the insurers claim denial rates,
17reasons for claim denials, and the outcome of any appeal of a claim denial for the
18previous year for all disability insurance policies under which the insurer provides
19coverage.
AB50-ASA2-AA8,197,2120(b) The commissioner shall maintain a public database of insurers claim
21denial rates and the outcomes of independent reviews under s. 632.835.
AB50-ASA2-AA8,198,222(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence
23or algorithmic decision-making in claims processing shall annually publish a report

1detailing all of the following for the previous year for all disability insurance policies
2under which the insurer provides coverage:
AB50-ASA2-AA8,198,431. The percentage of claims submitted to the insurer that were reviewed by
4artificial intelligence or algorithmic decision-making.
AB50-ASA2-AA8,198,752. The claim denial rate of claims reviewed by artificial intelligence or
6algorithmic decision-making compared to the claim denial rate of claims reviewed
7by humans.
AB50-ASA2-AA8,198,983. The steps the insurer takes to ensure fairness and accuracy in decisions
9made by artificial intelligence or algorithmic decision-making.
AB50-ASA2-AA8,198,1310(6) Claim denial rate audits. (a) The commissioner may conduct an audit
11of an insurer if the insurers claim denials are of such frequency as to indicate a
12general business practice. This paragraph is supplemental to and does not limit
13any other powers or duties of the commissioner.
AB50-ASA2-AA8,198,1514(b) The commissioner may collect any relevant information from an insurer
15that is necessary to conduct an audit under par. (a).
AB50-ASA2-AA8,198,1716(c) The commissioner may contract with a 3rd party to conduct an audit under
17par. (a).
AB50-ASA2-AA8,198,2218(d) The commissioner may, based on the findings of an audit under par. (a),
19order the insurer who is the subject of the audit to comply with a corrective action
20plan approved by the commissioner. The commissioner shall specify in any
21corrective action plan under this paragraph the deadline by which an insurer must
22be in compliance with the corrective action plan.
AB50-ASA2-AA8,198,2423(e) An insurer who is the subject of an audit under par. (a) shall provide a
24written response to any adverse findings of the audit.
AB50-ASA2-AA8,199,3
1(f) If an insurer fails to comply with a corrective action plan under par. (d) by
2the deadline specified by the commissioner, the commissioner may order the
3insurer to pay a forfeiture pursuant to s. 601.64 (3).
AB50-ASA2-AA8,199,74(7) Forfeitures. A violation of this section that results in a harmful delay in
5an insureds care or an adverse health outcome for an insured shall be subject to a
6civil forfeiture of $10,000 per occurrence, in addition to any other penalties provided
7in s. 601.64 (3) or other law..
AB50-ASA2-AA8,199,8875. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,199,99Section 9123. Nonstatutory provisions; Insurance.
AB50-ASA2-AA8,199,1010(1) Funding for health insurance navigators.
AB50-ASA2-AA8,199,1111(a) In this subsection:
AB50-ASA2-AA8,199,12121. Commissioner means the commissioner of insurance.
AB50-ASA2-AA8,199,14132. Navigator means an individual navigator licensed under s. 628.92 (1) or a
14navigator entity licensed under s. 628.92 (2).
AB50-ASA2-AA8,199,1715(b) From the appropriation under s. 20.145 (1) (g), the commissioner shall
16award $500,000 in fiscal year 2025-26 and shall award $500,000 in fiscal year 2026-
1727 to a navigator to prioritize services for the direct care workforce population..
AB50-ASA2-AA8,199,181876. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,199,1919Section 347. 15.01 (6) of the statutes is amended to read:
AB50-ASA2-AA8,200,102015.01 (6) Division, bureau, section, and unit means the subunits of a
21department or an independent agency, whether specifically created by law or
22created by the head of the department or the independent agency for the more
23economic and efficient administration and operation of the programs assigned to

