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AB50,287715Section 2877. 563.135 (1) (intro.) of the statutes is amended to read:
AB50,1391,1916563.135 (1) (intro.) An application for a license to conduct bingo for an
17organization listed under s. 563.11 (1) (b) to (d) shall be accompanied by a $5 $10
18license fee and a sworn statement by the owner or operator of the organization that
19all of the following rules shall apply to bingo conducted by the organization:
AB50,287820Section 2878. 563.80 (1) (intro.) and (b) of the statutes are consolidated,
21renumbered 563.80 (1) and amended to read:
AB50,1392,222563.80 (1) An occupational tax is imposed on those gross receipts of any
23licensed organization which are derived from the conduct of bingo, in the following

1amounts: (b) Two amount of 2 percent of the gross receipts received by a licensed
2organization during a year that exceed $30,000.
AB50,28793Section 2879. 563.80 (1) (a) of the statutes is repealed.
AB50,28804Section 2880. 563.92 (2) of the statutes is amended to read:
AB50,1392,145563.92 (2) The fee for a raffle license shall be $25 $50 and shall be remitted
6with the application. A raffle license shall be valid for 12 months and may be
7renewed as provided in s. 563.98 (1g). The department shall issue the license
8within 30 days after the filing of a complete application if the applicant qualifies
9under s. 563.907 and has not exceeded the limits of s. 563.91. The department shall
10notify the applicant within 15 days after it is filed if the raffle license application is
11incomplete or the application shall be considered complete. A complete license
12application that is not denied within 30 days after its filing shall be considered
13approved. All moneys received by the department under this subsection shall be
14credited to the appropriation account under s. 20.505 (8) (jn).
AB50,288115Section 2881. 601.25 of the statutes is created to read:
AB50,1392,1916601.25 Office of the public intervenor. (1) The office of the public
17intervenor shall assist individuals with insurance claims, policies, appeals, and
18other legal actions to pursue insurance coverage for medical procedures,
19prescription medications, and other health care services.
AB50,1392,2420(2) The office of the public intervenor may levy an assessment on each insurer
21that is authorized to engage in the business of insurance in this state. The
22assessment levied under this subsection shall be based on the insurers premium
23volume for disability insurance policies, as defined in s. 632.895 (1) (a), written in
24this state.
AB50,1393,2
1(3) The commissioner may provide by rule for the governance, duties, and
2administration of the office of the public intervenor.
AB50,28823Section 2882. 601.31 (1) (mv) of the statutes is created to read:
AB50,1393,64601.31 (1) (mv) For initial issuance or renewal of a license as a pharmacy
5benefit management broker or consultant under s. 628.495, amounts set by the
6commissioner by rule.
AB50,28837Section 2883. 601.31 (1) (nv) of the statutes is created to read:
AB50,1393,98601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
9representative under s. 632.863, an amount to be set by the commissioner by rule.
AB50,288410Section 2884. 601.31 (1) (nw) of the statutes is created to read:
AB50,1393,1311601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
12administrative organization under s. 632.864, an amount to be set by the
13commissioner by rule.
AB50,288514Section 2885. 601.41 (14) of the statutes is created to read:
AB50,1393,2015601.41 (14) Value-based diabetes medication pilot project. The
16commissioner shall develop a pilot project to direct a pharmacy benefit manager, as
17defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value-
18based, sole-source arrangement to reduce the costs of prescription medication used
19to treat diabetes. The commissioner may promulgate rules to implement this
20subsection.
AB50,288621Section 2886. 601.45 (1) of the statutes is amended to read:
AB50,1394,622601.45 (1) Costs to be paid by examinees. The reasonable costs of
23examinations and audits under ss. 601.43, 601.44, 601.455, and 601.83 (5) (f) shall
24be paid by examinees except as provided in sub. (4), either on the basis of a system

1of billing for actual salaries and expenses of examiners and other apportionable
2expenses, including office overhead, or by a system of regular annual billings to
3cover the costs relating to a group of companies, or a combination of such systems,
4as the commissioner may by rule prescribe. Additional funding, if any, shall be
5governed by s. 601.32. The commissioner shall schedule annual hearings under s.
6601.41 (5) to review current problems in the area of examinations.
AB50,28877Section 2887. 601.455 of the statutes is created to read:
AB50,1394,98601.455 Fair claims processing, health insurance transparency, and
9claim denial rate audits. (1) Definitions. In this section:
AB50,1394,1510(a) Claim denial means the refusal by an insurer to provide payment under
11a disability insurance policy for a service, treatment, or medication recommended
12by a health care provider. Claim denial includes the prospective refusal to pay for
13a service, treatment, or medication when a disability insurance policy requires
14advance approval before a prescribed medical service, treatment, or medication is
15provided.
AB50,1394,1616(b) Disability insurance policy has the meaning given in s. 632.895 (1) (a).
