2021 - 2022 LEGISLATURE
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2021 SENATE BILL 129
February 24, 2021 - Introduced by Senators BEWLEY, AGARD, CARPENTER,
ERPENBACH, JOHNSON, LARSON, PFAFF, RINGHAND, ROYS, SMITH and WIRCH,
cosponsored by Representatives HINTZ, ANDERSON, ANDRACA, BALDEH,
BILLINGS, BOWEN, BROSTOFF, CABRERA, CONLEY, CONSIDINE, DOYLE, DRAKE,
EMERSON, GOYKE, HAYWOOD, HEBL, HESSELBEIN, HONG, MCGUIRE, B. MEYERS,
MILROY, MOORE OMOKUNDE, L. MYERS, NEUBAUER, OHNSTAD, ORTIZ-VELEZ,
POPE, RIEMER, S. RODRIGUEZ, SHANKLAND, SHELTON, SINICKI, SNODGRASS,
SPREITZER, STUBBS, SUBECK, VINING and VRUWINK. Referred to Committee on
Government Operations, Legal Review and Consumer Protection.
1 AN ACT to amend 609.205 (2) (intro.) and (a) and 609.205 (3) (intro.); and to
2 create 609.205 (3m) of the statutes; relating to: out-of-network charges and
3 payments related to health coverage during COVID-19 pandemic.
Analysis by the Legislative Reference Bureau
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
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SENATE BILL 129
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.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
1 SECTION 1. 609.205 (2) (intro.) and (a) of the statutes are amended to read:
2 609.205 (2) (intro.) All of the following apply to a defined network plan or
3 preferred provider plan during the state of emergency related to public health
4 declared under s. 323.10 on March 12, 2020, by executive order 72, and for the 60 days
5 following the date that the state of emergency terminates until the conclusion of a
6 national emergency declared by the U.S. president under 50 USC 1621 in response
7 to the 2019 novel coronavirus or June 30, 2021, whichever is earlier:
8 (a) The plan may not require an enrollee to pay, including cost sharing, for a
9 service, treatment, or supply provided by a provider that is not a participating
10 provider in the plan's network of providers more than the enrollee would pay if the
11 service, treatment, or supply is provided by a provider that is a participating
12 provider. This subsection applies to any service, treatment, or supply that is related
13 to diagnosis or treatment for COVID-19 and to any service, treatment, or supply that
14 is provided by a provider that is not a participating provider because a participating
15 provider is unavailable due to the public health emergency.
16 SECTION 2. 609.205 (3) (intro.) of the statutes is amended to read:
17 609.205 (3) (intro.) During the state of emergency related to public health
18 declared under s. 323.10 on March 12, 2020, by executive order 72, and for the 60 days
19 following the date that the state of emergency terminates Until the conclusion of a
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SENATE BILL 129 SECTION 2
1 national emergency declared by the U.S. president under 50 USC 1621 in response
2 to the 2019 novel coronavirus or June 30, 2021, whichever is earlier, all of the
3 following apply to any health care provider or health care facility that provides a
4 service, treatment, or supply to an enrollee of a defined network plan or preferred
5 provider plan but is not a participating provider of that plan:
6 SECTION 3. 609.205 (3m) of the statutes is created to read:
7 609.205 (3m) This section does not apply to the reimbursement for
8 administration of the vaccine against the SARS-CoV-2 coronavirus, which results
9 in COVID-19. The reimbursement administration of the SARS-CoV-2 vaccine shall
10 be consistent with Section 3203 of the federal Coronavirus Aid, Relief, and Economic
11 Security Act and 45 CFR 147.130 (a).
12 (END)


Statutes affected:
Bill Text: 609.205(3)(intro.), 609.205