Wisconsin 2025 Regular Session Status: To Executive 4 R cosponsors

SB 4 — Relating to: agreements for direct primary care.

Last action — Failed to pass notwithstanding the objections of the Governor pursuant to Joint Rule 82

  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed Assembly
  5. 5
    To Executive
  6. 6
    Enacted

This bill has been sent to the executive. Introduced January 24, 2025. It awaits signature.

Vetoed by Governor Tony Evers (Democratic) on August 11, 2025.

Next likely step: the executive signs it into law or issues a veto.

Odds of enactment

Low chance

Based on the sponsor, cosponsors, and committee posture, this bill has a low chance of becoming law.

Upgrade to see the exact probability and what's driving it.

A statistical estimate from our own model of past outcomes — an insight, not a guarantee. Policymaking is volatile.

Prognosis

Likely to advance 74% · moderate confidence

  • To Executive

    Current position in the legislative process.

  • 13 sponsors

    1 primary, 12 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (4 R).

  • Cleared a recorded vote

    Passed 2 recorded votes so far.

Based on stage, sponsorship breadth, committee status, recorded votes, and cross-state momentum — a description of the observable signals, not a prediction.

Summary

An Act to create 146.78 and 600.01 (1) (b) 13. of the statutes;

Bill Text

What changed in the latest version

85 added · 184 removed

Plain-language change summary

The changes to Senate Bill 4 create a formal process for direct primary care agreements, allowing patients and healthcare providers to enter into contracts for primary care services for a set subscription fee and time period. This agreement must be in writing, signed by both parties, and outline the specific services provided, while also allowing either party to terminate the agreement with written notice. These amendments are significant because they provide clarity and structure to direct primary care arrangements, making it easier for patients to access care outside traditional insurance systems.

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- 2026 LEGISLATURE LRB-0507/1 JPC:emw SENATE BILL 4 January 24, 2025 - Introduced by Senators ABRAL -G UEVARA , KAPENGA , ASS and TESTIN , cosponsored by Representatives D UCHOW , BROOKS , ARMSTRONG , D ITTRICH, HURD, MURPHY , O'CONNOR , RODRIGUEZ and W ICHGERS .
Date of enactment:
Referred to Committee on Health.
Senate Bill 4 Date of publication*:
A N A CT to create 146.78 and 600.01 (1) (b) 13.
WISCONSIN ACT A N A CT to create 146.78 and 600.01 (1) (b) 13.
Analysis by the Legislative Reference Bureau This bill exempts valid direct primary care agreements from the application of insurance law.
The people of the state of Wisconsin, represented in sen- 4.
A “direct primary care agreement,” as defined in the bill, is a contract between a health care provider that provides primary care services under the provider’s scope of practice and an individual patient or the patient’s legal representative or employer in which the health care provider agrees to provide primary care services to the patient for an agreed-upon subscription fee and period of time.
Patient counseling and education.
A valid direct primary care agreement is in writing and satisfies all of the following:
ate and assembly, do enact as follows:
1.
It is signed by the health care provider or an agent of the health care provider and the individual patient, the patient’s legal representative, or a representative of the patient’s employer.
2.
It allows either party to terminate the agreement upon written notice.
3.
It describes and quantifies the specific primary care services that are provided under the agreement.
4.
It specifies the subscription fee for the agreement and specifies terms for termination of the agreement.
It specifies the duration of the agreement.
Provision of a broad spectrum of preventive and SECTION 1.
- 2026 Legislature - 2 - LRB-0507/1 JPC:emw SENATE BILL 4 SECTION 1 6.
It prohibits the provider and patient from billing an insurer or any other third party on a fee-for-service basis for the primary care services included in the subscription fee under the agreement.
7.
It prominently states, in writing, several provisions, including that the agreement is not health insurance and the agreement alone may not satisfy individual or employer insurance coverage requirements under federal law;
that the patient is responsible for paying, or directing the patient’s employer to pay, the provider for all services that are not included in the subscription fee under the agreement;
that the patient is encouraged to consult with a health insurance advisor, the patient’s health insurance carrier, or the patient’s employer-sponsored health plan, as applicable, before entering into the agreement;
and that direct primary care fees might not be credited toward deductibles or out-of-pocket maximum amounts under any health insurance the patient has.
Under the bill, a health care provider may not decline to enter into or terminate a direct primary care agreement with a patient solely because of the patient’s health status.
The bill allows a health care provider to decline to accept a patient for a direct primary care agreement only if the health care provider’s practice has reached its maximum patient capacity or if the patient’s medical condition is such that the health care provider is unable to provide the appropriate level and type of primary care services the patient requires.
A health care provider may terminate a direct primary care agreement with a patient only if the patient or the patient’s employer fails to pay the subscription fee, the patient fails repeatedly to adhere to the treatment plan, the patient has performed an act of fraud related to the direct primary care agreement, the patient is abusive in a manner described in the bill, the health care provider discontinues operation as a direct primary care provider, or the health care provider believes that the relationship is no longer therapeutic for the patient due to a dysfunctional relationship between the provider and the patient.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1.
curative health care over a period of time.
6.
Coordination of care.
(1) D EFINITIONS .
(1) D EF- (2) V ALID AGREEMENT .
A health care provider and INITIONS .
(a) “Direct primary care agreement” means a contract between a health care provider and an individual patient or the patient's legal representative or employer in which the health care provider agrees to provide primary care services to the individual patient for an agreed-upon subscription fee and period of time.
(a) XDirect primary care agreementY means a con- an individual patient or the patient[s legal representative tract between a health care provider and an individual or employer may enter into a direct primary care agree- patient or the patient's legal representative or employer ment.
- 2026 Legislature - 3 - LRB-0507/1 JPC:emw SENATE BILL 4 SECTION 1 (b) “Health care provider” means a health care provider under s.
A valid direct primary care agreement meets all of the following criteria:
146.81 (1) (a) to (p) that provides primary care services under the health care provider’s scope of practice.
in which the health care provider agrees to provide pri- (a) The direct primary care agreement is in writing.
(c) “Primary care services” means outpatient, general health care services of the type provided by a main source for regular health care services for patients at the time a patient seeks preventive care or first seeks health care services for a specific health concern and includes all of the following:
mary care services to the individual patient for an (b) The direct primary care agreement is signed by agreed-upon subscription fee and period of time.
1.
(b) XHealth care providerY means a health care the health care provider or an agent of the health care provider under s.
Care that promotes and maintains mental and physical health and wellness.
146.81 (1) (a) to (p) that provides pri- provider and the individual patient, the patient[s legal representative, or a representative of the patient[s mary care services under the health care provider[s employer.
