The bill requires DHS to provide reimbursement through the Medical
Assistance program to a hospital for services provided on an outpatient basis that are
usually reimbursed when provided at the hospital's inpatient facility but are
provided at the hospital's outpatient facility due to the 2019 novel coronavirus
pandemic. To receive reimbursement under the bill, the outpatient services must be
approved for federal financial participation and must be provided in a facility that
is operated by the hospital and is certified for outpatient services under the federal
Medicare program, including under the terms of a federal waiver issued during the
federally declared national emergency related to the 2019 novel coronavirus. DHS
must seek any federal approval necessary to provide the reimbursement. The
reimbursement requirement applies until the conclusion of a public health
emergency declared by the secretary of the federal Department of Health and
Human Services in response to the 2019 novel coronavirus or until June 30, 2021,
whichever is earlier.

The bill requires DHS to provide state payment for the testing and treatment
of health care workers who have been diagnosed with or are under investigation of
having COVID-19 or any other communicable disease. State coverage is available
only if the individual has no other form of coverage or funding for treatment available
from insurance, a health care coverage program, or under any grant, contract, or
other contractual arrangement. For purposes of the state coverage for uninsured
health care workers, the treatment that must be covered is any treatment that is
medically necessary and reasonably related to COVID-19 or any other
communicable disease or complications from COVID-19 or other communicable
disease.

The bill accepts the Medicaid expansion by changing the family income
eligibility level to up to 133 percent of the federal poverty line for parents and
caretaker relatives under BadgerCare Plus and for childless adults currently
covered under BadgerCare Plus Core and who are incorporated into BadgerCare
Plus in the bill. BadgerCare Plus and BadgerCare Plus Core are programs under the
state's Medical Assistance program, which provides health services to individuals

who have limited financial resources. The federal Patient Protection and Affordable
Care Act allows a state to receive an enhanced federal medical assistance percentage
payment for providing benefits to certain individuals through a state's Medical
Assistance program. The bill requires DHS to comply with all federal requirements
and to request any amendment to the state Medical Assistance plan, waiver of
Medicaid law, or other federal approval necessary to qualify for the highest available
enhanced federal medical assistance percentage for childless adults under the
BadgerCare Plus program. DHS must ensure that any increased funding resulting
from the bill is used to improve access to and affordability of health care and to
support health care quality for Wisconsin residents.

Under current law, certain parents and caretaker relatives with incomes of not
more than 100 percent of the federal poverty line, before a 5 percent income disregard
is applied, are eligible for BadgerCare Plus benefits. Under current law, childless
adults who 1) are under age 65; 2) have family incomes that do not exceed 100 percent
of the federal poverty line, before a 5 percent income disregard is applied; and 3) are
not otherwise eligible for Medical Assistance, including BadgerCare Plus, are
eligible for benefits under BadgerCare Plus Core. The bill eliminates the childless
adults demonstration project known as BadgerCare Plus Core.

The bill allows DHS to issue an order prohibiting the commencement of actions
for eviction or foreclosure for any period before January 1, 2022.

The bill provides funding to DHS for community testing, contact tracing,
vaccinations, and public awareness related to COVID-19.

The bill appropriates $25,000,000 to the Department of Children and Families
to give financial assistance to providers of child care services that have lost income
as a result of the 2019 novel coronavirus.

The federal Coronavirus Aid, Relief, and Economic Security (CARES) Act of
2020 provided federal funding for a rental assistance program administered by DOA.
Under that program, Wisconsin residents suffering a loss of income due to the 2019
novel coronavirus, and who met income and certain other eligibility requirements,
could apply for assistance in paying their rent. The bill appropriates $25,000,000 of
general purpose revenue for that program.

The bill prohibits insurers that offer health insurance, self-insured
governmental health plans, and pharmacy benefit managers from requiring, before
January 1, 2022, prior authorization for early refills of a prescription drug or
otherwise restricting the period of time in which a prescription drug may be refilled
and from imposing a limit on the quantity of prescription drugs that may be obtained

if the quantity is no more than a 90-day supply. These prohibitions do not apply if
the prescription drug is a controlled substance. The bill reinstates the prohibitions
that were enacted in 2019 Wisconsin Act 185 but that expired with the termination
of the state of emergency related to public health declared on March 12, 2020, by the
governor.

The bill specifies that, before January 1, 2022, a physician or nurse anesthetist
for whom Wisconsin is not a principal place of practice but who is temporarily
authorized to practice in Wisconsin may fulfill financial responsibility requirements
by filing with the commissioner of insurance a certificate of insurance for a policy of
health care liability insurance issued by an insurer authorized in a certain
jurisdiction specified in the bill. Additionally, under those same circumstances, the
physician or nurse anesthetist may elect to be covered by Wisconsin's health care
liability laws.

The bill prohibits, through December 31, 2021, a defined network plan,
including a health maintenance organization, or preferred provider plan from
requiring an enrollee of the plan to pay more for a service, treatment, or supply
provided by an out-of-network provider than if the service, treatment, or supply is
provided by an in-network provider. This prohibition applies to any service,
treatment, or supply that is related to the diagnosis of or treatment for COVID-19
and that is provided by an out-of-network provider because a participating provider
is unavailable due to the COVID-19 pandemic. For a service, treatment, or supply
provided under those circumstances, the bill requires the plan to reimburse the
out-of-network provider at 250 percent of the federal Medicare program rate. Also,
under those circumstances, any health care provider or facility that provides a
service, treatment, or supply to an enrollee of a plan but is not a participating
provider of that plan shall accept as payment in full any payment by a plan that is
at least 250 percent of the federal Medicare program rate and may not charge the
enrollee an amount that exceeds the amount that the provider or facility is
reimbursed by the plan. Similar prohibitions and requirements were created in 2019
Wisconsin Act 185, except that the reimbursement rate in Act 185 for an
out-of-network provider was 225 percent of the federal Medicare program rate. The
Act 185 prohibitions and requirements applied only during the state of emergency
related to public health declared on March 12, 2020, and for 60 days following the
termination of that state of emergency.

The bill requires every health insurance policy and every self-insured
governmental health plan that generally covers testing for and treatment of
infectious disease to provide coverage of testing for, diagnosis and treatment of, and
administration of any vaccination developed to prevent COVID-19 without
imposing any copayment or coinsurance. This requirement applies through
December 31, 2021. A health insurance policy is referred to in the bill as a disability
insurance policy. Current law requires health insurance policies and self-insured

governmental health plans to cover, until March 13, 2021, testing for COVID-19
without imposing any copayment or coinsurance.

The bill requires every health insurance policy and every self-insured
governmental health plan that generally covers testing for and treatment of
infectious disease to provide coverage of testing for and treatment of COVID-19 or
any other communicable disease for a frontline health care worker who has been
diagnosed with or is under investigation of having COVID-19 or any other
communicable disease without imposing any copayment or coinsurance. A health
insurance policy is referred to in the bill as a disability insurance policy. For purposes
of required insurance coverage, the treatment that must be covered is any treatment
that is medically necessary and reasonably related to COVID-19 or any other
communicable disease or complications from COVID-19 or other communicable
disease.

The bill prohibits a health insurance policy or a self-insured health plan of the
state or a county, city, village, town, or school district from denying coverage for a
treatment or service provided through telehealth if that treatment or service is
covered under the policy or plan when provided in person by a health care provider.
This prohibition applies through December 31, 2021. Health insurance policies are
known as disability insurance policies in the bill. Telehealth is a practice of health
care delivery, diagnosis, consultation, treatment, or transfer of medically relevant
data by means of audio, video, or data communications that are used either during
a patient visit or a consultation or are used to transfer medically relevant data about
a patient.