Amendment AA8-ASA2-AB50

AB50-ASA2-AA8,256,19 a. Health care costs, prices, and affordability.

AB50-ASA2-AA8,256,21 b. The availability or accessibility of health care services to the affected community.

AB50-ASA2-AA8,256,23 c. Health care provider cost trends and containment of total state health care spending.

AB50-ASA2-AA8,256,24 d. Access to services in medically underserved areas.

AB50-ASA2-AA8,257,2 e. Rectifying historical and contemporary factors contributing to a lack of health equities or access to services.

AB50-ASA2-AA8,257,4 f. The functioning and competitiveness of the markets for health care and health insurance.

AB50-ASA2-AA8,257,6 g. The potential effects of the material change transaction on health outcomes, quality, access, equity, or workforce for residents of this state.

AB50-ASA2-AA8,257,7 h. The potential loss of or change in access to essential services.

AB50-ASA2-AA8,257,10 2. Whether the material change transaction is contrary to or violates any applicable law, including state antitrust laws, laws restricting the corporate practice of medicine, or consumer protection laws.

AB50-ASA2-AA8,257,12 3. Whether the benefits of the transaction are likely to outweigh any anticompetitive effect from the transaction.

AB50-ASA2-AA8,257,13 4. Whether the transaction is in the public interest.

AB50-ASA2-AA8,257,16 (d) This subsection does not limit or alter any existing authority of the attorney general or any state agency to enforce any other law, including state or federal antitrust law, or to review nonprofit transactions.

AB50-ASA2-AA8,257,20 (5) Post-transaction oversight. (a) Enforcement by the attorney general. 1. The attorney general may subpoena any records necessary to enforce any provisions of this section or to investigate suspected violations of any provisions of this section or any conditions imposed by conditional approval pursuant to sub. (4).

AB50-ASA2-AA8,258,4 2. The attorney general may enforce any requirement of this section and any conditions imposed by a conditional approval pursuant to sub. (4) to the fullest extent provided by law, including damages. In addition to any legal remedies the attorney general may have, the attorney general shall be entitled to specific performance, injunctive relief, and other equitable remedies a court deems appropriate for any violations or imminent violation of any requirement of this section or breach of any of the conditions and shall be entitled to recover its attorney fees and costs incurred in remedying each violation.

AB50-ASA2-AA8,258,10 3. In addition to the remedies set forth in subd. 2., any person who violates this section or of any conditions imposed pursuant to a conditional approval under sub. (4) is subject to a forfeiture of $10,000 per day, which the attorney general may seek to recover by action on behalf of the state. The attorney general may also rescind or deny approval for any other past, pending, or future material change transactions involving the health care entity or an affiliate.

AB50-ASA2-AA8,258,13 4. Nothing in this paragraph shall narrow, abrogate, or otherwise alter the authority of the attorney general to prosecute violations of antitrust or consumer protection requirements.

AB50-ASA2-AA8,258,16 (b) Enforcement by the department. 1. The department may audit the books, documents, records, and data of any entity that is subject to a conditional approval under sub. (4) to monitor compliance with the conditions.

AB50-ASA2-AA8,258,20 2. Any entity that violates any provision of this section, any rules adopted pursuant thereto, or any condition imposed pursuant to a conditional approval under sub. (4) shall be subject to a forfeiture of $10,000 per day for any violation of this section.

AB50-ASA2-AA8,258,23 3. The department may refer any entity to the attorney general to review for enforcement of any noncompliance with this section and any conditions imposed by conditional approval pursuant to sub. (4).

AB50-ASA2-AA8,259,4 (c) Monitoring. In order to effectively monitor ongoing compliance with the terms and conditions of any material change transaction subject to prior notice, approval, or conditional approval under sub. (4), the department may, in its sole discretion, conduct a review or audit and may contract with experts and consultants to assist in this regard.

AB50-ASA2-AA8,259,11 (d) Reporting. One year, 2 years, and 5 years following the completion of the material change transaction approved or conditionally approved by the department after a comprehensive review under sub. (3), and upon future intervals determined at the discretion of the department, the health care entity or any person, corporation, partnership, or other entity that acquired direct or indirect control over the health care entity shall submit reports to the department that do all of the following:

AB50-ASA2-AA8,259,13 1. Demonstrate compliance with conditions placed on the material change transaction, if any.

AB50-ASA2-AA8,259,14 2. Analyze cost trends and cost growth trends of the transacting parties.

AB50-ASA2-AA8,259,16 3. Analyze any changes or effects of the material change transaction on patient access, availability of services, workforce, quality, or equity.

AB50-ASA2-AA8,259,20 (e) Costs. The department shall be entitled to charge costs to the transacting parties for all actual, reasonable, and direct costs incurred in monitoring ongoing compliance with the terms and conditions of the sale or transfer of assets, including contractor and administrative costs.

AB50-ASA2-AA8,259,21 (6) Rules. The department may promulgate rules to implement this section.

AB50-ASA2-AA8,403 Section 403. 150.994 of the statutes is created to read:

AB50-ASA2-AA8,260,2 150.994 Corporate practice of medicine. The corporate practice of medicine is prohibited. The department shall promulgate rules to define what conduct constitutes the corporate practice of medicine for purposes of this section.

AB50-ASA2-AA8,404 Section 404. 150.996 of the statutes is created to read:

AB50-ASA2-AA8,260,9 150.996 Transparency in ownership and control of health care entities. (1) Reporting of ownership and control. Each health care entity shall report to the department on an annual basis and upon the consummation of a material change transaction involving the entity as set forth in s. 150.992, in a form and manner required by the department, all of the following information, as applicable:

AB50-ASA2-AA8,260,10 (a) Legal name of entity.

AB50-ASA2-AA8,260,11 (b) Business address of entity.

AB50-ASA2-AA8,260,12 (c) Locations of operations.

AB50-ASA2-AA8,260,14 (d) Business identification numbers of the entity, as applicable, including all of the following:

AB50-ASA2-AA8,260,15 1. Taxpayer identification number.

AB50-ASA2-AA8,260,16 2. National provider identifier.

AB50-ASA2-AA8,260,17 3. Employer identification number.

AB50-ASA2-AA8,260,18 4. Centers for Medicare and Medicaid Services certification number.

AB50-ASA2-AA8,260,19 5. National Association of Insurance Commissioners identification number.

AB50-ASA2-AA8,260,21 6. A personal identification number associated with a license issued by the commissioner of insurance.

AB50-ASA2-AA8,260,23 7. Pharmacy benefit manager identification number associated with a license or registration of the pharmacy benefit manager in this state.

AB50-ASA2-AA8,260,24 (e) Name and contact information of a representative of the entity.

AB50-ASA2-AA8,261,4 (f) The name, business address, and business identification numbers listed in par. (d) for each person or entity that, with respect to the relevant health care entity, has an ownership or investment interest, has a controlling interest, is a management services organization, or is a significant equity investor.

AB50-ASA2-AA8,261,6 (g) A current organizational chart showing the business structure of the health care entity, including all of the following:

AB50-ASA2-AA8,261,7 1. Any entity listed in par. (f).

AB50-ASA2-AA8,261,9 2. Affiliates, including entities that control or are under common control as the health care entity.

AB50-ASA2-AA8,261,10 3. Subsidiaries.

AB50-ASA2-AA8,261,12 (h) For a health care entity that is a provider organization or a health care facility, all of the following information:

AB50-ASA2-AA8,261,15 1. a. The affiliated health care providers identified by name, license type, specialty, national provider identifier, and other applicable identification number listed in par. (d).

AB50-ASA2-AA8,261,16 b. The address of the principal practice location.

AB50-ASA2-AA8,261,17 c. Whether the health care provider is employed or contracted by the entity.

AB50-ASA2-AA8,261,19 2. The name and address of affiliated health care facilities by license number, license type, and capacity in each major service area.

AB50-ASA2-AA8,261,21 (i) The names, national provider identifier, if applicable, and compensation of all of the following:

AB50-ASA2-AA8,261,23 a. The members of the governing board, board of directors, or similar governance body for the health care entity.

AB50-ASA2-AA8,262,2 b. Any entity that is owned or controlled by, affiliated with, or under common control as the health care entity.

AB50-ASA2-AA8,262,3 c. Any entity listed in par. (f).

AB50-ASA2-AA8,262,7 (j) Comprehensive financial reports of the health care entity and any ownership or control entities, including audited financial statements, cost reports, annual costs, annual receipts, realized capital gains and losses, accumulated surplus, and accumulated reserves.

AB50-ASA2-AA8,262,9 (2) Exceptions. All of the following health care entities are exempt from the reporting requirements under sub. (1):

AB50-ASA2-AA8,262,14 (a) A health care entity that is an independent provider organization, without any ownership or control entities, consisting of 2 or fewer physicians, provided that if that health care entity experiences a material change transaction under s. 150.992, the health care entity is subject to reporting under sub. (1) upon the consummation of the transaction.

AB50-ASA2-AA8,262,20 (b) A health care provider or provider organization that is owned or controlled by another health care entity, if the health care provider or provider organization is shown in the organizational chart submitted under sub. (1) (g) and the owning or controlling health care entity reports all the information required under sub. (1) on behalf of the controlled or owned entity. Health care facilities are not subject to this exception.

AB50-ASA2-AA8,263,2 (3) Rules. (a) The department shall promulgate any rules necessary to implement this section, specify the format and content of reports, and impose penalties for noncompliance. The department may require additional reporting of data or information that it determines is necessary to better protect the public’s interest in monitoring the financial conditions, organizational structure, business practices, and market share of each registered health care entity.

AB50-ASA2-AA8,263,4 (b) The department may assess administrative fees on health care entities in an amount to help defray the costs in overseeing and implementing this section.

AB50-ASA2-AA8,263,8 (4) Ownership information. (a) Information provided under this section shall be public information and may not be considered confidential, proprietary, or a trade secret, except that any individual health care provider’s taxpayer identification that is also their social security number shall be confidential.

AB50-ASA2-AA8,263,11 (b) Not later than December 31, 2028, and annually thereafter, the department shall post on its publicly available website a report with respect to the previous one-year period, including all of the following information:

AB50-ASA2-AA8,263,13 1. The number of health care entities reporting for the year, disaggregated by the business structure of each specified entity.

AB50-ASA2-AA8,263,15 2. The names, addresses, and business structure of any entities with an ownership or controlling interest in each health care entity.

AB50-ASA2-AA8,263,16 3. Any change in ownership or control for each health care entity.

AB50-ASA2-AA8,263,17 4. Any change in the tax identification number of a health care entity.

AB50-ASA2-AA8,263,21 5. As applicable, the name, address, tax identification number, and business structure of other affiliates under common control, subsidiaries, and management services entities for the health care entity, including the business type and the tax identification number of each.

AB50-ASA2-AA8,263,23 6. An analysis of trends in horizontal and vertical consolidation, disaggregated by business structure and provider type.

AB50-ASA2-AA8,264,7 (c) The department may share information reported under this section with the attorney general, other state agencies, and other state officials to reduce or avoid duplication in reporting requirements or to facilitate oversight or enforcement under state law. Any tax identification numbers that are individual social security numbers may be shared with the attorney general, other state agencies, or other state officials that agree to maintain the confidentiality of such information. The department may, in consultation with the relevant state agencies, merge similar reporting requirements where appropriate.

AB50-ASA2-AA8,264,12 (5) Enforcement. (a) Audit and inspection authority. The department is authorized to audit and inspect the records of any health care entity that has failed to submit complete information pursuant to this section or if the department has reason to question the accuracy or completeness of the information submitted pursuant this section.

AB50-ASA2-AA8,264,15 (b) Random audits. The department shall conduct annual audits of a random sample of health care entities to verify compliance with, accuracy, and completeness of the reported information pursuant to this section.

AB50-ASA2-AA8,264,18 (c) Penalty for failure to report. If a health care entity fails to provide a complete report under sub. (1), or submits a report containing false information, the entity shall be subject to all of the following civil penalties, as appropriate:

AB50-ASA2-AA8,264,22 1. Health care entities consisting of independent health care providers or provider organizations without any 3rd-party ownership or control entities, with 10 or fewer physicians or less than $10 million in annual revenue, a forfeiture of up to $50,000 for each report not provided or containing false information.

AB50-ASA2-AA8,264,24 2. For all other health care entities, a forfeiture of up to $500,000 for each report not provided or containing false information.

AB50-ASA2-AA8,9419 Section 9419. Effective dates; Health Services.

AB50-ASA2-AA8,265,3 (1) Healthcare ownership and transparency. The creation of subch. IX of ch. 150, ss. 150.99, 150.992, 150.994, and 150.996 takes effect on January 1, 2027.”.

AB50-ASA2-AA8,265,4 123. At the appropriate places, insert all of the following:

AB50-ASA2-AA8,265,5 “Section 405. 49.79 (7w) (a) 1. of the statutes is amended to read:

AB50-ASA2-AA8,265,11 49.79 (7w) (a) 1. “Eligible retailer” includes any supermarket, grocery store, wholesaler, small-scale store, corner store, convenience store, neighborhood store, bodega, farmers’ market, direct-marketing farmer, nonprofit cooperative food- purchasing venture, or community-supported agriculture program means a retailer authorized to participate in the food stamp program federal supplemental nutrition assistance program.

AB50-ASA2-AA8,406 Section 406. 49.79 (7w) (b) of the statutes is amended to read:

AB50-ASA2-AA8,266,8 49.79 (7w) (b) The department shall, through a competitive selection process, contract with one or more nonprofit 3rd-party organizations to administer a healthy food incentive program statewide. The healthy food incentive program shall provide to any food stamp program recipient assistance group that uses benefits at an eligible retailer participating in the healthy food incentive program under this subsection a monetary amount up to the amount of food stamp program benefits used at the eligible retailer for the purpose of purchasing fruits and vegetables from the eligible retailer. In administering the program, a nonprofit 3rd- party organization shall prioritize including in the healthy food incentive program eligible retailers that source fruits and vegetables primarily from growers in this state and shall establish a timeline for expiration of matching monetary amounts provided for the purchase of fruits and vegetables under the healthy food incentive program such that a matching monetary amount expires no later than one year after it is provided. The department may establish a maximum amount of benefits that may be matched per day for a food stamp program recipient assistance group. Any nonprofit 3rd-party organization administering the healthy food incentive program shall ensure that matching amounts provided under the program that are unused and expire remain with the nonprofit 3rd-party organization and, upon expiration, are available for use to provide matching amounts to other food stamp recipients assistance groups under the program.

AB50-ASA2-AA8,407 Section 407. 49.79 (7w) (c) of the statutes is amended to read:

AB50-ASA2-AA8,266,18 49.79 (7w) (c) The department may allocate no more than 25 percent of the funding available for the healthy food incentive program under this subsection to program development, promotion of and outreach for the program, training, data collection, evaluation, administration, and reporting and shall allocate the remainder of the funding available to the eligible retailers participating in the healthy food incentive program under this subsection. The department shall seek, or require any 3rd-party organization chosen under par. (b) to seek, any available federal matching moneys from the Gus Schumacher Nutrition Incentive Program to fund the healthy food incentive program under this subsection.

AB50-ASA2-AA8,408 Section 408. 49.79 (7w) (cd) of the statutes is created to read:

AB50-ASA2-AA8,266,22 49.79 (7w) (cd) A 3rd-party organization chosen under par. (b) may retain for administrative purposes an amount not to exceed 33 percent of the total contracted amount or the applicable cap found in federal law or guidance, whichever is lower.

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

AB50-ASA2-AA8,267,5 (1) Healthy food incentive plan. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (bt), the dollar amount for fiscal year 2025-26 is increased by $488,600. In the schedule under s. 20.005 (3) for the appropriation to the department of health services under s. 20.435 (4) (bt), the dollar amount for fiscal year 2026-27 is increased by $488,600.”.