This bill would limit when health insurance companies can ask people to pay back money they already received for medical claims. It directly affects individuals with disability insurance policies, health maintenance organizations, and other health coverage plans. Under the new rules, insurers can only request repayment of already paid claims within 12 months of the initial payment, or 18 months if the claim involved coordination with other programs like Medicare or state medical assistance. The only exception allows retroactive denials if the original claim information was found to be fraudulent.
This bill limits when health insurance companies can demand repayment for claims they have already paid. It applies to disability insurance policies and various health care plans, including those offered by the state, counties, and other organizations. Under the bill, insurers can only request repayment within 12 months of making the initial payment, or 18 months if the claim involved coordination with other programs like Medicare or state medical assistance. The only exception is when the original claim was based on fraudulent information. The bill would take effect for policy years beginning on the date it is enacted, with special rules for plans covered by collective bargaining agreements.
AB 1081 adjusts payment rates for opioid treatment programs using medication-based care to match Medicare rates for comparable services starting in 2027. It also sets new staffing requirements, including a medical director with addiction medicine experience who must be present 40% of dosing time (reduced to 20% for the first 60 days of operation), and mandates one counselor for every 55 enrolled patients. The bill changes admission rules for minors, requiring documented failed detox attempts and written parental consent, while adding requirements for initial physical exams and Hepatitis/HIV testing with patient consent. These provisions directly affect all Wisconsin opioid treatment programs providing medication-assisted therapy.
SB 1047 adjusts payment rates for medication-based opioid treatment services to match Medicare rates starting in 2027, directly affecting opioid treatment programs (OTPs) and their patients. It eliminates a requirement for OTPs to document enrollment details and mandates specific staffing rules, including having a nurse present during dosing and maintaining a 1 counselor-to-55-patient ratio. The bill also updates admission criteria, requiring documented failed detox attempts for minors seeking maintenance treatment and clarifying initial dose limits for new patients. These changes aim to standardize care and payment while ensuring program compliance with federal and state regulations.
AB 720 requires health insurance plans - including defined network plans, preferred provider plans, and government self-insured plans - to cover emergency ambulance services provided by non-participating ambulance providers. It mandates payment at the lowest of three rates: a mutually agreed rate, a local governmental rate, or 350% of the Medicare rate for the same area. Plans must pay ambulance providers directly within 30 days for clean claims, cannot impose additional costs on enrollees beyond standard cost-sharing, and must provide clear explanations for denied claims. The bill excludes air ambulance services and applies to all health insurance plans covering emergency medical services.
SB 711 requires health insurance plans (including preferred provider plans and self-insured government plans) to cover emergency ambulance services provided by non-participating ambulance providers at specific rates. It mandates payment at the lowest of: (1) a mutually agreed rate, (2) a local government-set rate, or (3) 350% of the Medicare rate for the same area. The bill also requires insurers to pay ambulance providers directly within 30 days for clean claims, prohibits billing patients for extra costs beyond standard copays/deductibles, and excludes air ambulance services from coverage. This directly affects health insurance plans, ambulance providers, and patients receiving emergency ambulance care.