1the department or independent agency. The office of credit unions in the
2department of financial institutions, the office of the inspector general in the
3department of children and families, the office of the public intervenor in the office
4of the commissioner of insurance, the office of the inspector general in the
5department of health services, and the office of childrens mental health in the
6department of health services have the meaning of division under this
7subsection. The office of the long-term care ombudsman under the board on aging
8and long-term care and the office of educational accountability and the office of
9literacy in the department of public instruction have the meaning of bureau
10under this subsection.
AB50-ASA2-AA8,34811Section 348. 15.732 of the statutes is created to read:
AB50-ASA2-AA8,200,141215.732 Same; attached office. (1) Office of the public intervenor.
13There is created an office of the public intervenor which is attached to the office of
14the commissioner of insurance.
AB50-ASA2-AA8,34915Section 349. 20.145 (1) (g) 1. of the statutes is amended to read:
AB50-ASA2-AA8,200,181620.145 (1) (g) 1. All moneys received under ss. 601.25 (2), 601.31, 601.32,
17601.42 (7), 601.45, and 601.47 and by the commissioner for expenses related to
18insurance company restructurings, except for restructurings specified in par. (h).
AB50-ASA2-AA8,35019Section 350. 601.25 of the statutes is created to read:
AB50-ASA2-AA8,200,2320601.25 Office of the public intervenor. (1) The office of the public
21intervenor shall assist individuals with insurance claims, policies, appeals, and
22other legal actions to pursue insurance coverage for medical procedures,
23prescription medications, and other health care services.
AB50-ASA2-AA8,201,424(2) The office of the public intervenor may levy an assessment on each insurer

1that is authorized to engage in the business of insurance in this state. The
2assessment levied under this subsection shall be based on the insurers premium
3volume for disability insurance policies, as defined in s. 632.895 (1) (a), written in
4this state.
AB50-ASA2-AA8,201,65(3) The commissioner may provide by rule for the governance, duties, and
6administration of the office of the public intervenor..
AB50-ASA2-AA8,201,7777. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,201,168Section 351. 20.005 (3) (schedule) of the statutes: at the appropriate place,
9insert the following amounts for the purposes indicated:
AB50-ASA2-AA8,35217Section 352. 20.165 (1) (e) of the statutes is created to read:
AB50-ASA2-AA8,201,191820.165 (1) (e) Statewide clinician wellness program. The amounts in the
19schedule for the statewide clinician wellness program under s. 440.03 (18).
AB50-ASA2-AA8,35320Section 353. 440.03 (18) of the statutes is created to read:
AB50-ASA2-AA8,202,221440.03 (18) The department may provide a statewide clinician wellness
22program to provide support to healthcare workers in this state in maintaining their
23physical and mental health and ensuring long-term vitality and effectiveness for

1their patients and their profession. The department shall ensure that the program
2is coordinated with the procedure under sub. (1c)..
AB50-ASA2-AA8,202,3378. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,202,44Section 354. 609.823 of the statutes is created to read:
AB50-ASA2-AA8,202,75609.823 Coverage without prior authorization for inpatient mental
6health services. Limited service health organizations, preferred provider plans,
7and defined network plans are subject to s. 632.891.
AB50-ASA2-AA8,3558Section 355. 632.891 of the statutes is created to read:
AB50-ASA2-AA8,202,139632.891 Coverage without prior authorization for inpatient mental
10health services. A disability insurance policy, as defined in s. 632.895 (1) (a), or
11self-insured health plan, as defined in s. 632.745 (24), that covers inpatient mental
12health services may not require prior authorization for the provision or coverage of
13those services.
AB50-ASA2-AA8,932314Section 9323. Initial applicability; Insurance.
AB50-ASA2-AA8,202,1515(1) Inpatient mental health prior authorization.
AB50-ASA2-AA8,202,1916(a) For policies and plans containing provisions inconsistent with ss. 609.823
17and 632.891, the treatment of ss. 609.823 and 632.891 first applies to policy or plan
18years beginning on January 1 of the year following the year in which this paragraph
19takes effect, except as provided in par. (b).
AB50-ASA2-AA8,203,220(b) For policies and plans that are affected by a collective bargaining
21agreement containing provisions inconsistent with ss. 609.823 and 632.891, the
22treatment of ss. 609.823 and 632.891 first applies to policy or plan years beginning
23on the effective date of this subsection or on the day on which the collective

1bargaining agreement is newly established, extended, modified, or renewed,
2whichever is later.
AB50-ASA2-AA8,94233Section 9423. Effective dates; Insurance.
AB50-ASA2-AA8,203,64(1) Inpatient mental health prior authorization. The treatment of ss.
5609.823 and 632.891 and Section 9323 (1) of this act takes effect on the first day of
6the 4th month beginning after publication..
AB50-ASA2-AA8,203,7779. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,203,88Section 9219. Fiscal changes; Health Services.
AB50-ASA2-AA8,203,99(1) Behavioral health licensure and oversight staff.
AB50-ASA2-AA8,203,1810(a) In the schedule under s. 20.005 (3) for the appropriation to the department
11of health services under s. 20.435 (6) (jm), the dollar amount for fiscal year 2025-26
12is increased by $145,000 to increase the authorized FTE positions in the
13department of health services by 1.89 PR positions to support the certification,
14licensure, and oversight of behavioral health, and alcohol and other drug abuse
15treatment programs.. In the schedule under s. 20.005 (3) for the appropriation to
16the department of health services under s. 20.435 (6) (jm), the dollar amount for
17fiscal year 2026-27 is increased by $193,400 for the positions authorized under this
18paragraph.
AB50-ASA2-AA8,204,319(b) In the schedule under s. 20.005 (3) for the appropriation to the department
20of health services under s. 20.435 (6) (m), the dollar amount for fiscal year 2025-26
21is increased by $85,200 to increase the authorized FTE positions in the department
22of health services by 1.11 FED positions to support the certification, licensure, and
23oversight of behavioral health, and alcohol and other drug abuse treatment
24programs.. In the schedule under s. 20.005 (3) for the appropriation to the

1department of health services under s. 20.435 (6) (m), the dollar amount for fiscal
2year 2026-27 is increased by $113,600 for the positions authorized under this
3paragraph.
AB50-ASA2-AA8,204,64(c) The positions authorized under pars. (a) and (b) shall be 2.0 surveyor
5positions and 1.0 license permit program associate position to provide
6administrative support to facilitate processing of the increased survey capacity..
AB50-ASA2-AA8,204,7780. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,204,88Section 9219. Fiscal changes; Health Services.
AB50-ASA2-AA8,204,99(1) Quality assurance services.
AB50-ASA2-AA8,204,1710(a) In the schedule under s. 20.005 (3) for the appropriation to the department
11of health services under s. 20.435 (6) (jm), the dollar amount for fiscal year 2025-26
12is increased by $481,700 to increase the authorized FTE positions for the
13department by 8.0 PR positions to address a backlog of surveys conducted by the
14bureau of assisted living. In the schedule under s. 20.005 (3) for the appropriation
15to the department of health services under s. 20.435 (6) (jm), the dollar amount for
16fiscal year 2026-27 is increased by $642,200 to provide funding for the positions
17authorized under this paragraph.
AB50-ASA2-AA8,205,218(b) In the schedule under s. 20.005 (3) for the appropriation to the department
19of health services under s. 20.435 (6) (n), the dollar amount for fiscal year 2025-26
20is increased by $160,500 to increase the authorized FTE positions for the
21department by 3.0 FED positions to address a backlog of surveys conducted by the
22bureau of assisted living. In the schedule under s. 20.005 (3) for the appropriation
23to the department of health services under s. 20.435 (6) (n), the dollar amount for

1fiscal year 2026-27 is increased by $214,100 to provide funding for the positions
2authorized under this paragraph..
AB50-ASA2-AA8,205,3381. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,205,44Section 9219. Fiscal changes; Health Services.
AB50-ASA2-AA8,205,145(1) Cardiac arrest registry to enhance survival. In the schedule under
6s. 20.005 (3) for the appropriation to the department of health services under s.
720.435 (1) (a), the dollar amount for fiscal year 2025-26 is increased by $25,000 to
8fund automatic data uploading privileges in the Cardiac Arrest Registry to
9Enhance Survival (CARES) digital registry of out-of-hospital cardiac arrests. In
10the schedule under s. 20.005 (3) for the appropriation to the department of health
11services under s. 20.435 (1) (a), the dollar amount for fiscal year 2026-27 is
12increased by $25,000 to fund automatic data uploading privileges in the Cardiac
13Arrest Registry to Enhance Survival (CARES) digital registry of out-of-hospital
14cardiac arrests..
AB50-ASA2-AA8,205,151582. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,205,1616Section 9119. Nonstatutory provisions; Health Services.
AB50-ASA2-AA8,206,217(1) Senior care reestimate. For fiscal year 2025-26, to reflect a reestimate
18of benefit costs under the senior care program, the GPR funding for senior care
19shall be decreased by $4,402,700; the FED funding for senior care shall be increased
20by $1,357,800; and the PR funding for senior care shall be decreased by
21$32,679,200. For fiscal year 2026-27, to reflect a reestimate of benefit costs under
22the senior care program, the GPR funding for senior care shall be decreased by

1$1,646,400; the FED funding for senior care shall be increased by $1,288,400; and
2the PR funding for senior care shall be decreased by $29,613,000..
AB50-ASA2-AA8,206,3383. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,206,44Section 356. 46.995 (4) of the statutes is created to read:
AB50-ASA2-AA8,206,8546.995 (4) The department shall ensure that any child who is eligible and who
6applies for the disabled childrens long-term support program that is operating
7under a waiver of federal law receives services under the disabled childrens
8long‑term support program that is operating under a waiver of federal law..
AB50-ASA2-AA8,206,9984. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,206,1010Section 9219. Fiscal changes; Health Services.
AB50-ASA2-AA8,206,1811(1) Community aids basic county allocations. In the schedule under s.
1220.005 (3) for the appropriation to the department of health services under s.
1320.435 (7) (b), the dollar amount for fiscal year 2025-26 is increased by $1,698,200
14to increase basic county allocations under the community aids program.. In the
15schedule under s. 20.005 (3) for the appropriation to the department of health
16services under s. 20.435 (7) (b), the dollar amount for fiscal year 2026-27 is
17increased by $5,162,600 to increase basic county allocations under the community
18aids program..
AB50-ASA2-AA8,206,191985. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,206,2020Section 357. 20.435 (4) (bm) of the statutes is amended to read:
AB50-ASA2-AA8,207,152120.435 (4) (bm) Medical Assistance, food stamps, and Badger Care
22administration; contract costs, insurer reports, and resource centers. Biennially, the
23amounts in the schedule to provide a portion of the state share of administrative

1contract costs for the Medical Assistance program under subch. IV of ch. 49 and the
2Badger Care health care program under s. 49.665 and to provide the state share of
3administrative costs for the food stamp program under s. 49.79, other than
4payments under s. 49.78 (8), to develop and implement a registry of recipient
5immunizations, to reimburse 3rd parties for their costs under s. 49.475, for costs
6associated with outreach activities, for state administration of state supplemental
7grants to supplemental security income recipients under s. 49.77, for grants under
8ss. 46.73 and 46.74, and for services of resource centers under s. 46.283. No state
9positions may be funded in the department of health services from this
10appropriation, except positions for the performance of duties under a contract in
11effect before January 1, 1987, related to the administration of the Medical
12Assistance program between the subunit of the department primarily responsible
13for administering the Medical Assistance program and another subunit of the
14department. Total administrative funding authorized for the program under s.
1549.665 may not exceed 10 percent of the amounts budgeted under pars. (p) and (x).
AB50-ASA2-AA8,35816Section 358. 20.435 (4) (pa) of the statutes is amended to read:
AB50-ASA2-AA8,207,231720.435 (4) (pa) Federal aid; Medical Assistance and food stamp contracts
18administration. All federal moneys received for the federal share of the cost of
19contracting for payment and services administration and reporting, other than
20moneys received under pars. (nn) and (np), to reimburse 3rd parties for their costs
21under s. 49.475, for administrative contract costs for the food stamp program under
22s. 49.79, for grants under ss. 46.73 and 46.74, and for services of resource centers
23under s. 46.283.
AB50-ASA2-AA8,359
1Section 359. 46.73 of the statutes is created to read:
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