LRB-0055/2
ALL:kjf:jf
2009 - 2010 LEGISLATURE
May 7, 2009 - Introduced by Senators Lehman, Taylor, Plale, Schultz, Wirch and
Holperin, cosponsored by Representatives Barca, Zigmunt, Benedict,
Turner, Kerkman, Steinbrink, Friske, Mason, Townsend, Zepnick, Ballweg,
Berceau and Petrowski. Referred to Committee on Health, Health
Insurance, Privacy, Property Tax Relief, and Revenue.
SB191,2,4
1An Act to renumber 45.40 (1);
to amend 15.085 (1m) (b), 15.406 (3) (intro.),
225.36 (1), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2) (e), 45.40 (2m) (a), 45.40
3(2m) (b), 45.40 (3m), 49.45 (9), 49.855 (4m) (b), 50.36 (3) (b), 50.36 (3) (c), 50.39
4(3), 146.37 (1g), 180.1901 (1m) (bk), 185.981 (1), 185.981 (2), 185.981 (3),
5185.981 (4), 185.982 (1), 343.62 (4) (a) 4., subchapter IV (title) of chapter 448
6[precedes 448.60], 448.60 (1), 450.11 (8) (bm), 632.64, 632.99, 655.45 (1), 812.30
7(9), 814.29 (1) (d) 1., 895.48 (1m) (a) (intro.) and 2., 905.04 (title), 905.04 (1) (b),
8905.04 (1) (c), 905.04 (2) and 905.04 (3); and
to create 45.40 (1g), 45.40 (1t) and
9905.04 (1) (dg) of the statutes;
relating to: podiatrist-patient privilege,
10immunity exemption for podiatrists providing emergency care at athletic
11events, allowing podiatrists to determine an illness or injury and complete
12forms for the purpose of granting assistance to needy veterans, allowing
13podiatrists to determine disability for the purpose of issuing certain hunting
14permits, cooperatives organized to provide sickness care, the Podiatrists
1Affiliated Credentialing Board, allowing podiatrists to certify driver school
2instructors' physical fitness, allowing Medical Assistance recipients to freely
3choose among podiatrists, and giving equal weight to certifications of disability
4by podiatrists for insurance purposes.
Analysis by the Legislative Reference Bureau
Under current law, certain health care providers, including physicians, first
responders, and dentists, who render voluntary health care to a participant in an
athletic event or contest at a school are immune from civil liability for their acts or
omissions. The immunity applies only if certain conditions are met, including that
the health care is rendered at the site of event or contest and that there is no
compensation paid to the health care provider. This bill adds podiatrists to those who
are immune from civil liability for their acts or omissions while rendering voluntary
health care to a participant in an athletic event or contest at a school.
Currently, a communication by a patient to certain health care professionals,
including physicians, chiropractors, and psychologists, is privileged. The patient
may refuse to disclose, and can prevent the health care provider from disclosing, a
communication made for the purpose of diagnosis or treatment of the patient. This
bill adds podiatrists to those whose communication regarding diagnosis or treatment
may be prevented from being disclosed by the patient.
Under current law, the Department of Transportation (DOT) issues driver
school instructors' licenses. DOT may not issue an instructor's license to an
applicant unless the applicant submits a statement completed by a physician or
another specified medical care provider certifying that the applicant is physically fit
to teach driving. This bill adds podiatrists to the list of medical care providers that
may certify to DOT that an applicant is physically fit to teach driving.
Under current law, the Department of Veterans Affairs (DVA) may grant
assistance to needy veterans who have suffered a loss of income due to illness, injury,
or natural disaster. By rule, DVA has defined an illness or injury as a physical or
mental health problem that is diagnosed by a physician, dentist, optometrist, or
audiologist. This bill expands the health care providers who can diagnose an illness
or injury for DVA purposes to include podiatrists.
Under current law, the Department of Natural Resources (DNR) is authorized
to issue certain hunting permits that authorize hunting by persons who have a
physical disability (specialized permits). Among the privileges granted by these
specialized permits is the privilege of hunting with assistance rendered by another
person. In order to obtain a specialized permit from DNR, a person must submit an
application furnished by DNR that includes a statement or report prepared and
signed by a licensed physician or chiropractor verifying that the applicant is
physically disabled. A person may also obtain a specialized permit even if the person
would otherwise be ineligible for a specialized permit if DNR, based on the
recommendation of a licensed physician or chiropractor, determines that the
issuance of the permit complies with the intent of the law. This bill authorizes an
applicant for a specialized permit to submit a statement, report, or recommendation
from a licensed podiatrist, as well as from a physician or chiropractor, in support of
a specialized permit application.
This bill changes the name of the Podiatrists Affiliated Credentialing Board to
the Podiatry Affiliated Credentialing Board.
Current law permits the organization of a cooperative to provide sickness care
through contracts with physicians, medical societies, chiropractors, optometrists,
dentists, dental societies, hospitals, and others. This bill adds podiatrists to the list
of enumerated providers of sickness care.
Under current law, life insurers, health insurers, and disability insurers are
required to give equal weight to certifications of disability by physicians and by
chiropractors, with respect to matters within the scope of the professional license of
each. This bill requires those insurers also to give equal weight to certifications of
disability by podiatrists with respect to matters within the scope of their professional
licenses.
Current law provides that a person who is eligible for health care coverage
under the Medical Assistance (MA) program may, unless limited by the Department
of Health Services, which administers MA, use the provider of his or her choice, and
lists the types of providers for which the person has free choice. The list includes
physicians, chiropractors, dentists, and pharmacists. This bill adds podiatrists to
the list of providers for which a person who is eligible for MA has free choice.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB191, s. 1
1Section
1. 15.085 (1m) (b) of the statutes is amended to read:
SB191,3,62
15.085
(1m) (b) The public members of the physical therapists affiliated
3credentialing board,
podiatrists podiatry affiliated credentialing board or
4occupational therapists affiliated credentialing board shall not be engaged in any
5profession or occupation concerned with the delivery of physical or mental health
6care.
SB191, s. 2
7Section
2. 15.406 (3) (intro.) of the statutes is amended to read:
SB191,4,28
15.406
(3) (intro.)
Podiatrists Podiatry affiliated credentialing board. 9There is created in the department of regulation and licensing, attached to the
1medical examining board, a
podiatrists podiatry affiliated credentialing board
2consisting of the following members appointed for 4-year terms:
SB191, s. 3
3Section
3. 25.36 (1) of the statutes is amended to read:
SB191,4,224
25.36
(1) Except as provided in sub. (2), all moneys appropriated or transferred
5by law shall constitute the veterans trust fund which shall be used for the lending
6of money to the mortgage loan repayment fund under s. 45.37 (5) (a) 12. and for the
7veterans programs under ss. 20.485 (2) (m), (mn), (tm), (u), (v), (vo), (vy), (w), (z), and
8(zm), 45.03 (19), 45.07, 45.20, 45.21, 45.40
(1)
(1m), 45.41, 45.42, 45.43, and 45.82 and
9administered by the department of veterans affairs, including all moneys received
10from the federal government for the benefit of veterans or their dependents; all
11moneys paid as interest on and repayment of loans under the post-war
12rehabilitation fund; soldiers rehabilitation fund, veterans housing funds as they
13existed prior to July 1, 1961; all moneys paid as interest on and repayment of loans
14under this fund; all moneys paid as expenses for, interest on, and repayment of
15veterans trust fund stabilization loans under s. 45.356, 1995 stats.; all moneys paid
16as expenses for, interest on, and repayment of veterans personal loans; the net
17proceeds from the sale of mortgaged properties related to veterans personal loans;
18all mortgages issued with the proceeds of the 1981 veterans home loan revenue bond
19issuance purchased with moneys in the veterans trust fund; all moneys received from
20the state investment board under s. 45.42 (8) (b); all moneys received from the
21veterans mortgage loan repayment fund under s. 45.37 (7) (a) and (c); and all gifts
22of money received by the board of veterans affairs for the purposes of this fund.
SB191, s. 4
23Section
4. 29.193 (2) (b) 2. of the statutes is amended to read:
SB191,5,324
29.193
(2) (b) 2. An applicant shall submit an application on a form prepared
25and furnished by the department, which shall include a written statement or report
1prepared and signed by a licensed physician
or
, a licensed chiropractor,
or a licensed
2podiatrist prepared no more than 6 months preceding the application and verifying
3that the applicant is physically disabled.
SB191, s. 5
4Section
5. 29.193 (2) (c) 3. of the statutes is amended to read:
SB191,5,135
29.193
(2) (c) 3. The department may issue a Class B permit to an applicant
6who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under
7subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the
8applicant and the recommendation of a licensed physician
or
, a licensed chiropractor
,
9or a licensed podiatrist selected by the applicant from a list of licensed physicians
10and, licensed chiropractors
, and licensed podiatrists compiled by the department,
11the department finds that issuance of a permit complies with the intent of this
12subsection. The use of this review procedure is discretionary with the department
13and all costs of the review procedure shall be paid by the applicant.
SB191, s. 6
14Section
6. 29.193 (2) (e) of the statutes is amended to read:
SB191,5,2315
29.193
(2) (e)
Review of decisions. An applicant denied a permit under this
16subsection, except a permit under par. (c) 3., may obtain a review of that decision by
17a licensed physician
or, a licensed chiropractor
, or a licensed podiatrist designated
18by the department and with an office located in the department district in which the
19applicant resides. The department shall pay for the cost of a review under this
20paragraph unless the denied application on its face fails to meet the standards set
21forth in par. (c) 1. or 2. A review under this paragraph is the only method of review
22of a decision to deny a permit under this subsection and is not subject to further
23review under ch. 227.
SB191, s. 7
24Section
7. 45.40 (1) of the statutes is renumbered 45.40 (1m).
SB191, s. 8
25Section
8. 45.40 (1g) of the statutes is created to read:
SB191,6,1
145.40
(1g) Definitions. In this section:
SB191,6,22
(a) "Health care provider" includes a podiatrist licensed under s. 448.63.
SB191,6,53
(b) "Illness" or "injury" means a physical or mental health problem that has
4been diagnosed by a health care provider acting within the scope of the podiatrist's
5license.
SB191, s. 9
6Section
9. 45.40 (1t) of the statutes is created to read:
SB191,6,97
45.40
(1t) Completion of health care forms. A health care provider may
8complete the medical forms necessary for the receipt of aid under this section if the
9provider has diagnosed the veteran and determined the veteran's medical condition.
SB191, s. 10
10Section
10. 45.40 (2m) (a) of the statutes is amended to read:
SB191,6,1611
45.40
(2m) (a) The unremarried spouse and dependent children of a veteran
12who died on active duty, or in the line of duty while on active or inactive duty for
13training purposes, in the U.S. armed forces or forces incorporated in the U.S. armed
14forces are eligible to receive payments under subs.
(1) (1m) and (2) if the household
15income of those persons does not exceed the income limitations established under
16sub. (3m).
SB191, s. 11
17Section
11. 45.40 (2m) (b) of the statutes is amended to read:
SB191,6,2318
45.40
(2m) (b) The spouse and dependent children of a member of the U.S.
19armed forces or of the Wisconsin national guard who has been activated or deployed
20to serve in the U.S. armed forces who are residents of this state, who have suffered
21a loss of income due to that activation or deployment, and who experience an
22economic emergency during the member's activation or deployment are eligible to
23receive assistance under subs.
(1) (1m) and (2).
SB191, s. 12
24Section
12. 45.40 (3m) of the statutes is amended to read:
SB191,7,3
145.40
(3m) Rules. The department shall promulgate rules establishing
2eligibility criteria and household income limits for payments under subs.
(1) (1m),
3(2), and (2m).
SB191, s. 13
4Section
13. 49.45 (9) of the statutes is amended to read:
SB191,8,45
49.45
(9) Free choice. Any person eligible for medical assistance under s.
649.46, 49.468, 49.47, or 49.471 may use the physician, chiropractor, dentist,
7pharmacist,
podiatrist, hospital, skilled nursing home, health maintenance
8organization, limited service health organization, preferred provider plan or other
9licensed, registered or certified provider of health care of his or her choice, except that
10free choice of a provider may be limited by the department if the department's
11alternate arrangements are economical and the recipient has reasonable access to
12health care of adequate quality. The department may also require a recipient to
13designate, in any or all categories of health care providers, a primary health care
14provider of his or her choice. After such a designation is made, the recipient may not
15receive services from other health care providers in the same category as the primary
16health care provider unless such service is rendered in an emergency or through
17written referral by the primary health care provider. Alternate designations by the
18recipient may be made in accordance with guidelines established by the department.
19Nothing in this subsection shall vitiate the legal responsibility of the physician,
20chiropractor, dentist, pharmacist,
podiatrist, skilled nursing home, hospital, health
21maintenance organization, limited service health organization, preferred provider
22plan or other licensed, registered or certified provider of health care to patients. All
23contract and tort relationships with patients shall remain, notwithstanding a
24written referral under this section, as though dealings are direct between the
25physician, chiropractor, dentist, pharmacist,
podiatrist, skilled nursing home,
1hospital, health maintenance organization, limited service health organization,
2preferred provider plan or other licensed, registered or certified provider of health
3care and the patient. No physician, chiropractor, pharmacist
, podiatrist, or dentist
4may be required to practice exclusively in the medical assistance program.
SB191, s. 14
5Section
14. 49.855 (4m) (b) of the statutes is amended to read:
SB191,9,96
49.855
(4m) (b) The department of revenue may provide a certification that it
7receives under sub. (1), (2m), (2p), or (2r) to the department of administration. Upon
8receipt of the certification, the department of administration shall determine
9whether the obligor is a vendor or is receiving any other payments from this state,
10except for wages, retirement benefits, or assistance under s. 45.352, 1971 stats., s.
1145.40
(1) (1m), this chapter, or ch. 46, 108, or 301. If the department of
12administration determines that the obligor is a vendor or is receiving payments from
13this state, except for wages, retirement benefits, or assistance under s. 45.352, 1971
14stats., s. 45.40
(1) (1m), this chapter, or ch. 46, 108, or 301, it shall begin to withhold
15the amount certified from those payments and shall notify the obligor that the state
16intends to reduce any payments due the obligor by the amount the obligor is
17delinquent under the support, maintenance, or receiving and disbursing fee order or
18obligation, by the outstanding amount for past support, medical expenses, or birth
19expenses under the court order, or by the amount due under s. 46.10 (4), 49.345 (4),
20or 301.12 (4). The notice shall provide that within 20 days after receipt of the notice
21the obligor may request a hearing before the circuit court rendering the order under
22which the obligation arose. An obligor may, within 20 days after receiving notice,
23request a hearing under this paragraph. Within 10 days after receiving a request for
24hearing under this paragraph, the court shall set the matter for hearing. A circuit
25court commissioner may conduct the hearing. Pending further order by the court or
1circuit court commissioner, the department of children and families or its designee,
2whichever is appropriate, may not disburse the payments withheld from the obligor.
3The sole issues at the hearing are whether the obligor owes the amount certified and,
4if not and it is a support or maintenance order, whether the money withheld shall be
5paid to the obligor or held for future support or maintenance, except that the obligor's
6ability to pay is also an issue at the hearing if the obligation relates to an order under
7s. 767.805 (4) (d) 1. or 767.89 (3) (e) 1. and the order specifies that the court found that
8the obligor's income was at or below the poverty line established under
42 USC 9902 9(2).
SB191, s. 15
10Section
15. 50.36 (3) (b) of the statutes is amended to read:
SB191,9,1811
50.36
(3) (b) If, as a result of peer investigation or written notice thereof, a
12hospital staff member who is licensed by the medical examining board or
podiatrists 13podiatry affiliated credentialing board, for any reasons that include the quality of or
14ability to practice, loses his or her hospital staff privileges, has his or her hospital
15staff privileges reduced or resigns from the hospital staff, the hospital shall so notify
16the medical examining board or
podiatrists podiatry affiliated credentialing board,
17whichever is applicable, within 30 days after the loss, reduction or resignation takes
18effect. Temporary suspension due to incomplete records need not be reported.
SB191, s. 16
19Section
16. 50.36 (3) (c) of the statutes is amended to read:
SB191,9,2520
50.36
(3) (c) If, as a result of peer investigation or written notice thereof, a
21hospital staff member who is licensed by the medical examining board or
podiatrists 22podiatry affiliated credentialing board, for reasons that do not include the quality of
23or ability to practice, loses his or her hospital staff privileges for 30 days or more, has
24his or her hospital staff privileges reduced for 30 days or more or resigns from the
25hospital staff for 30 days or more, the hospital shall so notify the medical examining
1board or
podiatrists podiatry affiliated credentialing board, whichever is applicable,
2within 30 days after the loss, reduction or resignation takes effect. Temporary
3suspension due to incomplete records need not be reported.
SB191, s. 17
4Section
17. 50.39 (3) of the statutes is amended to read:
SB191,10,135
50.39
(3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and
6252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional
7institutions governed by the department of corrections under s. 301.02, and the
8offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448
9are exempt from ss. 50.32 to 50.39. Sections 50.32 to 50.39 do not abridge the rights
10of the medical examining board, physical therapists affiliated credentialing board,
11podiatrists podiatry affiliated credentialing board, dentistry examining board,
12pharmacy examining board, chiropractic examining board, and board of nursing in
13carrying out their statutory duties and responsibilities.
SB191, s. 18
14Section
18. 146.37 (1g) of the statutes is amended to read:
SB191,11,415
146.37
(1g) Except as provided in s. 153.85, no person acting in good faith who
16participates in the review or evaluation of the services of health care providers or
17facilities or the charges for such services conducted in connection with any program
18organized and operated to help improve the quality of health care, to avoid improper
19utilization of the services of health care providers or facilities or to determine the
20reasonable charges for such services, or who participates in the obtaining of health
21care information under ch. 153, is liable for any civil damages as a result of any act
22or omission by such person in the course of such review or evaluation. Acts and
23omissions to which this subsection applies include, but are not limited to, acts or
24omissions by peer review committees or hospital governing bodies in censuring,
25reprimanding, limiting or revoking hospital staff privileges or notifying the medical
1examining board or
podiatrists
podiatry affiliated credentialing board under s. 50.36
2or taking any other disciplinary action against a health care provider or facility and
3acts or omissions by a medical director in reviewing the performance of emergency
4medical technicians or ambulance service providers.
SB191, s. 19
5Section
19. 180.1901 (1m) (bk) of the statutes is amended to read:
SB191,11,76
180.1901
(1m) (bk)
Podiatrists Podiatry affiliated credentialing board under
7subch. IV of ch. 448.
SB191, s. 20
8Section
20. 185.981 (1) of the statutes is amended to read:
SB191,11,149
185.981
(1) Cooperative associations may be organized under this chapter
10without capital stock, exclusively to establish and operate in the state or in any
11county or counties therein a nonprofit plan or plans for sickness care, including
12hospital care, for their members and their dependents through contracts with
13physicians, medical societies, chiropractors, optometrists, dentists, dental societies,
14hospitals
, podiatrists and others.
SB191, s. 21
15Section
21. 185.981 (2) of the statutes is amended to read:
SB191,12,216
185.981
(2) Such associations shall operate only on a cooperative nonprofit
17basis and for the purpose of establishing, maintaining and operating a voluntary
18nonprofit health, dental or vision care plan or plans or for constructing, operating
19and maintaining nonprofit hospitals or other facilities whereby sickness care,
20including hospital, dental or vision care, is provided at the expense of such
21association, its members or both, to such persons or groups of persons as shall become
22subscribers to such plan, under contracts which will entitle each such subscriber to
23definite medical, surgical, chiropractic, vision, dental or hospital care, appliances
24and supplies, by physicians and surgeons licensed and registered under ch. 448,
25podiatrists licensed under ch. 448, optometrists licensed under ch. 449, chiropractors
1licensed under ch. 446 and dentists licensed under ch. 447 in their offices, in
2hospitals, in other facilities and in the home.
SB191, s. 22
3Section
22. 185.981 (3) of the statutes is amended to read:
SB191,12,114
185.981
(3) No cooperative association organized for the purposes provided in
5ss. 185.981 to 185.983 shall be prevented from contracting with any hospital in this
6state for the rendition of such hospital care as is included within such a plan because
7such hospital participates in any other such plan, or in a plan organized and operated
8under ss. 148.03 and 613.80. No hospital may discriminate against any physician
9and surgeon, chiropractor
or, dentist
, or podiatrist with respect to the use of such
10hospital's facilities by reason of his or her participation in a sickness care plan of a
11cooperative.
SB191, s. 23
12Section
23. 185.981 (4) of the statutes is amended to read:
SB191,12,2313
185.981
(4) No contract by or on behalf of any such cooperative association shall
14provide for the payment of any cash, indemnity or other material benefit by that
15association to the subscriber or the subscriber's estate on account of death, illness or
16injury, nor be in any way related to the payment of any such benefit by any other
17agency, but any such association may stipulate in its plan that it will pay any
18nonparticipating physician and surgeon, optometrist, chiropractor, dentist
or, 19podiatrist, or hospital outside of its normal territory for sickness or hospital care
20rendered any covered member or a member's covered dependent who is in need of the
21benefits of such plan when he or she is outside of the territory of such association in
22which the benefits of such plan are normally available. Any such plan may prescribe
23monetary limitations with respect to such extraterritorial benefits.
SB191, s. 24
24Section
24. 185.982 (1) of the statutes is amended to read:
SB191,13,14
1185.982
(1) No sickness care plan or contract issued thereunder by such
2cooperative association shall interfere with the manner or mode of the practice of
3medicine, optometry, chiropractic
or, dentistry,
or podiatry, the relationship of
4physician, chiropractor, optometrist
or, dentist
, or podiatrist and patient, nor the
5responsibility of physician, chiropractor, optometrist
or
, dentist
, or podiatrist to
6patient. A plan may require persons covered to utilize health care providers
7designated by the cooperative association. The cooperative association may provide
8health care services directly through providers who are employees of the cooperative
9association or through agreements with individual providers or groups of providers
10organized on a group practice or individual practice basis. In making such
11agreements, no plan may refuse to provide coverage for vision care services or
12procedures provided by an optometrist licensed under ch. 449 within the scope of the
13practice of optometry, as defined in s. 449.01 (1), if the plan provides coverage for the
14same services or procedures when provided by another health care provider.
SB191, s. 25
15Section
25. 343.62 (4) (a) 4. of the statutes is amended to read:
SB191,13,2416
343.62
(4) (a) 4. The applicant submits with the application a statement
17completed within the immediately preceding 24 months, except as provided by rule,
18by a physician licensed to practice medicine in any state, from an advanced practice
19nurse licensed to practice nursing in any state, from a physician assistant licensed
20or certified to practice in any state,
from a podiatrist licensed to practice in any state, 21from a chiropractor licensed to practice chiropractic in any state, or from a Christian
22Science practitioner residing in this state, and listed in the Christian Science journal
23certifying that, in the medical care provider's judgment, the applicant is physically
24fit to teach driving.
SB191, s. 26
1Section
26. Subchapter IV (title) of chapter 448 [precedes 448.60] of the
2statutes is amended to read:
SB191,14,44
SUBCHAPTER IV
SB191,14,6
5PODIATRISTS PODIATRY AFFILIATED
6
CREDENTIALING BOARD
SB191, s. 27
7Section
27. 448.60 (1) of the statutes is amended to read: