Amendment SSA1-AB1038

AB1038-SSA1,60,13 4. Licensed as a pharmacist under ch. 450.

AB1038-SSA1,60,14 5. Licensed as a psychologist under ch. 455.

AB1038-SSA1,60,17 6. A clinical social worker, marriage and family therapist, or professional counselor licensed under ch. 457 or an independent social worker or social worker certified under ch. 457.

AB1038-SSA1,60,18 7. A clinical substance abuse counselor certified under s. 440.88.

AB1038-SSA1,60,20 8. Any practitioner holding a credential to practice a profession that is identified by the department of health services during an emergency period.

AB1038-SSA1,60,23 (2) Temporary credentials for former health care providers during emergency. (a) During an emergency period, the department may grant a temporary credential to a health care provider if all of the following apply:

AB1038-SSA1,60,24 1. The health care provider submits an application to the department.

AB1038-SSA1,61,4 2. The department determines that the health care provider satisfies the eligibility requirements for the credential and is fit to practice after conducting an investigation of the health care provider's arrest or conviction record and record of professional discipline.

AB1038-SSA1,61,7 (b) If the department denies a health care provider's application for a temporary credential under this subsection, the department shall notify the health care provider of the reason for denial.

AB1038-SSA1,61,11 (c) Notwithstanding ss. 441.06 (4), 441.15 (2), 447.03 (1) and (2), 448.03 (1) (a), (b), and (c) and (1m), and 450.03 (1), during an emergency period, a health care provider granted a temporary credential under this subsection may provide services for which the health care provider has been licensed or certified.

AB1038-SSA1,61,15 (d) A health care provider who provides services authorized by a temporary credential granted under this subsection shall maintain malpractice insurance that satisfies the requirements of the profession for which the health care provider has been licensed or certified.

AB1038-SSA1,61,17 (e) A temporary credential granted under this subsection expires at the conclusion of the emergency period during which the credential was granted.

AB1038-SSA1,123 Section 123. 440.096 of the statutes is created to read:

AB1038-SSA1,61,21 440.096 Health care providers from other states; credentials during emergency; fee waivers. (1) Temporary credentials for health care providers from other states during emergency. (a) In this subsection:

AB1038-SSA1,61,23 1. “Emergency period” means a period covered by a public health emergency declared under s. 323.10, including any extension, plus 90 days.

AB1038-SSA1,62,2 2. “Health care provider” means an individual who holds a valid, unexpired license, certificate, or registration granted by another state or territory that authorizes or qualifies the individual to perform acts that are substantially the same as the acts that any of the following are licensed or certified to perform:

AB1038-SSA1,62,4 a. A registered nurse, licensed practical nurse, or nurse-midwife licensed under ch. 441.

AB1038-SSA1,62,5 b. A dentist licensed under ch. 447.

AB1038-SSA1,62,7 c. A physician, physician assistant, or perfusionist licensed under ch. 448 or a respiratory care practitioner certified under ch. 448.

AB1038-SSA1,62,8 d. A pharmacist licensed under ch. 450.

AB1038-SSA1,62,9 e. A psychologist licensed under ch. 455.

AB1038-SSA1,62,12 f. A clinical social worker, marriage and family therapist, or professional counselor licensed under ch. 457 or an independent social worker or social worker certified under ch. 457.

AB1038-SSA1,62,13 g. A clinical substance abuse counselor certified under s. 440.88.

AB1038-SSA1,62,15 h. Any practitioner holding a credential to practice a profession that is identified by the department of health services during an emergency period.

AB1038-SSA1,62,17 (b) 1. During an emergency period, the department may grant a temporary credential to a health care provider if all of the following apply:

AB1038-SSA1,62,18 a. The health care provider submits an application to the department.

AB1038-SSA1,62,22 b. The department determines that the health care provider satisfies the eligibility requirements for the credential and is fit to practice after conducting an investigation of the health care provider's arrest or conviction record and record of professional discipline.

