LRB-3787/1
MPG:cjs&ahe
2015 - 2016 LEGISLATURE
February 23, 2016 - Introduced by Senators Lasee and Carpenter, cosponsored by
Representatives Sanfelippo, Murphy, Rohrkaste, Skowronski and
Considine. Referred to Committee on Health and Human Services.
SB762,2,17 1An Act to renumber 446.05 (1) and subchapter VIII of chapter 448 [precedes
2448.980]; to amend 15.085 (1m) (b), 15.406 (4) (a), 29.193 (1m) (a) 2. (intro.),
329.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193
4(2) (e), 45.40 (1g) (a), 49.45 (9), 50.36 (3) (a), 50.36 (3) (b), 50.36 (3) (c), 50.39 (3),
577.54 (14) (b), 77.54 (14) (c), 77.54 (14) (d), 77.54 (14) (f) 7., 102.13 (1) (a), 102.13
6(1) (b) (intro.), 102.13 (1) (b) 1., 102.13 (1) (b) 3., 102.13 (1) (b) 4., 102.13 (1) (d)
71., 102.13 (1) (d) 2., 102.13 (1) (d) 3., 102.13 (1) (d) 4., 102.13 (2) (a), 102.13 (2)
8(b), 102.13 (3), 102.16 (3), 102.17 (1) (d) 1., 102.17 (1) (d) 2., 102.17 (1) (e), 102.17
9(1) (g), 102.29 (3), 102.42 (1), 102.42 (2) (a), 102.61 (1g) (c), 118.15 (3) (a), 118.29
10(1) (e), 146.37 (1g), 146.89 (1) (r) 1., 146.903 (1) (b), 146.997 (1) (d) 4., 155.01 (7),
11185.981 (1), 185.981 (2), 185.981 (3), 185.981 (4) (a), 185.982 (1), 185.982 (2),
12254.35 (3) (c), 254.39 (1), 255.06 (1) (d), 257.01 (5) (a), 257.01 (5) (b), 287.07 (7)
13(c) 1. a., 341.14 (1a), 341.14 (1e) (a), 341.14 (1m), 341.14 (1q), 343.51 (1), 343.62
14(4) (a) 4., 441.001 (3) (a), 441.001 (4) (b), 446.02 (6m), 446.026 (1) (a), 448.03 (2)

1(a), 448.52 (2m) (a), 448.52 (2m) (b), 448.56 (1), 448.56 (1m) (b), 448.956 (1m),
2448.956 (3) (c), 448.956 (4), 450.10 (3) (a) 5., 454.02 (2) (a), 462.04, 609.70 (title),
3628.46 (2m) (a), 632.32 (2) (am), 632.64, 632.87 (3) (a) (intro.), 632.87 (3) (a) 1.,
4632.87 (3) (a) 2., 632.87 (3) (b) (intro.), 632.87 (3) (b) 1., 632.87 (3) (b) 2., 632.87
5(3) (b) 3., 632.87 (3) (b) 4., 632.875 (1) (b), 632.875 (1) (c), 632.875 (2) (intro.),
6632.875 (2) (b), 632.875 (3) (a), 632.875 (3) (b), 632.99, 655.45 (1), 895.453 (title),
7895.453 (2) (intro.), 895.453 (2) (b), 895.453 (2) (e), 895.453 (3), 895.453 (4) (a),
8895.453 (4) (b), 895.48 (1m) (a) (intro.), 895.48 (1m) (a) 2., 905.04 (title), 905.04
9(1) (b), 905.04 (1) (c), 905.04 (2), 905.04 (3), 905.04 (4) (a), 905.04 (4) (e) 3., 949.01
10(4), 949.04 (3) and 961.01 (19) (a); and to create 15.406 (7), 48.981 (2) (a) 6m.,
1149.46 (2) (b) 11m., 77.54 (14) (f) 7m., 146.81 (1) (ev), 180.1901 (1m) (bw), 252.14
12(1) (ar) 4r., 440.03 (13) (b) 53s., 440.08 (2) (a) 60s., 446.02 (7d) (d), 446.05 (1) (b),
13448.21 (1) (f), subchapter VIII of chapter 448 [precedes 448.971], 450.11 (8) (f),
14462.02 (2) (g), 600.03 (38s), 600.03 (41s), 632.875 (1) (bm), 632.875 (1) (dm),
15895.453 (1) (am), 895.453 (1) (cm) and 905.04 (1) (bd) of the statutes; relating
16to:
licensure of primary spinal care practitioners, granting rule-making
17authority, and providing a criminal penalty.
Analysis by the Legislative Reference Bureau
This bill establishes a licensure program for primary spinal care practitioners
to be administered by the Spinal Medicine Affiliated Credentialing Board, which is
created in the bill and attached to the Medical Examining Board. The affiliated
credentialing board consists of three primary spinal care practitioners, one
physician licensed by the Medical Examining Board, and one public member, all of
whom serve staggered four-year terms.
Under the bill, a primary spinal care practitioner is an individual who
possesses the degree of doctor of chiropractic medicine or equivalent degree as
determined by the affiliated credentialing board. The bill defines "spinal medicine"
in relevant part as the integration and application of the practice of chiropractic and
the practice of medicine and surgery, both as defined under current law, that is

