Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB792 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	LRB-0433/1
2	2	JPC:kms&wlj
3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 792
5	5	December 8, 2023 - Introduced by Representatives J. ANDERSON, CLANCY,
6	6	CONSIDINE, DRAKE, EMERSON, JACOBSON, JOERS, MADISON, MOORE OMOKUNDE,
7	7	ORTIZ-VELEZ, RATCLIFF, SHANKLAND, SHELTON and SNODGRASS, cosponsored by
8	8	Senators LARSON, CARPENTER and SPREITZER. Referred to Committee on
9	9	Insurance.
10	10	*AUTHORS SUBJECT TO CHANGE*
11	11	AN ACT to create 609.048 of the statutes; relating to: evaluation of health plan
12	12	network sufficiency.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill requires the commissioner of insurance to determine the sufficiency
15	15	of the network of providers of a defined network plan or preferred provider plan to
16	16	ensure that all covered services are accessible to enrollees without unreasonable
17	17	travel or delay. Defined network plans and preferred provider plans are types of
18	18	managed care organizations that provide health care benefits to their enrollees. The
19	19	bill authorizes the commissioner to require a plan to make accommodations for
20	20	enrollees to obtain covered services if the plan's network is insufficient. The bill also
21	21	specifies factors that the commissioner may consider when determining whether a
22	22	plan's network is sufficient.
23	23	For further information see the state fiscal estimate, which will be printed as
24	24	an appendix to this bill.
25	25	The people of the state of Wisconsin, represented in senate and assembly, do
26	26	enact as follows:
27	27	SECTION 1. 609.048 of the statutes is created to read:
28	28	609.048 Network sufficiency. The commissioner shall determine the
29	29	sufficiency of a defined network plan's or preferred provider plan's network to ensure
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34	34	5 - 2 -2023 - 2024 Legislature LRB-0433/1
35	35	JPC:kms&wlj
36	36	SECTION 1 ASSEMBLY BILL 792
37	37	that all covered services are accessible to enrollees without unreasonable travel or
38	38	delay. The commissioner may require a defined network plan or preferred provider
39	39	plan to make accommodations for enrollees to obtain covered services if its network
40	40	is insufficient. Factors the commissioner may consider when determining network
41	41	sufficiency include any of the following:
42	42	(1) The ratio of primary providers to enrollees.
43	43	(2) The geographic accessibility of providers.
44	44	(3) The waiting time for an appointment with a provider of a particular
45	45	specialty in the network.
46	46	(4) The ability of the network to meet the needs of the population of enrollees.
47	47	(5) The extent to which providers in the network are accepting new patients.
48	48	(6) Whether the plan has a process of ensuring that enrollees are able to obtain
49	49	a covered service at an out-of-pocket cost that is equivalent to the cost of a service
50	50	provided by a provider in the network if a provider in the network is not available
51	51	to provide the covered service without unreasonable travel or delay.
52	52	(END)
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