Wisconsin 2019-2020 Regular Session Status: To Executive 20 R cosponsors

AB 26 — Relating to: direct primary care agreements.

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

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

This bill died with 2019-2020 Regular Session. It reached “To Executive” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.

This bill is no longer active — its legislative session has ended, so there is no live prognosis. It would have to be reintroduced in the current session to move again.

Bill Text

What changed in the latest version

130 added · 12 removed

Plain-language change summary

The amendment to Assembly Bill 26 clarifies that while direct primary care agreements are exempt from insurance regulations, the Commissioner of Insurance can still regulate any contracts that do not meet the criteria of a valid direct primary care agreement. This change matters because it ensures that there is oversight for agreements that could be misrepresented as direct primary care but do not actually meet the specified standards, thus protecting consumers from potential pitfalls in their health care agreements.

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- 2020 LEGISLATURE LRBa0533/1 TJD:skw ASSEMBLY AMENDMENT 1, TO ASSEMBLY BILL 26 September 20, 2019 - Offered by RepresentativesARGENT and SANFELIPPO.
- 2020 LEGISLATURE LRB-1202/1 TJD:kjf ASSEMBLY BILL 26 February 19, 2019 - Introduced by Representatives ANFELIPPO, ROOKS , DITTRIC, D UCHOW , FELZKOWSKI , GUNDRUM , HORLACHER , H UTTON , JAGLER, K ATSMA, K ITCHENS, KNODL, KUGLITSCH, KULP, OUDENBECK , MURPHY, NOVAK, PETERSEN, P LUMER , QUINN, R AMTHUN , R OHRKASTE , SKOWRONSKI , SORTWELL , SPIROS, S TAFSHOLT, AUCHEN , THIESFELDT, ITTL, USLER, VANDERM EER , ORPAGEL and W ICHGERS , cosponsored by Senators KAPENGA , DARLING, TIFFANY, BERNIER, C RAIG, KOOYENGA , NASS and S TROEBEL .
At the locations indicated, amend the bill as follows:
Referred to Committee on Small Business Development.
A N A CT to create 146.78 and 600.01 (1) (b) 13.
of the statutes;
relating to:
direct primary care agreements.
Analysis by the Legislative Reference Bureau This bill exempts valid direct primary care agreements from the application of insurance law.
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 his or her legal representative, or an employer in which the health care provider agrees to provide primary care services to the patient or employee for an agreed-upon subscription fee and period of time.
A valid direct primary care agreement is signed and in writing and does all of the following:
1) allows either party to terminate the agreement upon written notice and specifies the terms for termination and the subscription fee;
2) describes and quantifies the specific primary care services that are provided under the agreement;
3) specifies the duration of the agreement;
4) prominently states that the agreement is not health insurance and may not satisfy insurance coverage requirements under federal law;
5) 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;
6) prominently states that the individual patient, or employer if applicable, is responsible for paying the provider for all services that are not included in the subscription fee under the agreement;
and 7) prominently states that the patient is urged to consult with any health insurance carrier the patient has before entering the agreement, that some services provided under the agreement may be covered by any health insurance the - 2020 Legislature - 2 - LRB-1202/1 TJD:kjf ASSEMBLY BILL 26 patient has, and that direct primary care fees may not be credited toward deductibles or out-of-pocket maximum amounts under any health insurance the patient has.
The bill prohibits a health care provider from discriminating on the basis of age, citizenship status, color, disability, gender or gender identity, genetic information, health status, existence of a preexisting medical condition, national origin, religion, sex, sexual orientation, or any other protected class when selecting patients for entering into direct primary care agreements.
The health care provider, however, may base subscription fees under a direct primary care agreement on age.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SECTION 1.
146.78 of the statutes is created to read:
146.78 Direct primary care agreement.
(1) D EFINITIONS.
In this section:
(a) “Direct primary care agreement" means a contract between a health care provider and an individual patient or his or her legal representative or an employer in which the health care provider agrees to provide primary care services to the individual patient or employee for an agreed-upon subscription fee and period of time.
(b) “Health care provider" means a health care provider under s.
146.81 (1) (a) to (p) that provides primary care services under the provider's scope of practice.
(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:
Page 5, line 3:
Care that promotes and maintains mental and physical health and wellness.
after “protection." insert “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 s.
2.
146.78 (2) and that meet the definition of insurance under s.
Care that prevents disease.
600.03 (25).".
3.
Screening, diagnosing, and treating acute or chronic conditions caused by disease, injury, or illness.
4.
Patient counseling and education.
LRB-1202/1 - 2020 Legislature - 3 - TJD:kjf SECTION 1 ASSEMBLY BILL 26 5.
Provision of a broad spectrum of preventive and curative health care over a period of time.
6.
Coordination of care.
(2) VALID AGREEMENT.A health care provider and an individual patient or his or her legal representative or an employer may enter into a direct primary care agreement.
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A valid direct primary care agreement meets all of the following criteria:
(a) The agreement is in writing.
(b) The agreement 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 employer.
(c) The agreement allows either party to the agreement to terminate the agreement upon written notice to the other party.
(d) The agreement describes and quantifies the specific primary care services that are provided under the agreement.
(e) The agreement specifies the subscription fee for the agreement and specifies terms for termination of the agreement, including any possible refund of fees to the patient.
(f) The agreement specifies the duration of the agreement.
(g) The agreement prominently states, in writing, that the agreement is not health insurance and that the agreement alone may not satisfy individual or employer insurance coverage requirements under federal law.
(h) 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 agreement.
- 2020 Legislature - 4 - LRB-1202/1 TJD:kjf ASSEMBLY BILL 26 SECTION 1 (i) The agreement prominently states, in writing, that the individual patient or the employer, if applicable, is responsible for paying the provider for all services that are not included in the subscription fee under the agreement.
(j) The agreement prominently states, in writing, that the patient is encouraged to consult with his or her health insurance carrier, if the patient has health insurance, before entering into the agreement, that some services provided under the agreement may be covered under any health insurance the patient has, and that 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.
(3) PATIENT SELECTION.In selecting patients with whom to enter into a direct primary care agreement, a health care provider may not discriminate on the basis of age, citizenship status, color, disability, gender or gender identity, genetic information, health status, existence of a preexisting medical condition, national origin, race, religion, sex, sexual orientation, or any other protected class.
A health care provider may base subscription fees under a direct primary care agreement on age.
(4) INSURANCE NETWORK PARTICIPATION.
A health care provider who has a practice in which he or she enters into direct primary care agreements may participate in a network of a health insurance carrier only to the extent that the provider is willing and able to comply with the terms of the participation agreement with the carrier and meet any other terms and conditions of network participation as determined by the health insurance carrier.
LRB-1202/1 - 2020 Legislature - 5 - TJD:kjf SECTION 1 ASSEMBLY BILL 26 (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.
SECTION 2.
600.01 (1) (b) 13.
of the statutes is created to read:
600.01 (1) (b) 13.
Valid direct primary care agreements under s.
146.78 (2).
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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 5-12-2020 pursuant to Joint Rule 82 (2)(a)

