AB50,1422,15 2. The notice provides a good faith estimate of the amount that the nonparticipating provider may charge the enrollee for the item or service involved, including notification that the estimate does not constitute a contract with respect to the charges estimated for the item or service.

AB50,1422,18 3. The notice includes a list of the participating providers at the participating facility who would be able to provide the item or service and notification that the enrollee may be referred to one of those participating providers.

AB50,1422,21 4. The notice includes information about whether or not prior authorization or other care management limitations may be required before receiving an item or service at the participating facility.

AB50,1422,23 5. The notice clearly states that consent is optional and that the patient may elect to seek care from an in-network provider.

AB50,1423,1 6. The notice is worded in plain language.

AB50,1423,3 7. The notice is available in languages other than English. The commissioner shall identify languages for which the notice should be available.

AB50,1423,8 8. The enrollee provides consent to the nonparticipating provider to be treated by the nonparticipating provider, and the consent acknowledges that the enrollee has been informed that the charge paid by the enrollee may not meet a limitation that the enrollee’s defined network plan, preferred provider plan, or self-insured governmental plan places on cost sharing, such as an in-network deductible.

AB50,1423,10 9. A signed copy of the consent described under subd. 8. is provided to the enrollee.

AB50,1423,12 (b) To be considered adequate, the notice and consent under par. (a) shall meet one of the following requirements, as applicable:

AB50,1423,16 1. If the enrollee makes an appointment for the item or service at least 72 hours before the day on which the item or service is to be provided, any notice under par. (a) shall be provided to the enrollee at least 72 hours before the day of the appointment at which the item or service is to be provided.

AB50,1423,19 2. If the enrollee makes an appointment for the item or service less than 72 hours before the day on which the item or service is to be provided, any notice under par. (a) shall be provided to the enrollee on the day that the appointment is made.

AB50,1424,3 (c) A provider of an item or service who is entitled to payment under sub. (3) may not bill or hold liable an enrollee for any amount for an ancillary item or service that is more than the cost-sharing amount calculated under sub. (3) (b) for the item or service, whether or not provided by a physician or non-physician practitioner, unless the commissioner specifies by rule that the provider may bill or hold the enrollee liable for the ancillary item or service, if the item or service is any of the following:

AB50,1424,4 1. Related to an emergency medical service.

AB50,1424,5 2. Anesthesiology.

AB50,1424,6 3. Pathology.

AB50,1424,7 4. Radiology.

AB50,1424,8 5. Neonatology.

AB50,1424,10 6. An item or service provided by an assistant surgeon, hospitalist, or intensivist.

AB50,1424,11 7. A diagnostic service, including a radiology or laboratory service.

AB50,1424,13 8. An item or service provided by a specialty practitioner that the commissioner specifies by rule.

AB50,1424,16 9. An item or service provided by a nonparticipating provider when there is no participating provider who can furnish the item or service at the participating facility.

AB50,1424,19 (d) Any notice and consent provided under par. (a) may not extend to items or services furnished as a result of unforeseen, urgent medical needs that arise at the time the item or service is provided.

AB50,1424,21 (e) Any consent provided under par. (a) shall be retained by the provider for no less than 7 years.

AB50,1425,8 (5) Notice by provider or facility. Beginning no later than January 1, 2026, a health care provider or health care facility shall make available, including posting on a website, to enrollees in defined network plans, preferred provider plans, and self-insured governmental plans notice of the requirements on a provider or facility under sub. (4), of any other applicable state law requirements on the provider or facility with respect to charging an enrollee for an item or service if the provider or facility does not have a contractual relationship with the plan, and of information on contacting appropriate state or federal agencies in the event the enrollee believes the provider or facility violates any of the requirements under this section or other applicable law.

AB50,1426,2 (6) Negotiation; dispute resolution. A provider or facility that is entitled to receive an initial payment or notice of denial under sub. (2) (c) 4. a. or (3) (c) may initiate, within 30 days of receiving the initial payment or notice of denial, open negotiations with the defined network plan, preferred provider plan, or self-insured governmental plan to determine a payment amount for an emergency medical service or other item or service for a period that terminates 30 days after initiating open negotiations. If the open negotiation period under this subsection terminates without determination of a payment amount, the provider, facility, defined network plan, preferred provider plan, or self-insured governmental plan may initiate, within the 4 days beginning on the day after the open negotiation period ends, the independent dispute resolution process as specified by the commissioner. If the independent dispute resolution decision-maker determines the payment amount, the party to the independent dispute resolution process whose amount was not selected shall pay the fees for the independent dispute resolution. If the parties to the independent dispute resolution reach a settlement on the payment amount, the parties to the independent dispute resolution shall equally divide the payment for the fees for the independent dispute resolution.

AB50,1426,3 (7) Continuity of care. (a) In this subsection:

AB50,1426,4 1. “Continuing care patient” means an individual who is any of the following:

AB50,1426,6 a. Undergoing a course of treatment for a serious and complex condition from a provider or facility.

AB50,1426,8 b. Undergoing a course of institutional or inpatient care from a provider or facility.