SB665,22,924
102.18
(1) (bg) 1. If the division finds under par. (b) that an insurer or
25self-insured employer is liable under this chapter for any health services provided
1to an injured employee by a health service provider, but that the reasonableness of
2the fee charged by the health service provider is in dispute, the division may include
3in its order under par. (b) a determination made by the department under s. 102.16
4(2) as to the reasonableness of the fee or, if such a determination has not yet been
5made, the division may notify, or direct the insurer or self-insured employer to notify,
6the health service provider under s. 102.16 (2) (b) that the reasonableness of the fee
7is in dispute.
This subdivision does not apply to a health service provided to an
8injured employee beginning on the date on which the notice under s. 102.423 (1) (a)
9is published in the Wisconsin Administrative Register.
SB665,38
10Section
38. 102.18 (1) (bp) of the statutes is amended to read:
SB665,23,211
102.18
(1) (bp) If the
department or the division determines that the employer
12or insurance carrier suspended, terminated, or failed to make payments or failed to
13report an injury as a result of malice or bad faith, the
department or the division may
14include a penalty in an award to an employee for each event or occurrence of malice
15or bad faith. That penalty is the exclusive remedy against an employer or insurance
16carrier for malice or bad faith. If the penalty is imposed for an event or occurrence
17of malice or bad faith that causes a payment that is due an injured employee to be
18delayed in violation of s. 102.22 (1) or overdue in violation of s. 628.46 (1), the
19department or the division may not also order an increased payment under s. 102.22
20(1) or the payment of interest under s. 628.46 (1). The
department or the division may
21award an amount that the
department or the division considers just, not to exceed
22the lesser of 200 percent of total compensation due or $30,000 for each event or
23occurrence of malice or bad faith. The
department or the division may assess the
24penalty against the employer, the insurance carrier, or both. Neither the employer
25nor the insurance carrier is liable to reimburse the other for the penalty amount. The
1division department may, by rule, define actions that demonstrate malice or bad
2faith.
SB665,39
3Section
39. 102.18 (2) (a) of the statutes is amended to read:
SB665,23,64
102.18
(2) (a) The department shall have and maintain on its staff such
5examiners as are necessary to hear and decide claims for compensation described in
6s. 102.16 (1) (b)
1. and to assist in the effective administration of this chapter.
SB665,40
7Section
40. 102.18 (5) of the statutes is amended to read:
SB665,23,208
102.18
(5) If it appears to the
department or the division that a mistake may
9have been made as to cause of injury in the findings, order, or award upon an alleged
10injury based on accident, when in fact the employee was suffering from an
11occupational disease, within 3 years after the date of the findings, order, or award
12the
department or the division may, upon its own motion, with or without hearing,
13set aside the findings, order
, or award, or the
department or the division may take
14that action upon application made within those 3 years. After an opportunity for
15hearing, the division may, if in fact the employee is suffering from disease arising out
16of the employment, make new findings, and a new order or award, or the division may
17reinstate the previous findings, order, or award.
The department may, if in fact the
18employee is suffering from disease arising out of the employment, make new
19findings, and a new order or award, or the department may reinstate the previous
20findings, order, or award when no hearing is requested.
SB665,41
21Section
41. 102.18 (6) of the statutes is amended to read:
SB665,24,222
102.18
(6) In case of disease arising out of employment, the
department or the 23division may from time to time review its findings, order, or award, and make new
24findings, or a new order or award, based on the facts regarding disability or otherwise
1as those facts may appear at the time of the review. This subsection shall not affect
2the application of the limitation in s. 102.17 (4).
SB665,42
3Section
42. 102.33 (1m) of the statutes is created to read:
SB665,24,84
102.33
(1m) Each employer shall post, in each workplace, a notice in a form
5approved by the department setting forth employees' rights under this chapter. The
6department shall, in conjunction with its activities under s. 102.14 (2m), include in
7the notice information to educate injured employees regarding opiate therapies,
8opiate addiction, and alternative treatments for pain.
SB665,43
9Section
43. 102.33 (2) (b) 7. of the statutes is created to read:
SB665,24,1510
102.33
(2) (b) 7. The requester is the department of health services, a county
11department of social services under s. 46.215 or 46.22, or a county department of
12human services under s. 46.23, and the request is limited to the name and address
13of the employee who is the subject of the record, the name and address of the
14employee's employer, and any financial information about that employee contained
15in the record.
SB665,44
16Section
44. 102.39 of the statutes is repealed.
SB665,45
17Section
45. 102.423 of the statutes is created to read:
SB665,24,25
18102.423 Health service fee schedule. (1) Health service fee schedule.
19(a) By January 1, 2019, the department shall establish a schedule of the maximum
20fees that a health care provider may charge an employer or insurer for health
21services provided to an injured employee who claims benefits under this chapter.
22When that schedule is established, the department shall notify the legislative
23reference bureau and the legislative reference bureau shall publish that notice in the
24Wisconsin Administrative Register. For the health services in the schedule, the
25department shall do all of the following:
SB665,25,4
11. Based on sources obtained by the department, determine, to the extent
2possible, the average negotiated price made for group health benefit plans, as defined
3in s. 632.745 (9), group health plans, as defined in s. 632.745 (10), and self-insured
4health plans, as defined in s. 632.745 (24).
SB665,25,852. Determine the rates under the program under
42 USC 1395 et seq. for health
6services using the Medicare billing code system, including Current Procedural
7Terminology codes, as maintained by the American Medical Association, and
8Healthcare Common Procedural Coding System codes.
SB665,25,109
3. Set the maximum fee for each health service included in the schedule by
10doing all of the following:
SB665,25,1311
a. Using the rates for health services determined under subd. 2., determine as
12a percentage the average variance between those amounts and the amounts under
13subd. 1.
SB665,25,1514
b. Increase the rates for health services determined under subd. 2. by the
15percentage determined under subd. 3. a.
SB665,25,1716
c. Subject to subd. 4., increase the amounts determined under subd. 3. b. by 2.5
17percent for administrative costs.
SB665,26,518
4. Prior to the date on which the notice is published in the Wisconsin
19Administrative Register under this paragraph, one or more health care providers
20may petition the department to hold a public hearing to gather information to be used
21to determine if the increase under subd. 3. c. for administrative costs is sufficient to
22pay for the unique administrative costs incurred in treating worker's compensation
23patients as compared to patients whose bills are paid by other means. If the
24department determines, based on the request and information gathered and
25submitted, that the percentage increase under subd. 3. c. for unique administrative
1costs is generally insufficient to pay for the unique administrative costs incurred by
2health care providers for treating worker's compensation patients, the department
3shall establish and apply an alternative increase for the unique administrative costs
4that is not more than 10 percent of the cost of the service as determined under subd.
53. b.
SB665,26,96
(b) 1. In this paragraph, “consumer price index" means the average of the
7consumer price index for medical care services over each 12-month period for all
8urban consumers, U.S. city average, as determined by the bureau of labor statistics
9of the federal department of labor.
SB665,26,1410
2. On each January 1, beginning with January 1, 2020, the department shall
11adjust the maximum fees established under par. (a) by the percentage difference
12between the consumer price index for the 12-month period ending on December 31
13of the preceding year and the consumer price index for the 12-month period ending
14on December 31 of the year before the preceding year.
SB665,26,1815
(c) No less often than every 10 years, the department shall obtain health service
16negotiated price data from the sources specified in par. (a) 1., redetermine the
17average negotiated prices specified in par. (a) 1., and revise the maximum fees
18established under par. (a) based on that redetermined average.
SB665,26,2019
(d) The department shall publish the fee schedule established under par. (a) on
20the department's Internet site.
SB665,26,25
21(2) Liability of employer or insurer. (a) The liability of an employer or insurer
22for a health service included in the fee schedule established under sub. (1) is limited
23to the maximum fee allowed under the schedule for that health service as of the date
24on which the health service was provided or the health care provider's actual fee for
25the health service as of that date, whichever is less.
SB665,27,4
1(b) A health care provider that provides health services to an injured employee
2under this chapter may not collect, or bring an action to collect, from the injured
3employee any charge that is in excess of the liability of the employer or insurer under
4this subsection.
SB665,27,75
(c) This subsection first applies to a health service provided to an injured
6employee on the date on which the notice under sub. (1) (a) is published in the
7Wisconsin Administrative Register.
SB665,27,9
8(3) Records. Records related to the collection of any information under sub.
9(1) (a) 1. are not subject to the right of inspection and copying under s. 19.35 (1).
SB665,27,10
10(4) Rules. The department shall promulgate rules to implement this section.
SB665,46
11Section
46. 102.425 (2m) of the statutes is created to read:
SB665,27,1312
102.425
(2m) Opiates and pain relief. (a) In this subsection, “opiate” has the
13meaning given in s. 961.01 (16).
SB665,27,1814
(b) No practitioner may dispense more than a 7-day supply of an opiate to treat
15an injury for which an employer or insurer is liable under this chapter.
16Notwithstanding s. 102.16 (2m) (c), a supply greater than a 7-day supply shall be
17considered to be unnecessary treatment for purposes of s. 102.16 (2m) without the
18need for a written opinion under s. 102.16 (2m) (c).
SB665,47
19Section
47. 102.427 of the statutes is created to read:
SB665,27,22
20102.427 Electronic billing. Any health service provider that provides care
21to an injured employee under this chapter shall use an electronic billing system and
22be able to receive payments electronically.
SB665,48
23Section
48. 102.44 (1) (ag) of the statutes is amended to read:
SB665,28,824
102.44
(1) (ag) Notwithstanding any other provision of this chapter, every
25employee who is receiving compensation under this chapter for permanent total
1disability or continuous temporary total disability more than 24 months after the
2date of injury resulting from an injury that occurred prior to January 1,
2003 2005,
3shall receive supplemental benefits that shall be payable by the employer or the
4employer's insurance carrier, or in the case of benefits payable to an employee under
5s. 102.66, shall be paid by the department out of the fund created under s. 102.65.
6Those supplemental benefits shall be paid only for weeks of disability occurring after
7January 1,
2005 2007, and shall continue during the period of such total disability
8subsequent to that date.
SB665,49
9Section
49. 102.44 (1) (am) of the statutes is amended to read:
SB665,28,1410
102.44
(1) (am) If the employee is receiving the maximum weekly benefits in
11effect at the time of the injury, the supplemental benefit for a week of disability
12occurring after
March 2, 2016 the effective date of this paragraph .... [LRB inserts
13date], shall be an amount that, when added to the regular benefit established for the
14case, shall equal
$669 $711.
SB665,50
15Section
50. 102.44 (1) (b) of the statutes is amended to read:
SB665,28,2116
102.44
(1) (b) If the employee is receiving a weekly benefit that is less than the
17maximum benefit that was in effect on the date of the injury, the supplemental
18benefit for a week of disability occurring after
March 2, 2016 the effective date of this
19paragraph .... [LRB inserts date], shall be an amount sufficient to bring the total
20weekly benefits to the same proportion of
$669
$711 as the employee's weekly benefit
21bears to the maximum in effect on the date of injury.
SB665,51
22Section
51. 102.44 (2) of the statutes is amended to read:
SB665,29,323
102.44
(2) In case of permanent total disability, aggregate indemnity shall be
24weekly indemnity for the period that the employee may live. Total impairment for
25industrial use of both eyes, the loss of both arms at or near the shoulder, the loss of
1both legs at or near the hip, or the loss of one arm at the shoulder and one leg at the
2hip constitutes permanent total disability. This enumeration is not exclusive, but in
3other cases the
department or the division shall find the facts.
SB665,52
4Section
52. 102.44 (6) (b) of the statutes is amended to read:
SB665,29,105
102.44
(6) (b) If during the period set forth in s. 102.17 (4) the employment
6relationship is terminated by the employer at the time of the injury or by the
7employee because his or her physical or mental limitations prevent his or her
8continuing in such employment, or if during that period a wage loss of 15 percent or
9more occurs, the
department or the division may reopen any award and make a
10redetermination taking into account loss of earning capacity.
SB665,53
11Section
53. 102.525 of the statutes is created to read:
SB665,29,15
12102.525 Additional payment for permanent partial disability. (1) If any
13of the following applies during the period set forth in s. 102.17 (4) with respect to an
14employee who sustains a disability specified under s. 102.52, the number of weeks
15for which indemnity shall be payable shall be increased by 15 percent:
SB665,29,1816
(a) The employment relationship is terminated by the employer at the time of
17the injury or by the employee because his or her physical or mental limitations
18prevent his or her continuing in the employment.
SB665,29,1919
(b) The percentage of wage loss during the period is 15 percent or more.
SB665,29,21
20(2) For the purpose of determining the percentage of wage loss under sub. (1)
21(b), all of the following apply:
SB665,29,2322
(a) Wage loss shall be determined based on wages as determined under s.
23102.11.
SB665,29,2524
(b) The percentage wage loss shall be determined using actual average wages
25over a period of at least 13 weeks following the employee's injury.
SB665,30,2
1(c) The determination of wage loss may not take into account any of the
2following:
SB665,30,43
1. Any period during which benefits are payable for temporary disability under
4s. 102.43 (5).
SB665,30,55
2. Any period during which the employee received benefits under ch. 108.
SB665,30,66
3. Any payments for permanent partial disability under s. 102.52.
SB665,30,10
7(3) For the purposes of sub. (1), if an employer makes a good faith offer of
8employment that is refused by the employee without just cause, the employee is
9considered to have returned to work at the amount of wages the employee would have
10received but for the employee's refusal of employment.
SB665,30,12
11(4) An increase under sub. (1) shall be applied after the application of any
12increase under s. 102.53 or 102.54.
SB665,54
13Section
54. 102.61 (2) of the statutes is amended to read:
SB665,30,2014
102.61
(2) The
department, the division, the commission, and the courts shall
15determine the rights and liabilities of the parties under this section in like manner
16and with like effect as the
department, the division, the commission, and the courts
17determine other issues under this chapter. A determination under this subsection
18may include a determination based on the evidence regarding the cost or scope of the
19services provided by a private rehabilitation counselor under sub. (1m) (a) or the cost
20or reasonableness of a rehabilitative training program developed under sub. (1m) (a).
SB665,55
21Section
55. 102.62 of the statutes is amended to read:
SB665,31,12
22102.62 Primary and secondary liability; unchangeable. In case of
23liability under s. 102.57 or 102.60, the liability of the employer shall be primary and
24the liability of the insurance carrier shall be secondary. If proceedings are had before
25the department or the division for the recovery of that liability,
the department or the
1division shall set forth in its award the amount and order of liability as provided in
2this section. Execution shall not be issued against the insurance carrier to satisfy
3any judgment covering that liability until execution has first been issued against the
4employer and has been returned unsatisfied as to any part of that liability. Any
5provision in any insurance policy undertaking to guarantee primary liability or to
6avoid secondary liability for a liability under s. 102.57 or 102.60 is void. If the
7employer has been adjudged bankrupt or has made an assignment for the benefit of
8creditors, if the employer, other than an individual, has gone out of business or has
9been dissolved, or if the employer is a corporation and its charter has been forfeited
10or revoked, the insurer shall be liable for the payment of that liability without
11judgment or execution against the employer, but without altering the primary
12liability of the employer.
SB665,56
13Section
56. 102.75 (1m) of the statutes is amended to read:
SB665,31,1814
102.75
(1m) The moneys collected under subs. (1) and (1g) and under ss. 102.28
15(2) and 102.31 (7), together with all accrued interest, shall constitute a separate
16nonlapsible fund designated as the worker's compensation operations fund. Moneys
17in the fund may be expended only as provided in ss. 20.427 (1) (ra) and 20.445 (1) (ra),
18(rb),
(rc), and (rp) and may not be used for any other purpose of the state.
SB665,57
19Section
57. 102.80 (1) (d) of the statutes is amended to read:
SB665,31,2120
102.80
(1) (d) Amounts collected from employees or dependents of employees
21under s. 102.81 (4) (b)
and (c).
SB665,58
22Section
58. 102.81 (4) (b) (intro.) of the statutes is amended to read:
SB665,31,2523
102.81
(4) (b) (intro.) If the employee or dependent receives compensation from
24the employee's employer
or a 3rd party liable under s. 102.29, pay to the department
25the lesser of the following:
SB665,59
1Section
59. 102.81 (4) (b) 2. of the statutes is amended to read:
SB665,32,32
102.81
(4) (b) 2. The amount after attorney fees and costs that the employee
3or dependent received from the employer
or 3rd party.
SB665,60
4Section
60. 102.81 (4) (c) of the statutes is created to read:
SB665,32,75
102.81
(4) (c) If the employee or dependent receives compensation from a 3rd
6party that is liable under s. 102.29, pay to the department the proceeds as specified
7under s. 102.29 (1) (b).
SB665,61
8Section
61. 102.81 (5) of the statutes is amended to read:
SB665,32,109
102.81
(5) The department of justice may bring an action to collect
the a 10payment under sub. (4)
(b) or (c).
SB665,62
11Section
62. 102.82 (1) of the statutes is amended to read:
SB665,32,2012
102.82
(1) Except as provided in sub. (2) (ar), an uninsured employer shall
13reimburse the department for any payment made under s. 102.81 (1) to or on behalf
14of an employee of the uninsured employer or to an employee's dependents and for any
15expenses paid by the department in administering the claim of the employee or
16dependents, less amounts repaid by the employee or dependents under s. 102.81 (4)
17(b)
or (c). The reimbursement owed under this subsection is due within 30 days after
18the date on which the department notifies the uninsured employer that the
19reimbursement is owed. Interest shall accrue on amounts not paid when due at the
20rate of 1 percent per month.
SB665,63
21Section
63. 108.227 (1) (e) 16. of the statutes is created to read:
SB665,32,2322
108.227
(1) (e) 16. A license issued by the division of hearings and appeals
23under s. 102.17 (1) (c).
SB665,64
24Section
64. 108.227 (1) (f) of the statutes is amended to read:
SB665,33,8
1108.227
(1) (f) “Licensing department" means the department of
2administration;
the division of hearings and appeals; the department of agriculture,
3trade and consumer protection; the board of commissioners of public lands; the
4department of children and families; the ethics commission; the department of
5financial institutions; the department of health services; the department of natural
6resources; the department of public instruction; the department of revenue; the
7department of safety and professional services; the office of the commissioner of
8insurance; or the department of transportation.
SB665,65
9Section
65. 108.227 (1m) (intro.) of the statutes is amended to read:
SB665,33,1510
108.227
(1m) General provisions. (intro.) The department shall promulgate
11rules specifying procedures to be used before taking action under sub. (3) (b) or s.
12102.17 (1) (ct), 103.275 (2) (bt), 103.34 (10) (d), 103.91 (4) (d), 103.92 (8), 104.07 (7),
13or 105.13 (4) with respect to a person whose license or credential is to be denied, not
14renewed, discontinued, suspended, or revoked, including rules with respect to all of
15the following:
SB665,66
16Section
66. 108.227 (3) (a) 3. of the statutes is amended to read:
SB665,33,2017
108.227
(3) (a) 3. Upon the request of any person whose license or certificate
18has been previously revoked or denied under s.
102.17 (1) (ct), 103.275 (2) (bt), 103.34
19(10) (d), 103.91 (4) (d), 103.92 (8), 104.07 (7), or 105.13 (4), reinstate the license or
20certificate if the applicant is not liable for delinquent contributions.
SB665,67
21Section
67. 108.227 (5) (a) of the statutes is amended to read:
SB665,34,1322
108.227
(5) (a) The department of workforce development shall conduct a
23hearing requested by a license holder or applicant for a license or license renewal or
24continuation under sub. (2) (b) 1. b., or as requested under s.
102.17 (1) (ct), 103.275
25(2) (bt), 103.34 (10) (d), 103.91 (4) (d), 103.92 (8), 104.07 (7), or 105.13 (4), to review
1a certification or determination of contribution delinquency that is the basis of a
2denial, suspension, or revocation of a license or certificate in accordance with this
3section or an action taken under s.
102.17 (1) (ct), 103.275 (2) (bt), 103.34 (10) (d),
4103.91 (4) (d), 103.92 (8), 104.07 (7), or 105.13 (4). A hearing under this paragraph
5is limited to questions of mistaken identity of the license or certificate holder or
6applicant and of prior payment of the contributions that the department of workforce
7development certified or determined the license or certificate holder or applicant
8owes the department. At a hearing under this paragraph, any statement filed by the
9department of workforce development, the licensing department, or the supreme
10court, if the supreme court agrees, may be admitted into evidence and is prima facie
11evidence of the facts that it contains. Notwithstanding ch. 227, a person entitled to
12a hearing under this paragraph is not entitled to any other notice, hearing, or review,
13except as provided in sub. (6).
SB665,68
14Section
68. 108.227 (5) (b) 1. of the statutes is amended to read: