SB 645

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.