SB111,1516,1918 e. Terminally ill and receiving treatment for the illness from a provider or
19facility.
SB111,1516,2020 2. “Serious and complex condition” means any of the following:
SB111,1516,2321 a. In the case of an acute illness, a condition that is serious enough to require
22specialized medical treatment to avoid the reasonable possibility of death or
23permanent harm.
SB111,1517,3
1b. In the case of a chronic illness or condition, a condition that is
2life-threatening, degenerative, potentially disabling, or congenital and requires
3specialized medical care over a prolonged period of time.
SB111,1517,94 (b) If an enrollee is a continuing care patient and is obtaining items or services
5from a participating provider or facility and the contract between the defined
6network plan, preferred provider plan, or self-insured governmental plan and the
7participating provider or facility is terminated or the coverage of benefits that
8include the items or services provided by the participating provider or facility are
9terminated by the plan, the plan shall do all of the following:
SB111,1517,1210 1. Notify each enrollee of the termination of the contract or benefits and of the
11right for the enrollee to elect to continue transitional care from the provider or facility
12under this subsection.
SB111,1517,1413 2. Provide the enrollee an opportunity to notify the plan of the need for
14transitional care.
SB111,1517,2115 3. Allow the enrollee to elect to continue to have the benefits provided under
16the plan under the same terms and conditions as would have applied to the item or
17service if the termination had not occurred for the course of treatment related to the
18enrollee's status as a continuing care patient beginning on the date on which the
19notice under subd. 1. is provided and ending 90 days after the date on which the
20notice under subd. 1. is provided or the date on which the enrollee is no longer a
21continuing care patient, whichever is earlier.
SB111,1517,25 22(9) Rule making. The commissioner may promulgate any rules necessary to
23implement this section, including specifying the independent dispute resolution
24process. The commissioner may promulgate rules to modify the list of those items
25and services for which a provider may not balance bill under sub. (5) (c).
SB111,2920
1Section 2920. 609.713 of the statutes is created to read:
SB111,1518,3 2609.713 Essential health benefits; preventive services. Defined network
3plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).
SB111,2921 4Section 2921 . 609.719 of the statutes is created to read:
SB111,1518,6 5609.719 Telehealth services. Limited service health organizations,
6preferred provider plans, and defined network plans are subject to s. 632.871.
SB111,2922 7Section 2922 . 609.83 of the statutes is amended to read:
SB111,1518,10 8609.83 Coverage of drugs and devices ; application of payments.
9Limited service health organizations, preferred provider plans, and defined network
10plans are subject to ss. 632.853, 632.862, and 632.895 (16t) and (16v).
SB111,2923 11Section 2923 . 609.83 of the statutes, as affected by 2021 Wisconsin Act .... (this
12act), section 2922, is amended to read:
SB111,1518,15 13609.83 Coverage of drugs and devices; application of payments.
14Limited service health organizations, preferred provider plans, and defined network
15plans are subject to ss. 632.853, 632.862, and 632.895 (6) (b), (16t), and (16v).
SB111,2924 16Section 2924 . 609.83 of the statutes, as affected by 2021 Wisconsin Act .... (this
17act), section 2923, is amended to read:
SB111,1518,21 18609.83 Coverage of drugs and devices; application of payments.
19Limited service health organizations, preferred provider plans, and defined network
20plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (6) (b), (16t), and
21(16v).
SB111,2925 22Section 2925 . 609.847 of the statutes is created to read:
SB111,1518,25 23609.847 Preexisting condition discrimination and certain benefit
24limits prohibited.
Limited service health organizations, preferred provider plans,
25and defined network plans are subject to s. 632.728.
SB111,2926
1Section 2926. 616.09 (1) (a) 2. of the statutes is amended to read:
SB111,1519,52 616.09 (1) (a) 2. Plans authorized under s. 616.06 are subject to s. 610.21, 1977
3stats., s. 610.55, 1977 stats., s. 610.57, 1977 stats., and ss. 628.34 to 628.39, 1977
4stats., to chs. 600, 601, 620, 625, 627 and 645, to ss. 632.72, 632.755, 632.86 632.861
5and 632.87 and to this subchapter except s. 616.08.
SB111,2927 6Section 2927 . 625.12 (1) (a) of the statutes is amended to read:
SB111,1519,87 625.12 (1) (a) Past and prospective loss and expense experience within and
8outside of this state, except as provided in s. 632.728.
SB111,2928 9Section 2928 . 625.12 (1) (e) of the statutes is amended to read:
SB111,1519,1110 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
11including the judgment of technical personnel.
SB111,2929 12Section 2929 . 625.12 (2) of the statutes is amended to read:
SB111,1519,2113 625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729,
14risks may be classified in any reasonable way for the establishment of rates and
15minimum premiums, except that no classifications may be based on race, color, creed
16or national origin, and classifications in automobile insurance may not be based on
17physical condition or developmental disability as defined in s. 51.01 (5). Subject to
18ss. 632.365, 632.728, and 632.729, rates thus produced may be modified for
19individual risks in accordance with rating plans or schedules that establish
20reasonable standards for measuring probable variations in hazards, expenses, or
21both. Rates may also be modified for individual risks under s. 625.13 (2).