November 7, 2023 - Introduced by Senator Jacque, cosponsored by Representatives Wichgers and Sinicki. Referred to Committee on Insurance and Small Business.
SB645,,22An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983 (1) (intro.); and to create 609.843 and 632.895 (18) of the statutes; relating to: coverage of routine care related to certain clinical trials by health insurance policies and plans. SB645,,33Analysis by the Legislative Reference Bureau This bill makes several changes with respect to coverage of routine patient costs and items or services by health insurance policies and plans furnished in connection with participation in an approved clinical trial. The bill requires health insurance policies that provide coverage for hospital care to provide coverage for routine patient costs and items or services furnished in connection with participation by a qualified individual in an approved clinical trial. “Qualified individual” is defined under the bill to mean an individual who is eligible to participate in an approved clinical trial according to the trial protocol with respect to treatment of cancer or other life-threatening condition. The bill prohibits health insurance policies from discriminating against any individual based on the individual’s participation in an approved clinical trial. Health insurance policies are referred to in the bill as disability insurance policies.
Further, the bill requires limited service health organizations, preferred provider plans, and defined network plans that provide coverage of routine patient costs and items or services furnished in connection with participation by a qualified individual in an approved clinical trial to impose the same cost-sharing requirements to such item or service when provided by a nonparticipating provider that would apply if such item or service were furnished by a participating provider and pay to the nonparticipating provider the amount by which the recognized amount for such item or service exceeds the cost-sharing amount for such item or service.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
For further information see the state fiscal estimate, which will be printed as an appendix to this bill.