AB50,1417,85(he) The commissioner shall ensure that sufficient funds are available for the
6healthcare stability plan under this section to operate as described in the approval
7of the federal department of health and human services dated July 29, 2018, and in
8any waiver extension approvals.
AB50,28969Section 2896. 601.83 (1) (h) 1. to 3. of the statutes are created to read:
AB50,1417,1010601.83 (1) (h) 1. In 2025, $230,000,000.
AB50,1417,11112. In 2026, $250,000,000.
AB50,1417,20123. In 2027 and in each year thereafter, the maximum expenditure amount for
13the previous year, adjusted to reflect the percentage increase, if any, in the
14consumer price index for all urban consumers, U.S. city average, for the medical
15care group, as determined by the U.S. department of labor, for the 12-month period
16ending on December 31 of the year before the year in which the amount is
17determined. The commissioner shall determine the annual adjustment amount for
18a particular year in January of the previous year. The commissioner shall publish
19the new maximum expenditure amount under this subdivision each year in the
20Wisconsin Administrative Register.
AB50,289721Section 2897. 601.83 (1) (hm) of the statutes is repealed.
AB50,289822Section 2898. 609.04 of the statutes is created to read:
AB50,1417,2423609.04 Preventing surprise medical bills; emergency medical
24services. (1) Definitions. In this section:
AB50,1418,1
1(a) Emergency medical condition means all of the following:
AB50,1418,521. A medical condition, including a mental health condition or substance use
3disorder condition, manifesting itself by acute symptoms of sufficient severity,
4including severe pain, such that the absence of immediate medical attention could
5reasonably be expected to result in any of the following:
AB50,1418,76a. Placing the health of the individual or, with respect to a pregnant woman,
7the health of the woman or her unborn child in serious jeopardy.
AB50,1418,88b. Serious impairment of bodily function.
AB50,1418,99c. Serious dysfunction of any bodily organ or part.
AB50,1418,13102. With respect to a pregnant woman who is having contractions, a medical
11condition for which there is inadequate time to safely transfer the pregnant woman
12to another hospital before delivery or for which the transfer may pose a threat to the
13health or safety of the pregnant woman or the unborn child.
AB50,1418,1614(b) Emergency medical services, with respect to an emergency medical
15condition, has the meaning given for emergency services in 42 USC 300gg-111 (a)
16(3) (C).
AB50,1418,1817(c) Independent freestanding emergency department has the meaning given
18in 42 USC 300gg-111 (a) (3) (D).
AB50,1418,2019(d) Out-of-network rate has the meaning given by the commissioner by rule
20or, in the absence of such rule, the meaning given in 42 USC 300gg-111 (a) (3) (K).
AB50,1419,221(e) Preferred provider plan, notwithstanding s. 609.01 (4), includes only any
22preferred provider plan, as defined in s. 609.01 (4), that has a network of

1participating providers and imposes on enrollees different requirements for using
2providers that are not participating providers.
AB50,1419,43(f) Recognized amount has the meaning given by the commissioner by rule
4or, in the absence of such rule, the meaning given in 42 USC 300gg-111 (a) (3) (H).
AB50,1419,85(g) Self-insured governmental plan means a self-insured health plan of the
6state or a county, city, village, town, or school district that has a network of
7participating providers and imposes on enrollees in the self-insured health plan
8different requirements for using providers that are not participating providers.
AB50,1419,119(h) Terminated means the expiration or nonrenewal of a contract.
10Terminated does not include a termination of a contract for failure to meet
11applicable quality standards or for fraud.
AB50,1419,1612(2) Emergency medical services. A defined network plan, preferred
13provider plan, or self-insured governmental plan that covers any benefits or
14services provided in an emergency department of a hospital or emergency medical
15services provided in an independent freestanding emergency department shall
16cover emergency medical services in accordance with all of the following:
AB50,1419,1717(a) The plan may not require a prior authorization determination.
AB50,1419,2018(b) The plan may not deny coverage on the basis of whether or not the health
19care provider providing the services is a participating provider or participating
20facility.
AB50,1419,2321(c) If the emergency medical services are provided to an enrollee by a provider
22or in a facility that is not a participating provider or participating facility, the plan
23complies with all of the following:
AB50,1420,4
11. The emergency medical services are covered without imposing on an
2enrollee a requirement for prior authorization or any coverage limitation that is
3more restrictive than requirements or limitations that apply to emergency medical
4services provided by participating providers or in participating facilities.
AB50,1420,852. Any cost-sharing requirement imposed on an enrollee for the emergency
6medical services is no greater than the requirements that would apply if the
7emergency medical services were provided by a participating provider or in a
8participating facility.
AB50,1420,1393. Any cost-sharing amount imposed on an enrollee for the emergency medical
10services is calculated as if the total amount that would have been charged for the
11emergency medical services if provided by a participating provider or in a
12participating facility is equal to the recognized amount for such services, plan or
13coverage, and year.
AB50,1420,14144. The plan does all of the following: