AB133-SSA1, s. 2258 Section 2258. 149.12 (3) (b) of the statutes is amended to read:

AB133-SSA1,1159,19 149.12 (3) (b) Persons for whom deductible or coinsurance amounts are paid or reimbursed under ch. 47 for vocational rehabilitation, under s. 49.68 for renal disease, under s. 49.685 (8) for hemophilia, under s. 49.683 for cystic fibrosis or, under s. 253.05 for maternal and child health services or under s. 49.686 for the cost of drugs for the treatment of HIV infection or AIDS are not ineligible for coverage under the plan by reason of such payments or reimbursements.

AB133-SSA1, s. 2258d Section 2258d. 149.125 of the statutes is repealed.

AB133-SSA1, s. 2258f Section 2258f. 149.14 (2) (a) of the statutes is amended to read:

AB133-SSA1,1160,3 149.14 (2) (a) The plan shall provide every eligible person who is not eligible for medicare with major medical expense coverage. Major medical expense coverage offered under the plan under this section shall pay an eligible person's covered expenses, subject to sub. (3) and deductible, copayment and coinsurance payments authorized under sub. (5), up to a lifetime limit of $1,000,000 per covered individual. The maximum limit under this paragraph shall not be altered by the board, and no actuarially equivalent benefit may be substituted by the board.

AB133-SSA1, s. 2259 Section 2259. 149.14 (3) (intro.) of the statutes is amended to read:

AB133-SSA1,1160,19 149.14 (3) Covered expenses. (intro.) Except as provided in sub. (4), except as restricted by cost containment provisions under s. 149.17 (4) and except as reduced by the board under s. 149.15 (3) (e) or by the department under s. ss. 149.143 or and 149.144, covered expenses for the coverage under this section shall be the usual and customary charges payment rates established by the department under s. 149.142 for the services provided by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11. Except as provided in sub. (4), except as restricted by cost containment provisions under s. 149.17 (4) and except as reduced by the board under s. 149.15 (3) (e) or by the department under s. ss. 149.143 or and 149.144, covered expenses for the coverage under this section shall also be the usual and customary charges payment rates established by the department under s. 149.142 for the following services and articles if the service or article is prescribed by a physician who is licensed under ch. 448 or in another state and who is certified under s. 49.45 (2) (a) 11. and if the service or article is provided by a provider certified under s. 49.45 (2) (a) 11.:

AB133-SSA1, s. 2259f Section 2259f. 149.14 (3) (d) of the statutes is amended to read:

AB133-SSA1,1160,21 149.14 (3) (d) Drugs requiring a physician's prescription, subject to sub. (4c).

AB133-SSA1, s. 2259r Section 2259r. 149.14 (4) (d) of the statutes is amended to read:

AB133-SSA1,1161,2 149.14 (4) (d) That part of any charge for services or articles rendered or prescribed by a physician, dentist or other health care personnel which that exceeds the prevailing charge in the locality where the service is provided payment rate established by the department under s. 149.142 and reduced under ss. 149.143 and 149.144 or any charge not medically necessary.

AB133-SSA1, s. 2260 Section 2260. 149.14 (4) (g) of the statutes is amended to read:

AB133-SSA1,1161,4 149.14 (4) (g) Dental care except as provided in sub. (3) (m) and (q).

AB133-SSA1, s. 2260c Section 2260c. 149.14 (4) (n) of the statutes is created to read:

AB133-SSA1,1161,7 149.14 (4) (n) Services or drugs for the treatment of infertility, impotence or sterility.

AB133-SSA1, s. 2260d Section 2260d. 149.14 (4c) of the statutes is created to read:

AB133-SSA1,1161,11 149.14 (4c) Coverage of prescription drugs. (a) The department may require a pharmacist or pharmacy that provides a prescription drug to an eligible person to submit a payment claim directly to the plan administrator.

AB133-SSA1,1161,14 (b) The department may limit coverage of prescription drugs under sub. (3) (d) to those prescription drugs for which payment claims are submitted by pharmacists or pharmacies directly to the plan administrator.

AB133-SSA1, s. 2260h Section 2260h. 149.14 (4m) of the statutes is amended to read:

AB133-SSA1,1161,22 149.14 (4m) Payment is payment in full. Except for copayments, coinsurance or deductibles required or authorized under the plan, a provider of a covered service or article shall accept as payment in full for the covered service or article the payment rate determined under ss. 149.142, 149.143, and 149.144 and 149.15 (3) (e) and may not bill an eligible person who receives the service or article for any amount by which the charge for the service or article is reduced under s. 149.142, 149.143, or 149.144 or 149.15 (3) (e).

AB133-SSA1, s. 2260m Section 2260m. 149.14 (5) (title) of the statutes is amended to read:

AB133-SSA1,1161,24 149.14 (5) (title) Deductibles, copayments and coinsurance.

AB133-SSA1, s. 2260p Section 2260p. 149.14 (5) (e) of the statutes is created to read:

AB133-SSA1,1162,5 149.14 (5) (e) Subject to sub. (8) (b), the department may, by rule under s. 149.17 (4), establish copayments for prescription drug coverage under sub. (3) (d). Any copayment amounts or rates established are subject to the approval of the board. Copayments paid by an eligible person under this paragraph shall count toward the deductible and covered costs not paid by the plan under pars. (a) to (c).

AB133-SSA1, s. 2261 Section 2261. 149.14 (6) (title) of the statutes is created to read:

AB133-SSA1,1162,7 149.14 (6) (title) Preexisting conditions.

AB133-SSA1, s. 2261f Section 2261f. 149.14 (8) of the statutes is created to read:

AB133-SSA1,1162,12 149.14 (8) Applicability of medical assistance provisions. (a) Except as provided in par. (b), the department may, by rule under s. 149.17 (4), apply to the plan the same utilization and cost control procedures that apply under rules promulgated by the department to medical assistance under subch. IV of ch. 49.

AB133-SSA1,1162,15 (b) The department may not apply to eligible persons for covered services or articles the same copayments that apply to recipients of medical assistance under subch. IV of ch. 49 for services or articles covered under that program.