Cancer Policy News from the Wisconsin Cancer Collaborative | March 2022
State legislative wrap-up
Wisconsin's state legislative session recently ended. Several cancer-related bills were introduced this session that were actively tracked by our Policy Committee.

In this legislative recap, you'll get the latest on:

  • The bills that passed, the bills that didn't, and why they matter for patients and cancer care.
  • State and federal policy changes that impact cancer control in Wisconsin.
Want to learn more? Contact Policy Coordinator Amy Johnson.
Bills that passed
The following cancer-related bills passed this session and now await the Governor's signature or veto.
Licensing for genetic counselors
Assembly Bill 255 and Senate Bill 259

This legislation requires a state license for anyone who practices genetic counseling or uses the title of genetic counselor in Wisconsin. To be licensed, a genetic counselor must complete academic training, pass a qualifying exam, and be certified by the American Board of Genetic Counseling. Licenses would be granted by a newly created certifying board and would be renewed biennially.
Why this matters: Genetic counselors can help patients understand their family health history and cancer risk, and can help patients make decisions about cancer management, prevention, and screening.
Status: The legislation passed both the Assembly and Senate. Gov. Tony Evers has not announced whether he plans to sign it into law or veto it. 
BadgerCare eligibility
Assembly Bill 934 and Senate Bill 905

This legislation requires the Wisconsin Department of Health Services Division of Medicaid to check a beneficiary’s eligibility for Medicaid every six months, instead of once per year. The legislation also prohibits the state from sending renewal forms to beneficiaries that are pre-populated with personal information such as the beneficiary’s name and address. Individuals on Medicaid who do not tell the state about any personal income changes would be ineligible for Medicaid for six months. 
Why this matters: Shortening the time between enrollment periods could create financial uncertainty for cancer patients and survivors who depend on a full year of health insurance coverage for their treatments. 
Status: The legislation passed both the Assembly and Senate. Gov. Tony Evers has not announced whether he plans to sign it into law or veto it. 
Medicaid employment requirements
Assembly Bill 936 and Senate Bill 912

This legislation would disqualify from Medicaid any "able-bodied adults without dependents" who turn down new jobs or additional work hours that would cause them to lose their Medicaid benefits. The legislation contains limited exceptions for some people such as full-time students or caregivers of young children.
Why this matters: The legislation makes no allowances for why a person turns down a new job or additional hours, and it would apply regardless of whether the new job does or doesn’t offer health insurance.
Status: The legislation passed both the Assembly and Senate. Gov. Tony Evers has not announced whether he plans to sign it into law or veto it. 
Bills that made progress
Several cancer-related bills made progress this session, but didn't pass. These bills may be introduced next legislative session, which begins January 2023.
Tobacco 21
Assembly Bill 348 and Senate Bill 355

This legislation would have increased the legal age to possess, use, and purchase cigarettes, tobacco, nicotine products, and vapor devices from 18 to 21. Without this change in state law, the state is out of compliance with federal law, which raised the tobacco purchase age to 21 in late 2019. The lack of consistency between federal and state laws can create confusion for retailers and cause issues for enforcement.
Why this matters: Increasing the legal age for using tobacco has been shown to decrease the number of youth who smoke, as well as the number of people who begin smoking overall. 
Status: The bill was removed from the Senate floor votes on the last day of the session, effectively preventing the legislation from becoming law this year.
Licensing for e-cigarette retailers
Assembly Bill 250 and Senate Bill 285
As part of a larger bill amendment, this would have required state licensing for all Wisconsin retailers that sell electronic vaping devices (also called “e-cigarettes” or “vapor products”). Retailers currently do not need a license to sell these products.

Why this matters: Studies show that licensing is linked to lower rates of youth e-cigarette use and higher rates of enforcement of the law. 

Status: This passed the Assembly but did not get a full vote in the Senate.
White bagging
Assembly Bill 718 and Senate Bill 753

This legislation would prohibit the practice where health insurers require certain high-cost medications, administered in an outpatient setting, be received through specialty pharmacies often owned by the insurance company, instead of from the health care system pharmacy. The practice typically applies to clinician-administered drugs, such as chemotherapy, where change of dosage or strength tends to happen in the course of the therapy. According to patients and providers, medications may not arrive in time, may be the incorrect dose, or may have been mishandled during shipping.

The legislation is known as Koreen’s law, named for Koreen Holms of Eau Claire, a cancer survivor diagnosed with stage three triple negative breast cancer whose health insurer switched to white bagging during her treatment, causing disruptions in her care. 

Why this matters: According to oncologists, white bagging prevents providers from being able to mix appropriate doses for cancer patients at the time of the patient’s appointment, based on the patient’s needs. 

Status: The legislation received hearings in the Assembly and Senate committees, but did not advance to a vote.
Co-pay accumulator
Assembly Bill 184 and Senate Bill 215

This legislation addresses the high cost of prescription drugs. Pharmaceutical companies sometimes offset the cost of the prescription drugs by offering co-pay assistance to patients. This legislation would require insurers to count co-pay assistance towards a patient’s annual deductible or out-of-pocket maximum, for drugs that do not have a less expensive equivalent. 

Why this matters: The cost of prescription drugs can be overwhelming for patients and survivors. This legislation would reduce the amount that patients would pay out of pocket.

Status: The Assembly bill received a hearing in the Insurance, Licensing, and Forestry Committee, but the Senate bill did not advance through the committee process.
Step therapy exemption for metastatic cancer treatment
Assembly Bill 745 and Senate Bill 716

These bills would exempt metastatic cancer treatments from the practice known as “step therapy,” where health insurers require that less expensive therapies be tried before approving more expensive treatments. This legislation would seek to add an exemption to the 2019 Step Therapy Law in Wisconsin that established new specifications for health insurers to follow when requiring a patient try a different and less expensive treatment option than the one prescribed by the patient’s doctor.
Why this matters: Patients who are diagnosed with metastatic cancer would be able to receive the drug or treatment recommended by their oncologist.
Status: The Assembly bill received a hearing in the Insurance, Licensing, and Forestry Committee, but its Senate companion did not receive committee consideration.
Breast cancer screening coverage for higher-risk patients
Assembly Bill 416 and Senate Bill 413

These bills would require health insurers to cover follow-up mammograms and other screening tests for individuals with dense breast tissue and women at higher risk of breast cancer. The bills would limit the copay for these follow-up tests to no more than $50. This legislation builds on a 2017 state law that requires health facilities to notify patients, with their mammogram results, by mail if the test shows dense breast tissue.  
Why this matters: A mammogram may not be enough to detect cancer in women with dense breast tissue. Follow-up tests can be expensive. This legislation would lower out-of-pocket costs for patients, and would help to find some cancers earlier, when they may be easier to treat.
Status: A hearing was held on the Senate bill in the Health Committee, but the Assembly bill did not receive committee consideration. 
No action
Some cancer-related bills received no action during this session. These bills may be introduced next legislative session, which begins January 2023.
Legalizing medical marijuana
Assembly Bill 1067 and Senate Bill 1034 | Assembly Bill 1063 and Senate Bill 1035
Two separate sets of bills were introduced in the Assembly to legalize medical marijuana in Wisconsin. 

The first set, Assembly Bill 1067 and Senate Bill 1034, would legalize medical marijuana for eight qualifying health conditions, including cancer. Patients would be added to a state registry that would allow them to purchase medical marijuana from state-regulated dispensaries. To quality, patients would need a recommendation from their physician, physician assistant, or advanced practice nurse prescriber. Patients with a state registry identification card would be able to purchase a 30-day supply of a liquid, oil, pill, or tincture form of marijuana, but nothing in combustible (smoking) form. The legislation also would establish strict reporting and continuing education standards for medical providers. 

The second set, Assembly Bill 1063 and Senate Bill 1035, would legalize medical marijuana for 14 qualifying medical conditions, including cancer. Patients would need a valid identification card from the state’s medical marijuana registry, which may cost up to $150. To qualify, patients would need a recommendation from their established medical provider. Patients would be able to purchase no more than 12 plants and three ounces of leaves or flowers from a state-regulated dispensary.

Why this matters: Some patients with cancer use medical marijuana to address chemotherapy side effects and other symptoms.

Status: Both sets of bills were introduced at the end of the 2021-2022 legislative session and were not advanced by the Assembly Committee on Health.
Adding e-cigarettes and marijuana to indoor smoking ban
Assembly Bill 1123 and Senate Bill 1031

This legislation would add electronic smoking devices and marijuana to the state’s indoor smoking ban. The bills also revise the definition of smoking to include inhaling, exhaling, burning, or carrying any lighted or heated cigar, cigarette, pipe, hookah, or any device that is intended for inhalation, including natural or synthetic marijuana. The bill defines electronic smoking devices as a device used to deliver an aerosolized or vaporized liquid or other substance for inhalation, regardless of whether the liquid or the substances contains nicotine. Although a 2010 state law banned smoking in all indoor areas where employees and the public gather, the law currently does not apply to electronic smoking devices. A number of local governments have passed local smoke-free air laws that ban electronic smoking devices. 

Why this matters: Youth e-cigarette use in Wisconsin is on the rise. Banning e-cigarettes from indoor public places can help to discourage and de-normalize their use.

Status: Both bills were introduced late in the legislative session and were not considered by Senate or Assembly committees.
Infertility coverage
Assembly Bill 747 and Senate Bill 693

These bills would require health insurers to cover the diagnosis and treatment of infertility, including egg retrievals and single embryo transfer. The legislation also requires insurers to cover standard fertility preservation services, which is often used for patients prior to medical treatments that may harm their fertility, such as radiation, chemotherapy, or certain surgeries. 
Why this matters: Some cancers and cancer treatments can impact a patient’s ability to have children. Fertility services are expensive, and currently these services are not covered by most insurers in Wisconsin. This legislation would make fertility services more affordable and accessible for patients and survivors.

Status: Neither bill received a hearing in their assigned committees. 
Insurance assistance through income tax form
Assembly Bill 929 and Senate Bill 885

Legislation was introduced late in the session that would require the Wisconsin Department of Revenue to include questions on the state individual income tax form to determine whether taxpayers or their household members lack health insurance. Under the bills, a taxpayer would be able to check a box if they or a family member lack insurance, and then get follow-up help from the state to determine whether they qualify for BadgerCare Plus, the ACA Marketplace, or other health insurance programs. 

Why this matters: Health insurance is a major factor in whether patients with cancer get the treatments they need.

Status: Neither the Assembly nor Senate bill advanced through committee.
Other updates
A quick review of recent state and federal policy changes that affect patients and cancer care in Wisconsin.
Wisconsin Medicaid lowers screening age for colonoscopies
The Wisconsin Medicaid program will now cover colorectal cancer screenings for members beginning at age 45. Medicaid programs are required to cover services recommended by the United States Preventive Services Task Force. In May 2021, the USPSTF lowered the recommended age for most colorectal cancer screenings to 45 years. This means many cancers will be found earlier, when they may be easier to treat.

Private insurers required to cover follow-up colonoscopies
In January 2022, the federal government released guidance requiring most private health insurers to cover the full cost of follow-up colonoscopies after a positive non-invasive screening test. Under the new guidance, follow-up colonoscopies will be considered part of a patient's screening, and no longer diagnostic. This will dramatically lower many patients' out-of-pocket costs.

Medicare expands eligibility for lung cancer screening
More people on Medicare will be eligible for lung cancer screening, thanks to a recent decision that lowers the starting age for lung cancer screening from 55 to 50 years, and reduces the tobacco smoking history from at least 30 pack-years to at least 20 pack-years. Lung cancer is the leading cause of cancer death in Wisconsin. Expanding eligibility for screening will improve health outcomes by helping to detect lung cancer earlier.

New tobacco requirements for behavioral health providers
By October 2022, Wisconsin’s behavioral health providers who treat substance use disorders will be required to have written policies outlining their assessment and treatment plans for tobacco use disorders, and will be required to have a written policy regarding a smoke-free environment. The new requirements are the result of revisions to the State of Wisconsin’s Administrative Code Chapter 75.
New federal law limits surprise medical billing
A new law that bans surprise medical billing for health care services took effect Jan. 1. The No Surprises Act bans surprise billing and out-of-network charges for most emergency services and certain health care services from out-of-network providers that occur as part of a patient’s visit to an in-network facility. According to the Kaiser Family Foundation, the federal government estimates the new law will apply to about 10 million out-of-network surprise medical bills each year. 

Federal poverty level and SSI increases
Federal poverty levels have increased slightly from 2021 to 2022. Federal poverty levels are used to establish income limits for Medicaid programs like BadgerCare Plus. To qualify for BadgerCare Plus, an individual or household’s income cannot exceed 100 percent of the federal poverty level.

  • $13,590 per year for an individual
  • $18,310 per year for a family of two
  • $23,030 per year for a family of three
  • $27,750 per year for a family of four

The federal government also announced that monthly benefits for Social Security and Supplemental Security Income will have a 5.9% adjusted increase in 2022. 

Big changes coming for Medicaid enrollment
Medicaid enrollment determinations will resume once the federal COVID-19 Public Health Emergency ends, which is expected to happen sometime this year. Wisconsin’s Department of Health Services is working to restart the Medicaid renewal and termination process that was put on hold during the public health emergency. Wisconsinites on Medicaid should report any income changes or new contact information to their regional Wisconsin Department of Health Services partner.

If you work with people on Medicaid, you can learn more in the DHS Unwinding Toolkit.
Learn more about any of these bills or updates by emailing our Policy Coordinator Amy Johnson.
Formerly known as the Wisconsin Cancer Council. Here’s why we changed our name.