AB1038-SSA1,62,25 2. The department may determine the appropriate scope of the review under subd. 1. b. of the background of a health care provider who applies for a temporary credential under this paragraph.

AB1038-SSA1,63,3 3. If the department denies a health care provider's application for a temporary credential under this paragraph, the department shall notify the health care provider of the reason for the denial.

AB1038-SSA1,63,7 4. Notwithstanding ss. 441.06 (4), 441.15 (2), 447.03 (1) and (2), 448.03 (1) (a), (b), and (c) and (1m), and 450.03 (1), during an emergency period a health care provider granted a temporary credential under this paragraph may provide services for which the health care provider is licensed or certified.

AB1038-SSA1,63,11 5. A health care provider who provides services authorized by a temporary credential granted under this paragraph shall maintain malpractice insurance that satisfies the requirements of the profession for which the health care provider is licensed or certified.

AB1038-SSA1,63,13 6. A temporary credential granted under this paragraph expires at the conclusion of the emergency period during which the credential was granted.

AB1038-SSA1,63,21 (2) Authority to waive fees. Notwithstanding s. 440.05 and the applicable fee provisions in chs. 440 to 480, during an emergency period the department may waive fees for applications for an initial credential and renewal of a credential for registered nurses, licensed practical nurses, nurse-midwives, dentists, physicians, physician assistants, perfusionists, respiratory care practitioners, pharmacists, psychologists, clinical social workers, independent social workers, social workers, marriage and family therapists, professional counselors, and clinical substance abuse counselors.

AB1038-SSA1,124 Section 124. 450.11 (5) (a) of the statutes is amended to read:

AB1038-SSA1,64,7 450.11 (5) (a) Except as provided in par. pars. (bm) and (br), no prescription may be refilled unless the requirements of sub. (1) and, if applicable, sub. (1m) have been met and written, oral, or electronic authorization has been given by the prescribing practitioner. Unless the prescribing practitioner has specified in the prescription order that dispensing a prescribed drug in an initial amount followed by periodic refills as specified in the prescription order is medically necessary, a pharmacist may exercise his or her professional judgment to dispense varying quantities of the prescribed drug per fill up to the total number of dosage units authorized by the prescribing practitioner in the prescription order including any refills, subject to par. (b).

AB1038-SSA1,125 Section 125. 450.11 (5) (br) of the statutes is created to read:

AB1038-SSA1,64,14 450.11 (5) (br) 1. In the event a pharmacist receives a request for a prescription to be refilled and the prescription cannot be refilled as provided in par. (a), the pharmacist may, subject to subd. 2. a. to e., extend the existing prescription order and dispense the drug to the patient, if the pharmacist has not received and is not aware of written or oral instructions from the prescribing practitioner prohibiting further dispensing pursuant to or extension of the prescription order.

AB1038-SSA1,64,20 2. a. A prescribing practitioner may indicate, by writing on the face of the prescription order or, with respect to a prescription order transmitted electronically, by designating in electronic format the phrase “No extensions," or words of similar meaning, that no extension of the prescription order may be made under subd. 1. If such indication is made, the pharmacist may not extend the prescription order under subd. 1.

AB1038-SSA1,65,2 b. A pharmacist acting under subd. 1. may not extend a prescription order to dispense more than a 30-day supply of the prescribed drug, except that if the drug is typically packaged in a form that requires a pharmacist to dispense the drug in a quantity greater than a 30-day supply, the pharmacist may extend the prescription order as necessary to dispense the drug in the smallest quantity in which it is typically packaged.

AB1038-SSA1,65,4 c. A pharmacist may not extend a prescription order under subd. 1. for a drug that is a controlled substance.

AB1038-SSA1,65,7 d. A pharmacist may not extend a prescription order under subd. 1. for a particular patient if a prescription order was previously extended under subd. 1. for that patient during the period described in subd. 3.

