AB50: Bill Text

AB50,1478,23 43. Psychosocial and behavioral assessment for minors including newborns.

AB50,1479,2 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB50,1479,4 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB50,1479,5 46. Screening and counseling for intimate partner violence for adult women.

AB50,1479,8 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.

AB50,1479,10 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB50,1479,11 49. Folic acid supplement for adult women with reproductive capacity.

AB50,1479,12 50. Iron deficiency anemia screening for pregnant and lactating women.

AB50,1479,14 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB50,1479,16 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB50,1479,17 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB50,1479,20 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.

AB50,1479,23 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.

AB50,1480,2 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB50,1480,5 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.

AB50,1480,6 58. All contraceptives and services in accordance with sub. (17).

AB50,1480,8 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.

AB50,1480,11 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.

AB50,1480,14 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.

AB50,1480,18 (c) Subject to par. (d), no disability insurance policy, except any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12., 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.

AB50,1480,22 (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.

AB50,1481,2 2. If the primary reason for an office visit is not to obtain a preventive service specified under par. (b), the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB50,1481,12 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.

AB50,1481,17 4. If more than one well-woman visit described under par. (b) 47. is necessary to provide all necessary preventive services as determined by a qualified health care provider and in accordance with applicable recommendations for preventive services, the disability insurance policy or self-insured health plan may not apply a deductible to or impose a copayment or coinsurance on any such well-woman visit.

AB50,2961 Section 2961. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB50,1481,19 632.895 (14) (a) 1. i. Hepatitis A and B.

AB50,1481,20 j. Varicella and herpes zoster.

AB50,2962 Section 2962. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB50,1481,22 632.895 (14) (a) 1. k. Human papillomavirus.

AB50,1481,23 L. Meningococcal meningitis.

AB50,1482,1 m. Pneumococcal pneumonia.

AB50,1482,2 n. Influenza.

AB50,1482,3 o. Rotavirus.

AB50,2963 Section 2963. 632.895 (14) (b) of the statutes is amended to read:

AB50,1482,10 632.895 (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.

AB50,2964 Section 2964. 632.895 (14) (c) of the statutes is amended to read:

AB50,1482,16 632.895 (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.

AB50,2965 Section 2965. 632.895 (14) (d) 3. of the statutes is amended to read:

AB50,1482,20 632.895 (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).

AB50,2966 Section 2966. 632.895 (14m) of the statutes is created to read:

AB50,1482,23 632.895 (14m) Essential health benefits. (a) In this subsection, “self- insured health plan” has the meaning given in s. 632.85 (1) (c).

AB50,1483,4 (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).

AB50,1483,6 (c) In determining the essential health benefits for which coverage is required under par. (b), the commissioner shall do all of the following:

AB50,1483,8 1. Include benefits, items, and services in, at least, all of the following categories:

AB50,1483,9 a. Ambulatory patient services.

AB50,1483,10 b. Emergency services.

AB50,1483,11 c. Hospitalization.

AB50,1483,12 d. Maternity and newborn care.

AB50,1483,14 e. Mental health and substance use disorder services, including behavioral health treatment.

AB50,1483,15 f. Prescription drugs.

AB50,1483,16 g. Rehabilitative and habilitative services and devices.

AB50,1483,17 h. Laboratory services.

AB50,1483,18 i. Preventive and wellness services and chronic disease management.

AB50,1483,19 j. Pediatric services, including oral and vision care.

AB50,1484,2 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.

AB50,1484,5 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.

AB50,1484,7 4. Ensure that essential health benefit coverage is provided with no or limited cost-sharing requirements.

AB50,1484,11 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.

AB50,1484,14 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.

AB50,1484,18 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.

AB50,1485,2 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.

AB50,1485,7 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.

AB50,1485,9 (d) The commissioner shall periodically update, by rule, the essential health benefits under this subsection to address any gaps in access to coverage.

AB50,1485,14 (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.

AB50,1485,18 (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.

AB50,1485,20 (g) This subsection does not apply to any disability insurance policy that is described in s. 632.745 (11) (b) 1. to 12.

AB50,2967 Section 2967. 632.895 (15m) of the statutes is created to read:

AB50,1485,22 632.895 (15m) Coverage of infertility services. (a) In this subsection:

AB50,1486,5 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.

AB50,1486,7 2. “Infertility” means a disease, condition, or status characterized by any of the following:

AB50,1486,12 a. The failure to establish a pregnancy or carry a pregnancy to a live birth after regular, unprotected sexual intercourse for, if the woman is under the age of 35, no longer than 12 months or, if the woman is 35 years of age or older, no longer than 6 months, including any time during those 12 months or 6 months that the woman has a pregnancy that results in a miscarriage.

AB50,1486,14 b. An individual’s inability to reproduce either as a single individual or with a partner without medical intervention.

AB50,1486,16 c. A physician’s findings based on a patient’s medical, sexual, and reproductive history, age, physical findings, or diagnostic testing.

AB50,1486,18 3. “Self-insured health plan” means a self-insured health plan of the state or a county, city, village, town, or school district.

AB50,1487,2 4. “Standard fertility preservation service” means a procedure that is consistent with established medical practices or professional guidelines published by the American Society for Reproductive Medicine, or its successor organization, or the American Society of Clinical Oncology, or its successor organization, for a person who has a medical condition or is expected to undergo medication therapy, surgery, radiation, chemotherapy, or other medical treatment that is recognized by medical professionals to cause a risk of impairment to fertility.

AB50,1487,10 (b) Subject to pars. (c) to (e), every disability insurance policy and self-insured health plan that provides coverage for medical or hospital expenses shall cover diagnosis of and treatment for infertility and standard fertility preservation services. Coverage required under this paragraph includes at least 4 completed oocyte retrievals with unlimited embryo transfers, in accordance with the guidelines of the American Society for Reproductive Medicine, or its successor organization, and single embryo transfer when recommended and medically appropriate.

AB50,1487,12 (c) 1. A disability insurance policy or self-insured health plan may not do any of the following:

AB50,1487,15 a. Impose any exclusion, limitation, or other restriction on coverage required under par. (b) based on a covered individual’s participation in fertility services provided by or to a 3rd party.

AB50,1487,19 b. Impose any exclusion, limitation, or other restriction on coverage of medications that are required to be covered under par. (b) that are different from those imposed on any other prescription medications covered under the policy or plan.

AB50,1488,3 c. Impose any exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction on coverage that is required under par. (b) of diagnosis of and treatment for infertility and standard fertility preservation services that is different from an exclusion, limitation, cost-sharing requirement, benefit maximum, waiting period, or other restriction imposed on benefits for services that are covered by the policy or plan and that are not related to infertility.

AB50,1488,7 2. A disability insurance policy or self-insured health plan shall provide coverage required under par. (b) to any covered individual under the policy or plan, including any covered spouse or nonspouse dependent, to the same extent as other pregnancy-related benefits covered under the policy or plan.

AB50,1488,13 (d) The commissioner, after consulting with the department of health services on appropriate treatment for infertility, shall promulgate any rules necessary to implement this subsection. Before the promulgation of rules, disability insurance policies and self-insured health plans are considered to comply with the coverage requirements of par. (b) if the coverage conforms to the standards of the American Society for Reproductive Medicine.

AB50,1488,15 (e) This subsection does not apply to a disability insurance policy that is described under s. 632.745 (11) (b) 1. to 12.

AB50,2968 Section 2968. 632.895 (16m) (b) of the statutes is amended to read:

AB50,1488,21 632.895 (16m) (b) The coverage required under this subsection may be subject to any limitations, or exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. The coverage required under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB50,2969 Section 2969. 632.895 (17) (b) 1m. of the statutes is created to read:

AB50,1489,2 632.895 (17) (b) 1m. Oral contraceptives that are lawfully furnished over the counter without a prescription.

AB50,2970 Section 2970. 632.895 (17) (b) 2. of the statutes is amended to read:

AB50,1489,8 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan sterilization procedures, and patient education and counseling for all females with reproductive capacity.