AB50,1428,19 609.24 (5) Duration of benefits. If an enrollee is a continuing care patient, as defined in s. 609.04 (7) (a), and if any of the situations described under s. 609.04 (7) (b) (intro.) applies, all of the following apply to the enrollee’s defined network plan:

AB50,1428,22 (a) Subsection (1) (c) shall apply to any of the participating providers providing the enrollee’s course of treatment under s. 609.04 (7), including the enrollee’s primary care physician.

AB50,1429,2 (b) Subsection (1) (c) shall apply to lengthen the period in which benefits are provided under s. 609.04 (7) (b) 3. but may not be applied to shorten the period in which benefits are provided under s. 609.04 (7) (b) 3.

AB50,1429,4 (c) Subsection (1) (d) may not be applied in a manner that limits the enrollee’s rights under s. 609.04 (7) (b) 3.

AB50,1429,7 (d) No plan may contract or arrange with a participating provider to provide notice of the termination of the participating provider’s participation, pursuant to sub. (4).

AB50,2901 Section 2901. 609.40 of the statutes is created to read:

AB50,1429,10 609.40 Special enrollment period for pregnancy. Preferred provider plans and defined network plans are subject to s. 632.7498.

AB50,2902 Section 2902. 609.712 of the statutes is created to read:

AB50,1429,14 609.712 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

AB50,2903 Section 2903. 609.713 of the statutes is created to read:

AB50,1429,18 609.713 Qualified treatment trainee coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (7).

AB50,2904 Section 2904. 609.714 of the statutes is created to read:

AB50,1429,22 609.714 Substance abuse counselor coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (8).

AB50,2905 Section 2905. 609.718 of the statutes is created to read:

AB50,1430,2 609.718 Dental therapist coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (4e).

AB50,2906 Section 2906. 609.719 of the statutes is created to read:

AB50,1430,6 609.719 Coverage for telehealth services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.871.

AB50,2907 Section 2907. 609.74 of the statutes is created to read:

AB50,1430,9 609.74 Coverage of infertility services. Defined network plans and preferred provider plans are subject to s. 632.895 (15m).

AB50,2908 Section 2908. 609.815 of the statutes is created to read:

AB50,1430,13 609.815 Exemption from prior authorization requirements. Limited service health organizations, preferred provider plans, and defined network plans are subject to any rules promulgated by the commissioner under s. 632.848.

AB50,2909 Section 2909. 609.823 of the statutes is created to read:

AB50,1430,17 609.823 Coverage without prior authorization for inpatient mental health services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.891.

AB50,2910 Section 2910. 609.825 of the statutes is created to read:

AB50,1430,20 609.825 Coverage of emergency ambulance services. (1) In this section:

AB50,1430,21 (a) “Ambulance service provider” has the meaning given in s. 256.01 (3).

AB50,1431,2 (b) “Self-insured governmental plan” means a self-insured health plan of the state or a county, city, village, town, or school district that has a network of participating providers and imposes on enrollees in the self-insured health plan different requirements for using providers that are not participating providers.

AB50,1431,7 (2) A defined network plan, preferred provider plan, or self-insured governmental plan that provides coverage of emergency medical services shall cover emergency ambulance services provided by an ambulance service provider that is not a participating provider at a rate that is not lower than the greatest rate that is any of the following:

AB50,1431,9 (a) A rate that is set or approved by a local governmental entity in the jurisdiction in which the emergency ambulance services originated.