AB50,1394,1717(c) Health care provider has the meaning given in s. 146.81 (1) (a) to (p).
AB50,1394,2018(2) Claims processing. (a) Insurers shall process each claim for a disability
19insurance policy within a time frame that is reasonable and prevents an undue
20delay in an insureds care, taking into account the medical urgency of the claim.
AB50,1394,2421(b) If an insurer determines additional information is needed to process a
22claim for a disability insurance policy, the insurer shall request the information
23from the insured within 5 business days of making the determination and shall
24provide at least 15 days for the insured to respond.
AB50,1395,1
1(c) All claim denials shall include all of the following:
AB50,1395,321. A specific and detailed explanation of the reason for the denial that cites
3the exact medical or policy basis for the denial.
AB50,1395,642. A copy of or a publicly accessible link to any policy, coverage rules, clinical
5guidelines, or medical evidence relied upon in making the denial decision, with
6specific citation to the provision justifying the denial.
AB50,1395,973. Additional documentation, medical rationale, or criteria that must be met
8or provided for approval of the claim, including alternative options available under
9the policy.
AB50,1395,1210(d) If an insurer uses artificial intelligence or algorithmic decision-making in
11processing a claim for a disability insurance policy, the insurer must notify the
12insured in writing of that fact. The notice shall include all of the following:
AB50,1395,15131. A disclosure that artificial intelligence or algorithmic decision-making was
14used at any stage in reviewing the claim, even if a human later reviewed the
15outcome.
AB50,1395,18162. A detailed explanation of how the artificial intelligence or algorithmic
17decision-making reached its decision, including any factors the artificial
18intelligence or algorithmic decision-making weighed.
AB50,1395,20193. A contact point for requesting a human review of the claim if the claim was
20denied.
AB50,1395,2321(3) Independent review of denials. In addition to an insureds right to an
22independent review under s. 632.835, as applicable, insureds have the right to
23request a review by the office of the public intervenor of any claim denial.
AB50,1396,2
1(4) Prohibited practices. An insurer may not do any of the following with
2respect to a disability insurance policy:
AB50,1396,33(a) Use vague or misleading policy terms to justify a claim denial.
AB50,1396,44(b) Fail to provide a specific and comprehensible reason for a claim denial.
AB50,1396,65(c) Cancel coverage under the policy after a claim is submitted due to alleged
6misstatements on the policy application.
AB50,1396,87(d) Deny a claim based on hidden or ambiguous exclusions in a disability
8insurance policy.
AB50,1396,99(e) Stall review of a claim to avoid timely payment.
AB50,1396,1110(f) Reject a claim without reviewing all relevant medical records or consulting
11qualified experts.
AB50,1396,1312(g) Fail to properly review or respond to an insureds appeal in a timely
13manner.
AB50,1396,1514(h) Allow non-physician personnel to determine whether care is medically
15necessary.
AB50,1396,1716(i) Apply different medical necessity criteria based on financial interests
17rather than patient needs.
AB50,1396,1918(j) Disregard a treating health care providers medical assessment without a
19valid clinical reason.
AB50,1396,2120(k) Mandate prior approval for routine or urgent procedures in a manner that
21causes harmful delays.
AB50,1396,2422(L) For a disability insurance policy that provides coverage of emergency
23medical services, refuse to cover emergency medical services provided by out-of-
24network providers.
AB50,1397,2
1(m) List a health care provider as in-network on a provider directory and then
2deny a claim by stating the health care provider is out-of-network.
AB50,1397,43(n) Deny coverage based on age, gender, disability, or a chronic condition
4rather than medical necessity.
AB50,1397,65(o) Apply stricter standards in reviewing claims related to mental health
6conditions than claims related to physical health conditions.
AB50,1397,87(p) Perform a blanket denial of claims for high-cost conditions without an
8individualized review of each claim.
AB50,1397,99(r) Reclassify a claim to a lower-cost treatment to reduce insurer payout.
AB50,1397,1110(s) Require an insured to fail a cheaper treatment before approving coverage
11for necessary care.
AB50,1397,1212(t) Manipulate cost-sharing rules to shift higher costs to insureds.
AB50,1397,1713(5) Transparency and reporting. (a) Beginning on January 1, 2027, an
14insurer shall annually publish a report detailing the insurers claim denial rates,
15reasons for claim denials, and the outcome of any appeal of a claim denial for the
16previous year for all disability insurance policies under which the insurer provides
17coverage.
AB50,1397,1918(b) The commissioner shall maintain a public database of insurers claim
19denial rates and the outcomes of independent reviews under s. 632.835.
AB50,1397,2320(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence
21or algorithmic decision-making in claims processing shall annually publish a report
22detailing all of the following for the previous year for all disability insurance policies
23under which the insurer provides coverage:
AB50,1398,2
11. The percentage of claims submitted to the insurer that were reviewed by
2artificial intelligence or algorithmic decision-making.
