Overview
Wisconsin operates one of the largest private APCDs in the country, even though it is not mandated by statute. The Wisconsin Health Information Organization (WHIO), a private organization, gathers and makes healthcare claims data publicly accessible. With insurance claims data from sixteen commercial health plans and the state Medicaid program, the database provides consumers information about cost, population health, prescribing patterns, and more.
Wisconsin confers merger review authority of healthcare consolidation to the attorney general for all nonprofit hospitals. Not only does it mandate notice to the AG, it requires approval from both the AG and relevant state agencies. Additionally, Wisconsin has one of the strictest prohibitions in the country against exclusive contracting provisions between insurers and providers.
In healthcare market regulation, Wisconsin received a $2.4 million grant from CMS in 2014 to develop a state innovation plan to reduce Medicare and Medicaid costs. Wisconsin was one of the first five states to receive an approved 1332 waiver from the federal government. Recent state law mandates the Wisconsin Health Care Stability Plan (WIHSP), a publicly-funded reinsurance program, to expand access to care, reduce premium increases, keep more individuals insured, and entice insurers to offer insurance plans in the state. The program will pay insurers up to eighty percent of claims greater than $50,000 but less than $250,000. Wisconsin’s 1332 State Innovation Waiver to implement WIHSP was approved by HHS through 2023.
See below for an overview of existing Wisconsin state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/2/2023 - 1/1/2024 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
AB 1 – Wisconsin
Introduced: 2021 Status: Inactive / Dead
The bill prohibits, until the conclusion of a national emergency declared by the U.S. president in response to the 2019 novel coronavirus or until June 30, 2021, whichever is earlier, a defined network plan, including …
AB 1 (see companion bill SB 2) – Wisconsin
Introduced: 2019 Status: Inactive / Dead
Coverage of individuals with preexisting conditions. Every individual health benefit plan shall accept every individual in this state who applies for coverage and every group health benefit plan shall accept every employer in this state that …
AB 1014 (see companion bill SB 843) – Wisconsin
Introduced: 2018 Status: Inactive / Dead
This bill requires hospitals to provide each hospital patient with a plain-language, itemized bill that includes an explanation of all charges, regardless of the source of payment.
AB 1015 (see companion bill SB 880) – Wisconsin
Introduced: 2018 Status: Inactive / Dead
This bill prohibits hospitals from charging uninsured patients whose family income is less than 200 percent of the federal poverty line a rate for emergency services that exceeds 115 percent of the allowable charges under …
AB 1016 – Wisconsin
Introduced: 2020 Status: Inactive / Dead
Imposing disclosure and billing requirements for certain health care providers, creating an arbitration process, and granting rule-making authority. This bill creates disclosure, notice, billing, and arbitration requirements for the situation in which an enrollee in …
SB 380 (see companion bill AB 410) – Wisconsin
Introduced: 2019 Status: Enacted
Coverage of services under Medical Assistance provided through telehealth and other technologies, extending the time limit for emergency rule procedures, and granting rule-making authority. This bill requires the Department of Health Services to provide reimbursement …
Wis. Stat. § 100.20. Methods of Competition and Trade Practices: Marketing; Trade Practices – Wisconsin
Introduced: Status: Enacted
Methods of competition in business and trade practices in business shall be fair. Unfair methods of competition in business and unfair trade practices in business are hereby prohibited.
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Wis. Stat. § 103.465. Restrictive covenants in employment contracts: Employment Regulations – Wisconsin
Introduced: Status: Enacted
Provides “restrictions imposed [by the non-compete must be] reasonably necessary for the protection of the employer.”
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Wis. Stat. § 133.01. Legislative Intent: Trusts and Monopolies – Wisconsin
Introduced: Status: Enacted
The intent of this chapter is to safeguard the public against the creation or perpetuation of monopolies and to foster and encourage competition by prohibiting unfair and discriminatory business practices which destroy or hamper competition. …
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Wis. Stat. § 133.03. Unlawful Contracts; Conspiracies: Trusts and Monopolies – Wisconsin
Introduced: Status: Enacted
Every contract, combination in the form of trust or otherwise, or conspiracy, in restraint of trade or commerce is illegal. Every person who makes any contract or engages in any combination or conspiracy in restraint …
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Shaw v. Advocate Aurora Health Inc et al – Wisconsin
District Court: US District Court for the Eastern District of Wisconsin Status: Pending
On February 5, 2024, Plaintiffs brought suit on behalf of the class of Commercial Health Plan Members against Aurora Health Care and Advocate Aurora Health …
Uriel Pharmacy v. Advocate Aurora Health – Wisconsin
District Court: Eastern District of Wisconsin Status: Pending
Brought by Uriel Pharmacy, a self-insured employer, the federal lawsuit alleges Advocate forced insurers to enter all-or-nothing and anti-tiering and anti-steering contract terms. In addition, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Wisconsin operates on a biennial budget cycle. The governor submits a proposed budget in January of each odd-numbered year and the legislature adopts a budget in July. The budget cycle runs from July to June of the following odd-numbered year. See 2019-21 budget here.
KEY RESOURCES
Wisconsin Department of Justice
Wisconsin Office of the Commissioner of Insurance
Wisconsin Health Information Organization
Wisconsin Collaborative for Healthcare Quality
News & Articles