scope of practice.
(c) The direct primary care agreement allows either (c) XPrimary care servicesY means outpatient, gen- party to the direct primary care agreement to terminate eral health care services of the type provided by a main source for regular health care services for patients at the the direct primary care agreement upon written notice to the other party subject to the requirements under sub.
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time a patient seeks preventive care or first seeks health (3) for termination of the direct primary care agreement care services for a specific health concern and includes by the health care provider.
all of the following:
(d) The direct primary care agreement describes 1.
Care that promotes and maintains mental and and quantifies the specific primary care services that are physical health and wellness.
provided under the direct primary care agreement.
3.
(e) The direct primary care agreement specifies the 3.
Screening, diagnosis, and treatment of acute or chronic conditions caused by disease, injury, or illness.
Screening, diagnosis, and treatment of acute or subscription fee for the direct primary care agreement chronic conditions caused by disease, injury, or illness.
4.
and specifies terms for termination of the direct primary * Section 991.11, ISCONSINSTATUTES:
Patient counseling and education.
Effective date of acts.
5.
XEvery act and every portion of an act enacted by the legislature over the gov- ernor's partial veto which does not expressly prescribe the time when it takes effect shall take effect on the day after its date of publication.Y Wisconsin Act - 2 - 2025 Senate Bill 4 care agreement, including any possible refund of fees to level and type of primary care services the patient the patient or the patient[s employer.
Provision of a broad spectrum of preventive and curative health care over a period of time.
requires.
6.
(f) The direct primary care agreement specifies the (b) A health care provider may terminate a direct duration of the direct primary care agreement.
Coordination of care.
primary care agreement with a patient for only any of (g) The health care provider and the patient are pro- the following reasons:
(2) VALID AGREEMENT .
hibited from billing an insurer or any other 3rd party on 1.
A health care provider and an individual patient or the patient’s legal representative or employer may enter into a direct primary care agreement.
The patient or the patient[s employer fails to pay a fee-for-service basis for the primary care services in- the subscription fee.
A valid direct primary care agreement meets all of the following criteria:
cluded in the subscription fee under the direct primary 2.
(a) The direct primary care agreement is in writing.
The patient repeatedly fails to adhere to the treat- care agreement.
(b) The direct primary care agreement is signed by the health care provider or - 2026 Legislature - 4 - LRB-0507/1 JPC:emw SENATE BILL 4 SECTION 1 an agent of the health care provider and the individual patient, the patient’s legal representative, or a representative of the patient’s employer.
ment plan recommended by the health care provider.
(c) The direct primary care agreement allows either party to the direct primary care agreement to terminate the direct primary care agreement upon written notice to the other party subject to the requirements under sub.
(h) The direct primary care agreement prominently 3.
(3) for termination of the direct primary care agreement by the health care provider.
The patient has performed an act of fraud related states, in writing, all of the following:
(d) The direct primary care agreement describes and quantifies the specific primary care services that are provided under the direct primary care agreement.
to the direct primary care agreement.
(e) The direct primary care agreement specifies the subscription fee for the direct primary care agreement and specifies terms for termination of the direct primary care agreement, including any possible refund of fees to the patient or the patient’s employer.
(f) The direct primary care agreement specifies the duration of the direct primary care agreement.
(g) The health care provider and the patient are prohibited from billing an insurer or any other 3rd party on a fee-for-service basis for the primary care services included in the subscription fee under the direct primary care agreement.
(h) The direct primary care agreement prominently states, in writing, all of the following:
The direct primary care agreement is not health insurance, and the direct primary care agreement alone may not satisfy individual or employer insurance coverage requirements under federal law.
The direct primary care agreement is not health 4.
2.
The patient is abusive and presents an emotional insurance, and the direct primary care agreement alone or physical danger to the staff or other patients of the may not satisfy individual or employer insurance cover- health care provider.
The individual patient is responsible for paying the health care provider for - 2026 Legislature - 5 - LRB-0507/1 JPC:emw SENATE BILL 4 S ECTION 1 all services that are not included in the subscription fee under the direct primary care agreement or directing the patient’s employer to pay the health care provider for all services that are not included in the subscription fee under the direct primary care agreement, if applicable.
age requirements under federal law.
3.
The patient is encouraged to consult with a health insurance advisor, the patient’s health insurance carrier, or the patient’s employer-sponsored health plan, as applicable, before entering into the direct primary care agreement regarding coverage options for health care services that may not be covered through the direct primary care agreement.
4.
Some services provided under the direct primary care agreement may be covered under any health insurance the patient has.
Direct primary care fees might not be credited toward deductibles or out-of- pocket maximum amounts under the patient’s health insurance, if the patient has health insurance.
The health care provider discontinues operation 2.
(3) P ATIENT SELECTION;TERMINATION.
The individual patient is responsible for paying as a health care provider under direct primary care the health care provider for all services that are not in- agreements.
(a) A health care provider may not decline to enter into a direct primary care agreement or terminate a direct primary care agreement with a patient solely because of the patient’s health status.
cluded in the subscription fee under the direct primary 6.
A health care provider may decline to accept a patient for a direct primary care agreement for only any of the following reasons:
The health care provider believes that the rela- care agreement or directing the patient[s employer to tionship is no longer therapeutic for the patient due to a pay the health care provider for all services that are not dysfunctional relationship between the health care included in the subscription fee under the direct primary provider and the patient.
care agreement, if applicable.
(c) Nothing in this section shall be construed to 3.
The patient is encouraged to consult with a health limit the application of s.
106.52 to a health care insurance advisor, the patient[s health insurance carrier, provider[s practice.
or the patient[s employer-sponsored health plan, as ap- (4) INSURANCE NETWORK PARTICIPATION .
A health plicable, before entering into the direct primary care care provider who has a practice in which the health care agreement regarding coverage options for health care provider enters into direct primary care agreements may services that may not be covered through the direct pri- participate in a network of a health insurance carrier mary care agreement.
only to the extent that the health care provider is willing 4.
Some services provided under the direct primary and able to comply with the terms of the participation care agreement may be covered under any health insur- agreement with the health insurance carrier and meet ance the patient has.
any other terms and conditions of network participation 5.
Direct primary care fees might not be credited to- as determined by the health insurance carrier.
ward deductibles or out-of-pocket maximum amounts (5) CONSTRUCTION .
Nothing in this section shall be under the patient[s health insurance, if the patient has construed to limit the regulatory authority of the depart- health insurance.
ment of safety and professional services or the depart- (3) P ATIENT SELECTION ;
TERMINATION .
(a) A ment of agriculture, trade and consumer protection.
health care provider may not decline to enter into a di- Nothing in this section shall be construed to limit the au- rect primary care agreement or terminate a direct pri- thority of the office of the commissioner of insurance to mary care agreement with a patient solely because of the regulate contracts that do not satisfy the criteria to be a patient[s health status.
A health care provider may de- valid direct primary care agreement under sub.
(2) and cline to accept a patient for a direct primary care agree- that meet the definition of insurance under s.
600.03 ment for only any of the following reasons:
(25).
The health care provider’s practice has reached its maximum patient capacity.
The health care provider[s practice has reached its SECTION 2.
2.
The patient’s medical condition is such that the health care provider is - 2026 Legislature - 6 - LRB-0507/1 JPC:emw SENATE BILL 4 SECTION 1 unable to provide the appropriate level and type of primary care services the patient requires.
(b) A health care provider may terminate a direct primary care agreement with a patient for only any of the following reasons:
1.
The patient or the patient’s employer fails to pay the subscription fee.
2.
The patient repeatedly fails to adhere to the treatment plan recommended by the health care provider.
3.
The patient has performed an act of fraud related to the direct primary care agreement.
4.
The patient is abusive and presents an emotional or physical danger to the staff or other patients of the health care provider.
5.
The health care provider discontinues operation as a health care provider under direct primary care agreements.
6.
The health care provider believes that the relationship is no longer therapeutic for the patient due to a dysfunctional relationship between the health care provider and the patient.
(c) Nothing in this section shall be construed to limit the application of s.
106.52 to a health care provider’s practice.
(4) INSURANCE NETWORK PARTICIPATION .
A health care provider who has a practice in which the health care provider enters into direct primary care agreements may participate in a network of a health insurance carrier only to the extent that the health care provider is willing and able to comply with the terms of the participation agreement with the health insurance carrier and meet any other - 2026 Legislature - 7 - LRB-0507/1 JPC:emw SENATE BILL 4 SECTION 1 terms and conditions of network participation as determined by the health insurance carrier.
(5) C ONSTRUCTION.
Nothing in this section shall be construed to limit the regulatory authority of the department of safety and professional services or the department of agriculture, trade and consumer protection.
Nothing in this section shall be construed to limit the authority of the office of the commissioner of insurance to regulate contracts that do not satisfy the criteria to be a valid direct primary care agreement under sub.
(2) and that meet the definition of insurance under s.
600.03 (25).
S ECTION 2.
of the statutes is created to read:
of the statutes is cre- maximum patient capacity.
600.01 (1) (b) 13.
ated to read:
Valid direct primary care agreements under s.
2.
The patient[s medical condition is such that the 600.01 (1) (b) 13.
Valid direct primary care agree- health care provider is unable to provide the appropriate ments under s.
(END)
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Action History

  1. Failed to pass notwithstanding the objections of the Governor pursuant to Joint Rule 82

  2. Placed on calendar 5-12-2026 pursuant to Joint Rule 82 (2)(a)

  3. Report vetoed by the Governor on 8-8-2025

  4. Presented to the Governor on 8-7-2025

  5. Report correctly enrolled

  6. Received from Assembly concurred in

  7. Ordered immediately messaged

  8. Read a third time and concurred in

  9. Rules suspended

  10. Ordered to a third reading

  11. Read a second time

  12. Rules suspended to withdraw from calendar and take up

  13. Withdrawn from committee on Rules and referred to calendar of 5-13-2025

  14. Read first time and referred to committee on Rules

  15. Received from Senate

  16. Ordered immediately messaged

  17. Read a third time and passed, Ayes 18, Noes 14

  18. Rules suspended to give bill its third reading

  19. Ordered to a third reading

  20. Senate Amendment 1 rejected, Ayes 18, Noes 14

  21. Read a second time

  22. Senate Amendment 1 offered by Senators Spreitzer, Ratcliff, Carpenter, Dassler-Alfheim, Roys, Pfaff, Smith, Drake, Habush Sinykin, Hesselbein, L. Johnson, Keyeski, Larson and Wall

  23. Placed on calendar 3-18-2025 pursuant to Senate Rule 18(1)

  24. Senator Hutton added as a coauthor

  25. Available for scheduling

  26. Report passage recommended by Committee on Health, Ayes 3, Noes 2

  27. Executive action taken

  28. Public hearing held

  29. Senator Tomczyk added as a coauthor

  30. Read first time and referred to Committee on Health

  31. Introduced by Senators Cabral-Guevara, Kapenga, Nass and Testin; cosponsored by Representatives Duchow, Brooks, Armstrong, Dittrich, Hurd, Murphy, O'Connor, Rodriguez and Wichgers

Sponsors

  • Duchow · Cosponsor
  • Brooks · Cosponsor
  • Armstrong · Cosponsor
  • Dittrich · Cosponsor
  • Steve Nass · Cosponsor
  • Chris Kapenga · Cosponsor
  • Hurd · Cosponsor
  • Murphy · Cosponsor
  • O'Connor · Cosponsor
  • Rodriguez · Cosponsor
  • Wichgers · Cosponsor
  • Patrick Testin · Cosponsor
  • Rachael Cabral-Guevara · Primary

Sponsorship breakdown

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1 sponsors · 12 co-sponsors · 119 not signed on · 11 voted No

Sponsors (1)

Co-sponsors (12)

Not signed on (119)

119 members have not signed on to this bill.

Show all 119 →

"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

Senate Amendment 1 rejected

Passed 18 Yea · 14 Nay · 1 Other
Party YeaNayPresentNot Voting
Republican 18000
Democrat 01101
Unaffiliated 0300
Total 181401
% of votes cast 55%42%0%3%
How each member voted (33)
Member Party Vote
JOHNSON — Nay
DASSLER-ALFHEI — Nay
HABUSH SINYKIN — Nay
Carpenter, Tim Democrat Nay
Drake, Dora Democrat Nay
Hesselbein, Dianne Democrat Nay
Keyeski, Sarah Democrat Nay
Larson, Chris Democrat Nay
Pfaff, Brad Democrat Nay
Ratcliff, Melissa Democrat Nay
Roys, Kelda Democrat Not Voting
Smith, Jeff Democrat Nay
Spreitzer, Mark Democrat Nay
Wall, Jamie Democrat Nay
Wirch, Robert Democrat Nay
Bradley, Julian Republican Yea
Cabral-Guevara, Rachael Republican Yea
Felzkowski, Mary Republican Yea
Feyen, Dan Republican Yea
Hutton, Rob Republican Yea
Jacque, André Republican Yea
Jagler, John Republican Yea
James, Jesse Republican Yea
Kapenga, Chris Republican Yea
LeMahieu, Devin Republican Yea
Marklein, Howard Republican Yea
Nass, Steve Republican Yea
Quinn, Romaine Republican Yea
Stafsholt, Rob Republican Yea
Testin, Patrick Republican Yea
Tomczyk, Cory Republican Yea
Wanggaard, Van Republican Yea
Wimberger, Eric Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

What does SB 4 do?
An Act to create 146.78 and 600.01 (1) (b) 13. of the statutes;
Who sponsors SB 4?
SB 4 is sponsored by Duchow, Brooks, Armstrong, Dittrich, Nass, Steve (Republican), Kapenga, Chris (Republican), Hurd, Murphy, O'Connor, Rodriguez, Wichgers, Testin, Patrick (Republican), and Cabral-Guevara, Rachael (Republican).
What is the current status of SB 4?
This bill has been sent to the executive. Introduced January 24, 2025. It awaits signature.
Where can I track SB 4?
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