SB70-AA3,61,8 a. Undergoing a course of treatment for a serious and complex condition from a provider or facility.

SB70-AA3,61,10 b. Undergoing a course of institutional or inpatient care from a provider or facility.

SB70-AA3,61,12 c. Scheduled to undergo nonelective surgery, including receipt of postoperative care, from a provider or facility.

SB70-AA3,61,14 d. Pregnant and undergoing a course of treatment for the pregnancy from a provider or facility.

SB70-AA3,61,16 e. Terminally ill and receiving treatment for the illness from a provider or facility.

SB70-AA3,61,17 2. “Serious and complex condition” means any of the following:

SB70-AA3,61,20 a. In the case of an acute illness, a condition that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm.

SB70-AA3,61,23 b. In the case of a chronic illness or condition, a condition that is life-threatening, degenerative, potentially disabling, or congenital and requires specialized medical care over a prolonged period.

SB70-AA3,62,6 (b) If an enrollee is a continuing care patient and is obtaining items or services from a participating provider or participating facility and the contract between the defined network plan, preferred provider plan, or self-insured governmental plan and the provider or facility is terminated because of a change in the terms of the participation of the provider or facility in the plan or the contract between the defined network plan, preferred provider plan, or self-insured governmental plan and the provider or facility is terminated, resulting in a loss of benefits provided under the plan, the plan shall do all of the following:

SB70-AA3,62,9 1. Notify each enrollee of the termination of the contract or benefits and of the right for the enrollee to elect to continue transitional care from the participating provider or participating facility under this subsection.

SB70-AA3,62,11 2. Provide the enrollee an opportunity to notify the plan of the need for transitional care.

SB70-AA3,62,18 3. Allow the enrollee to elect to continue to have the benefits provided under the plan under the same terms and conditions as would have applied to the item or service if the termination had not occurred for the course of treatment related to the enrollee's status as a continuing care patient beginning on the date on which the notice under subd. 1. is provided and ending 90 days after the date on which the notice under subd. 1. is provided or the date on which the enrollee is no longer a continuing care patient, whichever is earlier.

SB70-AA3,62,21 (c) The provisions of s. 609.24 apply to a continuing care patient to the extent that s. 609.24 does not conflict with this subsection so as to limit the enrollee's rights under this subsection.

SB70-AA3,63,3 (8) Rule making. The commissioner may promulgate any rules necessary to implement this section, including specifying the independent dispute resolution process under sub. (6). The commissioner may promulgate rules to modify the list of those items and services for which a provider may not balance bill under sub. (4) (c). In promulgating rules under this subsection, the commissioner may consider any rules promulgated by the federal department of health and human services pursuant to the federal No Suprises Act, 42 USC 300gg-111, et seq.

SB70-AA3,38 Section 38. 609.24 (5) of the statutes is created to read:

SB70-AA3,63,7 609.24 (5) If an enrollee is a continuing care patient, as defined in s. 609.045 (7) (a), and if any of the situations described under s. 609.045 (7) (b) (intro.) applies, all of the following apply to the enrollee's defined network plan:

SB70-AA3,63,10 (a) Subsection (1) (c) shall apply to any of the participating providers providing the enrollee's course of treatment under s. 609.045 (7), including the enrollee's primary care physician.

SB70-AA3,63,13 (b) Subsection (1) (c) shall apply to lengthen the period in which benefits are provided under s. 609.045 (7) (b) 3., but shall not be applied to shorten the period in which benefits are provided under s. 609.045 (7) (b) 3.

SB70-AA3,63,15 (c) Subsection (1) (d) shall not be applied in a manner that limits the enrollee's rights under s. 609.045 (7) (b) 3.

SB70-AA3,63,18 (d) No plan may contract or arrange with a participating provider to provide notice of the termination of the participating provider's participation, pursuant to sub. (4).”.

SB70-AA3,63,19 182. Page 374, line 11: after that line insert:

SB70-AA3,63,20 “ Section 39. 609.74 of the statutes is created to read:

SB70-AA3,63,22 609.74 Coverage of infertility services. Defined network plans and preferred provider plans are subject to s. 632.895 (15m).

SB70-AA3,40 Section 40. 632.895 (15m) of the statutes is created to read:

SB70-AA3,63,24 632.895 (15m) Coverage of infertility services. (a) In this subsection:

SB70-AA3,64,6 1. “Diagnosis of and treatment for infertility” means any recommended procedure or medication to treat infertility at the direction of a physician that is consistent with established, published, or approved medical practices or professional guidelines from the American College of Obstetricians and Gynecologists, or its successor organization, or the American Society for Reproductive Medicine, or its successor organization.

SB70-AA3,64,8 2. “Infertility” means a disease, condition, or status characterized by any of the following:

SB70-AA3,64,13 a. The failure to establish a pregnancy or carry a pregnancy to a live birth after regular, unprotected sexual intercourse for, if the woman is under the age of 35, no longer than 12 months or, if the woman is 35 years of age or older, no longer than 6 months, including any time during those 12 months or 6 months that the woman has a pregnancy that results in a miscarriage.

SB70-AA3,64,15 b. An individual's inability to reproduce either as a single individual or with a partner without medical intervention.