Amendment AA8-ASA1-AB64

AB64-ASA1-AA8,26,6 11. Lipid disorder screening for minors 2 years of age or older, high risk women 20 years of age or older, men age 20 years of age or older at high risk for lipid disorders, and all men 35 years of age or older.

AB64-ASA1-AA8,26,9 12. Aspirin therapy for cardiovascular health for adults who have attained the age of 55 years but have not attained the age of 80 years and for men who have attained the age of 45 years but have not attained the age of 55 years.

AB64-ASA1-AA8,26,11 13. Behavioral counseling for cardiovascular health for adults who are overweight or obese and who have risk factors for cardiovascular disease.

AB64-ASA1-AA8,26,12 14. Type II diabetes screening for adults with elevated blood pressure.

AB64-ASA1-AA8,26,14 15. Depression screening for minors 11 years of age or older and for adults when follow-up supports are available.

AB64-ASA1-AA8,26,16 16. Hepatitis B screening for minors at high risk for infection and adults at high risk for infection.

AB64-ASA1-AA8,26,18 17. Hepatitis C screening for adults at high risk for infection and one time hepatitis C screening for adults born in 1945 to 1965.

AB64-ASA1-AA8,26,22 18. Obesity screening and management for all minors and adults with a body mass index indicating obesity, counseling and behavioral interventions for obese minors who are 6 years of age or older, and referral for intervention for obesity for adults with a body mass index of 30 kilograms per square meter or higher.

AB64-ASA1-AA8,26,24 19. Osteoporosis screening for all women 65 years of age or older and for women at high risk for osteoporosis under the age of 65 years.

AB64-ASA1-AA8,26,25 20. Immunizations in accordance with sub. (14).

AB64-ASA1-AA8,27,3 21. Anemia screening for individuals 6 months of age or older and iron supplements for individuals at high risk for anemia and who have attained the age of 6 months but have not attained the age of 12 months.

AB64-ASA1-AA8,27,5 22. Fluoride varnish for prevention of tooth decay for minors at the age of eruption of their primary teeth.

AB64-ASA1-AA8,27,7 23. Fluoride supplements for prevention of tooth decay for minors 6 months of age or older who do not have fluoride in their water source.

AB64-ASA1-AA8,27,8 24. Gonorrhea prophylaxis treatment for newborns.

AB64-ASA1-AA8,27,9 25. Health history and physical exams for prenatal visits and for minors.

AB64-ASA1-AA8,27,11 26. Length and weight measurements for newborns and height and weight measurements for minors.

AB64-ASA1-AA8,27,13 27. Head circumference and weight for length measurements for newborns and minors who have not attained the age of 3 years.

AB64-ASA1-AA8,27,14 28. Body mass index for minors 2 years of age or older.

AB64-ASA1-AA8,27,16 29. Blood pressure measurements for minors 3 years of age or older and a blood pressure risk assessment at birth.

AB64-ASA1-AA8,27,18 30. Risk assessment and referral for oral health issues for minors who have attained the age of 6 months but have not attained the age of 7 years.

AB64-ASA1-AA8,27,20 31. Blood screening for newborns and minors who have not attained age 2 months.

AB64-ASA1-AA8,27,21 32. Screening for critical congenital health defect for newborns.

AB64-ASA1-AA8,27,22 33. Lead screenings in accordance with sub. (10).

AB64-ASA1-AA8,27,24 34. Metabolic and hemoglobin screening and screening for phenylketonuria, sickle cell anemia, and congenital hypothyroidism for minors including newborns.

AB64-ASA1-AA8,28,2 35. Tuberculin skin test based on risk assessment for minors one month of age or older.

AB64-ASA1-AA8,28,4 36. Tobacco counseling and cessation interventions for individuals who are 5 years of age or older.

AB64-ASA1-AA8,28,6 37. Vision and hearing screening and assessment for minors including newborns.

AB64-ASA1-AA8,28,8 38. Sexually transmitted infection and human immunodeficiency virus counseling for sexually active minors.

AB64-ASA1-AA8,28,11 39. Risk assessment for sexually transmitted infection for minors who are 10 years of age or older and screening for sexually transmitted infection for minors who are 16 years of age or older.

AB64-ASA1-AA8,28,12 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

AB64-ASA1-AA8,28,14 41. Autism screening for minors who have attained the age of 18 months but have not attained the age of 25 months.

AB64-ASA1-AA8,28,15 42. Developmental screening and surveillance for minors including newborns.

AB64-ASA1-AA8,28,16 43. Psychosocial and behavioral assessment for minors including newborns.

AB64-ASA1-AA8,28,18 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB64-ASA1-AA8,28,20 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB64-ASA1-AA8,28,21 46. Screening and counseling for intimate partner violence for adult women.

AB64-ASA1-AA8,28,24 47. Well-woman visits for women who have attained the age of 18 years but have not attained the age of 65 years and well-woman visits for recommended preventive services, preconception care, and prenatal care.

AB64-ASA1-AA8,29,2 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB64-ASA1-AA8,29,3 49. Folic acid supplement for adult women with reproductive capacity.

AB64-ASA1-AA8,29,4 50. Iron deficiency anemia screening for pregnant and lactating women.

AB64-ASA1-AA8,29,6 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB64-ASA1-AA8,29,8 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB64-ASA1-AA8,29,9 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB64-ASA1-AA8,29,11 54. Screening for gonorrhea for pregnant and sexually active females 24 years of age or younger and females older than 24 years of age who are at risk for infection.

AB64-ASA1-AA8,29,14 55. Screening for chlamydia for pregnant and sexually active females 24 years of age and younger and females older than 24 years of age who are at risk for infection.

AB64-ASA1-AA8,29,16 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB64-ASA1-AA8,29,19 57. Human immunodeficiency virus screening for adults who have attained the age of 15 years but have not attained the age of 66 years and individuals at high risk of infection who are younger than 15 years of age or older than 65 years of age.

AB64-ASA1-AA8,29,20 58. All contraceptives and services in accordance with sub. (17).

AB64-ASA1-AA8,29,22 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. Preventive Services Task Force.

AB64-ASA1-AA8,29,25 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration's Bright Futures project.

AB64-ASA1-AA8,30,3 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the Advisory Committee on Immunization Practices.

AB64-ASA1-AA8,30,6 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB64-ASA1-AA8,30,10 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB64-ASA1-AA8,30,13 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB64-ASA1-AA8,30,22 3. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers, the policy or plan may apply deductibles to and impose copayments or coinsurance on the office visit and the preventive service. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers because there is no available health care provider in the policy's or plan's network of providers that provides the preventive service, the policy or plan may not apply deductibles to or impose copayments or coinsurance on preventive service.

AB64-ASA1-AA8,31,2 4. If multiple well-woman visits described under par. (b) 47. are required to fulfill all necessary preventive services and are in accordance with clinical recommendations, the disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to any of those well-woman visits.

AB64-ASA1-AA8,2219d Section 2219d. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB64-ASA1-AA8,31,4 632.895 (14) (a) 1. i. Hepatitis A and B.

AB64-ASA1-AA8,31,5 j. Varicella and herpes zoster.

AB64-ASA1-AA8,2219f Section 2219f. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB64-ASA1-AA8,31,7 632.895 (14) (a) 1. k. Human papillomavirus.

AB64-ASA1-AA8,31,8 L. Meningococcal meningitis.

AB64-ASA1-AA8,31,9 m. Pneumococcal pneumonia.

AB64-ASA1-AA8,31,10 n. Influenza.

AB64-ASA1-AA8,31,11 o. Rotavirus.

AB64-ASA1-AA8,2219h Section 2219h. 632.895 (14) (b) of the statutes is amended to read:

AB64-ASA1-AA8,31,18 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for an insured or plan participant, including a dependent who is a child of the insured or plan participant.

AB64-ASA1-AA8,2219j Section 2219j. 632.895 (14) (c) of the statutes is amended to read:

AB64-ASA1-AA8,31,24 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

AB64-ASA1-AA8,2219m Section 2219m. 632.895 (14) (d) 3. of the statutes is amended to read:

AB64-ASA1-AA8,32,3 632.895 (14) (d) 3. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

AB64-ASA1-AA8,2219p Section 2219p. 632.895 (16m) (b) of the statutes is amended to read:

AB64-ASA1-AA8,32,9 632.895 (16m) (b) The coverage required under this subsection may be subject to any limitations, or exclusions , or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. The coverage required under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB64-ASA1-AA8,2219r Section 2219r. 632.895 (17) (b) 2. of the statutes is amended to read:

AB64-ASA1-AA8,32,15 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan sterilization procedures, and patient education and counseling for all females with reproductive capacity.

AB64-ASA1-AA8,2219t Section 2219t. 632.895 (17) (c) of the statutes is amended to read:

AB64-ASA1-AA8,33,6 632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions, and limitations, or cost-sharing provisions that apply generally to the coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices that is provided under the policy or self-insured health plan. A disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to at least one of each type of contraceptive method approved by the federal food and drug administration for which coverage is required under this subsection. The disability insurance policy or self-insured health plan may apply reasonable medical management to a method of contraception to limit coverage under this subsection that is provided without being subject to a deductible, copayment, or coinsurance to prescription drugs without a brand name. The disability insurance policy or self-insured health plan may apply a deductible or impose a copayment or coinsurance for coverage of a contraceptive that is prescribed for a medical need if the services for the medical need would otherwise be subject to a deductible, copayment, or coinsurance.”.

AB64-ASA1-AA8,33,7 27. Page 925, line 14: after that line insert:

AB64-ASA1-AA8,33,8 “ Section 2218s. 609.845 of the statutes is created to read:

AB64-ASA1-AA8,33,10 609.845 Lifetime and annual limits. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.883.

AB64-ASA1-AA8,2218x Section 2218x. 632.883 of the statutes is created to read:

AB64-ASA1-AA8,33,15 632.883 Lifetime and annual limits. (1) No group or individual disability insurance policy, as defined in s. 632.895 (1) (a), and no self-insured health plan, as defined in s. 632.745 (24), may impose a lifetime limit on the dollar value of benefits provided under the policy or plan.

AB64-ASA1-AA8,33,18 (2) No group or individual disability insurance policy, as defined in s. 632.895 (1) (a), and no self-insured health plan, as defined in s. 632.745 (24), may impose an annual limit on the dollar value of benefits under the policy or plan.”.

AB64-ASA1-AA8,33,19 28. Page 1015, line 10: after that line insert:

AB64-ASA1-AA8,34,2 “(5r) Extension of prescription drug assistance for elderly. The department of health services shall request from the federal secretary of health and human services any waiver of federal medicaid laws necessary to permit the department of health services to continue administering the program under section 49.688 of the statutes for 4 years from the date the waiver under this subsection is granted. The department shall implement any waiver received under this subsection.”.

AB64-ASA1-AA8,34,3 29. Page 1015, line 10: after that line insert:

AB64-ASA1-AA8,34,4 “(5p) Medical Assistance nonemergency medical transportation.

AB64-ASA1-AA8,34,12 (b) The department of health services shall, to the extent permitted by the contract, modify the contract that is in effect on the effective date of this paragraph for the arrangement and reimbursement of nonemergency medical transportation services to recipients of Medical Assistance under subchapter IV of chapter 49 of the statutes to exclude recipients of Medical Assistance residing in Buffalo, Eau Claire, Jefferson, Kenosha, Milwaukee, Ozaukee, Pepin, Racine, Rock, Trempealeau, Walworth, Washington, and Waukesha counties from that contract unless the county chooses to remain under the original contract.

AB64-ASA1-AA8,35,4 (c) If the department of health services modifies the contract under paragraph (b), the department of health services shall make alternative arrangements with counties, health maintenance organizations, or transportation providers to provide nonemergency medical transportation services to Medical Assistance recipients who reside in the counties specified in paragraph (b ), except any county that chooses to remain under the original contract, no later than January 1, 2019. The department of health services shall include in any contract for alternative arrangements under this paragraph a requirement that the nonemergency medical transportation provider submit to the department of health services information substantially similar to the information required under the original contract including trip log data, summary information on all calls for services and contacts with Medical Assistance recipients, encounter data based on Centers for Medicare and Medicaid Services 1500 claim form data, network provider information, accident and moving violation reports, vehicle reports, complaint summary reports, telecommunications system reports, annual fiscal audit reports, and daily reports including numbers of trips, canceled trips, denied trips, and complaints.”.