Wisconsin Health Insurance Transparency and Badger Care

The Governor has signed a Wisconsin health insurance transparency bill that requires a health care provider to specify charge information for diagnosing and treating 25 presenting conditions: the provider’s median billed charges; the reimbursement amount under Medical Assistance; the reimbursement amount under Medicare; and the average allowable payment from private, third-party payers. This applies to health care facilities including hospitals, ambulatory surgical centers or nursing homes, and to associations of providers that include four or more practitioners.  The law also requires a self-insured health plan of the state, county, city, village, town, or school district, and insurers providing coverage under a Wisconsin health insurance policy to provide, upon request, to an insured a good faith estimate of the enrollee’s total out-of-pocket cost for a specified health care service in the geographic region in which the service will be provided. The estimate is not legally binding.

In addition, before concluding its general floor sessions on April 23, the legislature passed bills regarding health IT exchange and mandates for newborn hearing screening, coverage for diagnostic or surgical procedures to cover colorectal cancer examinations and laboratory tests, and changes to the mental-health parity mandate. Lastly, a law was passed that authorizes the state to establish and operate a health care benefit plan for individuals on the waiting list for the BadgerCare Plus Core Plan. To be known as the BadgerCare Plus Basic Plan, it will provide primary and preventive care. The Basic Plan, including both benefits and administration, will be funded entirely from premiums set by the state and paid by individuals with coverage under the Basic Plan. An Assembly amendment sunsets the plan to coincide with the implementation of federal health care reform.

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