Wisconsin Assembly Bill AB1187

Wisconsin 2023-2024 Regular Session

• Introduced: 4/9/24
• Refer: 4/9/24
• Failed: 4/15/24

Caption

Provisional approval as a participating provider in a defined network health plan.

Impact

The bill mandates that health care providers receive payments for services rendered during the provisional approval period, which can last until they receive a final decision on their application, or at least for two weeks following a denial. This aspect of the bill is positioned to protect providers from financial loss while they await final approval, potentially impacting the operational capacity of network plans and their financial management. Critics may argue that it could lead to increased costs for these plans or incentivize the approval of less qualified providers, but proponents believe it fosters inclusivity and timely access to health services.

Summary

Assembly Bill 1187 introduces measures for health care providers seeking to join defined network plans, such as health maintenance organizations (HMOs). The notable provision in this bill is the requirement for defined network plans to issue provisional approvals to applicants, allowing them to provide services and obtain reimbursement as if they were fully approved participants even before their applications receive final approval. This initiative aims to streamline and expedite the inclusion of new health care providers into networks, which can ultimately enhance patient access to services.

Contention

There may be points of contention regarding the balance of safety and accessibility in health care provision. Stakeholders such as health insurers, providers, and consumer advocacy groups may debate whether the expedited provisional approvals could compromise patient safety or if it could adequately support the need for more inclusive health care options. The effectiveness of the bill will largely hinge on the implementation process and adhere to regulatory oversight, ensuring that quality is maintained without unduly hindering the participation of qualified providers.