AB356: Bill Text

AB356,37,23 (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 2 years, 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 2 years, withdraw or withhold approval of all continuing education courses sponsored by the organization that made the delegation.

AB356,38,2 (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).

AB356, s. 116 Section 116. 446.03 (intro.) of the statutes is amended to read:

AB356,38,7 446.03 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:

AB356, s. 117 Section 117. 446.03 (8) of the statutes is created to read:

AB356,38,10 446.03 (8) Has violated this chapter or any rule promulgated under this chapter.

AB356, s. 118 Section 118. 446.035 of the statutes is created to read:

AB356,38,14 446.035 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).

AB356,38,19 (b) A peer review panel may be selected from a list of nominees that is submitted every 24 months by the Wisconsin Chiropractic Association. If the Wisconsin Chiropractic Association fails to submit a list of nominees, the examining board may solicit nominations for the peer review panel pursuant to a process developed by the department.

AB356,38,20 (c) A nominee under par. (b) shall meet all of the following requirements:

AB356,38,21 1. Possess a valid license to practice chiropractic in this state.

AB356,39,2 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.

AB356,39,5 3. Be diploma eligible in a specialty that requires at least 300 hours of postgraduate credit hours approved by the American Chiropractic Association or the International Chiropractors Association.

AB356,39,7 4. Not have been subject to disciplinary action under this chapter or by any regulatory or government agency.

AB356,39,9 5. Have completed an annual utilization review course approved by the examining board.

AB356,39,12 (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.

AB356,39,18 (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:

AB356,39,19 1. A written statement of the matter he or she wishes to be reviewed.

AB356,39,21 2. Clinical documentation relating to the course of treatment or the conduct he or she wishes to be reviewed.

AB356,39,23 3. Any other information the patient, chiropractor, insurer, or examining board wishes to include to support his or her request for review.

AB356,40,2 (b) The department shall charge a patient, chiropractor, or insurer that request a peer review a fee of $250. 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.

AB356,40,7 (c) Upon 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:

AB356,40,8 1. A written statement of response to the matter that is being reviewed.

AB356,40,10 2. Clinical documentation relating to the course of treatment or conduct that is being reviewed.

AB356,40,12 3. Any other information the patient, chiropractor, or insurer wishes to include to support his or her response.

AB356,40,14 (d) No patient, chiropractor, or insurer may appear before the peer review panel or a peer reviewer.

AB356,40,25 (e) 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. A peer reviewer chosen under this paragraph or par. (h) may not have a material professional, familial, or financial interest during the 12 months preceding his or her performance as a peer reviewer relating to a patient, chiropractor, insurer, or any agent or affiliate of a patient, chiropractor, or insurer named or involved in the peer review request.

AB356,41,10 (f) Within 30 business days of receiving the documents specified in par. (e), 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.

AB356,41,16 (g) 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.

AB356,42,8 (h) Upon receipt of a request for appeal and the fee specified in par. (g), the department shall forward all of the documents received under pars. (a), (c), and (f) 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.

AB356,42,12 (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.

AB356,42,15 (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.

AB356, s. 119 Section 119. 446.04 (6), (7), (8), (9), (10) and (11) of the statutes are created to read:

AB356,42,20 446.04 (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.

AB356,42,21 (7) Billing for a service that was not performed. This includes:

AB356,42,23 (a) Billing for a service that was performed by a staff person without the training required by the laws of this state.

AB356,43,3 (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.

AB356,43,6 (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.

AB356,43,9 (8) Failure to collect a deductible or co-payment required by a patient's insurer. This subsection does not apply if the patient has financial hardship and the chiropractor documents the financial hardship.

AB356,43,10 (9) Falsifying a claim.

AB356,43,12 (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.

AB356,43,19 (11) Sexual misconduct. (a) Under this subsection, a chiropractor engages in sexual misconduct if he or she engages in sexual contact, exposure, or gratification, sexually offensive communication, dating a patient under the chiropractor's professional 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.

AB356,43,22 (b) Under this subsection, "contact violation" means any violation of par. (a) that involves physical contact with a patient under the chiropractor's professional care or treatment.

AB356,43,25 (c) Under this subsection, "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.

AB356,44,4 (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.

AB356,44,7 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.

AB356,44,9 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.

AB356, s. 120 Section 120. 446.05 (1) of the statutes is amended to read:

AB356,44,16 446.05 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.

AB356, s. 121 Section 121. 446.05 (2) of the statutes is amended to read:

AB356,44,22 446.05 (2) Upon Except as provided in sub. (3), 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.

AB356, s. 122 Section 122. 446.05 (3) of the statutes is created to read:

AB356,44,25 446.05 (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.

AB356, s. 123 Section 123. 447.03 (3) (h) of the statutes is amended to read:

AB356,45,4 447.03 (3) (h) A physician or surgeon licensed in this state, as defined in s. 448.01 (5), who extracts teeth, or operates upon the palate or maxillary bones and investing tissues, or who administers anesthetics, either general or local.

AB356, s. 124 Section 124. 449.01 (2) of the statutes is amended to read:

AB356,45,13 449.01 (2) Dispensing opticians. A dispensing optician is one who practices optical dispensing. The practice of optical dispensing comprises the taking of necessary facial measurements and the processing, fitting and adjusting of mountings, frames, lenses and kindred products in the filling of prescriptions of duly licensed physicians or optometrists for ophthalmic lenses. Duplications, replacements or reproductions not requiring optometric service may be done without prescription. Nothing herein contained shall change the responsibility of physician to patient, or optometrist to patient.

AB356, s. 125 Section 125. 449.01 (5) of the statutes is created to read:

AB356,45,16 449.01 (5) Physician. In this chapter, "physician" has the meaning given in s. 448.01 (5).

AB356, s. 126 Section 126. 449.02 (2) of the statutes is amended to read:

AB356,45,23 449.02 (2) This section shall not apply to physicians and surgeons duly licensed as such in Wisconsin nor shall this section apply to the sale of spectacles containing simple lenses of a plus power only at an established place of business incidental to other business conducted therein, without advertising other than price marking on the spectacles, if no attempt is made to test the eyes. The term "simple lens" shall not include bifocals.

AB356, s. 127 Section 127. 450.01 (15m) of the statutes is created to read:

AB356,45,25 450.01 (15m) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 128 Section 128. 450.01 (22) of the statutes is amended to read:

AB356,46,5 450.01 (22) "Vaccination protocol" means a written protocol agreed to by a physician, as defined in s. 448.01 (5), and a pharmacist that establishes procedures and record-keeping and reporting requirements for the administration of a vaccine by a pharmacist for a period specified in the protocol that may not exceed 2 years.

AB356, s. 129 Section 129. 454.01 (14m) of the statutes is created to read:

AB356,46,7 454.01 (14m) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 130 Section 130. 454.02 (1) of the statutes is amended to read:

AB356,46,12 454.02 (1) Licenses to practice barbering or cosmetology do not confer the right to diagnose, prescribe for or treat diseases or conditions except as indicated in the definition of barbering or cosmetology in s. 454.01 (5) or under the direction of a licensed and practicing physician.

AB356, s. 131 Section 131. 459.035 of the statutes is amended to read:

AB356,46,18 459.035 Medical exam before being fitted. A hearing aid shall not be fitted for or sold to a child 16 years of age or younger unless within 90 days prior to the fitting the person to be fitted has been examined by a physician, as defined in s. 448.01 (5), to determine whether or not he or she has any physical deficiencies that would prohibit the effective use of a hearing aid.

AB356, s. 132 Section 132. 560.33 (1) (e) of the statutes is amended to read:

AB356,46,21 560.33 (1) (e) The business is not predominantly engaged in professional services provided by accountants, lawyers, or physicians, as defined in s. 448.01 (5).

AB356, s. 133 Section 133. 600.03 (34m) of the statutes is created to read:

AB356,46,23 600.03 (34m) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 134 Section 134. 609.22 (4m) (a) of the statutes is amended to read:

AB356,47,8 609.22 (4m) (a) A defined network plan that provides coverage of obstetric or gynecologic services may not require a female enrollee of the defined network plan to obtain a referral for covered obstetric or gynecologic benefits provided by a participating provider who is a physician licensed under ch. 448 and who specializes in obstetrics and gynecology, regardless of whether the participating provider is the enrollee's primary provider. Notwithstanding sub. (4), the defined network plan may not require the enrollee to obtain a standing referral under the procedure established under sub. (4) (a) for covered obstetric or gynecologic benefits.

AB356, s. 135 Section 135. 632.76 (2) (b) of the statutes is amended to read:

AB356,48,2 632.76 (2) (b) Notwithstanding par. (a), no claim for loss incurred or disability commencing after 6 months from the date of issue of a medicare supplement policy, medicare replacement policy or long-term care insurance policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage. A medicare supplement policy, medicare replacement policy or long-term care insurance policy may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician, as defined in s. 448.01 (5), within 6 months before the effective date of coverage. Notwithstanding par. (a), if on the basis of information contained in an application for insurance a medicare supplement policy, medicare replacement policy or long-term care insurance policy excludes from coverage a condition by name or specific description, the exclusion must terminate no later than 6 months after the date of issue of the medicare supplement policy, medicare replacement policy or long-term care insurance policy. The commissioner may by rule exempt from this paragraph certain classes of medicare supplement policies, medicare replacement policies and long-term care insurance policies, if the commissioner finds the exemption is not adverse to the interests of policyholders and certificate holders.

AB356, s. 136 Section 136. 647.01 (6) of the statutes is amended to read:

AB356,48,6 647.01 (6) "Medical services" means those services pertaining to medical or dental care that are performed on behalf of patients by or at the direction of a physician licensed under ch. 448 or a dentist licensed under ch. 447.

AB356, s. 137 Section 137. 655.001 (10m) of the statutes is repealed.

AB356, s. 138 Section 138. 700.16 (4) (d) of the statutes is amended to read:

AB356,48,11 700.16 (4) (d) Transfers, outright or in trust, to the state society of physicians and surgeons, as defined in s. 448.01 (5), incorporated under the law of this state, when the transfer is for the advancement of medical science;

AB356, s. 139 Section 139. 765.03 (1) of the statutes is amended to read:

AB356,48,22 765.03 (1) No marriage shall be contracted while either of the parties has a husband or wife living, nor between persons who are nearer of kin than 2nd cousins except that marriage may be contracted between first cousins where the female has attained the age of 55 years or where either party, at the time of application for a marriage license, submits an affidavit signed by a physician, as defined in s. 448.01 (5), stating that either party is permanently sterile. Relationship under this section shall be computed by the rule of the civil law, whether the parties to the marriage are of the half or of the whole blood. A marriage may not be contracted if either party has such want of understanding as renders him or her incapable of assenting to marriage.

AB356, s. 140 Section 140. 767.001 (5m) of the statutes is created to read:

AB356,48,24 767.001 (5m) "Physician" has the meaning given in s. 448.01 (5).

AB356, s. 141 Section 141. 804.10 (1) of the statutes is renumbered 804.10 (1r).