AB50,1398,532. The claim denial rate of claims reviewed by artificial intelligence or
4algorithmic decision-making compared to the claim denial rate of claims reviewed
5by humans.
AB50,1398,763. The steps the insurer takes to ensure fairness and accuracy in decisions
7made by artificial intelligence or algorithmic decision-making.
AB50,1398,118(6) Claim denial rate audits. (a) The commissioner may conduct an audit
9of an insurer if the insurers claim denials are of such frequency as to indicate a
10general business practice. This paragraph is supplemental to and does not limit
11any other powers or duties of the commissioner.
AB50,1398,1312(b) The commissioner may collect any relevant information from an insurer
13that is necessary to conduct an audit under par. (a).
AB50,1398,1514(c) The commissioner may contract with a 3rd party to conduct an audit under
15par. (a).
AB50,1398,2016(d) The commissioner may, based on the findings of an audit under par. (a),
17order the insurer who is the subject of the audit to comply with a corrective action
18plan approved by the commissioner. The commissioner shall specify in any
19corrective action plan under this paragraph the deadline by which an insurer must
20be in compliance with the corrective action plan.
AB50,1398,2221(e) An insurer who is the subject of an audit under par. (a) shall provide a
22written response to any adverse findings of the audit.
AB50,1399,223(f) If an insurer fails to comply with a corrective action plan under par. (d) by

1the deadline specified by the commissioner, the commissioner may order the
2insurer to pay a forfeiture pursuant to s. 601.64 (3).
AB50,1399,63(7) Forfeitures. A violation of this section that results in a harmful delay in
4an insureds care or an adverse health outcome for an insured shall be subject to a
5civil forfeiture of $10,000 per occurrence, in addition to any other penalties provided
6in s. 601.64 (3) or other law.
AB50,28887Section 2888. 601.575 of the statutes is created to read:
AB50,1399,138601.575 Prescription drug importation program. (1) Importation
9program requirements. The commissioner, in consultation with persons
10interested in the sale and pricing of prescription drugs and appropriate officials
11and agencies of the federal government, shall design and implement a prescription
12drug importation program for the benefit of residents of this state, that generates
13savings for residents, and that satisfies all of the following:
AB50,1399,1614(a) The commissioner shall designate a state agency to become a licensed
15wholesale distributor or to contract with a licensed wholesale distributor and shall
16seek federal certification and approval to import prescription drugs.
AB50,1399,1817(b) The program shall comply with relevant requirements of 21 USC 384,
18including safety and cost savings requirements.
AB50,1399,2019(c) The program shall import prescription drugs from Canadian suppliers
20regulated under any appropriate Canadian or provincial laws.
AB50,1399,2221(d) The program shall have a process to sample the purity, chemical
22composition, and potency of imported prescription drugs.
AB50,1400,223(e) The program shall import only those prescription drugs for which
24importation creates substantial savings for residents of this state and only those

1prescription drugs that are not brand-name drugs and that have fewer than 4
2competitor prescription drugs in the United States.
AB50,1400,43(f) The commissioner shall ensure that prescription drugs imported under the
4program are not distributed, dispensed, or sold outside of this state.
AB50,1400,55(g) The program shall ensure all of the following:
AB50,1400,761. Participation by any pharmacy or health care provider in the program is
7voluntary.
AB50,1400,982. Any pharmacy or health care provider participating in the program has the
9appropriate license or other credential in this state.
AB50,1400,12103. Any pharmacy or health care provider participating in the program charges
11a consumer or health plan the actual acquisition cost of the imported prescription
12drug that is dispensed.
AB50,1400,1613(h) The program shall ensure that a payment by a health plan or health
14insurance policy for a prescription drug imported under the program reimburses no
15more than the actual acquisition cost of the imported prescription drug that is
16dispensed.
AB50,1400,1817(i) The program shall ensure that any health plan or health insurance policy
18participating in the program does all of the following:
AB50,1400,20191. Maintains a formulary and claims payment system with current
20information on prescription drugs imported under the program.
AB50,1400,23212. Bases cost-sharing amounts for participants or insureds under the plan or
22policy on no more than the actual acquisition cost of the prescription drug imported
23under the program that is dispensed to the participant or insured.
AB50,1401,3
13. Demonstrates to the commissioner or a state agency designated by the
2commissioner how premiums under the plan or policy are affected by savings on
3prescription drugs imported under the program.
AB50,1401,64(j) Any wholesale distributor importing prescription drugs under the program
5shall limit its profit margin to the amount established by the commissioner or a
6state agency designated by the commissioner.
AB50,1401,87(k) The program may not import any generic prescription drug that would
8violate federal patent laws on branded products in the United States.
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