SB275: Bill Text

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:

SB275,17,24 446.05 (4) The examining board shall suspend the license of a chiropractor who commits a fourth violation of s. 446.04 (1) to (10) for not less than 2 years.

SB275, s. 22 Section 22. 446.07 (title) of the statutes is repealed and recreated to read:

SB275,18,1 446.07 (title) Penalties.

SB275, s. 23 Section 23. 446.07 of the statutes is renumbered 446.07 (1).

SB275, s. 24 Section 24. 446.07 (2) of the statutes is created to read:

SB275,18,9 446.07 (2) If the examining board finds that a chiropractor is guilty of the unprofessional conduct specified in s. 446.04 (6), the examining board shall assess against the chiropractor a forfeiture of 3 times the amount that the chiropractor billed a patient for inappropriate, unnecessary, or substandard chiropractic care or $5,000, whichever is less. This subsection applies only if the examining board makes a 2nd or subsequent such finding regarding a chiropractor.

SB275, s. 25 Section 25. Initial applicability.

SB275,18,16 (1) Continuing education. If the effective date of this subsection is before January 1, 2004, the treatment of sections 446.02 (1) (b) and (4) and 446.025 of the statutes first applies to chiropractors whose licenses expire on January 1, 2005. If the effective date of this subsection is on or after January 1, 2004, the treatment of sections 446.02 (1) (b) and (4) and 446.025 of the statutes first applies to chiropractors whose licenses expire on January 1, 2007.

SB275,18,20 (2) Violations and offenses. The treatment of sections 446.03 (intro.) and 446.05 (1) of the statutes and the creation of sections 446.03 (8), 446.04 (6), (7), (8), (9), (10), and (11), and 446.07 (2) of the statutes first apply to violations that occur, and offenses that are committed, on the effective date of this subsection.

SB275,18,21 (3) License suspension.

SB275,18,24 (a) The treatment of section 446.05 (2) of the statutes and the creation of section 446.05 (3) of the statutes first apply to 3rd violations that occur on the effective date of this paragraph.

SB275,19,3 (b) The treatment of section 446.05 (1) of the statutes and the creation of section 446.05 (4) of the statutes first apply to 4th violations that occur on the effective date of this paragraph.

SB275, s. 26 Section 26. Effective dates. This act takes effect on the first day of the 2nd month beginning after publication, except as follows:

SB275,19,7 (1) The treatment of sections 446.02 (6m) and 446.035 of the statutes take effect on the first day of the 7th month beginning after publication.

SB275,19,8 (End)