SB762: Bill Text

SB762,43,18 (b) The licensee meets all of the following conditions:

SB762,43,19 1. The licensee's principal place of practice is not in this state.

SB762,43,21 2. The licensee will not be engaged in the practice of spinal medicine in this state for more than 240 hours during the following 12 months.

SB762,43,24 3. The licensee has in effect malpractice liability insurance coverage that covers services provided by the licensee to patients in this state and that is in any of the following amounts:

SB762,44,3 a. At least the minimum amount of malpractice liability insurance coverage that is required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located.

SB762,44,9 b. If the licensee is not required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located to have in effect a minimum amount of malpractice liability insurance coverage, at least the minimum amount of malpractice liability insurance coverage that the affiliated credentialing board determines is necessary to protect the public.

SB762,44,12 (2) A licensee's principal place of practice is not in this state for purposes of sub. (1) (b) if the affiliated credentialing board determines that, during the following 12 months, any of the following applies:

SB762,44,14 (a) More than 50 percent of the licensee's practice will be performed outside this state.

SB762,44,16 (b) More than 50 percent of the income from the licensee's practice will be derived from outside this state.

SB762,44,18 (c) More than 50 percent of the licensee's patients will be treated by the licensee outside this state.

SB762,44,21 (3) The affiliated credentialing board may suspend, revoke, or refuse to issue or renew the license of a person who fails to procure or to submit proof of the malpractice liability insurance coverage required under sub. (1).

SB762,45,2 448.9745 Malpractice. Except as provided in s. 257.03, a person who practices spinal medicine without a license under s. 448.9725 may be liable for malpractice, and the person's ignorance of a duty ordinarily performed by a primary spinal care practitioner shall not limit his or her liability for an injury arising from his or her practice of spinal medicine.

SB762,45,6 448.975 Continuing education. (1) (a) 1. The affiliated credentialing board shall promulgate rules establishing requirements and procedures for licensees to complete continuing education programs or courses of study in order to qualify for renewal of a license granted under this subchapter.

SB762,45,8 2. The rules shall allow for program sponsors, as defined in s. 446.028, to conduct continuing education programs.

SB762,45,11 3. The rules shall require each licensee to complete at least 50 hours of approved continuing education within each 2-year period immediately preceding the renewal date specified under s. 440.08 (2) (a).

SB762,45,14 (b) 1. A licensee may apply up to 40 of the 50 continuing education hours required under par. (a) toward the continuing education requirements for chiropractors under ch. 446, as determined by the chiropractic examining board.

SB762,45,16 2. At least 25 of the 50 continuing education hours required under par. (a) shall include evidence-based pharmacology and medical procedures-based training.

SB762,45,20 (2) The affiliated credentialing board may waive all or part of the requirements under sub. (1) if the affiliated credentialing board determines that prolonged illness, disability, or other exceptional circumstances prevented a licensee from completing the requirements.

SB762,46,2 448.9755 Fee splitting and billing requirements. (1) Fee splitting. No licensee may give or receive, directly or indirectly, to or from any other person any fee, commission, rebate, or other form of compensation or anything of value for sending, referring, or otherwise inducing a person to communicate with a licensee in a professional capacity, or for any professional services not actually rendered personally by the licensee or at the licensee's direction.

SB762,46,13 (2) Separate billing required. Except as provided in sub. (4), a licensee who renders any spinal medicine service or assistance, or gives any spinal medicine advice or any similar advice or assistance, to any patient, primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber certified under s. 441.16 (2), partnership, or corporation, or to any other institution or organization, including a hospital, for which a charge is made to a patient, shall, except as authorized by Title 18 or Title 19 of the federal Social Security Act, render an individual statement or account of the charge directly to the patient, distinct and separate from any statement or account by any other primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber, or other person.

SB762,46,18 (3) Billing for tests performed by the state laboratory of hygiene. A licensee who charges a patient, other person, or 3rd-party payer for services performed by the state laboratory of hygiene shall identify the actual amount charged by the state laboratory of hygiene and shall restrict charges for those services to that amount.

SB762,46,23 (4) Billing by entity. If 2 or more licensees form an entity for the practice of spinal medicine, the entity may not render a single bill for health care services provided in the name of the entity unless each individual licensed, registered, or certified under this chapter or ch. 446, 449, 450, 455, 457, or 459, who provides services is individually identified on the bill as having rendered those services.

SB762,47,3 448.976 Disciplinary proceedings and actions. (1) In this section, "unprofessional conduct" means an act or attempted act of commission or omission, as defined by the affiliated credentialing board by rule, or an act by a primary spinal care practitioner otherwise in violation of this subchapter or in violation of ch. 446, 450, or 961.

SB762,47,10 (2) Investigation; hearing; action. (a) 1. The affiliated credentialing board shall investigate allegations of unprofessional conduct and negligence in the practice of spinal medicine. The affiliated credentialing board shall refer an allegation of a violation of ch. 446 to the chiropractic examining board for investigation, unless the alleged conduct also involves a violation of this subchapter or ch. 450 or 961, in which case the affiliated credentialing board and the chiropractic examining board shall consult concerning the investigation.

SB762,47,13 2. The affiliated credentialing board shall investigate information contained in reports filed with the affiliated credentialing board under s. 49.45 (2) (a) 12r., 50.36 (3) (b), 609.17, or 632.715, or under 42 CFR 1001.2005.

SB762,47,16 3. The affiliated credentialing board may use information contained in a report filed with the affiliated credentialing board under s. 50.36 (3) (c) as the basis of an investigation of a person named in the report.

SB762,47,21 4. The affiliated credentialing board may require a person to undergo and may consider the results of a physical, mental, or professional competency examination if the affiliated credentialing board believes that the results of the examination may be useful to the affiliated credentialing board in conducting an investigation under this paragraph.

SB762,47,25 (b) 1. After an investigation, if the affiliated credentialing board finds that there is probable cause to believe that a person is guilty of unprofessional conduct or negligence in the practice of spinal medicine, the affiliated credentialing board shall hold a hearing.

SB762,48,5 2. The affiliated credentialing board may require a person to undergo and may consider the results of a physical, mental, or professional competency examination if the affiliated credentialing board believes that the results of the examination may be useful to the affiliated credentialing board in conducting a hearing under subd. 1.

SB762,48,9 3. A finding by a court that a person has acted negligently in the practice of spinal medicine is conclusive evidence that the person is guilty of that negligence. A certified copy of the order of a court is presumptive evidence that the finding of negligence was made.

SB762,48,13 4. The affiliated credentialing board shall render a decision within 90 days after the date on which a hearing is held under subd. 1. or, if subsequent proceedings are conducted under s. 227.46 (2), within 90 days after the date on which those proceedings are completed.

SB762,48,19 (c) 1. After a disciplinary hearing under par. (b), the affiliated credentialing board may, when it determines that a court has found that a person has been negligent in the practice of spinal medicine or when it finds a person guilty of unprofessional conduct or negligence in the practice of spinal medicine, warn or reprimand that person, or limit, suspend, or revoke the person's license granted by the affiliated credentialing board.

SB762,48,25 2. The affiliated credentialing board may condition the removal of limitations on a license, or the restoration of a suspended or revoked license, upon obtaining minimum results specified by the affiliated credentialing board on a physical, mental, or professional competency examination if the affiliated credentialing board believes that obtaining the minimum results is related to correcting one or more of the bases upon which the limitation, suspension, or revocation was imposed.

SB762,49,2 (d) A person whose license under this subchapter is limited shall be permitted to continue practice if the he or she agrees to do all of the following:

SB762,49,3 1. Refrain from engaging in unprofessional conduct.

SB762,49,5 2. Appear before the affiliated credentialing board or its officers or agents at such times and places designated by the affiliated credentialing board.

SB762,49,7 3. Fully disclose to the affiliated credentialing board or its officers or agents the nature of the person's practice and conduct.

SB762,49,9 4. Fully comply with the limits placed on the person's practice and conduct by the affiliated credentialing board.

SB762,49,11 5. Obtain additional training, education or supervision required by the affiliated credentialing board.

SB762,49,12 6. Cooperate with the affiliated credentialing board.

SB762,49,17 (e) Unless a suspended license is revoked during the period of suspension, upon expiration of the period of suspension the affiliated credentialing board shall reinstate the person's license, except that the affiliated credentialing board may, as a condition precedent to the reinstatement of the license, require the person to pass any examination required for the original grant of the license.

SB762,49,20 (f) The affiliated credentialing board shall comply with rules of procedure for the investigation, hearing, and action promulgated by the department under s. 440.03 (1).

SB762,50,3 (3) Suspension pending hearing. (a) The affiliated credentialing board may summarily suspend a license granted by the affiliated credentialing board for a period not to exceed 30 days pending hearing if the affiliated credentialing board has in its possession evidence establishing probable cause to believe that the licensee has violated the provisions of this subchapter and that it is necessary to suspend the license immediately to protect the public health, safety, or welfare. The licensee shall be granted an opportunity to be heard before the affiliated credentialing board decides whether probable cause exists.

SB762,50,6 (b) The affiliated credentialing board may designate any of its officers to exercise the authority to suspend summarily a license, for a period not exceeding 72 hours.

SB762,50,12 (c) If a license has been summarily suspended under par. (a) or (b), the affiliated credentialing board may, while the hearing is in progress, extend the initial period of suspension for not more than an additional 30 days, except that if the licensee has caused a delay in the hearing process, the affiliated credentialing board may suspend the license from the time the hearing is commenced until a final decision is issued or may delegate such authority to the hearing examiner.

SB762,50,14 (4) Voluntary surrender. The affiliated credentialing board may negotiate stipulations in consideration for accepting the surrender of a license under s. 440.19.

SB762,50,17 (5) Restoration of a license. The affiliated credentialing board may restore a license that has been voluntarily surrendered or revoked on such terms and conditions as it considers appropriate.

SB762,50,24 448.9765 Hospital reports. (1) Within 30 days after receipt of a report under s. 50.36 (3) (c), the affiliated credentialing board shall notify the licensee, in writing, of the substance of the report. The licensee and the licensee's authorized representative may examine the report and may place into the record a statement, of reasonable length, of the licensee's view of the correctness or relevance of any information in the report. The licensee may institute an action in circuit court to amend or expunge any part of the licensee's record related to the report.

SB762,51,6 (2) If the affiliated credentialing board determines that a report submitted under s. 50.36 (3) (c) is without merit or that the licensee has sufficiently improved his or her conduct, the affiliated credentialing board shall remove the report from the licensee's record. If no report about a licensee is filed under s. 50.36 (3) (c) for 2 consecutive years, the licensee may petition the affiliated credentialing board to remove any prior reports not resulting in disciplinary action from his or her record.

SB762,51,7 (3) (a) In this subsection, "hospital" has the meaning specified in s. 50.33 (2).

SB762,51,12 (b) Upon the request of a hospital, the affiliated credentialing board shall provide the hospital with all information relating to a licensee's loss, reduction, or suspension of staff privileges from other hospitals and all information relating to the licensee's being found guilty of unprofessional conduct or negligence in the practice of chiropractic medicine under s. 448.976.

SB762,51,18 448.977 Injunctive relief. If the affiliated credentialing board has reason to believe that a person is violating this subchapter or a rule promulgated under this subchapter, the affiliated credentialing board, the department, the attorney general, or the district attorney of the proper county may investigate and may, in addition to all other remedies, bring an action in the name and on behalf of this state to enjoin the person from the violation.

SB762,51,19 448.9775 Penalties; appeal.

SB762,51,22 (1) Penalties. (a) Except as provided in par. (b), a person who violates a provision of this subchapter or a rule promulgated under this subchapter may be fined not more than $10,000 or imprisoned for not more than 9 months or both.

SB762,51,23 (b) A person who violates s. 448.9755 (3) may be fined not more than $250.

SB762,52,3 (2) Appeal. A person aggrieved by an action taken under this subchapter by the affiliated credentialing board, its officers, or its agents may apply for judicial review as provided in ch. 227, and shall file notice of such appeal with the affiliated credentialing board within 30 days. No court of this state may enter an ex parte stay of an action taken by the affiliated credentialing board under this subchapter.

SB762,52,6 448.978 Rules. The affiliated credentialing board shall promulgate rules defining the acts or attempted acts of commission or omission that constitute unprofessional conduct under s. 448.976 (1).

SB762,52,15 448.9785 Informed consent. Any primary spinal care practitioner who treats a patient shall inform the patient about the availability of reasonable alternate modes of treatment and about the benefits and risks of these treatments. The reasonable primary spinal care practitioner standard is the standard for informing a patient under this section. The reasonable primary spinal care practitioner standard requires disclosure only of information that a reasonable primary spinal care practitioner would know and disclose under the circumstances. The primary spinal care practitioner's duty to inform the patient under this section does not require disclosure of any of the following:

SB762,52,17 (1) Detailed technical information that in all probability a patient would not understand.

SB762,52,18 (2) Risks apparent or known to the patient.

SB762,52,20 (3) Extremely remote possibilities that might falsely or detrimentally alarm the patient.

SB762,52,22 (4) Information in emergencies where failure to provide treatment would be more harmful to the patient than treatment.

SB762,52,23 (5) Information in cases where the patient is incapable of consenting.

SB762,53,3 (6) Information about alternate modes of treatment for any condition the primary spinal care practitioner has not included in his or her diagnosis at the time the primary spinal care practitioner informs the patient.

SB762,91 Section 91. Subchapter VIII of chapter 448 [precedes 448.980] of the statutes, as created by 2015 Wisconsin Act 116, is renumbered subchapter IX of chapter 448 [precedes 448.980].

SB762,92 Section 92. 450.10 (3) (a) 5. of the statutes is amended to read:

SB762,53,10 450.10 (3) (a) 5. A physician, physician assistant, podiatrist, primary spinal care practitioner, physical therapist, physical therapist assistant, occupational therapist, or occupational therapy assistant licensed under ch. 448.

SB762,93 Section 93. 450.11 (8) (f) of the statutes is created to read:

SB762,53,13 450.11 (8) (f) The spinal medicine affiliated credentialing board, insofar as this section applies to primary spinal care practitioners.

SB762,94 Section 94. 454.02 (2) (a) of the statutes is amended to read:

SB762,53,18 454.02 (2) (a) Services performed by a person licensed, certified or registered under the laws of this state as a physician, physician assistant, podiatrist, primary spinal care practitioner, physical therapist, nurse or funeral director if those services are within the scope of the license, certificate or registration.

SB762,95 Section 95. 462.02 (2) (g) of the statutes is created to read:

SB762,53,23 462.02 (2) (g) A primary spinal care practitioner licensed under s. 448.9725 or a person under the direct supervision of such a primary spinal care practitioner, if the person has successfully completed a course of instruction approved by the chiropractic examining board related to X-ray examinations.

SB762,96 Section 96. 462.04 of the statutes is amended to read:

SB762,54,8 462.04 Prescription or order required. A person who holds a license or limited X-ray machine operator permit under this chapter may not use diagnostic X-ray equipment on humans for diagnostic purposes unless authorized to do so by prescription or order of a physician licensed under s. 448.04 (1) (a), a dentist licensed under s. 447.04 (1), a podiatrist licensed under s. 448.63, a primary spinal care practitioner licensed under s. 448.9725, a chiropractor licensed under s. 446.02, an advanced practice nurse certified under s. 441.16 (2), or a physician assistant licensed under s. 448.04 (1) (f).

SB762,97 Section 97. 600.03 (38s) of the statutes is created to read:

SB762,54,11 600.03 (38s) "Primary spinal care practitioner" has the meaning given in s. 448.971 (4).

SB762,98 Section 98. 600.03 (41s) of the statutes is created to read:

SB762,54,13 600.03 (41s) "Spinal medicine" has the meaning given in s. 448.971 (5).

SB762,99 Section 99. 609.70 (title) of the statutes is amended to read:

SB762,54,15 609.70 (title) Chiropractic and spinal medicine coverage.

SB762,100 Section 100. 628.46 (2m) (a) of the statutes is amended to read:

SB762,54,23 628.46 (2m) (a) Notwithstanding subs. (1) and (2) and except as provided in par. (b), a claim for payment for chiropractic or spinal medicine services is overdue if not paid within 30 days after the insurer receives clinical documentation from the chiropractor or primary spinal care practitioner that the services were provided unless, within those 30 days, the insurer provides to the insured and to the chiropractor or primary spinal care practitioner the written statement under s. 632.875 (2).

SB762,101 Section 101. 632.32 (2) (am) of the statutes is amended to read:

SB762,55,4 632.32 (2) (am) "Medical payments coverage" means coverage to indemnify for medical payments or chiropractic payments or both for the protection of all persons using the insured motor vehicle from losses resulting from bodily injury or death. "Medical payments coverage" includes coverage for spinal medicine.

SB762,102 Section 102. 632.64 of the statutes is amended to read:

SB762,55,16 632.64 Certification of disability. For the purpose of insurance policies that they issue, insurers doing a life insurance business in this state shall afford equal weight to a certification of disability signed by a physician with respect to matters within the scope of the physician's professional license, to a certification of disability signed by a chiropractor with respect to matters within the scope of the chiropractor's professional license, and to a certification of disability signed by a podiatrist with respect to matters within the scope of the podiatrist's professional license, and to a certification of a disability signed by a primary spinal care practitioner with respect to matters within the scope of the primary spinal care pratitioner's professional license. This section does not require an insurer to treat a certificate of disability as conclusive evidence of disability.

SB762,103 Section 103. 632.87 (3) (a) (intro.) of the statutes is amended to read:

SB762,56,2 632.87 (3) (a) (intro.) No policy, plan or contract may exclude coverage for diagnosis and treatment of a condition or complaint by a licensed chiropractor or licensed primary spinal care practitioner within the scope of the chiropractor's his or her professional license, if the policy, plan or contract covers diagnosis and treatment of the condition or complaint by a licensed physician or osteopath, even if different nomenclature is used to describe the condition or complaint. Examination by or referral from a physician shall not be a condition precedent for receipt of chiropractic or spinal medicine care under this paragraph. This paragraph does not: