SB 129

The bill prohibits, until the conclusion of a national emergency declared by the

U.S. president in response to the 2019 novel coronavirus or June 30, 2021, whichever

is earlier, a defined network plan, including a health maintenance organization, or

preferred provider plan from requiring an enrollee of the plan to pay more for a

service, treatment, or supply provided by an out-of-network provider than if the

service, treatment, or supply is provided by an in-network provider. This prohibition

applies to any service, treatment, or supply that is related to the diagnosis of or

treatment for COVID-19 and that is provided by an out-of-network provider

because a participating provider is unavailable due to the emergency. For a service,

treatment, or supply provided under those circumstances, the bill requires the plan

to reimburse the out-of-network provider at 225 percent of the federal Medicare

program rate. Also, under those circumstances, any health care provider or facility

that provides a service, treatment, or supply to an enrollee of a plan but is not a

participating provider of that plan shall accept as payment in full any payment by

a plan that is at least 225 percent of the federal Medicare program rate and may not

charge the enrollee an amount that exceeds the amount that the provider or facility

is reimbursed by the plan. Similar prohibitions and requirements to these were

created in

2019 Wisconsin Act 185

, but those prohibitions and requirements applied

only during the state of emergency related to public health declared on March 12,

2020, by the governor and for 60 days following the termination of that state of

emergency. The bill's prohibitions and requirements, however, do not apply to

reimbursement of the administration of the COVID-19 vaccine.

This proposal may contain a health insurance mandate requiring a social and

financial impact report under s. 601.423, stats.