AB1038-SSA1,65,14 e. A pharmacist shall, at the earliest reasonable time after acting under subd. 1., notify the prescribing practitioner or his or her office, but is not required to attempt to procure a new prescription order or refill authorization for the drug by contacting the prescribing practitioner or his or her office prior to acting under subd. 1. After acting under subd. 1., the pharmacist may notify the patient or other individual that any further refills will require the authorization of a prescribing practitioner.

AB1038-SSA1,65,17 3. This paragraph applies only during the period covered by a public health emergency declared by the governor under s. 323.10, including any extension. During that time, this paragraph supersedes par. (bm) to the extent of any conflict.

AB1038-SSA1,126 Section 126. 601.83 (7) of the statutes is created to read:

AB1038-SSA1,65,20 601.83 (7) COVID-19 costs. (a) In this subsection, “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.

AB1038-SSA1,65,25 (b) Notwithstanding subs. (2) and (4) (a), from the appropriations under s. 20.145 (5) (c) and (m), the commissioner may provide reinsurance payments to any eligible health carrier for costs related to COVID-19 incurred in benefit year 2020 for any enrolled individual, regardless whether the costs exceed the attachment point set under sub. (2) for the enrollee individual.

AB1038-SSA1,66,3 (c) Subject to par. (d), the commissioner may make payments for requests for costs related to COVID-19 that are submitted by an eligible health carrier in the manner established under sub. (5).

AB1038-SSA1,66,5 (d) An eligible health carrier shall comply with all of the following to receive a reinsurance payment under this subsection:

AB1038-SSA1,66,9 1. The carrier shall seek reinsurance from all other sources, including any federal funds or programs, before requesting reinsurance under this subsection. The carrier may not accept a reinsurance payment under this subsection if the costs for which reinsurance are requested have been paid by another source.

AB1038-SSA1,66,11 2. The carrier shall exclude from annual reinsurance requests made under sub. (5) costs for which the carrier requested reinsurance under par. (c).

AB1038-SSA1,66,15 (e) No later than September 30, 2020, the commissioner shall submit to the legislature under s. 13.172 (2) and the governor a report that specifies the requirements for an eligible health carrier to obtain a reinsurance payment under this subsection.

AB1038-SSA1,127 Section 127. 609.205 of the statutes is created to read:

AB1038-SSA1,66,21 609.205 Public health emergency. (1) All of the following apply to a defined network plan or preferred provider plan during a state of emergency related to public health declared under s. 323.10 or during a public health emergency declared under 42 USC 247d by the secretary of the federal department of health and human services:

AB1038-SSA1,67,5 (a) The plan may not require an enrollee to pay, including cost sharing, for a service, treatment, or supply provided by a provider that is not a participating provider in the plan's network of providers more than the enrollee would pay if the service, treatment, or supply is provided by a provider that is a participating provider. This subsection applies to any service, treatment, or supply that is related to diagnosis or treatment for the condition for which the public health emergency is declared and to any service, treatment, or supply that is provided by a provider that is not a participating provider because a participating provider is unavailable due to the public health emergency.

AB1038-SSA1,67,10 (b) The plan shall reimburse a provider that is not a participating provider for a service, treatment, or supply provided under the circumstances described under par. (a) at 250 percent of the rate the federal Medicare program reimburses the provider for the same or a similar service, treatment, or supply in the same geographic area.

AB1038-SSA1,67,16 (2) During a state of emergency related to public health declared under s. 323.10 or during a public health emergency declared under 42 USC 247d by the secretary of the federal department of health and human services, all of the following apply to any health care provider or health care facility that provides a service, treatment, or supply to an enrollee of a defined network plan or preferred provider plan but is not a participating provider of that plan:

AB1038-SSA1,67,20 (a) The health care provider or facility shall accept as payment in full any payment by a defined network plan or preferred provider plan that is at least 250 percent of the rate the federal Medicare program reimburses the provider for the same or a similar service, treatment, or supply in the same geographic area.

AB1038-SSA1,67,23 (b) The health care provider or facility may not charge the enrollee for the service, treatment, or supply an amount that exceeds the amount the provider or facility is reimbursed by the defined network plan or preferred provider plan.

AB1038-SSA1,67,25 (3) The commissioner may promulgate any rules necessary to implement this section.

AB1038-SSA1,128 Section 128. 609.719 of the statutes is created to read:

AB1038-SSA1,68,3 609.719 Telehealth services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.871.

AB1038-SSA1,129 Section 129. 609.83 of the statutes is amended to read:

AB1038-SSA1,68,7 609.83 Coverage of drugs and devices. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853 and 632.895 (16t) and (16v).

AB1038-SSA1,130 Section 130. 609.846 of the statutes is created to read:

AB1038-SSA1,68,11 609.846 Discrimination based on COVID-19 prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.729.

AB1038-SSA1,131 Section 131. 609.885 of the statutes is created to read:

AB1038-SSA1,68,14 609.885 Coverage of COVID-19. Defined network plans, preferred provider plans, and limited service health organizations are subject to s. 632.895 (14g).

AB1038-SSA1,132 Section 132. 625.12 (2) of the statutes is amended to read:

AB1038-SSA1,68,24 625.12 (2) Classification. Risks Except as provided in s. 632.729, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and 632.729, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).

AB1038-SSA1,133 Section 133 . 626.12 (4) of the statutes is created to read:

AB1038-SSA1,69,2 626.12 (4) Claims for certain injuries based on presumption. Rates or rating plans may not take into account any injury found under s. 102.03 (1) (h) 2.

AB1038-SSA1,134 Section 134. 628.34 (3) (a) of the statutes is amended to read:

AB1038-SSA1,69,10 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365, 632.729, 632.746 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB1038-SSA1,135 Section 135. 631.18 of the statutes is created to read:

AB1038-SSA1,69,16 631.18 Cancellation during public health emergency. During a state of emergency related to public health declared by the governor under s. 323.10, notwithstanding any contrary provision of chs. 600 to 655, no insurer may cancel any policy of insurance for nonpayment of premiums until at least 90 days after the unpaid premium was due.

AB1038-SSA1,136 Section 136. 632.729 of the statutes is created to read:

AB1038-SSA1,69,19 632.729 Prohibiting discrimination based on COVID-19. (1) Definitions. In this section:

AB1038-SSA1,69,20 (a) “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.

AB1038-SSA1,69,21 (b) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB1038-SSA1,69,22 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB1038-SSA1,69,23 (d) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB1038-SSA1,70,3 (2) Issuance or renewal. (a) An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, for the continued eligibility of any individual to remain enrolled, or for the renewal of coverage under the plan based on a current or past diagnosis or suspected diagnosis of COVID-19.

AB1038-SSA1,70,9 (b) An insurer that offers a group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not establish rules for the eligibility of any employer or other group to enroll, for the continued eligibility of any employer or group to remain enrolled, or for the renewal of an employer's or group's coverage under the plan based on a current or past diagnosis or suspected diagnosis of COVID-19 of any employee or other member of the group.

AB1038-SSA1,70,13 (3) Cancellation. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not use as a basis for cancellation of coverage during a contract term a current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19.

AB1038-SSA1,70,17 (4) Rates. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not use as a basis for setting rates for coverage a current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19.

AB1038-SSA1,70,23 (5) Premium grace period. An insurer that offers an individual or group health benefit plan, a pharmacy benefit manager, or a self-insured health plan may not refuse to grant to an individual, employer, or other group a grace period for the payment of a premium based on an individual's, employee's, or group member's current or past diagnosis of COVID-19 or suspected diagnosis of COVID-19 if a grace period for payment of premium would generally be granted under the plan.

AB1038-SSA1,137 Section 137. 632.871 of the statutes is created to read:

AB1038-SSA1,70,25 632.871 Telehealth services. (1) Definitions. In this section:

AB1038-SSA1,71,1 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).