SB275: Bill Text

SB275, s. 3 Section 3. 446.01 (1L) of the statutes is created to read:

SB275,5,10 446.01 (1L) "Pattern of conduct" means more than one occurrence.

SB275, s. 4 Section 4. 446.01 (1m) of the statutes is created to read:

SB275,5,15 446.01 (1m) "Peer review" means an evaluation based on generally accepted standards, by a peer review panel appointed under s. 446.035 (1), of the appropriateness, quality, and utilization of chiropractic health care provided to a patient or the conduct of a chiropractor alleged to have violated s. 446.04 (11).

SB275, s. 5 Section 5. 446.01 (2) (b) of the statutes is amended to read:

SB275,5,20 446.01 (2) (b) To employ or apply chiropractic adjustments, and the principles or techniques of chiropractic science, that are taught at a chiropractic college or university approved by the Council on Chiropractic Education or its successor, in the diagnosis, treatment or prevention of any of the conditions described in s. 448.01 (10).

SB275, s. 6 Section 6. 446.01 (3) of the statutes is created to read:

SB275,6,2 446.01 (3) "Utilization" means the treatment or services provided to a patient, including the frequency and duration of the treatment or services.

SB275, s. 7 Section 7. 446.02 (1) (b) of the statutes is amended to read:

SB275,6,12 446.02 (1) (b) Meets the requirements of continuing education for license renewal as the examining board may require under s. 446.025. During the time between initial licensure and commencement of a full 2-year licensure period new licensees shall not be required to meet continuing education requirements. Any person who has not engaged in the practice of chiropractic for 2 years or more, while holding a valid license under this chapter, and desiring to engage in such practice, shall be required by the examining board to complete a continuing education course at a school of chiropractic approved by the examining board or pass a practical examination administered by the examining board or both.

SB275, s. 8 Section 8. 446.02 (2) (b) of the statutes is amended to read:

SB275,6,21 446.02 (2) (b) The examining board shall promulgate rules establishing educational requirements for obtaining a license under par. (a). The rules shall require that an application for the license that is received by the department after June 30, 1998, be accompanied by satisfactory evidence that the applicant has a bachelor's degree from a college or university accredited by an accrediting body listed as nationally recognized by the secretary of the federal department of education, and has graduated from a college or university of chiropractic approved by the examining board accredited by the Council on Chiropractic Education or its successor.

SB275, s. 9 Section 9. 446.02 (4) of the statutes is amended to read:

SB275,7,10 446.02 (4) The renewal date and renewal fee for all licenses granted by the examining board are specified under s. 440.08 (2) (a). In an application for renewal, the applicant shall identify each employee, other than a nurse licensed under ch. 441, physical therapist licensed under subch. III of ch. 448, or athletic trainer licensed under subch. VI of ch. 448, to whom clinical work is delegated. If the examining board has promulgated rules requiring such an employee to complete a training program or course of instruction to perform the delegated work, the applicant shall also provide the name, date, and sponsoring organization for the training program or course of instruction that the employee completed. Except as provided in sub. (1) (b), the examining board may not renew a license unless the applicant for renewal identifies on a form provided by the department the continuing education courses approved under s. 446.025 (2) that the applicant has completed to satisfy the minimum number of hours required under s. 446.025 (1).

SB275, s. 10 Section 10. 446.02 (6m) of the statutes is created to read:

SB275,7,17 446.02 (6m) (a) Except as provided in par. (b), a chiropractor who is granted a license under this chapter on or before January 1, 2003, may provide counsel, guidance, direction, advice, or recommendations to a patient regarding the health benefits of vitamins, herbs, or nutritional supplements only if the chiropractor has completed 48 hours in a postgraduate course of study in nutrition that is approved by the examining board.

SB275,7,19 (b) Paragraph (a) does not apply to a chiropractor licensed under this chapter who is certified as a dietitian under subch. V of ch. 448.

SB275, s. 11 Section 11. 446.02 (7s) of the statutes is created to read:

SB275,8,5 446.02 (7s) (a) A chiropractor shall evaluate each patient to determine whether the patient has a condition that is treatable by chiropractic means. An evaluation shall be based on an examination that is appropriate to the patient. In conducting an evaluation, a chiropractor shall utilize chiropractic science, as defined by rule by the examining board, and the principles of education and training of the chiropractic profession. A chiropractor shall discontinue treatment by chiropractic means if, at any time, the chiropractor determines, or reasonably should have determined, that the patient's condition will not respond to further treatment by chiropractic means, except that a chiropractor may provide supportive care to a patient being treated by another health care professional.

SB275,8,11 (b) If a chiropractor determines, or reasonably should have determined, at any time, that a patient has a condition that is not treatable by chiropractic means, or will not respond to further treatment by chiropractic means, the chiropractor shall inform the patient and refer the patient to a physician licensed under subch. II of ch. 448. In making a referral under this paragraph, a chiropractor shall do one of the following:

SB275,8,14 1. Make a written referral to the physician that describes the chiropractor's findings, provide a copy of the written referral to the patient, and maintain a copy of the written referral in the patient record under sub. (7m) (a).

SB275,8,19 2. Make an oral referral to the physician or the physician's staff that describes the chiropractor's findings, notify the patient about the referral, make a written record of the referral, including the name of the physician or staff member and date of the referral, and maintain the written record in the patient record under sub. (7m) (a).

SB275, s. 12 Section 12. 446.02 (9) (a) of the statutes is amended to read:

SB275,9,5 446.02 (9) (a) A student or graduate of a college or university of chiropractic that is accredited by the Council on Chiropractic Education or its successor who practices chiropractic, in a program for the clinical training of students and graduates that is reviewed and approved by the examining board, under the supervision of a chiropractor who is approved by the examining board to supervise the clinical training of the student or graduate and who is licensed under this chapter and is responsible for the student's or graduate's practice in an infirmary, clinic, hospital or private chiropractic office that is connected or associated for training purposes with a college or university of chiropractic approved by the examining board that is accredited by the Council on Chiropractic Education or its successor.

SB275, s. 13 Section 13. 446.025 of the statutes is created to read:

SB275,9,13 446.025 Continuing education. (1) The examining board shall specify the minimum number of hours of continuing education courses that, except as provided in s. 446.02 (1) (b), an applicant for renewal of a license under this chapter is required to complete during a 2-year licensure period. Only courses approved by the examining board under sub. (2) may be used to satisfy the hours required. The examining board shall periodically publish updated lists of the courses that are approved under sub. (2).

SB275,9,15 (2) (a) The examining board may not approve a continuing education course unless the organization that sponsors the course satisfies all of the following:

SB275,9,20 1. The organization is the Wisconsin, American, or International Chiropractic Association or its successor, a college or university of chiropractic accredited by the Council on Chiropractic Education or its successor, or a college or university of medicine or osteopathy accredited by an accrediting body listed as nationally recognized by the secretary of the federal department of education.

SB275,9,21 2. The organization selects the instructor for the course.

SB275,9,25 3. The organization establishes the objectives of the course, prepares course materials, evaluates the subject matter prepared by the instructor, conducts a post-course evaluation, maintains course transcripts, and performs financial administration necessary for the course.

SB275,10,2 4. The organization proctors course attendance through an on-site representative to whom the organization provides written guidelines.

SB275,10,3 5. The organization provides attendance vouchers to course attendees.

SB275,10,5 6. The organization supplies a list of course attendees to the examining board in a manner prescribed by the examining board.

SB275,10,9 (b) Notwithstanding par. (a), the examining board may approve a continuing education course sponsored by an organization that does not satisfy a requirement under par. (a) 2. to 5. if the organization delegates satisfaction of the requirement to another organization and the other organization satisfies the requirement.

SB275,10,17 (3) If an organization that sponsors a course approved under sub. (2) fails to satisfy any requirement under sub. (2) (a) 2. to 5., the examining board shall, for a period of 90 days, withdraw or withhold approval of all continuing education courses sponsored by the organization. If an organization to whom satisfaction of any requirement under sub. (2) (a) 2. to 5. is delegated under sub. (2) (b) fails to satisfy the requirement, the examining board shall, for a period of 90 days, withdraw or withhold approval of all continuing education courses sponsored by the organization that made the delegation.

SB275,10,21 (4) During each 2-year licensure period, the department shall audit a percentage, as determined by the department, of the applications for renewal of a license under this chapter to verify that an applicant has completed the continuing education courses identified by the applicant under s. 446.02 (4).

SB275, s. 14 Section 14. 446.03 (intro.) of the statutes is amended to read:

SB275,11,2 446.03 Reprimand; license revocation, limitation or suspension. (intro.) The Subject to ss. 446.04 (11) (d) and 446.05 (3), the examining board, by order, may reprimand a licensee or registrant and may deny, limit, suspend or revoke any license or certificate of registration if the licensee or registrant:

SB275, s. 15 Section 15. 446.03 (8) of the statutes is created to read:

SB275,11,5 446.03 (8) Has violated this chapter or any rule promulgated under this chapter.

SB275, s. 16 Section 16. 446.035 of the statutes is created to read:

SB275,11,9 446.035 Peer review. (1) Appointment of peer review panel. (a) The examining board shall appoint a peer review panel of no fewer than 6 nor more than 12 members, pursuant to par. (b).

SB275,11,13 (b) The examining board may solicit nominations for the peer review panel pursuant to a process developed by the department. The examining board shall consider the recommendations of the Wisconsin Chiropractic Association regarding nominations.

SB275,11,14 (c) A nominee under par. (b) shall:

SB275,11,15 1. Possess a valid license to practice chiropractic in this state.

SB275,11,20 2. Have no less than 10 years in practice for a minimum of 20 hours per week within the preceding 2 years of his or her nomination for the peer review panel or, if the nominee is not in active practice at the time of his or her nomination due to a disability, have at least 5 years of practice for a minimum of 20 hours per week prior to the onset of his or her disability.

SB275,11,25 3. Be diplomate eligible in a specialty that requires at least 300 hours of postgraduate credit hours that are approved by the American Chiropractic Association or the International Chiropractors Association or that are provided through a single unified program at a college or university of chiropractic accredited by the Council on Chiropractic Education or its successor.

SB275,12,2 4. Not have been subject to disciplinary action under this chapter or by any regulatory or government agency.

SB275,12,4 5. Have completed an annual utilization review course approved by the examining board.

SB275,12,7 (d) The examining board may summarily remove a chiropractor from the peer review panel if the board finds that the reviewer is unqualified or if it finds that the reviewer's methods or practices are unprofessional.

SB275,12,13 (2) Procedure. (a) A patient, a chiropractor, an insurer, or the examining board may request a peer review, if the cost of the care in dispute for a course of treatment exceeds $500, by submitting a written request to the department and any fee required under par. (b). Within 5 business days of submitting the request, the patient, chiropractor, insurer, or examining board shall submit the following documents to the department:

SB275,12,14 1. A written statement of the matter he or she wishes to be reviewed.

SB275,12,16 2. Clinical documentation relating to the course of treatment or the conduct he or she wishes to be reviewed.

SB275,12,18 3. Any other information the patient, chiropractor, insurer, or examining board wishes to include to support his or her request for review.

SB275,12,22 (b) The department shall charge a patient, chiropractor, or insurer that requests a peer review a fee of $275. The department shall adjust the fee each year to reflect adjustments to the U.S. consumer price index for all consumers, U.S. city average, as determined by the U.S. department of labor.

SB275,13,2 (c) Within 15 business days of receipt of the documents and fee specified under par. (a), the department shall notify each patient, chiropractor, or insurer named in the request for review. Within 10 business days of receiving notification that a review has been requested, the patient, chiropractor, or insurer shall submit the following to the department:

SB275,13,3 1. A written statement of response to the matter that is being reviewed.

SB275,13,5 2. Clinical documentation relating to the course of treatment or conduct that is being reviewed.

SB275,13,7 3. Any other information the patient, chiropractor, or insurer wishes to include to support his or her response.

SB275,13,14 (d) The department shall remove identifying information regarding a chiropractor named in the request for review and, within 5 business days of receipt, shall forward all of the documents received under pars. (a) and (c) and payment of $235 to a peer reviewer chosen at random from the peer review panel. The department shall adjust the fee each year to reflect adjustments to the U.S. consumer price index for all consumers, U.S. city average, as determined by the U.S. department of labor.

SB275,13,24 (e) Within 30 business days of receiving the documents specified in par. (d), the peer reviewer shall make a determination of the quality, appropriateness, or utilization of the chiropractic services rendered to the patient. The peer reviewer shall determine that the chiropractor acted unprofessionally if he or she finds that, applying generally accepted standards, 50% or more of the chiropractic services identified in the request for peer review were inappropriate, unnecessary, or of substandard quality. The peer reviewer shall sign, with his or her name and address, and remit his or her findings to the department and the department shall issue a copy of the findings to each patient, chiropractor, or insurer named in the request and to the examining board.

SB275,14,6 (f) Within 30 days after the date of receipt of the peer reviewer's findings, a patient, chiropractor, insurer, or the examining board may request an appeal. The person requesting the appeal shall submit a written request to the department and pay a fee of $750. The department shall adjust the fee each year to reflect adjustments to the U.S. consumer price index for all consumers, U.S. city average, as determined by the U.S. department of labor.

SB275,14,23 (g) Upon receipt of a request for appeal and the fee specified in par. (f), the department shall forward all of the documents received under pars. (a), (c), and (e) and a payment of $235 each to 3 additional peer reviewers chosen at random from the peer review panel. The department shall adjust the fee each year to reflect adjustments to the U.S. consumer price index for all consumers, U.S. city average, as determined by the U.S. department of labor. The reviewers shall conduct a joint review of the submitted materials. Each peer reviewer shall determine that the chiropractor acted unprofessionally if he or she finds that, applying generally accepted standards, 50% or more of the chiropractic services identified in the request for peer review were inappropriate, unnecessary, or of substandard quality. Each peer reviewer shall sign, with his or her name and address, and remit his or her findings to the department. The department shall forward a copy of the joint review to each patient, chiropractor, or insurer named in the request for peer review. The department shall adopt the determination reached by a majority of the peer reviewers appointed under this paragraph of the quality, appropriateness, or utilization of the chiropractic services rendered to the patient or the conduct of the chiropractor.

SB275,15,2 (3) Civil liability. A member of a peer review panel is immune from civil liability for a finding, evaluation, recommendation, or other action he or she makes or takes while performing a peer review under this section. This subsection does not apply if the member of the peer review panel acts in fraud, conspiracy, or malice.

SB275,15,5 (4) Insurance coverage. No finding, evaluation, or recommendation reached by a peer reviewer may be used to determine whether insurance coverage or reimbursement is appropriate.

SB275,15,7 (5) Sunset. This section does not apply after the first day of the 30th month beginning after the effective date of this subsection .... [revisor inserts date].

SB275, s. 17 Section 17. 446.04 (6), (7), (8), (9), (10) and (11) of the statutes are created to read:

SB275,15,12 446.04 (6) A determination under s. 446.035 that 50% or more of the chiropractic services identified in a request for peer review were inappropriate, unnecessary, or of substandard quality.

SB275,15,13 (7) Billing for a service that was not performed. This includes:

SB275,15,15 (a) Billing for a service that was performed by a staff person without the training required by the laws of this state.

SB275,15,20 (b) A pattern of conduct in which a chiropractor bills a Current Procedural Terminology Code in a manner inconsistent with the published standards of the Current Procedural Terminology Code, the Current Procedural Terminology Assistant, the Wisconsin Chiropractic Association, the American Chiropractic Association, or the International Chiropractic Association.

SB275,15,23 (c) A pattern of conduct in which a chiropractor bills for a service using a higher level Current Procedural Terminology Code than the service that was actually provided to the patient with the intent of obtaining unearned reimbursement.

SB275,16,2 (8) Failure to collect a deductible or co-payment required by a patient's insurer. This subsection does not apply if the chiropractor has made reasonable efforts to collect the deductible or co-payment or if the patient has financial hardship and the chiropractor documents the financial hardship.

SB275,16,3 (9) Falsifying a claim.

SB275,16,5 (10) A pattern of conduct that involves billing for a unit of service that was not actually performed with the intent of obtaining unearned reimbursement.

SB275,16,6 (11) Sexual misconduct. In this subsection, all of the following apply:

SB275,16,14 (a) A chiropractor engages in sexual misconduct if he or she engages in sexual contact, exposure, or gratification, sexually offensive communication, dating a patient while the patient is under the chiropractor's professional care or treatment or within 6 months after the patient has been discharged from care or treatment, or other sexual behavior with or in the presence of a patient under the chiropractor's professional care or treatment and a reasonably prudent chiropractor under similar conditions and circumstances would find the conduct unprofessional. Consent is not an issue under this subsection.

SB275,16,16 (b) "Contact violation" means any violation of par. (a) that involves physical contact with a patient under the chiropractor's professional care or treatment.

SB275,16,19 (c) "Noncontact violation" means any violation of par. (a) that does not involve physical contact with a patient under the chiropractor's professional care or treatment.

SB275,16,23 (d) 1. The examining board shall require a chiropractor who commits a first noncontact violation under this subsection to attend training approved by the department regarding sexual misconduct and shall suspend his or her chiropractic license for not less than 90 days.

SB275,17,3 2. The examining board shall suspend the chiropractic license of a chiropractor who commits a 2nd noncontact violation or a first contact violation under this subsection for one year.

SB275,17,5 3. The examining board shall revoke the chiropractic license of a chiropractor who commits a 3rd noncontact or a 2nd contact violation under this subsection.

SB275, s. 18 Section 18. 446.05 (1) of the statutes is amended to read:

SB275,17,12 446.05 Procedure for hearings. (1) Subject to the rules promulgated under s. 440.03 (1), the examining board may make investigations and conduct hearings in regard to the conduct of any licensed chiropractor who, it has reason to believe, violated s. 446.02 or 446.03 (1), (6), (7), (7m), or (8) or committed any offense listed in s. 446.03. The person complained against may proceed to review any action of the examining board under ch. 227.

SB275, s. 19 Section 19. 446.05 (2) of the statutes is amended to read:

SB275,17,18 446.05 (2) Upon Except as provided in subs. (3) and (4), upon application and satisfactory proof that the cause of such revocation or suspension no longer exists, the examining board may reinstate any license or registration suspended or revoked by it. This subsection does not apply to a license or registration that is suspended under s. 440.13 (2) (c) or that is revoked under s. 440.12.

SB275, s. 20 Section 20. 446.05 (3) of the statutes is created to read:

SB275,17,21 446.05 (3) The examining board shall suspend the license of a chiropractor who commits a third violation of s. 446.04 (1) to (10) for not less than 6 months.

SB275, s. 21 Section 21. 446.05 (4) of the statutes is created to read: