DOA:......Lessner, BB0043 - Dental Therapists Coverage
For 2025-2027 Budget -- Not Ready For Introduction
An Act ...; relating to: the budget.
Analysis by the Legislative Reference Bureau
INSURANCE
Coverage of services, treatment, or procedures provided by dental therapists
Current law prohibits any health insurance plan from excluding coverage for diagnosis and treatment of a condition or complaint by a dental therapist within the scope of the dental therapist’s license if the health insurance plan covers diagnosis and treatment of the condition or complaint by another health care provider. This bill instead prohibits any health insurance plan from excluding coverage for dental services, treatment, or procedures provided by a dental therapist within the scope of the dental therapist’s license if the health insurance plan covers the dental services, treatment, or procedures when provided by another health care provider. “Dental therapist” is defined under current law as an individual who engages in the limited practice of dentistry.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
Section 1. 609.718 of the statutes is created to read:
609.718 Dental therapist coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (4e).
Section 2. 632.87 (1) of the statutes is amended to read:
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).
Section 3. 632.87 (4) of the statutes is amended to read:
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).
Section 4. 632.87 (4e) of the statutes is created to read:
632.87 (4e) In this subsection, “dental therapist” means an individual licensed under s. 447.04 (1m).
(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).
Section 9323. Initial applicability; Insurance.
(1) Dental therapist coverage.
(a) For policies and plans containing provisions inconsistent with ss. 609.718 and 632.87 (1), (4), and (4e), the treatment of ss. 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).
(b) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with ss. 609.718 and 632.87 (1), (4), and (4e), the treatment of ss. 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.
Section 9423. Effective dates; Insurance.
(1) Dental therapist coverage. The treatment of ss. 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.
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