  3. Report vetoed by the Governor on 2-28-2020

  4. Presented to the Governor on 2-25-2020

  5. Report correctly enrolled on 2-25-2020

  6. LRB correction (Assembly Amendment 2)

  7. Received from Senate concurred in

  8. Messaged

  9. Refused to reconsider vote by which Assembly Bill 26 was concurred in offered by Senator Fitzgerald, Ayes 12, Noes 21

  10. Move to call the question

  11. Concurred in, Ayes 20, Noes 13

  12. Move to call the question, Ayes 19, Noes 14

  13. Read a third time

  14. Ordered to a third reading, Ayes 19, Noes 14

  15. Move to call the question, Ayes 19, Noes 14

  16. Senate Amendment 1 laid on table, Ayes 19, Noes 14

  17. Senate Amendment 1 laid on table, Ayes 19, Noes 14

  18. Read a second time

  19. Senate Amendment 2 offered by Senators Carpenter, Ringhand, L. Taylor, Risser and Johnson

  20. Senate Amendment 1 offered by Senators Hansen, Shilling, Bewley, Miller, Risser, Erpenbach, Carpenter, Larson and Ringhand

  21. Placed on calendar 2-19-2020 pursuant to Senate Rule 18(1)

  22. Public hearing requirement waived by committee on Senate Organization, pursuant to Senate Rule 18 (1m), Ayes 5, Noes 0

  23. Available for scheduling

  24. Read first time and referred to committee on Senate Organization

  25. Received from Assembly

  26. Ordered immediately messaged

  27. Representative Petryk added as a coauthor

  28. Read a third time and passed, Ayes 61, Noes 36

  29. Rules suspended

  30. Ordered to a third reading

  31. Assembly Amendment 2 adopted, Ayes 61, Noes 36

  32. Assembly Amendment 2 offered by Representative Sanfelippo

  33. Assembly Amendment 1 adopted

  34. Read a second time

  35. Placed on calendar 1-21-2020 by Committee on Rules

  36. Referred to committee on Rules

  37. Report passage as amended recommended by Committee on Small Business Development, Ayes 13, Noes 1

  38. Report Assembly Amendment 1 adoption recommended by Committee on Small Business Development, Ayes 14, Noes 0

  39. Executive action taken

  40. Representative Allen withdrawn as a coauthor

  41. Assembly Amendment 1 offered by Representatives Sargent and Sanfelippo

  42. Representative Allen added as a coauthor

  43. Representative Edming added as a coauthor

  44. Public hearing held

  45. Representative James added as a coauthor

  46. Read first time and referred to Committee on Small Business Development

  47. Introduced by Representatives Sanfelippo, Brooks, Dittrich, Duchow, Felzkowski, Gundrum, Horlacher, Hutton, Jagler, Katsma, Kitchens, Knodl, Kuglitsch, Kulp, Loudenbeck, Murphy, Novak, Petersen, Plumer, Quinn, Ramthun, Rohrkaste, Skowronski, Sortwell, Spiros, Stafsholt, Tauchen, Thiesfeldt, Tittl, Tusler, VanderMeer, Vorpagel and Wichgers; cosponsored by Senators Kapenga, Darling, Tiffany, Bernier, Craig, Kooyenga, Nass and Stroebel

Sponsors

Sponsorship breakdown

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33 sponsors · 0 co-sponsors · 99 not signed on · 27 voted No

Sponsors (33)

Co-sponsors (0)

None.

Not signed on (99)

99 members have not signed on to this bill.

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"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

CALL THE QUESTION

Passed 19 Yea · 14 Nay
Party YeaNayPresentNot Voting
Unaffiliated 10900
Republican 8000
Democrat 1500
Total 191400
% of votes cast 58%42%0%0%
How each member voted (33)
Member Party Vote
BERNIER — Yea
ROTH — Yea
COWLES — Yea
KOOYENGA — Yea
STROEBEL — Yea
CRAIG — Yea
DARLING — Yea
TIFFANY — Yea
OLSEN — Yea
PETROWSKI — Yea
BEWLEY — Nay
SHILLING — Nay
MILLER — Nay
ERPENBACH — Nay
RINGHAND — Nay
HANSEN — Nay
RISSER — Nay
JOHNSON — Nay
SCHACHTNER — Nay
Carpenter, Tim Democrat Nay
Fitzgerald, Joan Democrat Yea
Larson, Chris Democrat Nay
Smith, Jeff Democrat Nay
Taylor, Sequanna Democrat Nay
Wirch, Robert Democrat Nay
Feyen, Dan Republican Yea
Jacque, André Republican Yea
Kapenga, Chris Republican Yea
LeMahieu, Devin Republican Yea
Marklein, Howard Republican Yea
Nass, Steve Republican Yea
Testin, Patrick Republican Yea
Wanggaard, Van Republican Yea

Official roll call →

CONCURRENCE

Passed 20 Yea · 13 Nay
Party YeaNayPresentNot Voting
Unaffiliated 10900
Republican 8000
Democrat 2400
Total 201300
% of votes cast 61%39%0%0%
How each member voted (33)
Member Party Vote
BERNIER — Yea
PETROWSKI — Yea
ROTH — Yea
COWLES — Yea
KOOYENGA — Yea
STROEBEL — Yea
CRAIG — Yea
DARLING — Yea
TIFFANY — Yea
OLSEN — Yea
BEWLEY — Nay
MILLER — Nay
ERPENBACH — Nay
RINGHAND — Nay
HANSEN — Nay
RISSER — Nay
JOHNSON — Nay
SCHACHTNER — Nay
SHILLING — Nay
Carpenter, Tim Democrat Yea
Fitzgerald, Joan Democrat Yea
Larson, Chris Democrat Nay
Smith, Jeff Democrat Nay
Taylor, Sequanna Democrat Nay
Wirch, Robert Democrat Nay
Feyen, Dan Republican Yea
Jacque, André Republican Yea
Kapenga, Chris Republican Yea
LeMahieu, Devin Republican Yea
Marklein, Howard Republican Yea
Nass, Steve Republican Yea
Testin, Patrick Republican Yea
Wanggaard, Van Republican Yea

Official roll call →

RECONSIDERATION OF CONCURRENCE

Failed 12 Yea · 21 Nay
Party YeaNayPresentNot Voting
Unaffiliated 91000
Democrat 3300
Republican 0800
Total 122100
% of votes cast 36%64%0%0%
How each member voted (33)
Member Party Vote
BEWLEY — Yea
SCHACHTNER — Yea
ERPENBACH — Yea
MILLER — Yea
SHILLING — Yea
HANSEN — Yea
RINGHAND — Yea
JOHNSON — Yea
RISSER — Yea
BERNIER — Nay
PETROWSKI — Nay
ROTH — Nay
COWLES — Nay
KOOYENGA — Nay
STROEBEL — Nay
CRAIG — Nay
DARLING — Nay
TIFFANY — Nay
OLSEN — Nay
Carpenter, Tim Democrat Nay
Fitzgerald, Joan Democrat Nay
Larson, Chris Democrat Yea
Smith, Jeff Democrat Yea
Taylor, Sequanna Democrat Nay
Wirch, Robert Democrat Yea
Feyen, Dan Republican Nay
Jacque, André Republican Nay
Kapenga, Chris Republican Nay
LeMahieu, Devin Republican Nay
Marklein, Howard Republican Nay
Nass, Steve Republican Nay
Testin, Patrick Republican Nay
Wanggaard, Van Republican Nay

Official roll call →

CALL THE QUESTION

Passed 19 Yea · 14 Nay
Party YeaNayPresentNot Voting
Unaffiliated 10900
Republican 8000
Democrat 1500
Total 191400
% of votes cast 58%42%0%0%
How each member voted (33)
Member Party Vote
BERNIER — Yea
ROTH — Yea
COWLES — Yea
KOOYENGA — Yea
STROEBEL — Yea
CRAIG — Yea
DARLING — Yea
TIFFANY — Yea
OLSEN — Yea
PETROWSKI — Yea
BEWLEY — Nay
SHILLING — Nay
MILLER — Nay
ERPENBACH — Nay
RINGHAND — Nay
HANSEN — Nay
RISSER — Nay
JOHNSON — Nay
SCHACHTNER — Nay
Carpenter, Tim Democrat Nay
Fitzgerald, Joan Democrat Yea
Larson, Chris Democrat Nay
Smith, Jeff Democrat Nay
Taylor, Sequanna Democrat Nay
Wirch, Robert Democrat Nay
Feyen, Dan Republican Yea
Jacque, André Republican Yea
Kapenga, Chris Republican Yea
LeMahieu, Devin Republican Yea
Marklein, Howard Republican Yea
Nass, Steve Republican Yea
Testin, Patrick Republican Yea
Wanggaard, Van Republican Yea

Official roll call →

SUSPEND RULES FOR THIRD READING

Passed 19 Yea · 14 Nay
Party YeaNayPresentNot Voting
Unaffiliated 10900
Republican 8000
Democrat 1500
Total 191400
% of votes cast 58%42%0%0%
How each member voted (33)
Member Party Vote
BERNIER — Yea
ROTH — Yea
COWLES — Yea
KOOYENGA — Yea
STROEBEL — Yea
CRAIG — Yea
DARLING — Yea
TIFFANY — Yea
OLSEN — Yea
PETROWSKI — Yea
BEWLEY — Nay
SHILLING — Nay
MILLER — Nay
ERPENBACH — Nay
RINGHAND — Nay
HANSEN — Nay
RISSER — Nay
JOHNSON — Nay
SCHACHTNER — Nay
Carpenter, Tim Democrat Nay
Fitzgerald, Joan Democrat Yea
Larson, Chris Democrat Nay
Smith, Jeff Democrat Nay
Taylor, Sequanna Democrat Nay
Wirch, Robert Democrat Nay
Feyen, Dan Republican Yea
Jacque, André Republican Yea
Kapenga, Chris Republican Yea
LeMahieu, Devin Republican Yea
Marklein, Howard Republican Yea
Nass, Steve Republican Yea
Testin, Patrick Republican Yea
Wanggaard, Van Republican Yea

Official roll call →

PASSAGE

Passed 61 Yea · 36 Nay · 2 Other
Party YeaNayPresentNot Voting
Republican 36000
Democrat 01400
Unaffiliated 252200
Total 613600
% of votes cast 63%37%0%0%
How each member voted (97)
Member Party Vote
BALLWEG — Yea
BOWEN — Nay
BRANDTJEN — Yea
BROSTOFF — Nay
CABRERA — Nay
CONSIDINE — Nay
CROWLEY — Nay
EDMING — Yea
FIELDS — Nay
GOYKE — Nay
GRUSZYNSKI — Nay
HEBL — Nay
HINTZ — Nay
HORLACHER — Yea
KATSMA — Yea
KERKMAN — Yea
KOLSTE — Nay
KUGLITSCH — Yea
LOUDENBECK — Yea
MACCO — Yea
MAGNAFICI — Yea
MEYERS — Nay
MILROY — Nay
MYERS — Nay
NYGREN — Yea
OHNSTAD — Nay
OLDENBURG — Yea
OTT — Yea
PETRYK — Yea
PLUMER — Yea
POPE — Nay
RAMTHUN — Yea
RIEMER — Nay
ROHRKASTE — Yea
SANFELIPPO — Yea
SARGENT — Nay
SCHRAA — Yea
SHANKLAND — Nay
SKOWRONSKI — Yea
STEINEKE — Yea
STUCK — Nay
TAUCHEN — Yea
THIESFELDT — Yea
VORPAGEL — Yea
VRUWINK — Nay
ZAMARRIPA — Nay
SPEAKER — Yea
Anderson, Clinton Democrat Nay
Billings, Jill Democrat Nay
Doyle, Steve Democrat Nay
Emerson, Jodi Democrat Nay
Haywood, Kalan Democrat Nay
Hesselbein, Dianne Democrat Nay
McGuire, Tip Democrat Nay
Neubauer, Greta Democrat Nay
Sinicki, Christine Democrat Nay
Spreitzer, Mark Democrat Nay
Stubbs, Shelia Democrat Nay
Subeck, Lisa Democrat Nay
Taylor, Sequanna Democrat Nay
Vining, Robyn Democrat Nay
Allen, Scott Republican Yea
August, Tyler Republican Yea
Born, Mark Republican Yea
Brooks, Robert Republican Yea
Dittrich, Barbara Republican Yea
Duchow, Cindi Republican Yea
Felzkowski, Mary Republican Yea
Gundrum, Rick Republican Yea
Jagler, John Republican Yea
James, Jesse Republican Yea
Kitchens, Joel Republican Yea
Knodl, Daniel Republican Yea
Krug, Scott Republican Yea
Kurtz, Tony Republican Yea
Murphy, David Republican Yea
Mursau, Jeffrey Republican Yea
Neylon, Adam Republican Yea
Novak, Todd Republican Yea
Petersen, Kevin Republican Yea
Pronschinske, Treig Republican Yea
Quinn, Romaine Republican Yea
Rodriguez, Jessie Republican Yea
Snyder, Patrick Republican Yea
Sortwell, Shae Republican Yea
Spiros, John Republican Yea
Stafsholt, Rob Republican Yea
Steffen, David Republican Yea
Summerfield, Rob Republican Yea
Swearingen, Rob Republican Yea
Tittl, Paul Republican Yea
Tranel, Travis Republican Yea
Tusler, Ron Republican Yea
VanderMeer, Nancy Republican Yea
Wichgers, Chuck Republican Yea
Wittke, Robert Republican Yea
Zimmerman, Shannon Republican Yea

Official roll call →

Subjects

healthcare health-insurance
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Frequently asked questions

Who sponsors AB 26?
AB 26 is sponsored by Sanfelippo, Duchow, Cindi (Republican), Felzkowski, Mary (Republican), Horlacher, Hutton, Rob (Republican), Jagler, John (Republican), Katsma, Kitchens, Joel (Republican), Knodl, Daniel (Republican), Kuglitsch, Kulp, Loudenbeck, Murphy, David (Republican), Novak, Todd (Republican), Petersen, Kevin (Republican), Plumer, Quinn, Romaine (Republican), Ramthun, Rohrkaste, Skowronski, Spiros, John (Republican), Stafsholt, Rob (Republican), Tauchen, Thiesfeldt, Tittl, Paul (Republican), Tusler, Ron (Republican), VanderMeer, Nancy (Republican), Vorpagel, Wichgers, Chuck (Republican), Sortwell, Shae (Republican), Gundrum, Rick (Republican), Dittrich, Barbara (Republican), and Brooks, Robert (Republican).
What is the current status of AB 26?
This bill died with 2019-2020 Regular Session. It reached “To Executive” and never advanced before the session ended, so it can no longer move — a new version would have to be reintroduced in the current session.
Where can I track AB 26?
Track AB 26 free on One Click Politics — get push/email alerts when it moves.

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