Wisconsin Legislature: AB43: Bill Text

The bill also requires that a PSAO disclose to OCI the extent of any ownership
or control by an entity that provides pharmacy services; provides prescription drug
or device services; or manufactures, sells, or distributes prescription drugs,
biologicals, or medical devices. The PSAO must notify OCI within five days of any
material change in its ownership or control related to such an entity.

Licensure of pharmaceutical representatives

The bill requires a pharmaceutical representative to be licensed by OCI and to
display the pharmaceutical representative's license during each visit with a health
care professional. The bill defines “pharmaceutical representative” to mean an
individual who markets or promotes pharmaceuticals to health care professionals on
behalf of a pharmaceutical manufacturer for compensation. The term of a license
issued under the bill is one year, and the license is renewable. Under the bill, the
license fee is set by the commissioner of insurance. The bill directs the commissioner
to promulgate administrative rules to implement the bill's requirements, including
rules that require pharmaceutical representatives to complete continuing
educational coursework as a condition of licensure. An individual who violates any
of the requirements under the bill is subject to a fine, and the individual's license may
be suspended or revoked.

Moneys from professional regulation used for general program operations

The bill credits to the appropriation account for OCI's general program
operations all moneys received from the regulation of pharmacy benefit managers,

pharmacy benefit management brokers, pharmacy benefit management
consultants, PSAOs, and pharmaceutical representatives.

Coverage of infertility services

The bill requires health insurance policies and self-insured governmental
health plans that cover medical or hospital expenses to cover diagnosis of and
treatment for infertility and standard fertility preservation services. Coverage
required under the bill must include at least four completed egg retrievals with
unlimited embryo transfers, in accordance with certain guidelines, and single
embryo transfer is allowed when recommended and medically appropriate. Policies
and plans are prohibited from imposing an exclusion, limitation, or other restriction
on coverage of medications of which the bill requires coverage that is not imposed on
any other prescription medications covered under the policy or plan. Similarly,
policies and plans may not impose any exclusion, limitation, cost-sharing
requirement, benefit maximum, waiting period, or other restriction on diagnosis,
treatment, or services for which coverage is required under the bill that is different
from any exclusion, limitation, cost-sharing requirement, benefit maximum,
waiting period, or other restriction imposed on benefits for other services. Also,
policies and plans may not impose an exclusion, limitation, or other restriction on
diagnosis, treatment, or services for which coverage is required under the bill on the
basis that an insured person participates in fertility services provided by or to a third
party.

Coverage of treatment or services provided by qualified treatment trainees

The bill prohibits any health insurance plan from excluding coverage for
mental health or behavioral health treatment or services provided by a qualified
treatment trainee within the scope of the qualified treatment trainee's education and
training if the health insurance plan covers the mental health or behavioral health
treatment or services when provided by another health care provider. “Qualified
treatment trainee” is defined under current law to mean either a graduate student
who is enrolled in an accredited institution in psychology, counseling, marriage and
family therapy, social work, nursing, or a closely related field, or a person with a
graduate degree from an accredited institution and course work in psychology,
counseling, marriage and family therapy, social work, nursing, or a closely related
field who has not yet completed the applicable supervised practice requirements
described under the administrative code.

Coverage of treatment or services provided by substance abuse counselors

The bill prohibits any health insurance plan from excluding coverage for
alcoholism or other drug abuse treatment or services provided by a certified
substance abuse counselor within the scope of the substance abuse counselor's
education and training if the health insurance plan covers the alcoholism or other
drug abuse treatment or services when provided by another health care provider.
“Substance abuse counselor” is defined under current law to mean a substance abuse
counselor-in-training, a substance abuse counselor, or a clinical substance abuse
counselor.

Telehealth parity

The bill requires health insurance policies and self-insured governmental
health plans to cover a treatment or service that is provided through telehealth if the
treatment or service is covered by the policy or plan when provided in person. A
policy or plan may limit its coverage to those treatments or services that are
medically necessary. “Telehealth” is defined in the bill as 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 consultation or are used to transfer medically relevant data about a
patient. A self-insured governmental health plan is a self-funded health plan of the
state or a county, city, village, town, or school district.

The bill also sets parameters on the coverage of telehealth treatments and
services that is required in the bill. A policy or plan may not subject a telehealth
treatment or service to a greater deductible, copayment, or coinsurance than if
provided in person. Similarly, a policy or plan may not impose a policy or calendar
year or lifetime benefit limit or other maximum limitation or a prior authorization
requirement on a telehealth treatment or service that is not imposed on treatments
or services provided through manners other than telehealth. A policy or plan also
may not place unique location requirements on a telehealth treatment or service. If
a policy or plan covers a telehealth treatment or service that has no in-person
equivalent, the policy or plan must disclose this in the policy or plan materials.

State-based exchange

The bill directs OCI to establish and operate a state-based health insurance
exchange. Under current law, the federal Patient Protection and Affordable Care Act
(ACA) requires that an exchange be established in each state to facilitate the
purchase of qualified health insurance coverage by individuals and small employers.
Under the ACA, a state must operate its own state-based exchange, use the federally
facilitated exchange operated by the federal Department of Health and Human
Services, or adopt a hybrid approach under which the state operates a state-based
exchange but uses the federal platform, known as HealthCare.gov, to handle
eligibility and enrollment functions. Wisconsin currently uses the federally
facilitated exchange. The bill directs OCI to establish and operate a state-based
exchange, first by using the federal platform and then transitioning to a fully
state-run exchange. The bill authorizes OCI to enter into any agreement with the
federal government necessary to implement those provisions. The bill also requires
that OCI impose a user fee on insurers offering plans through the state-based
exchange. Under current law, the ACA imposes user fees on insurers offering plans
through federally facilitated exchanges and state-based exchanges using the federal
platform, which are currently 2.75 percent and 2.25 percent of total monthly
premiums, respectively. The bill authorizes OCI to impose a user fee at the following
rates:

1. For any plan year that OCI operates the state-based exchange using the
federal platform, the rate is 0.5 percent.

2. For the first two plan years that OCI operates the fully state-run exchange,
the rate is equal to the user fee for the federally facilitated exchanges. For later plan
years, the rate is set by OCI by rule.

The bill also creates an annual GPR appropriation for OCI's general program
operations and allows OCI to spend up to $1,000,000 from that appropriation in fiscal
year 2023-24 for the development of a public option health insurance plan.

Insurer network adequacy standards

The bill allows OCI to promulgate administrative rules to establish minimum
network time and distance standards and minimum network wait-time standards
for defined network plans and preferred provider plans. The bill specifies that OCI,
in promulgating rules under the bill, must consider standards adopted by the federal
Centers for Medicare and Medicaid Services for qualified health plans offered on the
federally-facilitated health insurance marketplace established pursuant to the
ACA.

Wisconsin Healthcare Stability Plan spending limit

The bill directs the commissioner of insurance to index for inflation the annual
maximum expenditure amount under the Wisconsin Healthcare Stability Plan
(WIHSP). Under current law, WIHSP makes a reinsurance payment to a health
insurance carrier if the claims for an individual who is enrolled in a health benefit
plan with that carrier exceed a threshold amount, known as the attachment point,
in a benefit year. WIHSP is administered by OCI and operates under specific terms
and conditions of a waiver agreement between OCI and the federal Department of
Health and Human Services, which was dated July 29, 2018. Currently, the
commissioner is limited to spending $230,000,000 for WIHSP from all revenue
sources in a year, unless JCF increases the amount.

Beginning in 2025, the bill directs the commissioner to annually adjust the
annual expenditure limit based on the increase, if any, in the medical care index of
the consumer price index. The bill also specifies that OCI's authority includes the
authority to operate WIHSP under any waiver extension approvals.

Prescription drug importation program

The bill requires the commissioner of insurance, in consultation with persons
interested in the sale and pricing of prescription drugs and federal officials and
agencies, to design and implement a prescription drug importation program for the
benefit of and that generates savings for residents of this state. The bill establishes
requirements for the program, including all of the following: 1) the commissioner
must designate a state agency to become a licensed wholesale distributor or contract
with a licensed wholesale distributor and to seek federal certification and approval
to import prescription drugs; 2) the program must comply with certain federal
regulations and import from Canadian suppliers only prescription drugs that are not
brand-name drugs, have fewer than four competitor drugs in this country, and for
which importation creates substantial savings; 3) the commissioner must ensure
that prescription drugs imported under the program are not distributed, dispensed,
or sold outside of Wisconsin; and 4) the program must have an audit procedure to
ensure the program complies with certain requirements specified in the bill. Before

submitting the proposed program to the federal government for certification, the
commissioner must submit the proposed program to JCF for its approval.

State prescription drug purchasing entity

The bill requires OCI to conduct a study on the viability of creating or
implementing a state prescription drug purchasing entity.

Short-term, limited duration plan coverage requirements

The bill sets certain coverage requirements on individual health plans that are
short-term, limited duration plans. Under current law, a short-term, limited
duration plan is individual health benefit plan coverage that is marketed and
designed to provide short-term coverage as a bridge between other coverages and
that has a term of not more than 12 months and an aggregate term of all consecutive
periods of coverage that does not exceed 18 months. Under current law, an insurer
generally must renew individual health coverage at the option of the insured, but an
insurer is not required to renew a short-term, limited duration plan.

The bill requires an insurer that offers a short-term, limited duration plan to
accept each individual who applies for coverage, regardless of whether the individual
has a preexisting condition. The bill also prohibits a short-term, limited duration
plan from imposing a preexisting condition exclusion. Under current law, a
short-term, limited duration plan may impose a preexisting condition exclusion, but
the plan must reduce the length of time of the exclusion by the aggregate duration
of the insured's consecutive periods of coverage. Under current law, a preexisting
condition exclusion is a period of time during which a plan will not cover a medical
condition for which the insured received some medical attention before the effective
date of coverage.

Under the bill, an insurer that offers a short-term, limited duration plan may
not vary premium rates for a specific plan except on the basis of 1) whether the plan
covers an individual or a family; 2) area in this state; 3) age; and 4) tobacco use, as
specified in the bill. An insurer that offers a short-term, limited duration plan is
prohibited under the bill from establishing rules for the eligibility of any individual
to enroll based on certain health status-related factors, which are specified in the
bill, and from requiring an enrollee to pay a greater premium, contribution,
deductible, copayment, or coinsurance amount than is required of a similarly
situated enrollee based on a health status-related factor. Under the bill, a
short-term, limited duration plan may not establish lifetime limits or limits for the
duration of the coverage on the dollar value of benefits for an enrollee or a dependent
of an enrollee under the plan.

Finally, the bill reduces the maximum allowable term of a short-term, limited
duration plan from 12 months to three months and reduces the maximum aggregate
duration from 18 months to six months.

Eliminate obsolete OCI appropriation

The bill eliminates an obsolete appropriation. The 2021-23 biennial budget act
required the transfer of $1,520,300 in each fiscal year of that biennium from the
unencumbered balance of the program-revenue-funded general program
operations appropriation of OCI to an interagency and intraagency operations

appropriation created in the act for the purpose of general program operations. The
bill eliminates that appropriation.

justice

Grant programs

Treatment alternatives and diversion grants

Under current law, DOJ, in collaboration with DOC and DHS, awards grants
to counties and tribes that have established qualifying treatment alternatives and
diversion (TAD) programs that offer substance abuse or mental health treatment
services as alternatives to prosecution or incarceration in order to reduce recidivism,
promote public safety, and reduce prison and jail populations.

Under current law, in order to qualify for a TAD grant, a county's or tribe's
program is required to match 25 percent of the grant and to charge participants a fee
to participate. A county or tribe that receives a TAD grant must create an oversight
committee to administer and evaluate its program. DOJ is required to make grants
available to any county or tribe on a competitive basis every five years. At the end
of the five-year grant cycle, DOJ is required to prepare a comprehensive report on
the grant program based on annual reports and other data it collects from the
counties and tribes.

Under current law, one of the appropriations used to fund the TAD grant
program provides that DOJ may use that appropriation to provide a TAD grant to
counties that were not a recipient of a TAD grant as of September 23, 2017.

The bill makes several changes to the TAD grant program. Under the bill, a
program funded by a TAD grant need not focus solely on alcohol and other drug
treatment, but must employ evidence-based practices targeted to the population
served by the program. The bill changes the match requirement from 25 percent to
10 percent and changes the competitive grant process to a four-year cycle. The bill
allows, but does not require, an eligible program to charge participants a fee for their
treatment. The bill also eliminates certain requirements pertaining to exposure of
genitals during drug testing. The bill also provides that the appropriation that was
formerly limited to providing a TAD grant to a county that had not received one as
of September 23, 2017, may be used to provide a TAD grant to a county that is not
a recipient of a TAD grant on the effective date of the bill.

Under current law, when a person pleads or is found guilty of certain drug
offenses, the court is required to order a substance use assessment. Under current
law, the court does not have to order an assessment if the person is already covered
by such an order, has recently completed an assessment under such an order, or is
participating in a TAD program. The bill specifies that if a person is participating
in any evidence-based substance use disorder treatment program as determined by
DOJ, regardless of its status relating to the TAD program, the court does not need
to order an assessment.

Community policing and community prosecution program grants

Under current law, DOJ awards grants to local governments for many
purposes, including for community-oriented policing-house programs and to
increase beat patrol officers. The bill adds that DOJ must award grants to cities,

villages, towns, counties, and tribes to fund community policing and community
prosecution programs.

Sexual assault victim services grants for the Wisconsin Coalition Against
Sexual Assault

Under current law, DOJ administers a grant program to provide grants to
organizations that provide services to victims of sexual assault. The bill requires
that, in addition to the other grants under the program, DOJ must provide an annual
grant of $343,000 to the Wisconsin Coalition Against Sexual Assault. Under the bill,
the Wisconsin Coalition Against Sexual Assault may also apply for additional grants
under the program.

Law enforcement recruitment, retention, and wellness grants

Under current law, DOJ awards grants for many purposes, including for
community-oriented policing-house programs and to increase beat patrol officers.
The bill adds that DOJ must award grants to law enforcement agencies and tribal
law enforcement agencies in this state to fund programs that recruit and retain law
enforcement officers and that promote officer wellness.

Crime victims services grants

Under current law, DOJ awards grants for many purposes, including grants to
organizations to provide services for sexual assault victims. The bill adds that DOJ
must award grants to organizations that provide services for crime victims.

Elder abuse grants and hotline

Attorney general and litigation

Powers of the attorney general

The bill repeals changes made to the powers of the attorney general in 2017
Wisconsin Act 369 relating to the power to compromise or discontinue civil actions
prosecuted by DOJ and the power to compromise and settle actions in cases where
DOJ is defending the state. The bill reestablishes these settlement powers as they
existed under the law before 2017 Wisconsin Act 369 was enacted.

The bill allows the attorney general to compromise or discontinue actions
prosecuted by DOJ 1) when directed by the officer, department, board, or commission
that directed the prosecution or 2) with the approval of the governor when the action
is prosecuted by DOJ on the initiative of the attorney general or at the request of any
individual. The bill eliminates the requirement for approval of a compromise or
discontinuance from a legislative intervenor or JCF. It also eliminates the
requirement for the attorney general to obtain approval of a compromise or
discontinuance by the Joint Committee on Legislative Organization in certain
circumstances before submitting a proposed plan to JCF.

Under the bill, when DOJ is defending the state, the attorney general may
compromise and settle the action as the attorney general determines to be in the best
interest of the state. The bill eliminates the requirement under current law that, in

actions for injunctive relief or if there is a proposed consent decree, the attorney
general must 1) obtain the approval of any legislative intervenor or 2) if there is no
intervenor, submit a proposed plan to JCF and, in certain circumstances, obtain
approval of JCF. The bill also eliminates the requirement for the attorney general
to obtain approval from JCLO in certain circumstances before submitting a proposed
plan of settlement or compromise to JCF.

Gifts and grants and disposition of settlement funds

The bill repeals certain changes made by 2017 Wisconsin Act 369 relating to
gifts and grants and certain proceeds received by DOJ, specifically reversing
provisions that changed a DOJ gifts and grants appropriation and a DOJ gifts,
grants, and proceeds appropriation from continuing appropriations to annual
appropriations.

Second, the bill repeals the requirement that the attorney general must deposit
all settlement funds into the general fund. The bill restores procedures relating to
discretionary settlement funds under which the attorney general could expend
certain settlement funds not committed under the terms of a settlement after
submitting a plan to JCF for passive review only if either 1) the cochairpersons of
JCF do not schedule a meeting or 2) a meeting is scheduled and JCF approves a plan
for expenditure.

Certain legal expenses related to the tobacco settlement agreement

The bill establishes an appropriation from which DOJ may expend moneys for
its legal expenses related to participation in arbitration or other alternative dispute
resolution processes arising from payments under the Attorneys General Master
Tobacco Settlement Agreement of November 23, 1998. In 1998, numerous states and
territories including Wisconsin agreed to a settlement with the major U.S. tobacco
companies regarding dozens of state lawsuits brought to recover health care costs
associated with treating smoking-related illnesses. Under the agreement, the state
receives annual payments from U.S. tobacco product manufacturers in perpetuity.

General justice

Background checks on all transfers of firearms

Current law provides that a federally licensed firearms dealer may not transfer
a handgun after a sale until the dealer has performed a background check on the
prospective transferee to determine if he or she is prohibited from possessing a
firearm under state or federal law. The bill generally prohibits any person from
transferring any firearm, including the frame or receiver of a firearm, unless the
transfer occurs through a federally licensed firearms dealer and involves a
background check of the prospective transferee. Under the bill, the prohibition does
not apply to 1) a transfer to a firearms dealer or to a law enforcement or armed
services agency; 2) a transfer of a firearm classified as antique; 3) a transfer for no
more than 14 days for the purpose of hunting or target shooting that involves no more
than nominal consideration; or 4) a transfer that is by gift, bequest, or inheritance
to a family member. A person who is convicted of violating the prohibition is guilty
of a misdemeanor and must be fined not less than $500 nor more than $10,000, may

be imprisoned for not more than nine months, and may not possess a firearm for a
period of two years.

Creating the Office of Missing and Murdered Indigenous Women

The bill creates within DOJ the Office of Missing and Murdered Indigenous
Women, which is tasked with providing certain services to crime victims, their
families, witnesses, and others who are members of a tribe; providing training
relating to missing and murdered indigenous women, including search, rescue, and
response training; and establishing a grant program related to missing and
murdered indigenous women.

Hate crimes reporting portal

The bill requires DOJ to develop an Internet-based reporting system and a
telephone hotline for the reporting of hate crimes. Under the bill, DOJ must conduct
a public education campaign on hate crimes and where to report them and must
collect data relating to the reporting of hate crimes.

Relator appropriation

The bill creates a continuing appropriation to hold all money received by DOJ
that is owed to a relator, to provide payments to relators. A relator is a type of party
in a legal action in whose name an action is brought by a state.

Repeal of report on field prosecutor positions

2017 Wisconsin Act 261 created two field prosecutor attorney positions in DOJ
to assist the Division of Criminal Investigation and district attorneys. Act 261 also
required DOJ to submit annual reports to JCF on the activities and effectiveness of
the attorneys. The project positions terminate on April 11, 2023. The bill repeals the
requirement that DOJ submit the corresponding annual report.

Name of Shot Spotter Program

Under current law, DOJ provides money to the Shot Spotter Program in the city
of Milwaukee. The bill changes the name of the program to the “Gunfire Detection
Program.”

local government

Levy limits

Local levy overview

Generally, under current law, local levy increase limits are applied to the
property tax levies that are imposed by political subdivisions in December of each
year. Current law prohibits a political subdivision from increasing its levy by a
percentage that exceeds its valuation factor, which is defined as the greater of either
0 percent or the percentage change in the political subdivision's equalized value due
to new construction, less improvements removed.

Current law contains a number of exceptions to these levy increase limits, such
as amounts a county levies for a countywide emergency medical system, for a county
children with disabilities education board, and for certain bridge and culvert
construction and repair. In addition, a political subdivision may exceed the levy
increase limit that is otherwise applicable if its governing body adopts a resolution
to do so and if that resolution is approved by the voters in a referendum.

Alternative minimum valuation factor increase

The bill increases the alternative minimum valuation factor used to calculate
local levy limits from 0 percent to 2 percent, beginning with levies imposed in
December 2023.

Reduction for certain service revenues

Under current law, a political subdivision must reduce its allowable levy by the
estimated amount of any revenue from fees or payments in lieu of taxes if the revenue
is received for providing certain covered services that were funded with property tax
revenues in calendar year 2013. The covered services are certain garbage collection,
fire protection, snow plowing, street sweeping, and storm water management.

The bill repeals the requirement that a political subdivision must reduce its
allowable levy by the estimated amount of revenues received for providing covered
services that were funded with property tax revenues in calendar year 2013.