Amendment ASA1-AB969

2025 - 2026 LEGISLATURE

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CMH:wlj

ASSEMBLY SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 969

February 18, 2026 - Offered by Representative Neubauer.

AB969-ASA1,1,9 An Act to renumber 632.895 (8) (a) 1.; to renumber and amend 632.895 (8) (d); to amend 40.51 (8m), 49.46 (1) (a) 1m., 49.46 (1) (j), 49.47 (4) (ag) 2., 49.471 (6) (b), 49.471 (7) (b) 1., 66.0137 (4), 120.13 (2) (g) and 609.80; to create 49.46 (2) (b) 6. n., 632.895 (8) (a) 1b., 632.895 (8) (a) 1f., 632.895 (8) (a) 1k., 632.895 (8) (a) 1s., 632.895 (8) (a) 1w., 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 and extension of eligibility under the Medical Assistance program for postpartum women.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB969-ASA1,1 Section 1. 40.51 (8m) of the statutes is amended to read:

AB969-ASA1,2,4 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.722, 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).

AB969-ASA1,2 Section 2. 49.46 (1) (a) 1m. of the statutes is amended to read:

AB969-ASA1,2,10 49.46 (1) (a) 1m. Any pregnant woman whose income does not exceed the standard of need under s. 49.19 (11) and whose pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 90th 365th day after the last day of the pregnancy falls.

AB969-ASA1,3 Section 3. 49.46 (1) (j) of the statutes is amended to read:

AB969-ASA1,2,16 49.46 (1) (j) An individual determined to be eligible for benefits under par. (a) 9. remains eligible for benefits under par. (a) 9. for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 90th 365th day after the last day of the pregnancy falls without regard to any change in the individual’s family income.

AB969-ASA1,4 Section 4. 49.46 (2) (b) 6. n. of the statutes is created to read:

AB969-ASA1,2,19 49.46 (2) (b) 6. n. Breast screenings for which coverage is required under s. 632.895 (8) (am).

AB969-ASA1,5 Section 5. 49.47 (4) (ag) 2. of the statutes is amended to read:

AB969-ASA1,3,2 49.47 (4) (ag) 2. Pregnant and the woman’s pregnancy is medically verified. Eligibility continues to the last day of the month in which the 60th day or, if approved by the federal government, the 90th 365th day after the last day of the pregnancy falls.

AB969-ASA1,6 Section 6. 49.471 (6) (b) of the statutes is amended to read:

AB969-ASA1,3,8 49.471 (6) (b) A pregnant woman who is determined to be eligible for benefits under sub. (4) remains eligible for benefits under sub. (4) for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 90th 365th day after the last day of the pregnancy falls without regard to any change in the woman’s family income.

AB969-ASA1,7 Section 7. 49.471 (7) (b) 1. of the statutes is amended to read:

AB969-ASA1,3,21 49.471 (7) (b) 1. A pregnant woman whose family income exceeds 300 percent of the poverty line may become eligible for coverage under this section if the difference between the pregnant woman’s family income and the applicable income limit under sub. (4) (a) is obligated or expended for any member of the pregnant woman’s family for medical care or any other type of remedial care recognized under state law or for personal health insurance premiums or for both. Eligibility obtained under this subdivision continues without regard to any change in family income for the balance of the pregnancy and to the last day of the month in which the 60th day or, if approved by the federal government, the 90th 365th day after the last day of the woman’s pregnancy falls. Eligibility obtained by a pregnant woman under this subdivision extends to all pregnant women in the pregnant woman’s family.

AB969-ASA1,8 Section 8. 66.0137 (4) of the statutes is amended to read:

AB969-ASA1,4,6 66.0137 (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), 632.722, 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).

AB969-ASA1,9 Section 9. 120.13 (2) (g) of the statutes is amended to read:

AB969-ASA1,4,11 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 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).

AB969-ASA1,10 Section 10. 609.80 of the statutes is amended to read:

AB969-ASA1,4,17 609.80 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.

AB969-ASA1,11 Section 11. 632.895 (8) (a) 1. of the statutes is renumbered 632.895 (8) (a) 1y.

AB969-ASA1,12 Section 12. 632.895 (8) (a) 1b. of the statutes is created to read:

AB969-ASA1,4,22 632.895 (8) (a) 1b. “Breast magnetic resonance imaging” means a diagnostic tool that uses a powerful magnetic field, radio waves, and a computer to produce detailed pictures of the structures within the breast.

AB969-ASA1,13 Section 13. 632.895 (8) (a) 1f. of the statutes is created to read:

AB969-ASA1,5,2 632.895 (8) (a) 1f. “Breast tomosynthesis” means a procedure that uses X-rays to take a series of pictures of the inside of the breast from many different angles.

AB969-ASA1,14 Section 14. 632.895 (8) (a) 1k. of the statutes is created to read:

AB969-ASA1,5,5 632.895 (8) (a) 1k. “Breast ultrasound” means a noninvasive diagnostic tool that uses high-frequency sound.

AB969-ASA1,15 Section 15. 632.895 (8) (a) 1s. of the statutes is created to read:

AB969-ASA1,5,10 632.895 (8) (a) 1s. “Diagnostic breast examination” means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging, breast ultrasound, breast tomosynthesis, or diagnostic mammography that is used to evaluate any of the following:

AB969-ASA1,5,12 a. An abnormality seen or suspected from a screening examination for breast cancer.

AB969-ASA1,5,14 b. An abnormality that is detected by a health care provider or patient by another means of examination.

AB969-ASA1,16 Section 16. 632.895 (8) (a) 1w. of the statutes is created to read:

AB969-ASA1,5,17 632.895 (8) (a) 1w. “Diagnostic mammography” means a diagnostic tool that uses X-rays and is designed to evaluate an abnormality in the breast.

AB969-ASA1,17 Section 17. 632.895 (8) (a) 5. of the statutes is created to read:

AB969-ASA1,5,20 632.895 (8) (a) 5. “Self-insured health plan” has the meaning given in s. 632.745 (24).

AB969-ASA1,18 Section 18. 632.895 (8) (a) 6. of the statutes is created to read:

AB969-ASA1,6,3 632.895 (8) (a) 6. “Supplemental breast screening examination” means a medically necessary and appropriate examination of the breast using breast magnetic resonance imaging or breast ultrasound that is used to screen for breast cancer when there is no abnormality seen or suspected, based on personal or family medical history or additional factors that may increase an individual’s risk of breast cancer.

AB969-ASA1,19 Section 19. 632.895 (8) (am) of the statutes is created to read:

AB969-ASA1,6,6 632.895 (8) (am) 1. Every disability insurance policy and self-insured health plan shall provide coverage of diagnostic breast examinations.

AB969-ASA1,6,13 2. Every disability insurance policy and self-insured health plan shall provide coverage to 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, for supplemental breast screening examinations.

AB969-ASA1,20 Section 20. 632.895 (8) (d) of the statutes is renumbered 632.895 (8) (d) 1. and amended to read:

AB969-ASA1,6,21 632.895 (8) (d) 1. Coverage is required under this subsection despite whether the woman shows any symptoms of breast cancer. Except as provided in subds. 2. and 3. and pars. (b), (c) and (e), coverage under this subsection may only be subject to exclusions and limitations, including deductibles, copayments and restrictions on excessive charges, that are applied to other radiological examinations covered under the disability insurance policy.

AB969-ASA1,21 Section 21. 632.895 (8) (d) 2. of the statutes is created to read:

AB969-ASA1,7,2 632.895 (8) (d) 2. a. A disability insurance policy or self-insured health plan may not impose on a covered individual a cost-sharing amount for a diagnostic breast examination.

AB969-ASA1,7,8 b. A disability insurance policy or self-insured health plan may not impose on a covered individual a cost-sharing amount for the first supplemental breast screening examination in a policy year. A disability insurance policy or self-insured health plan may impose on a covered individual a cost-sharing amount as provided in subd. 1. for any subsequent supplemental breast screening examinations in a policy year.

AB969-ASA1,22 Section 22. 632.895 (8) (d) 3. of the statutes is created to read:

AB969-ASA1,7,18 632.895 (8) (d) 3. If, under federal law, application of this paragraph would result in ineligibility for a health savings account under section 223 of the Internal Revenue Code, this paragraph shall apply to a health-savings-account-qualified high deductible health plan with respect to the deductible of such a plan only after the enrollee has satisfied the minimum deductible under section 223 of the Internal Revenue Code, except with respect to items or services that are preventive care pursuant to section 223 (c) (2) (C) of the Internal Revenue Code, in which case this paragraph shall apply regardless of whether the minimum deductible under section 223 of the Internal Revenue Code has been satisfied.

AB969-ASA1,23 Section 23. Initial applicability.

AB969-ASA1,7,22 (1) For policies and plans containing provisions inconsistent with this act, the act first applies to policy or plan years beginning on January 1 of the year following the year in which this subsection takes effect, except as provided in sub. (2).

AB969-ASA1,8,3 (2) For policies and plans that are affected by a collective bargaining agreement containing provisions inconsistent with this act, this act first applies to policy or plan years beginning on the effective date of this subsection or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.