limited to conditions of the spine and the musculoskeletal, neuromuscular, and
nervous systems. The practice of spinal medicine does not include surgery or, unless
under the direction of a physician, the administration of a general anesthetic.
Under the bill, and subject to certain exceptions, a person may practice spinal
medicine in Wisconsin only if he or she is licensed by the affiliated credentialing
board as a primary spinal care practitioner. The affiliated credentialing board may
grant a license to practice spinal medicine to an applicant who, among other things,
has practiced as a licensed chiropractor in good standing with the Chiropractic
Examining Board for at least two years and has a degree of doctor of spinal medicine
or equivalent degree from a program in chiropractic medicine approved by the
affiliated credentialing board. A licensed primary spinal care practitioner must keep
current his or her chiropractor license with the Chiropractic Examining Board.
The bill requires the affiliated credentialing board to establish continuing
education requirements for licensed primary spinal care practitioners and
authorizes up to 80 percent of those hours to count toward the continuing education
requirements for a chiropractor license held with the Chiropractic Examining Board.
The bill requires at least 50 percent of those hours to include evidence-based
pharmacology and medical procedures-based training. Under the bill, a licensed
primary spinal care practitioner has authority to prescribe and administer
prescription drugs.
The bill requires primary spinal care practitioners to maintain specific levels
of malpractice liability insurance coverage and establishes various requirements
with respect to fee splitting and billing for services. Those malpractice insurance,
fee splitting, and billing requirements, as well as other requirements in the bill, are
substantially similar to the requirements for podiatrists under current law.
The bill also treats primary spinal care practitioners similar to chiropractors
in some respects. For example, the bill requires primary spinal care practitioners to
refer a patient to a physician if the primary spinal care practitioner determines that
the patient's condition is beyond the scope of the practice of spinal medicine. Also,
the bill includes insurance coverage parity requirements that closely track the
coverage requirements for treatment provided by chiropractors.
The bill requires the affiliated credentialing board and the Chiropractic
Examining Board each to refer to the other board for investigation an allegation of
a violation by a primary spinal care practitioner of the laws administered by that
other board. If the alleged conduct involves a violation both of the laws applicable
to primary spinal care practitioners and of the laws applicable to chiropractors, the
bill requires the two boards to consult concerning the investigation of that alleged
conduct. Otherwise, the affiliated credentialing board's authority to investigate
misconduct and discipline licensed primary spinal care practitioners is typical of
that for other similar boards, especially the Podiatry Affiliated Credentialing Board.

For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB762,1 1Section 1. 15.085 (1m) (b) of the statutes is amended to read:
SB762,4,52 15.085 (1m) (b) The public members of the podiatry affiliated credentialing
3board, spinal medicine affiliated credentialing board, or occupational therapists
4affiliated credentialing board shall not be engaged in any profession or occupation
5concerned with the delivery of physical or mental health care.
SB762,2 6Section 2. 15.406 (4) (a) of the statutes is amended to read:
SB762,4,107 15.406 (4) (a) Four athletic trainers who are licensed under subch. VI of ch. 448
8and who have not been issued a credential in athletic training by a governmental
9authority in a jurisdiction outside this state. One of the athletic trainer members
10may also be licensed under ch. 446 or 447 or subch. II, III or, IV, or VIII of ch. 448.
SB762,3 11Section 3. 15.406 (7) of the statutes is created to read:
SB762,4,1512 15.406 (7) Spinal medicine affiliated credentialing board. There is created
13in the department of safety and professional services, attached to the medical
14examining board, a spinal medicine affiliated credentialing board consisting of the
15following members appointed for 4-year terms:
SB762,4,1716 (a) Three primary spinal care practitioners who are licensed under subch. VIII
17of ch. 448.
SB762,4,1818 (b) A physician, as defined in s. 448.01 (5).
SB762,4,1919 (c) One public member.
SB762,4 20Section 4. 29.193 (1m) (a) 2. (intro.) of the statutes, as affected by 2015
21Wisconsin Act 97
, is amended to read:
SB762,5,5
129.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one
2or both arms or one or both hands and fails to meet the minimum standards of any
3one of the following standard tests, administered under the direction of a licensed
4physician, a licensed physician assistant, a licensed primary spinal care practitioner,
5a licensed chiropractor, or a certified advanced practice nurse prescriber:
SB762,5 6Section 5. 29.193 (2) (b) 2. of the statutes, as affected by 2015 Wisconsin Act
797
, is amended to read:
SB762,5,148 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared
9and furnished by the department, which shall include a written statement or report
10prepared and signed by a licensed physician, a licensed physician assistant, a
11licensed chiropractor, a licensed podiatrist, a licensed primary spinal care
12practitioner,
or a certified advanced practice nurse prescriber prepared no more than
136 months preceding the application and verifying that the applicant is physically
14disabled.
SB762,6 15Section 6. 29.193 (2) (c) 3. of the statutes, as affected by 2015 Wisconsin Act
1697
, is amended to read:
SB762,6,317 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant
18who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
19subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
20applicant and the recommendation of a licensed physician, a licensed physician
21assistant, a licensed chiropractor, a licensed podiatrist, a licensed primary spinal
22care practitioner,
or a certified advanced practice nurse prescriber selected by the
23applicant from a list of licensed physicians, licensed physician assistants, licensed
24chiropractors, licensed podiatrists, licensed primary spinal care practitioners, and
25certified advanced practice nurse prescribers compiled by the department, the

1department finds that issuance of a permit complies with the intent of this
2subsection. The use of this review procedure is discretionary with the department
3and all costs of the review procedure shall be paid by the applicant.
SB762,7 4Section 7. 29.193 (2) (cd) 2. b. of the statutes, as affected by 2015 Wisconsin
5Act 97
, is amended to read:
SB762,6,116 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function
7in one or both arms and fails to meet the minimum standards of the standard upper
8extremity pinch test, the standard grip test, or the standard nine-hole peg test,
9administered under the direction of a licensed physician, a licensed primary spinal
10care practitioner,
a licensed physician assistant, a licensed chiropractor, or a certified
11advanced practice nurse prescriber.
SB762,8 12Section 8. 29.193 (2) (cd) 2. c. of the statutes, as affected by 2015 Wisconsin
13Act 97
, is amended to read:
SB762,6,1814 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in
15one or both shoulders and fails to meet the minimum standards of the standard
16shoulder strength test, administered under the direction of a licensed physician, a
17licensed primary spinal care practitioner,
a licensed physician assistant, a licensed
18chiropractor, or a certified advanced practice nurse prescriber.
SB762,9 19Section 9. 29.193 (2) (e) of the statutes, as affected by 2015 Wisconsin Act 97,
20is amended to read:
SB762,7,521 29.193 (2) (e) Review of decisions. An applicant denied a permit under this
22subsection, except a permit under par. (c) 3., may obtain a review of that decision by
23a licensed physician, a licensed physician assistant, a licensed chiropractor, a
24licensed podiatrist, a licensed primary spinal care practitioner, or a certified
25advanced practice nurse prescriber designated by the department and with an office

1located in the department district in which the applicant resides. The department
2shall pay for the cost of a review under this paragraph unless the denied application
3on its face fails to meet the standards set forth in par. (c) 1. or 2. A review under this
4paragraph is the only method of review of a decision to deny a permit under this
5subsection and is not subject to further review under ch. 227.
SB762,10 6Section 10. 45.40 (1g) (a) of the statutes is amended to read:
SB762,7,117 45.40 (1g) (a) "Health care provider" means an advanced practice nurse
8prescriber certified under s. 441.16 (2), an audiologist licensed under ch. 459, a
9dentist licensed under ch. 447, an optometrist licensed under ch. 449, a physician
10licensed under s. 448.02, or a podiatrist licensed under s. 448.63, or a primary spinal
11care practitioner licensed under s. 448.9725
.
SB762,11 12Section 11. 48.981 (2) (a) 6m. of the statutes is created to read:
SB762,7,1313 48.981 (2) (a) 6m. A primary spinal care practitioner.
SB762,12 14Section 12. 49.45 (9) of the statutes is amended to read:
SB762,8,1615 49.45 (9) Free choice. Any person eligible for medical assistance under s.
1649.46, 49.468, 49.47, or 49.471 may use the physician, chiropractor, dentist,
17pharmacist, podiatrist, primary spinal care practitioner, hospital, skilled nursing
18home, health maintenance organization, limited service health organization,
19preferred provider plan or other licensed, registered or certified provider of health
20care of his or her choice, except that free choice of a provider may be limited by the
21department if the department's alternate arrangements are economical and the
22recipient has reasonable access to health care of adequate quality. The department
23may also require a recipient to designate, in any or all categories of health care
24providers, a primary health care provider of his or her choice. After such a
25designation is made, the recipient may not receive services from other health care

1providers in the same category as the primary health care provider unless such
2service is rendered in an emergency or through written referral by the primary
3health care provider. Alternate designations by the recipient may be made in
4accordance with guidelines established by the department. Nothing in this
5subsection shall vitiate the legal responsibility of the physician, chiropractor,
6dentist, pharmacist, podiatrist, primary spinal care practitioner, skilled nursing
7home, hospital, health maintenance organization, limited service health
8organization, preferred provider plan or other licensed, registered or certified
9provider of health care to patients. All contract and tort relationships with patients
10shall remain, notwithstanding a written referral under this section, as though
11dealings are direct between the physician, chiropractor, dentist, pharmacist,
12podiatrist, primary spinal care practitioner, skilled nursing home, hospital, health
13maintenance organization, limited service health organization, preferred provider
14plan or other licensed, registered or certified provider of health care and the patient.
15No physician, chiropractor, pharmacist, podiatrist, primary spinal care practitioner,
16or dentist may be required to practice exclusively in the medical assistance program.
SB762,13 17Section 13. 49.46 (2) (b) 11m. of the statutes is created to read:
SB762,8,1818 49.46 (2) (b) 11m. The services of primary spinal care practitioners.
SB762,14 19Section 14. 50.36 (3) (a) of the statutes is amended to read:
SB762,9,320 50.36 (3) (a) Any person licensed to practice medicine and surgery under subch.
21II of ch. 448 or, podiatry under subch. IV of ch. 448, or spinal medicine under subch.
22VIII of ch. 448
shall be afforded an equal opportunity to obtain hospital staff
23privileges and may not be denied hospital staff privileges solely for the reason that
24the person is an osteopathic physician and surgeon or , a podiatrist, or a primary
25spinal care practitioner
. Each individual hospital shall retain the right to determine

1whether the applicant's training, experience and demonstrated competence is
2sufficient to justify the granting of hospital staff privileges or is sufficient to justify
3the granting of limited hospital staff privileges.
SB762,15 4Section 15. 50.36 (3) (b) of the statutes is amended to read:
SB762,9,135 50.36 (3) (b) If, as a result of peer investigation or written notice thereof, a
6hospital staff member who is licensed by the medical examining board or, podiatry
7affiliated credentialing board, or spinal medicine affiliated credentialing board, for
8any reasons that include the quality of or ability to practice, loses his or her hospital
9staff privileges, has his or her hospital staff privileges reduced or resigns from the
10hospital staff, the hospital shall so notify the medical examining board or, podiatry
11affiliated credentialing board, or spinal medicine affiliated credentialing board,
12whichever is applicable, within 30 days after the loss, reduction or resignation takes
13effect. Temporary suspension due to incomplete records need not be reported.
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