AB43: Bill Text

AB43,,8918 24. Gonorrhea prophylaxis treatment for newborns.

AB43,,8919 25. Health history and physical exams for prenatal visits and for minors.

AB43,,8920 26. Length and weight measurements for newborns and height and weight measurements for minors.

AB43,,8921 27. Head circumference and weight-for-length measurements for newborns and minors who have not attained the age of 3 years.

AB43,,8922 28. Body mass index for minors 2 years of age or older.

AB43,,8923 29. Blood pressure measurements for minors 3 years of age or older and a blood pressure risk assessment at birth.

AB43,,8924 30. Risk assessment and referral for oral health issues for minors who have attained the age of 6 months but have not attained the age of 7 years.

AB43,,8925 31. Blood screening for newborns and minors who have not attained the age of 2 months.

AB43,,8926 32. Screening for critical congenital health defects for newborns.

AB43,,8927 33. Lead screenings in accordance with sub. (10).

AB43,,8928 34. Metabolic and hemoglobin screening and screening for phenylketonuria, sickle cell anemia, and congenital hypothyroidism for minors including newborns.

AB43,,8929 35. Tuberculin skin test based on risk assessment for minors one month of age or older.

AB43,,8930 36. Tobacco counseling and cessation interventions for individuals who are 5 years of age or older.

AB43,,8931 37. Vision and hearing screening and assessment for minors including newborns.

AB43,,8932 38. Sexually transmitted infection and human immunodeficiency virus counseling for sexually active minors.

AB43,,8933 39. Risk assessment for sexually transmitted infection for minors who are 10 years of age or older and screening for sexually transmitted infection for minors who are 16 years of age or older.

AB43,,8934 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

AB43,,8935 41. Autism screening for minors who have attained the age of 18 months but have not attained the age of 25 months.

AB43,,8936 42. Developmental screening and surveillance for minors including newborns.

AB43,,8937 43. Psychosocial and behavioral assessment for minors including newborns.

AB43,,8938 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB43,,8939 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB43,,8940 46. Screening and counseling for intimate partner violence for adult women.

AB43,,8941 47. Well-woman visits for women who have attained the age of 18 years but have not attained the age of 65 years and well-woman visits for recommended preventive services, preconception care, and prenatal care.

AB43,,8942 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB43,,8943 49. Folic acid supplement for adult women with reproductive capacity.

AB43,,8944 50. Iron deficiency anemia screening for pregnant and lactating women.

AB43,,8945 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB43,,8946 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB43,,8947 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB43,,8948 54. Screening for gonorrhea for pregnant and sexually active females 24 years of age or younger and females older than 24 years of age who are at risk for infection.

AB43,,8949 55. Screening for chlamydia for pregnant and sexually active females 24 years of age and younger and females older than 24 years of age who are at risk for infection.

AB43,,8950 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB43,,8951 57. Human immunodeficiency virus screening for adults who have attained the age of 15 years but have not attained the age of 66 years and individuals at high risk of infection who are younger than 15 years of age or older than 65 years of age.

AB43,,8952 58. All contraceptives and services in accordance with sub. (17).

AB43,,8953 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. preventive services task force.

AB43,,8954 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration’s Bright Futures project.

AB43,,8955 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the federal advisory committee on immunization practices.

AB43,,8956 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB43,,8957 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB43,,8958 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB43,,8959 3. Except as otherwise provided in this subdivision, if a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy’s or self-insured health plan’s network of providers, the policy or plan may apply deductibles to and impose copayments or coinsurance on the office visit and the preventive service. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy’s or self-insured health plan’s network of providers because there is no available health care provider in the policy’s or plan’s network of providers that provides the preventive service, the policy or plan may not apply deductibles to or impose copayments or coinsurance on the preventive service.

AB43,,8960 4. If multiple well-woman visits described under par. (b) 47. are required to fulfill all necessary preventive services and are in accordance with clinical recommendations, the disability insurance policy or self-insured health plan may not apply a deductible to or impose a copayment or coinsurance on any of those well-woman visits.

AB43,3101 Section 3101. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB43,,8962 632.895 (14) (a) 1. i. Hepatitis A and B.

AB43,,8963 j. Varicella and herpes zoster.

AB43,3102 Section 3102. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB43,,8965 632.895 (14) (a) 1. k. Human papillomavirus.

AB43,,8966 L. Meningococcal meningitis.

AB43,,8967 m. Pneumococcal pneumonia.

AB43,,8968 n. Influenza.

AB43,,8969 o. Rotavirus.

AB43,3103 Section 3103. 632.895 (14) (b) of the statutes is amended to read:

AB43,,8971 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for an insured or plan participant, including a dependent who is a child of the insured or plan participant.

AB43,3104 Section 3104. 632.895 (14) (c) of the statutes is amended to read:

AB43,,8973 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

AB43,3105 Section 3105. 632.895 (14) (d) 3. of the statutes is amended to read:

AB43,,8975 632.895 (14) (d) 3. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

AB43,3106 Section 3106. 632.895 (14m) of the statutes is created to read:

AB43,,8977 632.895 (14m) Essential health benefits. (a) In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB43,,8978 (b) On a date specified by the commissioner, by rule, every disability insurance policy, except as provided in par. (g), and every self-insured health plan shall provide coverage for essential health benefits as determined by the commissioner, by rule, subject to par. (c).

AB43,,8979 (c) In determining the essential health benefits for which coverage is required under par. (b), the commissioner shall do all of the following:

AB43,,8980 1. Include benefits, items, and services in, at least, all of the following categories:

AB43,,8981 a. Ambulatory patient services.

AB43,,8982 b. Emergency services.

AB43,,8983 c. Hospitalization.

AB43,,8984 d. Maternity and newborn care.

AB43,,8985 e. Mental health and substance use disorder services, including behavioral health treatment.

AB43,,8986 f. Prescription drugs.

AB43,,8987 g. Rehabilitative and habilitative services and devices.

AB43,,8988 h. Laboratory services.

AB43,,8989 i. Preventive and wellness services and chronic disease management.

AB43,,8990 j. Pediatric services, including oral and vision care.

AB43,,8991 2. Conduct a survey of employer-sponsored coverage to determine benefits typically covered by employers and ensure that the scope of essential health benefits for which coverage is required under this subsection is equal to the scope of benefits covered under a typical disability insurance policy offered by an employer to its employees.

AB43,,8992 3. Ensure that essential health benefits reflect a balance among the categories described in subd. 1. such that benefits are not unduly weighted toward one category.

AB43,,8993 4. Ensure that essential health benefit coverage is provided with no or limited cost-sharing requirements.

AB43,,8994 5. Require that disability insurance policies and self-insured health plans do not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.

AB43,,8995 6. Establish essential health benefits in a way that takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.

AB43,,8996 7. Ensure that essential health benefits established under this subsection are not subject to a coverage denial based on an insured’s or plan participant’s age, expected length of life, present or predicted disability, degree of dependency on medical care, or quality of life.

AB43,,8997 8. Require that disability insurance policies and self-insured health plans cover emergency department services that are essential health benefits without imposing any requirement to obtain prior authorization for those services and without limiting coverage for services provided by an emergency services provider that is not in the provider network of a policy or plan in a way that is more restrictive than requirements or limitations that apply to emergency services provided by a provider that is in the provider network of the policy or plan.

AB43,,8998 9. Require a disability insurance policy or self-insured health plan to apply to emergency department services that are essential health benefits provided by an emergency department provider that is not in the provider network of the policy or plan the same copayment amount or coinsurance rate that applies if those services are provided by a provider that is in the provider network of the policy or plan.

AB43,,8999 (d) The commissioner shall periodically update, by rule, the essential health benefits under this subsection to address any gaps in access to coverage.

AB43,,9000 (e) If an essential health benefit is also subject to mandated coverage elsewhere under this section and the coverage requirements are not identical, the disability insurance policy or self-insured health plan shall provide coverage under whichever subsection provides the insured or plan participant with more comprehensive coverage of the medical condition, item, or service.

AB43,,9001 (f) Nothing in this subsection or rules promulgated under this subsection prohibits a disability insurance policy or a self-insured health plan from providing benefits in excess of the essential health benefit coverage required under this subsection.

AB43,,9002 (g) This subsection does not apply to any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12.

AB43,3107 Section 3107. 632.895 (15m) of the statutes is created to read:

AB43,,9004 632.895 (15m) Coverage of infertility services. (a) In this subsection:

AB43,,9005 1. “Diagnosis of and treatment for infertility” means any recommended procedure or medication to treat infertility at the direction of a physician that is consistent with established, published, or approved medical practices or professional guidelines from the American College of Obstetricians and Gynecologists, or its successor organization, or the American Society for Reproductive Medicine, or its successor organization.

AB43,,9006 2. “Infertility” means a disease, condition, or status characterized by any of the following: