Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB723 Compare Versions

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

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1	1	LRB-0539/1
2	2	JPC:amn
3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 723
5	5	November 21, 2023 - Introduced by Senators ROYS, AGARD, CARPENTER, HESSELBEIN,
6	6	L. JOHNSON, LARSON, PFAFF, SMITH, SPREITZER, TAYLOR and WIRCH, cosponsored
7	7	by Representatives EMERSON, VINING, ANDRACA, BARE, CLANCY, CONLEY,
8	8	CONSIDINE, JACOBSON, JOERS, MADISON, MYERS, OHNSTAD, ORTIZ-VELEZ,
9	9	RATCLIFF, SHELTON, SINICKI, STUBBS and PALMERI. Referred to Committee on
10	10	Insurance and Small Business.
11	11	AN ACT to amend 40.51 (8), 66.0137 (4) and 120.13 (2) (g); and to create 632.8965
12	12	of the statutes; relating to: coverage of infertility services under self-insured
13	13	governmental health plans and health policies and plans offered to state
14	14	employees, and granting rule-making authority.
15	15	Analysis by the Legislative Reference Bureau
16	16	This bill requires self-insured governmental health plans and health care
17	17	coverage plans offered by the state to its employees that cover medical or hospital
18	18	expenses to cover diagnosis of and treatment for infertility and standard fertility
19	19	preservation services. Coverage required under the bill must include at least four
20	20	completed egg retrievals with unlimited embryo transfers in accordance with certain
21	21	guidelines and single embryo transfer is allowed when recommended and medically
22	22	appropriate. Policies and plans are prohibited from imposing an exclusion,
23	23	limitation, or other restriction on coverage of medications of which the bill requires
24	24	coverage that is not imposed on any other prescription medications covered under
25	25	the policy or plan. Similarly, policies and plans may not impose any exclusion,
26	26	limitation, cost-sharing requirement, benefit maximum, waiting period or other
27	27	restriction on diagnosis, treatment, or services for which coverage is required under
28	28	the bill that is different from any exclusion, limitation, cost-sharing requirement,
29	29	benefit maximum, waiting period or other restriction imposed on benefits for other
30	30	services. Also, policies and plans may not impose an exclusion, limitation, or other
31	31	restriction on diagnosis, treatment, or services for which coverage is required under
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36	36	JPC:amn
37	37	SENATE BILL 723
38	38	the bill on the basis that an insured person participates in fertility services provided
39	39	by or to a third party.
40	40	This proposal may contain a health insurance mandate requiring a social and
41	41	financial impact report under s. 601.423, stats.
42	42	The people of the state of Wisconsin, represented in senate and assembly, do
43	43	enact as follows:
44	44	SECTION 1. 40.51 (8) of the statutes is amended to read:
45	45	40.51 (8) Every health care coverage plan offered by the state under sub. (6)
46	46	shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.729, 632.746
47	47	(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,
48	48	632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to
49	49	(17), and 632.896, and 632.8965.
50	50	SECTION 2. 66.0137 (4) of the statutes is amended to read:
51	51	66.0137 (4) SELF-INSURED HEALTH PLANS. If a city, including a 1st class city, or
52	52	a village provides health care benefits under its home rule power, or if a town
53	53	provides health care benefits, to its officers and employees on a self-insured basis,
54	54	the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
55	55	632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
56	56	632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896,
57	57	632.8965, and 767.513 (4).
58	58	SECTION 3. 120.13 (2) (g) of the statutes is amended to read:
59	59	120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
60	60	49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.729, 632.746 (10) (a) 2. and (b) 2.,
61	61	632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6),
62	62	632.885, 632.89, 632.895 (9) to (17), 632.896, 632.8965, and 767.513 (4).
63	63	SECTION 4. 632.8965 of the statutes is created to read:
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84	84	LRB-0539/1
85	85	JPC:amn
86	86	SECTION 4
87	87	SENATE BILL 723
88	88	632.8965 Coverage of infertility services. (1) In this section:
89	89	(a) “Diagnosis of and treatment for infertility” means any recommended
90	90	procedure or medication at the direction of a physician that is consistent with
91	91	established, published, or approved medical practices or professional guidelines
92	92	from the American College of Obstetricians and Gynecologists, or its successor
93	93	organization, or the American Society for Reproductive Medicine, or its successor
94	94	organization.
95	95	(b) “Infertility” means a disease, condition, or status characterized by any of
96	96	the following:
97	97	1. The inability to achieve a successful pregnancy based on a patient's medical,
98	98	sexual, and reproductive history, age, physical findings, diagnostic testing, or any
99	99	combination of these factors.
100	100	2. The need for medical intervention, including the use of donor gametes or
101	101	donor embryos, in order to achieve a successful pregnancy either as an individual or
102	102	with a partner.
103	103	3. The failure to establish a pregnancy or carry a pregnancy to a live birth after
104	104	regular, unprotected sexual intercourse for, if the woman is under the age of 35, no
105	105	longer than 12 months or, if the woman is 35 years of age or older, no longer than 6
106	106	months including any time during those 12 months or 6 months that the woman has
107	107	a pregnancy that results in a miscarriage.
108	108	(c) “Self-insured health plan” means a self-insured health plan of the state or
109	109	a county, city, village, town, or school district.
110	110	(d) “Standard fertility preservation service” means a procedure that is
111	111	consistent with established medical practices or professional guidelines published
112	112	by the American Society of Clinical Oncology, or its successor organization, for a
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139	139	SECTION 4 SENATE BILL 723
140	140	person who has a medical condition or is expected to undergo medication therapy,
141	141	surgery, radiation, chemotherapy, or other medical treatment that is recognized by
142	142	medical professionals to cause a risk of impairment to fertility.
143	143	(2) Every self-insured health plan shall cover diagnosis of and treatment for
144	144	infertility and standard fertility preservation services. Coverage required under this
145	145	subsection includes at least 4 completed oocyte retrievals with unlimited embryo
146	146	transfers in accordance with the guidelines of the American Society for Reproductive
147	147	Medicine or its successor organization and single embryo transfer may be used when
148	148	recommended and medically appropriate.
149	149	(3) A self-insured health plan may not do any of the following:
150	150	(a) Impose any exclusions, limitations, or other restrictions on coverage
151	151	required under sub. (2) based on a covered individual's participation in fertility
152	152	services provided by or to a 3rd party.
153	153	(b) Impose any exclusion, limitation, or other restriction on coverage of
154	154	medications that are required to be covered under sub. (2) that are different from
155	155	those imposed on any other prescription medications covered under the policy or
156	156	plan.
157	157	(c) Impose any exclusion, limitation, cost-sharing requirement, benefit
158	158	maximum, waiting period, or other restriction on coverage of the diagnosis of and
159	159	treatment for infertility and standard fertility preservation services required under
160	160	sub. (2) that is different from an exclusion, limitation, cost-sharing requirement,
161	161	benefit maximum, waiting period, or other restriction imposed on benefits for
162	162	services that are covered by the policy or plan and that are not related to infertility.
163	163	(4) Every self-insured health plan shall provide coverage required under sub.
164	164	(2) to any covered individual under the policy or plan, including any covered spouse
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190	190	LRB-0539/1
191	191	JPC:amn
192	192	SECTION 4
193	193	SENATE BILL 723
194	194	and nonspouse dependent, to the same extent as other pregnancy-related benefits
195	195	covered under the policy or plan.
196	196	(5) The commissioner, after consulting with the department of health services
197	197	on appropriate treatment for infertility, shall promulgate any rules necessary to
198	198	implement this section. Before the promulgation of rules, self-insured health plans
199	199	are considered to comply with the coverage requirements of sub. (2) if the coverage
200	200	conforms to the standards of the American Society for Reproductive Medicine.
201	201	SECTION 5.0Initial applicability.
202	202	(1) For policies and plans containing provisions inconsistent with this act, the
203	203	act first applies to policy or plan years beginning on the effective date of this
204	204	subsection, except as provided in sub. (2).
205	205	(2) For policies and plans that are affected by a collective bargaining agreement
206	206	containing provisions inconsistent with this act, the act first applies to policy or plan
207	207	years beginning on the effective date of this subsection or on the day on which the
208	208	collective bargaining agreement is newly established, extended, modified, or
209	209	renewed, whichever is later.
210	210	(END)
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