WisconsinWisconsin providers could offer primary care through set-fee agreements
Wisconsin providers could offer listed primary care for a set fee under written terms that explain what the fee covers and that it is not insurance.
What it does
Patients, their representatives, or employers could pay a provider a set fee for listed primary care services under a written agreement. It must explain what it covers and that it is not health insurance.
Providers could refuse or end these agreements only for listed reasons, such as a full practice, nonpayment, fraud, or danger to others. A patient's health status alone would not be enough.
Providers who offer these agreements could join an insurer's network only if they can meet that insurer's participation terms.
Argument forPatients could see the covered services, price, and cancellation terms in writing before agreeing to pay a provider a regular fee.
Argument againstPatients might pay a subscription fee for care their health insurance also covers, and that fee may not count toward their deductible or yearly out-of-pocket limit.
More detail
A patient, the patient's representative, or the patient's employer may make a written agreement with a provider for primary care in return for a subscription fee. The agreement covers outpatient general care, including prevention, diagnosis and treatment, counseling, and care coordination. The agreement must list the services and fee, state its duration and cancellation terms, and be signed by the provider and patient or an authorized representative. Neither side may bill an insurer or another third party for covered services on a fee-for-service basis. The agreement must say it is not health insurance, may not meet federal coverage requirements, and may leave patients paying for services outside the fee. The agreement must state how long it lasts and how either side may end it.
A provider may refuse or end an agreement only for listed reasons. These rules apply to providers and patients with direct primary care agreements. A provider may not refuse or end an agreement solely because of a patient's health status. A provider may refuse a patient if the practice is full or cannot provide the care the patient's condition requires. A provider may end an agreement for nonpayment, repeated failure to follow a treatment plan, fraud, danger to staff or other patients, closing the direct primary care practice, or a relationship the provider believes is no longer therapeutic.
A provider who offers these agreements may join an insurer's network only if the provider can meet that insurer's participation terms. This applies to providers whose practice offers direct primary care agreements. The text preserves state agencies' regulatory authority and the insurance commissioner's authority over contracts that fail the agreement rules but meet the legal definition of insurance.
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Where it stands
- Introduced
- Passed Senate
- Passed House
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- May 13Failed to pass notwithstanding the objections of the Governor pursuant to Joint Rule 82Latest
- May 12Placed on calendar 5-12-2026 pursuant to Joint Rule 82 (2)(a)
- 2025
- Aug 11Report vetoed by the Governor Tony Evers on 8-8-2025Major
- Aug 7Presented to the Governor on 8-7-2025To Governor
- May 14Report correctly enrolledMinor
- May 13Received from Assembly concurred inMinor
- May 13Ordered immediately messaged
- May 13Read a third time and concurred inPassed House
- May 13Rules suspended
- May 13Ordered to a third readingMinor
- May 13Read a second timeMinor
- May 13Rules suspended to withdraw from calendar and take upMajor
- May 9Withdrawn from committee on Rules and referred to calendar of 5-13-2025Minor
- Apr 24Read first time and referred to committee on RulesMinor
- Mar 19Received from SenateMinor
- Mar 18Ordered immediately messaged
- Vote recorded Senate Amendment 1 rejected, Ayes 18, Noes 14. Result: pass.Upper
- Vote recorded PASSAGE. Result: pass.Upper
- Mar 18Read a third time and passed, Ayes 18, Noes 14Passed Senate
- Mar 18Rules suspended to give bill its third reading
- Mar 18Ordered to a third readingMinor
- Mar 18Senate Amendment 1 rejected, Ayes 18, Noes 14Minor
- Mar 18Read a second timeMinor
- Mar 18Senate Amendment 1 offered by Senators Spreitzer, Ratcliff, Carpenter, Dassler-Alfheim, Roys, Pfaff, Smith, Drake, Habush Sinykin, Hesselbein, L. Johnson, Keyeski, Larson and WallMinor
- Mar 14Placed on calendar 3-18-2025 pursuant to Senate Rule 18(1)
- Mar 10Senator Hutton added as a coauthor
- Feb 21Available for scheduling
- Vote recorded Report passage recommended by Committee on Health, Ayes 3, Noes 2. Result: pass.Upper
- Feb 21Report passage recommended by Committee on Health, Ayes 3, Noes 2Minor
- Feb 20Executive action taken
- Feb 12Public hearing held
- Feb 6Senator Tomczyk added as a coauthor
- Jan 24Read first time and referred to Committee on HealthMinor
- Jan 24Introduced by Senators Cabral-Guevara, Kapenga, Nass and Testin; cosponsored by Representatives Duchow, Brooks, Armstrong, Dittrich, Hurd, Murphy, O'Connor, Rodriguez and WichgersIntroduced
Healthcare