AB56: Bill Text

AB56,2061 Section 2061 . 462.02 (2) (d) of the statutes is amended to read:

AB56,1018,24 462.02 (2) (d) A dentist licensed under s. 447.04 (1), a dental therapist licensed under s. 447.04 (1m), a dental hygienist licensed under s. 447.04 (2), or a person under the direct supervision of a dentist.

AB56,2062 Section 2062 . 462.04 of the statutes is amended to read:

AB56,1019,9 462.04 Prescription or order required. A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a dentist licensed under s. 447.04 (1), a dental therapist licensed under s. 447.04 (1m), a podiatrist licensed under s. 448.63, a chiropractor licensed under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), a physician assistant licensed under s. 448.04 (1) (f), or, subject to s. 448.56 (7) (a), a physical therapist licensed under s. 448.53.

AB56,2063 Section 2063 . 463.10 (5) of the statutes is amended to read:

AB56,1019,14 463.10 (5) Exception. Subsections (2) to (4m) do not apply to a dentist who is licensed under s. 447.03 (1) or to a , dental therapist, or physician who tattoos or offers to tattoo a person in the course of the dentist's, dental therapist's, or physician's professional practice.

AB56,2064 Section 2064 . 463.12 (5) of the statutes is amended to read:

AB56,1019,19 463.12 (5) Exception. Subsections (2) to (4m) do not apply to a dentist who is licensed under s. 447.03 (1) or to a , dental therapist, or physician who pierces the body of or offers to pierce the body of a person in the course of the dentist's, dental therapist's, or physician's professional practice.

AB56,2065 Section 2065. 565.10 (17) of the statutes is created to read:

AB56,1020,2 565.10 (17) Setoff against retailer compensation. The department shall setoff any debt or other amount owed to the department, regardless of the origin, nature, or date of the debt or amount, against any compensation or payment owed to a lottery retailer under this chapter, whether owed by statute, rule, or contract. If, after the setoff, additional compensation or payment is due, the department shall setoff the remaining amount against all certified debts owed by the lottery retailer under ss. 71.93 and 71.935.

AB56,2066 Section 2066. 565.12 (1) (intro.) of the statutes is amended to read:

AB56,1020,6 565.12 (1) (intro.) A lottery retailer contract entered into under s. 565.10 may be terminated or suspended for a specified period if the department finds that the retailer has done any of the following before or after the contract was entered into:

AB56,2067 Section 2067. 565.30 (5) of the statutes is amended to read:

AB56,1021,13 565.30 (5) Withholding of delinquent state taxes, child support or debts owed the state. The administrator shall report the name, address and social security number or federal income tax number of each winner of a lottery prize equal to or greater than $600 and the name, address and social security number or federal income tax number of each person to whom a lottery prize equal to or greater than $600 has been assigned to the department of revenue to determine whether the payee or assignee of the prize is delinquent in the payment of state taxes under ch. 71, 72, 76, 77, 78 or 139 or, if applicable, in the court-ordered payment of child support or has a debt owing to the state under s. 71.93 or 71.935. Upon receipt of a report under this subsection, the department of revenue shall first ascertain based on certifications by the department of children and families or its designee under s. 49.855 (1) whether any person named in the report is currently delinquent in court-ordered payment of child support, and shall next certify to the administrator, whether any person named in the report is delinquent in court-ordered payment of child support or based on certifications by the department of children and families under s. 49.855 (1), is delinquent in the payment of state taxes under ch. 71, 72, 76, 77, 78 or 139, or has a debt under s. 71.93 or 71.935. Upon this certification by the department of revenue or upon court order the administrator shall withhold the certified amount and send it to the department of revenue for remittance to the appropriate agency or person. The department of revenue shall charge the winner or assignee of the lottery prize for the department of revenue's administrative expenses associated with withholding and remitting debt owed to a state agency a collection fee and may withhold the amount of the administrative expenses collection fee from the prize payment. The administrative expenses collection fee received or withheld by the department of revenue shall be credited to the appropriation under s. 20.566 (1) (h). In instances in which the payee or assignee of the prize is delinquent both in payments for state taxes and in court-ordered payments of child support, or is delinquent in one or both of these payments and has a debt owing to the state under s. 71.93 or 71.935, the amount remitted to the appropriate agency or person shall be in proportion to the prize amount as is the delinquency or debt owed by the payee or assignee setoff under s. 71.93 (3) (a).

AB56,2068 Section 2068. 601.31 (1) (n) of the statutes is amended to read:

AB56,1021,18 601.31 (1) (n) For appointing, or renewing an appointment of, an agent under s. 628.11, $16 annually for resident agents or $30 $40 annually for nonresident agents, unless the commissioner sets a higher fee by rule, to be paid at times and under procedures set by the commissioner.

AB56,2069 Section 2069 . 601.83 (1) (a) of the statutes is amended to read:

AB56,1022,7 601.83 (1) (a) The commissioner shall administer a state-based reinsurance program known as the healthcare stability plan in accordance with the specific terms and conditions approved by the federal department of health and human services dated July 29, 2018. Before December 31, 2023, the commissioner may not request from the federal department of health and human services a modification, suspension, withdrawal, or termination of the waiver under 42 USC 18052 under which the healthcare stability plan under this subchapter operates unless legislation has been enacted specifically directing the modification, suspension, withdrawal, or termination. Before December 31, 2023, the commissioner may request renewal, without substantive change, of the waiver under 42 USC 18052 under which the health care stability plan operates in accordance with s. 20.940 (4) unless legislation has been enacted that is contrary to such a renewal request. The commissioner shall comply with applicable timing in and requirements of s. 20.940.

AB56,2070 Section 2070. 609.713 of the statutes is created to read:

AB56,1022,10 609.713 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

AB56,2071 Section 2071. 609.847 of the statutes is created to read:

AB56,1022,14 609.847 Preexisting condition discrimination and certain benefit limits prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.728.

AB56,2072 Section 2072. 625.12 (1) (a) of the statutes is amended to read:

AB56,1022,17 625.12 (1) (a) Past and prospective loss and expense experience within and outside of this state, except as provided in s. 632.728.

AB56,2073 Section 2073. 625.12 (1) (e) of the statutes is amended to read:

AB56,1022,20 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, including the judgment of technical personnel.

AB56,2074 Section 2074. 625.12 (2) of the statutes is amended to read:

AB56,1023,5 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

AB56,2075 Section 2075. 625.15 (1) of the statutes is amended to read:

AB56,1023,14 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may itself establish rates and supplementary rate information for one or more market segments based on the factors in s. 625.12 and, if the rates are for motor vehicle liability insurance, subject to s. 632.365, or the insurer may use rates and supplementary rate information prepared by a rate service organization, with average expense factors determined by the rate service organization or with such modification for its own expense and loss experience as the credibility of that experience allows.

AB56,2076 Section 2076. 628.34 (3) (a) of the statutes is amended to read:

AB56,1023,22 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB56,2077 Section 2077 . 632.35 of the statutes is amended to read:

AB56,1024,3 632.35 Prohibited rejection, cancellation and nonrenewal. No insurer may cancel or refuse to issue or renew an automobile insurance policy wholly or partially because of one or more of the following characteristics of any person: age, sex, residence, race, color, creed, religion, national origin, ancestry, marital status or, occupation, or status as a holder or nonholder of a license under s. 343.03 (3m).

AB56,2078 Section 2078. 632.697 of the statutes is amended to read:

AB56,1024,13 632.697 Benefits subject to department's right to recover. Death benefits payable under a life insurance policy or an annuity are subject to the right of the department of health services to recover under s. 46.27 (7g) , 2017 stats., 49.496, 49.682, or 49.849 an amount equal to the medical assistance that is recoverable under s. 49.496 (3) (a), an amount equal to aid under s. 49.68, 49.683, 49.685, or 49.785 that is recoverable under s. 49.682 (2) (a) or (am), or an amount equal to long-term community support services under s. 46.27, 2017 stats., that is recoverable under s. 46.27 (7g) (c) 1., 2017 stats., and that was paid on behalf of the deceased policyholder or annuitant.

AB56,2079 Section 2079. 632.728 of the statutes is created to read:

AB56,1024,16 632.728 Coverage of persons with preexisting conditions; guaranteed issue; benefit limits. (1) Definitions. In this section:

AB56,1024,17 (a) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB56,1024,18 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB56,1024,24 (2) Guaranteed issue. (a) Every individual health benefit plan shall accept every individual in this state who, and every group health benefit plan shall accept every employer in this state that, applies for coverage, regardless of sexual orientation, gender identity, or whether or not any employee or individual has a preexisting condition. A health benefit plan may restrict enrollment in coverage described in this paragraph to open or special enrollment periods.

AB56,1025,3 (b) The commissioner shall establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan to allow individuals, including individuals who do not have coverage, to enroll in coverage.

AB56,1025,8 (3) Prohibiting discrimination based on health status. (a) An individual health benefit plan or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

AB56,1025,9 1. Health status.

AB56,1025,10 2. Medical condition, including both physical and mental illnesses.

AB56,1025,11 3. Claims experience.

AB56,1025,12 4. Receipt of health care.

AB56,1025,13 5. Medical history.

AB56,1025,14 6. Genetic information.

AB56,1025,16 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

AB56,1025,17 8. Disability.

AB56,1025,24 (b) An insurer offering an individual health benefit plan or a self-insured health plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor under par. (a) with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the plan.

AB56,1026,4 (c) Nothing in this subsection prevents an insurer offering an individual health benefit plan or a self-insured health plan from establishing premium discounts or rebates or modifying otherwise applicable cost sharing in return for adherence to programs of health promotion and disease prevention.

AB56,1026,7 (4) Premium rate variation. A health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific plan based only on the following considerations:

AB56,1026,8 (a) Whether the policy or plan covers an individual or a family.

AB56,1026,9 (b) Rating area in the state, as established by the commissioner.

AB56,1026,12 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

AB56,1026,13 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

AB56,1026,15 (5) Annual and lifetime limits. An individual or group health benefit plan or a self-insured health plan may not establish any of the following:

AB56,1026,17 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

AB56,1026,19 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

AB56,1027,2 (6) Short-term plans. This section and s. 632.76 apply to every short-term, limited-duration health insurance policy. In this subsection, “short-term, limited-duration health insurance policy” means health coverage that is provided under a contract with an insurer, has an expiration date specified in the contract that is less than 12 months after the original effective date of the contract, and, taking into account renewals or extensions, has a duration of no longer than 36 months in total. “Short-term, limited-duration health insurance policy” includes any short-term policy subject to s. 632.7495 (4).

AB56,2080 Section 2080. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and amended to read:

AB56,1027,11 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health benefit plan may, with respect to a participant or beneficiary under the plan, not impose a preexisting condition exclusion only if the exclusion relates to a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received within the 6-month period ending on the participant's or beneficiary's enrollment date under the plan on a participant or beneficiary under the plan.

AB56,2081 Section 2081. 632.746 (1) (b) of the statutes is repealed.

AB56,2082 Section 2082. 632.746 (2) (a) of the statutes is amended to read:

AB56,1027,17 632.746 (2) (a) An insurer offering a group health benefit plan may not treat impose a preexisting condition exclusion based on genetic information as a preexisting condition under sub. (1) without a diagnosis of a condition related to the information.

AB56,2083 Section 2083. 632.746 (2) (c), (d) and (e) of the statutes are repealed.

AB56,2084 Section 2084. 632.746 (3) (a) of the statutes is repealed.

AB56,2085 Section 2085 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).

AB56,2086 Section 2086 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.

AB56,2087 Section 2087 . 632.746 (5) of the statutes is repealed.

AB56,2088 Section 2088. 632.746 (8) (a) (intro.) of the statutes is amended to read:

AB56,1028,2 632.746 (8) (a) (intro.) A health maintenance organization that offers a group health benefit plan and that does not impose any preexisting condition exclusion under sub. (1) with respect to a particular coverage option may impose an affiliation period for that coverage option, but only if all of the following apply:

AB56,2089 Section 2089 . 632.748 (2) of the statutes is amended to read:

AB56,1028,10 632.748 (2) An insurer offering a group health benefit plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the plan.

AB56,2090 Section 2090. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:

AB56,1028,20 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years from the date of issue of the policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of loss. This paragraph does not apply to a group health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s. 632.85 (1) (c).

AB56,1029,2 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability commencing after 12 months from the date of issue of under an individual disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of the loss.

AB56,1029,9 2. Except as provided in subd. 3., an An individual disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 (4) and (5), may not define a preexisting condition more restrictively than a condition that was present before the date of enrollment for the coverage, whether physical or mental, regardless of the cause of the condition, for which and regardless of whether medical advice, diagnosis, care, or treatment was recommended or received within 12 months before the effective date of coverage.

AB56,2091 Section 2091. 632.76 (2) (ac) 3. of the statutes is repealed.

AB56,2092 Section 2092. 632.795 (4) (a) of the statutes is amended to read:

AB56,1029,23 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the same policy form and for the same premium as it originally offered in the most recent enrollment period, subject only to the medical underwriting used in that enrollment period. Unless otherwise prescribed by rule, the insurer may apply deductibles, preexisting condition limitations, waiting periods , or other limits only to the extent that they would have been applicable had coverage been extended at the time of the most recent enrollment period and with credit for the satisfaction or partial satisfaction of similar provisions under the liquidated insurer's policy or plan. The insurer may exclude coverage of claims that are payable by a solvent insurer under insolvency coverage required by the commissioner or by the insurance regulator of another jurisdiction. Coverage shall be effective on the date that the liquidated insurer's coverage terminates.

AB56,2093 Section 2093. 632.796 of the statutes is created to read:

AB56,1030,2 632.796 Drug cost report. (1) Definition. In this section, “ disability insurance policy” has the meaning given in s. 632.895 (1) (a).

AB56,1030,8 (2) Report required. Annually, at the time the insurer files its rate request with the commissioner, each insurer that offers a disability insurance policy that covers prescription drugs shall submit to the commissioner a report that identifies the 25 prescription drugs that are the highest cost to the insurer and the 25 prescription drugs that have the highest cost increases over the 12 months before the submission of the report.

AB56,2094 Section 2094. 632.865 (3) of the statutes is created to read:

AB56,1030,12 632.865 (3) Registration required. (a) No person may perform any activities of a pharmacy benefit manager in this state without first registering with the commissioner under this subsection.

AB56,1030,15 (b) The commissioner shall establish a registration procedure for pharmacy benefit managers. The commissioner may promulgate any rules necessary to implement the registration procedure under this paragraph.