LRB-0609/2
JPC:skw
2023 - 2024 LEGISLATURE
November 7, 2023 - Introduced by Senator Jacque, cosponsored by
Representatives Wichgers and Sinicki. Referred to Committee on Insurance
and Small Business.
SB645,1,4 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
2(1) (intro.); and to create 609.843 and 632.895 (18) of the statutes; relating to:
3coverage of routine care related to certain clinical trials by health insurance
4policies and plans.
Analysis by the Legislative Reference Bureau
This bill makes several changes with respect to coverage of routine patient costs
and items or services by health insurance policies and plans furnished in connection
with participation in an approved clinical trial. The bill requires health insurance
policies that provide coverage for hospital care to provide coverage for routine patient
costs and items or services furnished in connection with participation by a qualified
individual in an approved clinical trial. “Qualified individual” is defined under the
bill to mean an individual who is eligible to participate in an approved clinical trial
according to the trial protocol with respect to treatment of cancer or other
life-threatening condition. The bill prohibits health insurance policies from
discriminating against any individual based on the individual's participation in an
approved clinical trial. Health insurance policies are referred to in the bill as
disability insurance policies.
Further, the bill requires limited service health organizations, preferred
provider plans, and defined network plans that provide coverage of routine patient
costs and items or services furnished in connection with participation by a qualified
individual in an approved clinical trial to impose the same cost-sharing
requirements to such item or service when provided by a nonparticipating provider

that would apply if such item or service were furnished by a participating provider
and pay to the nonparticipating provider the amount by which the recognized
amount for such item or service exceeds the cost-sharing amount for such item or
service.
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:
SB645,1 1Section 1. 40.51 (8) of the statutes is amended to read:
SB645,2,62 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 609.843, 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.729,
4632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85,
5632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m)
6and (8) to (17), and 632.896.
SB645,2 7Section 2. 40.51 (8m) of the statutes is amended to read:
SB645,2,118 40.51 (8m) Every health care coverage plan offered by the group insurance
9board under sub. (7) shall comply with ss. 609.843, 631.95, 632.729, 632.746 (1) to
10(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
11632.861, 632.867, 632.885, 632.89, and 632.895 (11) to (17).
SB645,3 12Section 3. 66.0137 (4) of the statutes is amended to read:
SB645,3,213 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
14a village provides health care benefits under its home rule power, or if a town
15provides health care benefits, to its officers and employees on a self-insured basis,
16the self-insured plan shall comply with ss. 49.493 (3) (d), 609.843, 631.89, 631.90,
17631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,

1632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to
2(17), 632.896, and 767.513 (4).
SB645,4 3Section 4. 120.13 (2) (g) of the statutes is amended to read:
SB645,3,74 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
549.493 (3) (d), 609.843, 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b)
62., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6),
7632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB645,5 8Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
SB645,3,169 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
10cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
11646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
12601.45, 609.843, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89,
13631.93, 631.95, 632.72 (2), 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,
14632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6), 632.885,
15632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630,
16635, 645, and 646, but the sponsoring association shall:
SB645,6 17Section 6. 609.843 of the statutes is created to read:
SB645,3,19 18609.843 Coverage of routine care related to clinical trials. (1) In this
19section:
SB645,3,2020 (a) “Approved clinical trial” has the meaning given in 42 USC 300gg-8 (d).
SB645,3,2321 (b) “Life-threatening condition” means any disease or condition from which the
22likelihood of death is probable unless the course of the disease or condition is
23interrupted.
SB645,4,3
1(c) “Qualified individual” means an individual who is eligible to participate in
2an approved clinical trial according to the trial protocol with respect to treatment of
3cancer or other life-threatening condition.
SB645,4,54 (d) “Recognized amount” has the meaning given by the commissioner by rule
5or, in the absence of such rule, the meaning given in 42 USC 300gg-111 (a) (3) (H).
SB645,4,66 (e) “Routine patient costs” has the meaning given in 42 USC 300gg-8 (a) (2).
SB645,4,8 7(2) Limited service health organizations, preferred provider plans, and defined
8network plans are subject to s. 632.895 (18).
SB645,4,14 9(3) A limited service health organization, preferred provider plan, or defined
10network plan that provides coverage of routine patient costs and items or services
11furnished in connection with participation by a qualified individual in an approved
12clinical trial shall do all of the following with respect to routine patient costs and
13items or services furnished in connection with participation by a qualified individual
14in an approved clinical trial by a nonparticipating provider:
SB645,4,1615 (a) Impose the same cost-sharing requirements that would apply if such item
16or service were furnished by a participating provider.
SB645,4,1917 (b) Pay to such nonparticipating provider the amount by which the recognized
18amount for such item or service exceeds the cost-sharing amount for such item or
19service.
SB645,7 20Section 7. 632.895 (18) of the statutes is created to read:
SB645,4,2221 632.895 (18) Coverage of routine costs for clinical trials. (a) In this
22subsection:
SB645,4,2323 1. “Approved clinical trial” has the meaning given in 42 USC 300gg-8 (d).
SB645,5,3
12. “Life-threatening condition” means any disease or condition from which the
2likelihood of death is probable unless the course of the disease or condition is
3interrupted.
SB645,5,64 3. “Qualified individual” means an individual who is eligible to participate in
5an approved clinical trial according to the trial protocol with respect to treatment of
6cancer or other life-threatening condition.
SB645,5,77 4. “Routine patient costs” has the meaning given in 42 USC 300gg-8 (a) (2).
SB645,5,108 (b) Each disability insurance policy that provides coverage for hospital care
9shall provide coverage for routine patient costs and items or services furnished in
10connection with participation by a qualified individual in an approved clinical trial.
SB645,5,1211 (c) No disability insurance policy may discriminate against an individual on the
12basis of the individual's participation in an approved clinical trial.
SB645,8 13Section 8. Initial applicability.
SB645,5,1614 (1) For policies and plans containing provisions inconsistent with this act, the
15act first applies to policy or plan years beginning on January 1 of the year following
16the year in which this subsection takes effect, except as provided in sub. (2).
SB645,5,2117 (2) For policies and plans that are affected by a collective bargaining agreement
18containing provisions inconsistent with this act, this act first applies to policy or plan
19years beginning on the effective date of this subsection or on the day on which the
20collective bargaining agreement is newly established, extended, modified, or
21renewed, whichever is later.
SB645,9 22Section 9. Effective date.
SB645,5,2423 (1) This act takes effect on the first day of the 4th month beginning after
24publication.
SB645,5,2525 (End)
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