Amendment SSA1-AB1038

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).

AB1038-SSA1,71,2 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB1038-SSA1,71,6 (c) “Telehealth” means 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.

AB1038-SSA1,71,10 (2) Coverage denial prohibited. No disability insurance policy or self-insured health plan may deny coverage for a treatment or service provided through telehealth if that treatment or service is covered by the policy or plan when provided in person by a health care provider.

AB1038-SSA1,71,12 (3) Rule making. The commissioner may promulgate any rules necessary to implement this section.

AB1038-SSA1,138 Section 138. 632.895 (14g) of the statutes is created to read:

AB1038-SSA1,71,15 632.895 (14g) Coverage of COVID-19 . (a) In this subsection, “COVID-19” means an infection caused by the SARS-CoV-2 coronavirus.

AB1038-SSA1,71,21 (b) Every disability insurance policy, and every self-insured health plan of the state or of a county, city, town, village, or school district, that generally covers testing and treatment for infectious diseases shall provide coverage of testing and treatment for COVID-19, including any prescription drugs, and administration of any vaccination developed to prevent COVID-19 without imposing any copayment or coinsurance on the individual covered under the policy or plan.

AB1038-SSA1,139 Section 139. 632.895 (16v) of the statutes is created to read:

AB1038-SSA1,72,4 632.895 (16v) Prohibiting coverage limitations on prescription drugs. (a) During a state of emergency related to public health declared by the governor under s. 323.10, an insurer offering a disability insurance policy that covers prescription drugs, a self-insured health plan of the state or of a county, city, town, village, or school district that covers prescription drugs, or a pharmacy benefit manager acting on behalf of a policy or plan may not do any of the following in order to maintain coverage of a prescription drug:

AB1038-SSA1,72,6 1. Require prior authorization for early refills of a prescription drug or otherwise restrict the period of time in which a prescription drug may be refilled.

AB1038-SSA1,72,8 2. Impose a limit on the quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply.

AB1038-SSA1,72,10 (b) This subsection does not apply to a prescription drug that is a controlled substance, as defined in s. 961.01 (4).

AB1038-SSA1,140 Section 140. 655.0025 of the statutes is created to read:

AB1038-SSA1,72,15 655.0025 Participation during public health emergency. During a state of emergency declared under s. 323.10 related to public health all of the following apply to a physician or nurse anesthetist for whom this state is not a principal place of practice but who is authorized to practice in this state on a temporary basis:

AB1038-SSA1,72,19 (1) The physician or nurse anesthetist may fulfill the requirements of s. 655.23 (3) (a) by filing with the commissioner a certificate of insurance for a policy of health care liability insurance issued by an insurer that is authorized in a jurisdiction accredited by the National Association of Insurance Commissioners.

AB1038-SSA1,72,21 (2) The physician or nurse anesthetist may elect, in the manner designated by the commissioner by rule under s. 655.004, to be subject to this chapter.

AB1038-SSA1,141 Section 141. 704.17 (6) of the statutes is created to read:

AB1038-SSA1,73,4 704.17 (6) Public health emergency. (a) Notwithstanding subs. (1p) (a) and (2) (a), during any period covered by a public health emergency declared by the governor, including any extension under s. 323.10, and during the 45 days following that period, a landlord may not give a tenant who is in default of a rent payment a notice to pay rent or vacate within at least 5 days or a notice to vacate within at least 14 days that is based on a failure to pay rent and may not charge a late fee for a late payment of rent.

AB1038-SSA1,73,10 (b) If a landlord gave a tenant who is in default of a rent payment a notice to pay rent or vacate under sub. (1p) (a) or (2) (a) or a notice to vacate under sub. (1p) (a) before a period covered by a public health emergency declared by the governor, including any extension under s. 323.10, the days during that period and the 45 days following that period may not be counted in the 5 days to pay rent or 14 days to vacate under the notice.

AB1038-SSA1,142 Section 142. 704.23 of the statutes is amended to read:

AB1038-SSA1,73,19 704.23 Removal of tenant on termination of tenancy. If a tenant remains in possession without consent of the tenant's landlord after termination of the tenant's tenancy, the landlord may in every case proceed in any manner permitted by law to remove the tenant and recover damages for such holding over. This section does not apply if a tenant's tenancy has terminated because of a failure to pay rent prior to a period covered by a public health emergency declared by the governor, but the tenant has not yet been removed from the premises and a civil action of eviction has not yet been commenced.

AB1038-SSA1,143 Section 143. 704.25 (1) of the statutes is amended to read:

AB1038-SSA1,74,3 704.25 (1) Removal and recovery of damages. If a tenant holds over after expiration of a lease, the landlord may in every case proceed in any manner permitted by law to remove the tenant and recover damages for such holding over. This subsection does not apply if a tenant's tenancy has terminated, but would not otherwise have expired, because of a failure to pay rent prior to a period covered by a public health emergency declared by the governor, the tenant has not yet been removed from the premises, and a civil action of eviction has not yet been commenced.

