SB45,1426,18 a. In the case of an acute illness, a condition that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm.

SB45,1426,21 b. In the case of a chronic illness or condition, a condition that is life- threatening, degenerative, potentially disabling, or congenital and requires specialized medical care over a prolonged period.

SB45,1427,6 (b) If an enrollee is a continuing care patient and is obtaining items or services from a participating provider or participating facility and the contract between the defined network plan, preferred provider plan, or self-insured governmental plan and the provider or facility is terminated because of a change in the terms of the participation of the provider or facility in the plan or the contract between the defined network plan, preferred provider plan, or self-insured governmental plan and the provider or facility is terminated, resulting in a loss of benefits provided under the plan, the plan shall do all of the following:

SB45,1427,9 1. Notify each enrollee of the termination of the contract or benefits and of the right for the enrollee to elect to continue transitional care from the participating provider or participating facility under this subsection.

SB45,1427,11 2. Provide the enrollee an opportunity to notify the plan of the need for transitional care.

SB45,1427,18 3. Allow the enrollee to elect to continue to have the benefits provided under the plan under the same terms and conditions as would have applied to the item or service if the termination had not occurred for the course of treatment related to the enrollee’s status as a continuing care patient beginning on the date on which the notice under subd. 1. is provided and ending 90 days after the date on which the notice under subd. 1. is provided or the date on which the enrollee is no longer a continuing care patient, whichever is earlier.

SB45,1427,21 (c) The provisions of s. 609.24 apply to a continuing care patient to the extent that s. 609.24 does not conflict with this subsection so as to limit the enrollee’s rights under this subsection.

SB45,1428,6 (8) Rule making. The commissioner may promulgate any rules necessary to implement this section, including specifying the independent dispute resolution process under sub. (6). The commissioner may promulgate rules to modify the list of those items and services for which a provider may not bill or hold liable an enrollee under sub. (4) (c). In promulgating rules under this subsection, the commissioner may consider any rules promulgated by the federal department of health and human services pursuant to the federal No Surprises Act, 42 USC 300gg-111, et seq.

SB45,2899 Section 2899. 609.20 (3) of the statutes is created to read:

SB45,1428,14 609.20 (3) The commissioner may promulgate rules to establish minimum network time and distance standards and minimum network wait-time standards for defined network plans and preferred provider plans. In promulgating rules under this subsection, the commissioner shall consider standards adopted by the federal centers for medicare and medicaid services for qualified health plans, as defined in 42 USC 18021 (a), that are offered through the federal health insurance exchange established pursuant to 42 USC 18041 (c).

SB45,2900 Section 2900. 609.24 (5) of the statutes is created to read:

SB45,1428,19 609.24 (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:

SB45,1428,22 (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.

SB45,1429,2 (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.

SB45,1429,4 (c) Subsection (1) (d) may not be applied in a manner that limits the enrollee’s rights under s. 609.04 (7) (b) 3.

SB45,1429,7 (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).

SB45,2901 Section 2901. 609.40 of the statutes is created to read:

SB45,1429,10 609.40 Special enrollment period for pregnancy. Preferred provider plans and defined network plans are subject to s. 632.7498.

SB45,2902 Section 2902. 609.712 of the statutes is created to read:

SB45,1429,14 609.712 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

SB45,2903 Section 2903. 609.713 of the statutes is created to read:

SB45,1429,18 609.713 Qualified treatment trainee coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (7).

SB45,2904 Section 2904. 609.714 of the statutes is created to read:

SB45,1429,22 609.714 Substance abuse counselor coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (8).

SB45,2905 Section 2905. 609.718 of the statutes is created to read:

SB45,1430,2 609.718 Dental therapist coverage. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.87 (4e).

SB45,2906 Section 2906. 609.719 of the statutes is created to read:

SB45,1430,6 609.719 Coverage for telehealth services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.871.

SB45,2907 Section 2907. 609.74 of the statutes is created to read: