SB762: Bill Text

LRB-3787/1

MPG:cjs&ahe

2015 - 2016 LEGISLATURE

2015 Senate BILL 762

February 23, 2016 - Introduced by Senators Lasee and Carpenter, cosponsored by Representatives Sanfelippo, Murphy, Rohrkaste, Skowronski and Considine. Referred to Committee on Health and Human Services.

SB762,2,17 An Act to renumber 446.05 (1) and subchapter VIII of chapter 448 [precedes 448.980]; to amend 15.085 (1m) (b), 15.406 (4) (a), 29.193 (1m) (a) 2. (intro.), 29.193 (2) (b) 2., 29.193 (2) (c) 3., 29.193 (2) (cd) 2. b., 29.193 (2) (cd) 2. c., 29.193 (2) (e), 45.40 (1g) (a), 49.45 (9), 50.36 (3) (a), 50.36 (3) (b), 50.36 (3) (c), 50.39 (3), 77.54 (14) (b), 77.54 (14) (c), 77.54 (14) (d), 77.54 (14) (f) 7., 102.13 (1) (a), 102.13 (1) (b) (intro.), 102.13 (1) (b) 1., 102.13 (1) (b) 3., 102.13 (1) (b) 4., 102.13 (1) (d) 1., 102.13 (1) (d) 2., 102.13 (1) (d) 3., 102.13 (1) (d) 4., 102.13 (2) (a), 102.13 (2) (b), 102.13 (3), 102.16 (3), 102.17 (1) (d) 1., 102.17 (1) (d) 2., 102.17 (1) (e), 102.17 (1) (g), 102.29 (3), 102.42 (1), 102.42 (2) (a), 102.61 (1g) (c), 118.15 (3) (a), 118.29 (1) (e), 146.37 (1g), 146.89 (1) (r) 1., 146.903 (1) (b), 146.997 (1) (d) 4., 155.01 (7), 185.981 (1), 185.981 (2), 185.981 (3), 185.981 (4) (a), 185.982 (1), 185.982 (2), 254.35 (3) (c), 254.39 (1), 255.06 (1) (d), 257.01 (5) (a), 257.01 (5) (b), 287.07 (7) (c) 1. a., 341.14 (1a), 341.14 (1e) (a), 341.14 (1m), 341.14 (1q), 343.51 (1), 343.62 (4) (a) 4., 441.001 (3) (a), 441.001 (4) (b), 446.02 (6m), 446.026 (1) (a), 448.03 (2) (a), 448.52 (2m) (a), 448.52 (2m) (b), 448.56 (1), 448.56 (1m) (b), 448.956 (1m), 448.956 (3) (c), 448.956 (4), 450.10 (3) (a) 5., 454.02 (2) (a), 462.04, 609.70 (title), 628.46 (2m) (a), 632.32 (2) (am), 632.64, 632.87 (3) (a) (intro.), 632.87 (3) (a) 1., 632.87 (3) (a) 2., 632.87 (3) (b) (intro.), 632.87 (3) (b) 1., 632.87 (3) (b) 2., 632.87 (3) (b) 3., 632.87 (3) (b) 4., 632.875 (1) (b), 632.875 (1) (c), 632.875 (2) (intro.), 632.875 (2) (b), 632.875 (3) (a), 632.875 (3) (b), 632.99, 655.45 (1), 895.453 (title), 895.453 (2) (intro.), 895.453 (2) (b), 895.453 (2) (e), 895.453 (3), 895.453 (4) (a), 895.453 (4) (b), 895.48 (1m) (a) (intro.), 895.48 (1m) (a) 2., 905.04 (title), 905.04 (1) (b), 905.04 (1) (c), 905.04 (2), 905.04 (3), 905.04 (4) (a), 905.04 (4) (e) 3., 949.01 (4), 949.04 (3) and 961.01 (19) (a); and to create 15.406 (7), 48.981 (2) (a) 6m., 49.46 (2) (b) 11m., 77.54 (14) (f) 7m., 146.81 (1) (ev), 180.1901 (1m) (bw), 252.14 (1) (ar) 4r., 440.03 (13) (b) 53s., 440.08 (2) (a) 60s., 446.02 (7d) (d), 446.05 (1) (b), 448.21 (1) (f), subchapter VIII of chapter 448 [precedes 448.971], 450.11 (8) (f), 462.02 (2) (g), 600.03 (38s), 600.03 (41s), 632.875 (1) (bm), 632.875 (1) (dm), 895.453 (1) (am), 895.453 (1) (cm) and 905.04 (1) (bd) of the statutes; relating to: licensure of primary spinal care practitioners, granting rule-making authority, and providing a criminal penalty.

Analysis by the Legislative Reference Bureau

This bill establishes a licensure program for primary spinal care practitioners to be administered by the Spinal Medicine Affiliated Credentialing Board, which is created in the bill and attached to the Medical Examining Board. The affiliated credentialing board consists of three primary spinal care practitioners, one physician licensed by the Medical Examining Board, and one public member, all of whom serve staggered four-year terms.

Under the bill, a primary spinal care practitioner is an individual who possesses the degree of doctor of chiropractic medicine or equivalent degree as determined by the affiliated credentialing board. The bill defines "spinal medicine" in relevant part as the integration and application of the practice of chiropractic and the practice of medicine and surgery, both as defined under current law, that is limited to conditions of the spine and the musculoskeletal, neuromuscular, and nervous systems. The practice of spinal medicine does not include surgery or, unless under the direction of a physician, the administration of a general anesthetic.

Under the bill, and subject to certain exceptions, a person may practice spinal medicine in Wisconsin only if he or she is licensed by the affiliated credentialing board as a primary spinal care practitioner. The affiliated credentialing board may grant a license to practice spinal medicine to an applicant who, among other things, has practiced as a licensed chiropractor in good standing with the Chiropractic Examining Board for at least two years and has a degree of doctor of spinal medicine or equivalent degree from a program in chiropractic medicine approved by the affiliated credentialing board. A licensed primary spinal care practitioner must keep current his or her chiropractor license with the Chiropractic Examining Board.

The bill requires the affiliated credentialing board to establish continuing education requirements for licensed primary spinal care practitioners and authorizes up to 80 percent of those hours to count toward the continuing education requirements for a chiropractor license held with the Chiropractic Examining Board. The bill requires at least 50 percent of those hours to include evidence-based pharmacology and medical procedures-based training. Under the bill, a licensed primary spinal care practitioner has authority to prescribe and administer prescription drugs.

The bill requires primary spinal care practitioners to maintain specific levels of malpractice liability insurance coverage and establishes various requirements with respect to fee splitting and billing for services. Those malpractice insurance, fee splitting, and billing requirements, as well as other requirements in the bill, are substantially similar to the requirements for podiatrists under current law.

The bill also treats primary spinal care practitioners similar to chiropractors in some respects. For example, the bill requires primary spinal care practitioners to refer a patient to a physician if the primary spinal care practitioner determines that the patient's condition is beyond the scope of the practice of spinal medicine. Also, the bill includes insurance coverage parity requirements that closely track the coverage requirements for treatment provided by chiropractors.

The bill requires the affiliated credentialing board and the Chiropractic Examining Board each to refer to the other board for investigation an allegation of a violation by a primary spinal care practitioner of the laws administered by that other board. If the alleged conduct involves a violation both of the laws applicable to primary spinal care practitioners and of the laws applicable to chiropractors, the bill requires the two boards to consult concerning the investigation of that alleged conduct. Otherwise, the affiliated credentialing board's authority to investigate misconduct and discipline licensed primary spinal care practitioners is typical of that for other similar boards, especially the Podiatry Affiliated Credentialing Board.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB762,1 Section 1. 15.085 (1m) (b) of the statutes is amended to read:

SB762,4,5 15.085 (1m) (b) The public members of the podiatry affiliated credentialing board, spinal medicine affiliated credentialing board, or occupational therapists affiliated credentialing board shall not be engaged in any profession or occupation concerned with the delivery of physical or mental health care.

SB762,2 Section 2. 15.406 (4) (a) of the statutes is amended to read:

SB762,4,10 15.406 (4) (a) Four athletic trainers who are licensed under subch. VI of ch. 448 and who have not been issued a credential in athletic training by a governmental authority in a jurisdiction outside this state. One of the athletic trainer members may also be licensed under ch. 446 or 447 or subch. II, III or, IV, or VIII of ch. 448.

SB762,3 Section 3. 15.406 (7) of the statutes is created to read:

SB762,4,15 15.406 (7) Spinal medicine affiliated credentialing board. There is created in the department of safety and professional services, attached to the medical examining board, a spinal medicine affiliated credentialing board consisting of the following members appointed for 4-year terms:

SB762,4,17 (a) Three primary spinal care practitioners who are licensed under subch. VIII of ch. 448.

SB762,4,18 (b) A physician, as defined in s. 448.01 (5).

SB762,4,19 (c) One public member.

SB762,4 Section 4. 29.193 (1m) (a) 2. (intro.) of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,5,5 29.193 (1m) (a) 2. (intro.) Has a permanent substantial loss of function in one or both arms or one or both hands and fails to meet the minimum standards of any one of the following standard tests, administered under the direction of a licensed physician, a licensed physician assistant, a licensed primary spinal care practitioner, a licensed chiropractor, or a certified advanced practice nurse prescriber:

SB762,5 Section 5. 29.193 (2) (b) 2. of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,5,14 29.193 (2) (b) 2. An applicant shall submit an application on a form prepared and furnished by the department, which shall include a written statement or report prepared and signed by a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, a licensed primary spinal care practitioner, or a certified advanced practice nurse prescriber prepared no more than 6 months preceding the application and verifying that the applicant is physically disabled.

SB762,6 Section 6. 29.193 (2) (c) 3. of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,6,3 29.193 (2) (c) 3. The department may issue a Class B permit to an applicant who is ineligible for a permit under subd. 1., 2. or 2m. or who is denied a permit under subd. 1., 2. or 2m. if, upon review and after considering the physical condition of the applicant and the recommendation of a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, a licensed primary spinal care practitioner, or a certified advanced practice nurse prescriber selected by the applicant from a list of licensed physicians, licensed physician assistants, licensed chiropractors, licensed podiatrists, licensed primary spinal care practitioners, and certified advanced practice nurse prescribers compiled by the department, the department finds that issuance of a permit complies with the intent of this subsection. The use of this review procedure is discretionary with the department and all costs of the review procedure shall be paid by the applicant.

SB762,7 Section 7. 29.193 (2) (cd) 2. b. of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,6,11 29.193 (2) (cd) 2. b. The person has a permanent substantial loss of function in one or both arms and fails to meet the minimum standards of the standard upper extremity pinch test, the standard grip test, or the standard nine-hole peg test, administered under the direction of a licensed physician, a licensed primary spinal care practitioner, a licensed physician assistant, a licensed chiropractor, or a certified advanced practice nurse prescriber.

SB762,8 Section 8. 29.193 (2) (cd) 2. c. of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,6,18 29.193 (2) (cd) 2. c. The person has a permanent substantial loss of function in one or both shoulders and fails to meet the minimum standards of the standard shoulder strength test, administered under the direction of a licensed physician, a licensed primary spinal care practitioner, a licensed physician assistant, a licensed chiropractor, or a certified advanced practice nurse prescriber.

SB762,9 Section 9. 29.193 (2) (e) of the statutes, as affected by 2015 Wisconsin Act 97, is amended to read:

SB762,7,5 29.193 (2) (e) Review of decisions. An applicant denied a permit under this subsection, except a permit under par. (c) 3., may obtain a review of that decision by a licensed physician, a licensed physician assistant, a licensed chiropractor, a licensed podiatrist, a licensed primary spinal care practitioner, or a certified advanced practice nurse prescriber designated by the department and with an office located in the department district in which the applicant resides. The department shall pay for the cost of a review under this paragraph unless the denied application on its face fails to meet the standards set forth in par. (c) 1. or 2. A review under this paragraph is the only method of review of a decision to deny a permit under this subsection and is not subject to further review under ch. 227.

SB762,10 Section 10. 45.40 (1g) (a) of the statutes is amended to read:

SB762,7,11 45.40 (1g) (a) "Health care provider" means an advanced practice nurse prescriber certified under s. 441.16 (2), an audiologist licensed under ch. 459, a dentist licensed under ch. 447, an optometrist licensed under ch. 449, a physician licensed under s. 448.02, or a podiatrist licensed under s. 448.63, or a primary spinal care practitioner licensed under s. 448.9725.

SB762,11 Section 11. 48.981 (2) (a) 6m. of the statutes is created to read:

SB762,7,13 48.981 (2) (a) 6m. A primary spinal care practitioner.

SB762,12 Section 12. 49.45 (9) of the statutes is amended to read:

SB762,8,16 49.45 (9) Free choice. Any person eligible for medical assistance under s. 49.46, 49.468, 49.47, or 49.471 may use the physician, chiropractor, dentist, pharmacist, podiatrist, primary spinal care practitioner, hospital, skilled nursing home, health maintenance organization, limited service health organization, preferred provider plan or other licensed, registered or certified provider of health care of his or her choice, except that free choice of a provider may be limited by the department if the department's alternate arrangements are economical and the recipient has reasonable access to health care of adequate quality. The department may also require a recipient to designate, in any or all categories of health care providers, a primary health care provider of his or her choice. After such a designation is made, the recipient may not receive services from other health care providers in the same category as the primary health care provider unless such service is rendered in an emergency or through written referral by the primary health care provider. Alternate designations by the recipient may be made in accordance with guidelines established by the department. Nothing in this subsection shall vitiate the legal responsibility of the physician, chiropractor, dentist, pharmacist, podiatrist, primary spinal care practitioner, skilled nursing home, hospital, health maintenance organization, limited service health organization, preferred provider plan or other licensed, registered or certified provider of health care to patients. All contract and tort relationships with patients shall remain, notwithstanding a written referral under this section, as though dealings are direct between the physician, chiropractor, dentist, pharmacist, podiatrist, primary spinal care practitioner, skilled nursing home, hospital, health maintenance organization, limited service health organization, preferred provider plan or other licensed, registered or certified provider of health care and the patient. No physician, chiropractor, pharmacist, podiatrist, primary spinal care practitioner, or dentist may be required to practice exclusively in the medical assistance program.

SB762,13 Section 13. 49.46 (2) (b) 11m. of the statutes is created to read:

SB762,8,18 49.46 (2) (b) 11m. The services of primary spinal care practitioners.

SB762,14 Section 14. 50.36 (3) (a) of the statutes is amended to read:

SB762,9,3 50.36 (3) (a) Any person licensed to practice medicine and surgery under subch. II of ch. 448 or, podiatry under subch. IV of ch. 448, or spinal medicine under subch. VIII of ch. 448 shall be afforded an equal opportunity to obtain hospital staff privileges and may not be denied hospital staff privileges solely for the reason that the person is an osteopathic physician and surgeon or , a podiatrist, or a primary spinal care practitioner. Each individual hospital shall retain the right to determine whether the applicant's training, experience and demonstrated competence is sufficient to justify the granting of hospital staff privileges or is sufficient to justify the granting of limited hospital staff privileges.

SB762,15 Section 15. 50.36 (3) (b) of the statutes is amended to read:

SB762,9,13 50.36 (3) (b) If, as a result of peer investigation or written notice thereof, a hospital staff member who is licensed by the medical examining board or, podiatry affiliated credentialing board, or spinal medicine affiliated credentialing board, for any reasons that include the quality of or ability to practice, loses his or her hospital staff privileges, has his or her hospital staff privileges reduced or resigns from the hospital staff, the hospital shall so notify the medical examining board or, podiatry affiliated credentialing board, or spinal medicine affiliated credentialing board, whichever is applicable, within 30 days after the loss, reduction or resignation takes effect. Temporary suspension due to incomplete records need not be reported.

SB762,16 Section 16. 50.36 (3) (c) of the statutes is amended to read:

SB762,9,24 50.36 (3) (c) If, as a result of peer investigation or written notice thereof, a hospital staff member who is licensed by the medical examining board or, podiatry affiliated credentialing board, or spinal medicine affiliated credentialing board, for reasons that do not include the quality of or ability to practice, loses his or her hospital staff privileges for 30 days or more, has his or her hospital staff privileges reduced for 30 days or more or resigns from the hospital staff for 30 days or more, the hospital shall so notify the medical examining board or , podiatry affiliated credentialing board, or spinal medicine affiliated credentialing board, whichever is applicable, within 30 days after the loss, reduction or resignation takes effect. Temporary suspension due to incomplete records need not be reported.

SB762,17 Section 17. 50.39 (3) of the statutes is amended to read:

SB762,10,10 50.39 (3) Facilities governed by ss. 45.50, 48.62, 49.70, 49.72, 50.02, 51.09, and 252.10, juvenile correctional facilities as defined in s. 938.02 (10p), correctional institutions governed by the department of corrections under s. 301.02, and the offices and clinics of persons licensed to treat the sick under chs. 446, 447, and 448 are exempt from ss. 50.32 to 50.39. Sections 50.32 to 50.39 do not abridge the rights of the medical examining board, physical therapy examining board, podiatry affiliated credentialing board, spinal medicine affiliated credentialing board, dentistry examining board, pharmacy examining board, chiropractic examining board, and board of nursing in carrying out their statutory duties and responsibilities.

SB762,18 Section 18. 77.54 (14) (b) of the statutes is amended to read:

SB762,10,14 77.54 (14) (b) Furnished by a licensed physician, surgeon, podiatrist, primary spinal care practitioner, or dentist to a patient who is a human being for treatment of the patient.

SB762,19 Section 19. 77.54 (14) (c) of the statutes is amended to read:

SB762,10,18 77.54 (14) (c) Furnished by a hospital for treatment of any person pursuant to the order of a licensed physician, surgeon, podiatrist, primary spinal care practitioner, or dentist.

SB762,20 Section 20. 77.54 (14) (d) of the statutes is amended to read:

SB762,10,21 77.54 (14) (d) Sold to a licensed physician, surgeon, podiatrist, primary spinal care practitioner, dentist, or hospital for the treatment of a human being.

SB762,21 Section 21. 77.54 (14) (f) 7. of the statutes is amended to read:

SB762,10,23 77.54 (14) (f) 7. A podiatrist who is licensed under subch. IV of ch. 448.