2023 - 2024 LEGISLATURE
March 24, 2023 - Introduced by Representatives Gustafson, Binsfeld, Snodgrass,
J. Anderson, Andraca, Baldeh, Bare, Behnke, Cabrera, Conley, Considine,
Dittrich, Goeben, Joers, Krug, Macco, Murphy, Mursau, Ohnstad,
Ortiz-Velez, Palmeri, Rozar, Sinicki, Spiros, Stubbs, Subeck, Tusler,
Vining, Clancy, Madison and Haywood, cosponsored by Senators
Cabral-Guevara, Larson, Hesselbein, James, Spreitzer, Taylor and Wirch.
Referred to Committee on Health, Aging and Long-Term Care.
AB117,1,7 1An Act to renumber 632.895 (8) (a) 1.; to renumber and amend 632.895 (8)
2(d); to amend 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 609.80; and to create
349.46 (2) (b) 6. n., 632.895 (8) (a) 1c., 632.895 (8) (a) 1e., 632.895 (8) (a) 1g.,
4632.895 (8) (a) 1n., 632.895 (8) (a) 1r., 632.895 (8) (a) 4., 632.895 (8) (a) 5.,
5632.895 (8) (a) 6., 632.895 (8) (am), 632.895 (8) (d) 2. and 632.895 (8) (d) 3. of the
6statutes; relating to: coverage of breast cancer screenings by the Medical
7Assistance program and health insurance policies and plans.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies to provide coverage for
supplemental breast screening examinations or diagnostic breast examinations for
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. Health insurance policies are referred to in the statutes as disability
insurance policies. Self-insured governmental health plans are also required to
provide the coverage specified in the bill. The bill also requires coverage of those
breast screenings by the Medical Assistance program, which is the
state-administered Medicaid program that is jointly funded by the state and federal

governments and that provides health services to individuals with limited financial
resources.
Under the bill, health insurance policies may not charge a cost-sharing amount
for a supplemental breast screening examination or diagnostic breast examination.
The limitation on cost-sharing does not apply to the extent that the limitation would
result in ineligibility for a health savings account under the federal Internal Revenue
Code.
Health insurance policies are required under current law to cover two
mammographic breast examinations to screen for breast cancer for a woman from
ages 45 to 49 if certain criteria are satisfied. Health insurance policies must
currently cover annual mammograms for a woman once she attains the age of 50.
The coverage required under current law is required whether or not the woman
shows any symptoms of breast cancer and may be subject to only the same exclusions
and limitations, including cost sharing, that apply to other radiological
examinations under the policy. The bill does not change or eliminate the current
coverage requirements for mammograms, except that preferred provider plans are
explicitly included in the current law and the bill's requirements.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB117,1 1Section 1. 40.51 (8m) of the statutes is amended to read:
AB117,2,52 40.51 (8m) Every health care coverage plan offered by the group insurance
3board under sub. (7) shall comply with ss. 631.95, 632.729, 632.746 (1) to (8) and (10),
4632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.861,
5632.867, 632.885, 632.89, and 632.895 (8) and (11) to (17).
AB117,2 6Section 2. 49.46 (2) (b) 6. n. of the statutes is created to read:
AB117,2,87 49.46 (2) (b) 6. n. Breast screenings for which coverage is required under s.
8632.895 (8) (am).
AB117,3 9Section 3. 66.0137 (4) of the statutes is amended to read:
AB117,3,510 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
11a village provides health care benefits under its home rule power, or if a town

1provides health care benefits, to its officers and employees on a self-insured basis,
2the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
3632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
4632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896,
5and 767.513 (4).
AB117,4 6Section 4. 120.13 (2) (g) of the statutes is amended to read:
AB117,3,107 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
849.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2.,
9632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6),
10632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).
AB117,5 11Section 5. 609.80 of the statutes is amended to read:
AB117,3,16 12609.80 Coverage of mammograms. Defined network plans and preferred
13provider plans
are subject to s. 632.895 (8). Coverage of mammograms under s.
14632.895 (8) may be subject to any requirements that the defined network plan or
15preferred provider plan
imposes under s. 609.05 (2) and (3) on the coverage of other
16health care services obtained by enrollees.
AB117,6 17Section 6. 632.895 (8) (a) 1. of the statutes is renumbered 632.895 (8) (a) 1w.
AB117,7 18Section 7. 632.895 (8) (a) 1c. of the statutes is created to read:
AB117,3,2119 632.895 (8) (a) 1c. “Breast magnetic resonance imaging” means a diagnostic
20tool that uses a powerful magnetic field, radio waves, and a computer to produce
21detailed pictures of the structures within the breast.
AB117,8 22Section 8. 632.895 (8) (a) 1e. of the statutes is created to read:
AB117,3,2423 632.895 (8) (a) 1e. “Breast tomosynthesis” means a procedure that uses X-rays
24to take a series of pictures of the inside of the breast from many different angles.
AB117,9 25Section 9. 632.895 (8) (a) 1g. of the statutes is created to read:
AB117,4,2
1632.895 (8) (a) 1g. “Breast ultrasound” means a noninvasive diagnostic tool
2that uses high-frequency sound.
AB117,10 3Section 10. 632.895 (8) (a) 1n. of the statutes is created to read:
AB117,4,74 632.895 (8) (a) 1n. “Diagnostic breast examination” means a medically
5necessary and appropriate examination of the breast, including an examination
6using diagnostic mammography, breast magnetic resonance imaging, breast
7tomosynthesis, or breast ultrasound that is used to evaluate any of the following:
AB117,4,98 a. An abnormality seen or suspected from a screening examination for breast
9cancer.
AB117,4,1010 b. An abnormality that is detected by another means of examination.
AB117,11 11Section 11. 632.895 (8) (a) 1r. of the statutes is created to read:
AB117,4,1312 632.895 (8) (a) 1r. “Diagnostic mammography” means a diagnostic tool that
13uses X-rays and is designed to evaluate an abnormality in the breast.
AB117,12 14Section 12. 632.895 (8) (a) 4. of the statutes is created to read:
AB117,4,1615 632.895 (8) (a) 4. “Screening mammography” means an X-ray examination of
16the breasts taken to check for breast cancer in the absence of signs or symptoms.
AB117,13 17Section 13. 632.895 (8) (a) 5. of the statutes is created to read:
AB117,4,1918 632.895 (8) (a) 5. “Self-insured health plan” has the meaning given in s.
19632.745 (24).
AB117,14 20Section 14. 632.895 (8) (a) 6. of the statutes is created to read:
AB117,5,221 632.895 (8) (a) 6. “Supplemental breast screening examination” means a
22medically necessary and appropriate examination of the breast, including an
23examination using breast magnetic resonance imaging or breast ultrasound that is
24used to screen for breast cancer when there is no abnormality seen or suspected,

1based on personal or family medical history or additional factors that may increase
2an individual's risk of breast cancer.
AB117,15 3Section 15. 632.895 (8) (am) of the statutes is created to read:
AB117,5,144 632.895 (8) (am) Every disability insurance policy and self-insured health plan
5shall provide coverage to an individual who is at increased risk of breast cancer, as
6determined in accordance with the most recent applicable guidelines of the National
7Comprehensive Cancer Network, or has heterogeneously or extremely dense breast
8tissue, as defined by the Breast Imaging-Reporting and Data System established by
9the American College of Radiology, for supplemental breast screening examinations
10or diagnostic breast examinations for the detection of breast cancer, including
11diagnostic mammography, breast ultrasounds, breast magnetic resonance imaging,
12or other technologies as determined in accordance with applicable criteria and
13guidelines. Coverage required under this paragraph shall be subject to the limits on
14cost-sharing described under par. (d) 2. and 3.
AB117,16 15Section 16. 632.895 (8) (d) of the statutes is renumbered 632.895 (8) (d) 1. and
16amended to read:
AB117,5,2217 632.895 (8) (d) 1. Coverage is required under this subsection despite whether
18the woman shows any symptoms of breast cancer. Except as provided in subds. 2.
19and 3. and
pars. (b), (c) and (e), coverage under this subsection may only be subject
20to exclusions and limitations, including deductibles, copayments and restrictions on
21excessive charges, that are applied to other radiological examinations covered under
22the disability insurance policy.
AB117,17 23Section 17. 632.895 (8) (d) 2. of the statutes is created to read:
AB117,6,3
1632.895 (8) (d) 2. A disability insurance policy or self-insured health plan may
2not impose on a covered individual a cost-sharing amount for a supplemental breast
3screening examination or diagnostic breast examination.
AB117,18 4Section 18. 632.895 (8) (d) 3. of the statutes is created to read:
AB117,6,135 632.895 (8) (d) 3. If, under federal law, application of this paragraph would
6result in ineligibility for a health savings account under section 223 of the Internal
7Revenue Code, this paragraph shall apply to a health-savings-account-qualified
8high deductible health plan with respect to the deductible of such a plan only after
9the enrollee has satisfied the minimum deductible under section 223 of the Internal
10Revenue Code, except with respect to items or services that are preventive care
11pursuant to section 223 (c) (2) (C) of the Internal Revenue Code, in which case this
12paragraph shall apply regardless of whether the minimum deductible under section
13223 of the Internal Revenue Code has been satisfied.
AB117,19 14Section 19 . Initial applicability.
AB117,6,1715 (1) For policies and plans containing provisions inconsistent with this act, the
16act first applies to policy or plan years beginning on January 1 of the year following
17the year in which this subsection takes effect, except as provided in sub. (2).
AB117,6,2218 (2) For policies and plans that are affected by a collective bargaining agreement
19containing provisions inconsistent with this act, this act first applies to policy or plan
20years beginning on the effective date of this subsection or on the day on which the
21collective bargaining agreement is newly established, extended, modified, or
22renewed, whichever is later.
AB117,20 23Section 20 . Effective date.
AB117,7,2
1(1) This act takes effect on the first day of the 4th month beginning after
2publication.
AB117,7,33 (End)
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