AB1038-SSA1,144 Section 144. 799.24 (1m) of the statutes is created to read:

AB1038-SSA1,74,8 799.24 (1m) Public health emergency. Notwithstanding the provisions of sub. (1), during a period covered by a public health emergency declared by the governor, including any extension under s. 323.10, and during the 45 days following that period, no court may enter a judgment or order of eviction under sub. (1).

AB1038-SSA1,145 Section 145. 799.40 (1c) of the statutes is created to read:

AB1038-SSA1,74,17 799.40 (1c) Public health emergency. Notwithstanding sub. (1) or any other provision of this chapter, if a tenant's tenancy has terminated because of a failure to pay rent prior to a period covered by a public health emergency declared by the governor, but the tenant has not yet been removed from the premises and a civil action of eviction has not yet been commenced, the landlord may not commence a civil action of eviction based on the tenant's failure to pay rent during the period covered by the public health emergency, including any extension under s. 323.10, or during the 45 days following that period.

AB1038-SSA1,146 Section 146. 799.44 (2m) of the statutes is created to read:

AB1038-SSA1,74,23 799.44 (2m) Public health emergency. Notwithstanding the provisions of subs. (1) and (2), during a period covered by a public health emergency declared by the governor, including any extension under s. 323.10, and during the 45 days following that period, no court may enter an order for judgment under sub. (1) or order that a writ of restitution be issued under sub. (2).

AB1038-SSA1,147 Section 147. 799.45 (1m) of the statutes is created to read:

AB1038-SSA1,75,4 799.45 (1m) Public health emergency. Notwithstanding the provisions of this section, no sheriff may execute a writ of restitution during a period covered by a public health emergency declared by the governor, including any extension under s. 323.10, or during the 45 days following that period.

AB1038-SSA1,148 Section 148 . 938.026 of the statutes is created to read:

AB1038-SSA1,75,10 938.026 Public health emergency. During a public health emergency declared by the governor under s. 323.10, including any extension, notwithstanding ss. 938.217 (2) and 938.357 (2) (c), in emergency situations, a child may be placed in a licensed public or private shelter care facility as a transitional placement for not more than 40 days.

AB1038-SSA1,149 Section 149 . Nonstatutory provisions.

AB1038-SSA1,75,13 (1) Applications for heating assistance. Households may apply for heating assistance under s. 16.27 (4) (a) at any time during calendar year 2020.

AB1038-SSA1,75,14 (2) Professional licensing; emergency project positions.

AB1038-SSA1,76,2 (a) The authorized FTE positions for the department of safety and professional services are increased by 8.4 project positions, for a period ending on June 30, 2021, to be funded from the appropriation under s. 20.165 (1) (g) for the purposes of investigating complaints against a credential holder received by the department of safety and professional services or any examining board, affiliated credentialing board, or board in the department; investigating whether a person has practiced without a credential required under chs. 440 to 480; and investigating the criminal records and records of professional discipline of applicants for a credential. Two incumbent employees holding an LTE consumer protection investigator position; 1.9 incumbent employees holding an LTE legal associate position; one incumbent employee holding an LTE office associate position; and 3.5 employees holding an LTE office operations associate position shall be transferred to the FTE project positions being created in this paragraph.

AB1038-SSA1,76,12 (b) The authorized FTE positions for the department of safety and professional services are increased by 10.5 project positions, for a period ending on June 30, 2021, to be funded from the appropriation under s. 20.165 (1) (hg) for the purposes of reviewing applications for credentials received by the department of safety and professional services and credentialing boards and for assisting applicants for credentials. One incumbent employee holding an LTE attorney position; 2 incumbent employees holding an LTE legal associate position; 4 incumbent employees holding an LTE license and permit program associate position; and 3.5 incumbent employees holding an LTE office operations associate position shall be transferred to the FTE project positions being created in this paragraph.

AB1038-SSA1,76,20 (c) The authorized FTE positions for the department of safety and professional services are increased by 2.1 project positions, for a period ending on June 30, 2021, to be funded from the appropriation under s. 20.165 (2) (j) for the purpose of reviewing applications for credentials received by the department of safety and professional services and for assisting applicants for credentials. Two incumbent employees holding an LTE license and permit program associate position and 0.1 incumbent employees holding an LTE legal associate position shall be transferred to the FTE project positions being created in this paragraph.

AB1038-SSA1,76,23 (3) Medical Assistance program funding. The department of health services shall allocate in the following manner the moneys under Section 150 (8) for reimbursement increases due to the COVID-19 pandemic:

AB1038-SSA1,76,24 (a) $9,863,400 for fee-for-service institutional long-term care.

AB1038-SSA1,76,25 (b) $3,944,000 for fee-for-service personal care.

AB1038-SSA1,77,1 (c) $39,933,200 for managed long-term care.

AB1038-SSA1,77,2 (d) $14,861,900 for home and community-based waiver services.

AB1038-SSA1,77,3 (e) $25,822,500 as supplemental payments to hospitals.

AB1038-SSA1,77,8 (4) Local food bank grants. The department of health services may award grants to local food banks and may establish eligibility criteria and guidelines for those grants that, notwithstanding ss. 227.01 (3m) and (13), 227.10, and 227.112, need not be promulgated as rules under ch. 227, are not guidance documents, and are not subject to the requirements of s. 227.112.