SB743,7,1514 5. The notice clearly states that consent is optional and that the patient may
15elect to seek care from an in-network provider.
SB743,7,1616 6. The notice is worded in plain language.
SB743,7,1817 7. The notice is available in languages other than English. The commissioner
18shall identify languages for which the notice should be available.
SB743,7,2319 8. The enrollee provides consent to the nonparticipating provider to be treated
20by the nonparticipating provider, and the consent acknowledges that the enrollee
21has been informed that the charge paid by the enrollee may not meet a limitation that
22the enrollee's defined network plan, preferred provider plan, or self-insured
23governmental plan places on cost sharing, such as an in-network deductible.
SB743,7,2524 9. A signed copy of the consent described under subd. 8. is provided to the
25enrollee.
SB743,8,2
1(b) To be considered adequate, the notice and consent under par. (a) shall meet
2one of the following requirements, as applicable:
SB743,8,63 1. If the enrollee makes an appointment for the item or service at least 72 hours
4before the day on which the item or service is to be provided, any notice under par.
5(a) shall be provided to the enrollee at least 72 hours before the day of the
6appointment at which the item or service is to be provided.
SB743,8,97 2. If the enrollee makes an appointment for the item or service less than 72
8hours before the day on which the item or service is to be provided, any notice under
9par. (a) shall be provided to the enrollee on the day that the appointment is made.
SB743,8,1410 (c) A provider of an item or service that is entitled to payment under sub. (4)
11may not bill or hold liable an enrollee for any amount for an ancillary item or service
12that is more than the cost-sharing amount determined under sub. (4) (b) for the item
13or service, unless the commissioner specifies by rule that the provider may balance
14bill for the ancillary item or service, if the item or service is any of the following:
SB743,8,1515 1. Related to an emergency medical service.
SB743,8,1616 2. Anesthesiology.
SB743,8,1717 3. Pathology.
SB743,8,1818 4. Radiology.
SB743,8,1919 5. Neonatology.
SB743,8,2120 6. An item or service provided by an assistant surgeon, hospitalist, or
21intensivist.
SB743,8,2222 7. A diagnostic service, including a radiology or laboratory service.
SB743,8,2423 8. An item or service provided by a specialty practitioner that the commissioner
24specifies by rule.
SB743,9,3
19. An item or service provided by a nonparticipating provider when there is no
2participating provider that can furnish the item or service at the participating
3facility.
SB743,9,64 (d) Any notice and consent provided under par. (a) may not extend to items or
5services furnished as a result of unforeseen, urgent medical needs that arise at the
6time the item or service is provided.
SB743,9,87 (e) Any consent provided under par. (a) shall be retained by the provider for no
8less than 7 years.
SB743,9,18 9(6) Notice by provider or facility. Beginning no later than January 1, 2024,
10a health care provider or health care facility shall make available, including posting
11on a website, to enrollees in defined network plans, preferred provider plans, and
12self-insured governmental plans notice of the requirements on a provider or facility
13under subs. (3) and (5), of any other applicable state law requirements on the
14provider or facility with respect to charging an enrollee for an item or service if the
15provider or facility does not have a contractual relationship with the plan, and of
16information on contacting appropriate state or federal agencies in the event the
17enrollee believes the provider or facility violates any of the requirements under this
18section or other applicable law.
SB743,9,25 19(7) Negotiation; dispute resolution. A provider or facility that is entitled to
20receive an initial payment or notice of denial under sub. (2) (c) 4. a. or (4) (c) may
21initiate, within 30 days of receiving the initial payment or notice of denial, open
22negotiations with the defined network plan, preferred provider plan, or self-insured
23governmental plan to determine a payment amount for an emergency medical
24service or other item or service for a period that terminates 30 days after initiating
25open negotiations. If the open negotiation period under this subsection terminates

1without determination of a payment amount, the provider, facility, defined network
2plan, preferred provider plan, or self-insured governmental plan may initiate,
3within the 4 days beginning on the day after the open negotiation period ends, the
4independent dispute resolution process as specified by the commissioner. If the
5independent dispute resolution decision maker determines the payment amount,
6the party to the independent dispute resolution process whose amount was not
7selected shall pay the fees for the independent dispute resolution. If the parties to
8the independent dispute resolution reach a settlement on the payment amount, the
9parties to the independent dispute resolution shall equally divide the payment for
10the fees for the independent dispute resolution.
SB743,10,11 11(8) Continuity of care. (a) In this subsection:
SB743,10,1212 1. “Continuing care patient” means an individual who is any of the following:
SB743,10,1413 a. Undergoing a course of treatment for a serious and complex condition from
14a provider or facility.
SB743,10,1615 b. Undergoing a course of institutional or inpatient care from a provider or
16facility.
SB743,10,1817 c. Scheduled to undergo nonelective surgery, including receipt of postoperative
18care, from a provider or facility.
SB743,10,2019 d. Pregnant and undergoing a course of treatment for the pregnancy from a
20provider or facility.
SB743,10,2221 e. Terminally ill and receiving treatment for the illness from a provider or
22facility.
SB743,10,2323 2. “Serious and complex condition” means any of the following:
SB743,11,3
1a. In the case of an acute illness, a condition that is serious enough to require
2specialized medical treatment to avoid the reasonable possibility of death or
3permanent harm.
SB743,11,64 b. In the case of a chronic illness or condition, a condition that is
5life-threatening, degenerative, potentially disabling, or congenital and requires
6specialized medical care over a prolonged period.
SB743,11,137 (b) If an enrollee is a continuing care patient and is obtaining items or services
8from a participating provider or participating facility and the contract between the
9defined network plan, preferred provider plan, or self-insured governmental plan
10and the participating provider or participating facility is terminated or the coverage
11of benefits that include the items or services provided by the participating provider
12or participating facility are terminated by the plan, the plan shall do all of the
13following:
SB743,11,1614 1. Notify each enrollee of the termination of the contract or benefits and of the
15right for the enrollee to elect to continue transitional care from the provider or facility
16under this subsection.
SB743,11,1817 2. Provide the enrollee an opportunity to notify the plan of the need for
18transitional care.
SB743,11,2519 3. Allow the enrollee to elect to continue to have the benefits provided under
20the plan under the same terms and conditions as would have applied to the item or
21service if the termination had not occurred for the course of treatment related to the
22enrollee's status as a continuing care patient beginning on the date on which the
23notice under subd. 1. is provided and ending 90 days after the date on which the
24notice under subd. 1. is provided or the date on which the enrollee is no longer a
25continuing care patient, whichever is earlier.
SB743,12,3
1(c) The provisions of s. 609.24 apply to a continuing care patient to the extent
2that s. 609.24 does not conflict with this subsection so as to limit the enrollee's rights
3under this subsection.
SB743,12,8 4(9) Rule making. The commissioner may promulgate any rules necessary to
5implement this section, including specifying the independent dispute resolution
6process under sub. (7). The commissioner may promulgate rules to modify the list
7of those items and services for which a provider may not balance bill under sub. (5)
8(c).
SB743,12,99 (End)
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