This bill establishes new funding and administrative provisions for Wisconsin's Medical Assistance program, including grants for community primary care and outreach services. It allocates $41.75 million for 2025-26 and $66.75 million for 2026-27 to support community health centers in hiring health workers, nurses, and social workers to provide care coordination services, particularly for individuals facing barriers like mental illness or homelessness. The legislation also creates a stabilization fund of $20 million for the BadgerCare Direct program, which pays providers directly for services rather than through insurance intermediaries. Additionally, the bill adds requirements for the state to maintain a 24/7 nurse consultation helpline, improve provider recruitment, and explore ways to reduce healthcare costs while ensuring timely access to medically necessary services.
AB 754 requires most health insurance plans and disability policies covering preventive care to cover home test kits for sexually transmitted diseases (STIs), including HIV. It mandates coverage when a healthcare provider deems the test medically necessary and orders it directly or through a standing order. The law defines "home test kits" as products meeting CDC or FDA guidelines, allowing self-collection outside clinical settings. This applies to plans covering primary care or preventive services, including laboratory processing costs for approved kits.
Assembly Bill 8 establishes a legal framework for "direct primary care agreements" between health care providers and patients. These agreements allow patients or their employers to pay a direct subscription fee for a defined set of primary care services, rather than billing an insurer on a fee-for-service basis for those specific services. The bill outlines criteria for valid agreements, including requirements for written contracts, clear disclosures that these are not health insurance, and rules regarding termination and patient selection. It prohibits providers from declining or terminating an agreement solely based on a patient's health status or other protected characteristics.
Assembly Bill 43 permits pharmacists to prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives to individuals aged 18 and older. Pharmacists must adhere to new rules, including requiring patients to complete a self-assessment questionnaire and undergo a blood pressure screening. The bill also mandates that pharmacists report prescriptions to the patient's primary care provider, provide a written record, and carry malpractice liability insurance. Furthermore, it ensures these contraceptives are covered under Medical Assistance when prescribed by pharmacists and grants the Pharmacy Examining Board authority for related rule-making.
SB 373 limits health insurance plans' use of prior authorization for physical therapy, occupational therapy, speech therapy, and chiropractic care. It prohibits requiring prior approval for the first 12 visits per condition (or 90 days for chronic pain management at up to twice weekly visits) and mandates equivalent copays to primary care. Insurance plans must explain coverage denials in plain language and decide on reauthorizations within 3 business days (or approval is automatic). This directly affects health insurance plans and patients seeking these specific therapies in the state.
SB 4 establishes legal requirements for direct primary care agreements in Wisconsin. It defines these contracts as written arrangements between healthcare providers and patients (or employers) where providers offer ongoing primary care services for a fixed subscription fee. Key provisions mandate that agreements must detail specific services, specify the fee, allow termination with written notice, and be signed by both parties. The bill was vetoed by the Governor on August 11, 2025, preventing it from becoming law.
SB 50 establishes a Prescription Drug Affordability Review Board to address prescription drug costs, requiring it to meet quarterly and include balanced representation from pharmaceutical manufacturers, health insurers, healthcare providers, and the public. The bill allocates $500,000 annually for state operations related to this board and funds a pilot project to create value-based diabetes medication arrangements with pharmacy benefit managers. It also modifies Medicaid copayment rules to prevent providers from denying care due to inability to pay copays, while creating a new tool for prescribers to disclose drug costs to patients. Additionally, the bill authorizes partnerships with out-of-state drug repositories and allows pharmacists to count free clinic volunteer hours toward continuing education requirements.
AB 368 prevents health insurance plans from requiring prior authorization for the first 12 visits of physical therapy, occupational therapy, speech therapy, or chiropractic care per treatment episode. It also eliminates prior authorization for non-drug pain management (like therapy) for chronic pain patients during the first 90 days of treatment (up to twice weekly). Health plans must explain coverage denials in plain language, apply similar copays for these therapies as for primary care, and decide on reauthorization requests within 3 business days. This bill directly affects patients seeking these services, healthcare providers, and all health benefit plans or self-insured employer health plans in the state.
SB 39 proposes the establishment of a Palliative Care Council. This council would likely address matters related to palliative care services, which aim to provide comfort and support for patients with serious illnesses. An amendment to the bill details the required composition of the council's physician members. Specifically, it mandates that five physicians serve on the council, including two palliative care physicians (one specializing in pediatric palliative care) and two primary care physicians.
Senate Bill 42 allows pharmacists to prescribe and dispense hormonal contraceptive patches and self-administered oral hormonal contraceptives to individuals aged 18 and older. Pharmacists must follow specific procedures, including having patients complete a self-assessment questionnaire and undergo a blood pressure screening. The Pharmacy Examining Board will create rules for this process, which also requires pharmacists to report prescriptions to a patient's primary care practitioner and maintain malpractice insurance. Additionally, the bill ensures that Medical Assistance covers these contraceptive services when provided by certified pharmacists.
