March 8, 2023 - Introduced by Senators Cabral-Guevara, Hesselbein, James, Larson, Spreitzer, Taylor and Wirch, cosponsored by Representatives Gustafson, Binsfeld, Snodgrass, Andraca, Baldeh, Bare, Behnke, Cabrera, Considine, Conley, Dittrich, Goeben, J. Anderson, Joers, Krug, Macco, Murphy, Mursau, Ohnstad, Ortiz-Velez, Palmeri, Rozar, Sinicki, Spiros, Subeck, Tusler and Vining. Referred to Committee on Health.
SB121,,22An Act to renumber 632.895 (8) (a) 1.; to renumber and amend 632.895 (8) (d); to amend 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 609.80; and to create 49.46 (2) (b) 6. n., 632.895 (8) (a) 1c., 632.895 (8) (a) 1e., 632.895 (8) (a) 1g., 632.895 (8) (a) 1n., 632.895 (8) (a) 1r., 632.895 (8) (a) 4., 632.895 (8) (a) 5., 632.895 (8) (a) 6., 632.895 (8) (am), 632.895 (8) (d) 2. and 632.895 (8) (d) 3. of the statutes; relating to: coverage of breast cancer screenings by the Medical Assistance program and health insurance policies and plans. SB121,,33Analysis by the Legislative Reference Bureau This bill requires health insurance policies to provide coverage for supplemental breast screening examinations or diagnostic breast examinations for an individual who is at increased risk of breast cancer, as determined in accordance with the most recent applicable guidelines of the National Comprehensive Cancer Network, or has heterogeneously or extremely dense breast tissue, as defined by the Breast Imaging-Reporting and Data System established by the American College of Radiology. Health insurance policies are referred to in the statutes as disability insurance policies. Self-insured governmental health plans are also required to provide the coverage specified in the bill. The bill also requires coverage of those breast screenings by the Medical Assistance program, which is the state-administered Medicaid program that is jointly funded by the state and federal governments and that provides health services to individuals with limited financial resources.
Under the bill, health insurance policies may not charge a cost-sharing amount for a supplemental breast screening examination or diagnostic breast examination. The limitation on cost-sharing does not apply to the extent that the limitation would result in ineligibility for a health savings account under the federal Internal Revenue Code.
Health insurance policies are required under current law to cover two mammographic breast examinations to screen for breast cancer for a woman from ages 45 to 49 if certain criteria are satisfied. Health insurance policies must currently cover annual mammograms for a woman once she attains the age of 50. The coverage required under current law is required whether or not the woman shows any symptoms of breast cancer and may be subject to only the same exclusions and limitations, including cost sharing, that apply to other radiological examinations under the policy. The bill does not change or eliminate the current coverage requirements for mammograms, except that preferred provider plans are explicitly included in the current law and the bill’s requirements.
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.
SB121,,44The people of the state of Wisconsin, represented in senate and assembly, do enact as follows: SB121,15Section 1. 40.51 (8m) of the statutes is amended to read: SB121,,6640.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.885, 632.89, and 632.895 (8) and (11) to (17). SB121,27Section 2. 49.46 (2) (b) 6. n. of the statutes is created to read: SB121,,8849.46 (2) (b) 6. n. Breast screenings for which coverage is required under s. 632.895 (8) (am). SB121,39Section 3. 66.0137 (4) of the statutes is amended to read: SB121,,101066.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4). SB121,411Section 4. 120.13 (2) (g) of the statutes is amended to read: SB121,,1212120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4). SB121,513Section 5. 609.80 of the statutes is amended to read: SB121,,1414609.80 Coverage of mammograms. Defined network plans and preferred provider plans are subject to s. 632.895 (8). Coverage of mammograms under s. 632.895 (8) may be subject to any requirements that the defined network plan or preferred provider plan imposes under s. 609.05 (2) and (3) on the coverage of other health care services obtained by enrollees.