Amendment AA6-SB306

SB306-AA6,20,5 (b) "Low birth weight" means a birth weight that is more than 1,500 grams and less than 2,500 grams.

SB306-AA6,20,6 (c) "Very low birth weight" means a birth weight of 1,500 grams or less.

SB306-AA6,20,7 (d) "Very premature birth" means a birth at less than 32 weeks gestation.

SB306-AA6,20,19 (2) (a) The department shall annually prepare a report relating to fetal and infant mortality and birth outcomes in this state. The report shall include data related to births and birth outcomes in this state in the previous calendar year, and an analysis of that data. The department shall collaborate with local health departments, tribes, and other interested parties to determine the data and data analysis to be included in the report and the procedures by which the data will be collected and reported to the department. The department shall ensure that the report, to the greatest extent possible, includes data and analysis that are necessary and useful for the development and evaluation of programs to address disparities in birth outcomes among racial and ethnic groups in this state. The department shall periodically consult with interested parties to review and update the data and analysis required in the report as needed to ensure that this goal continues to be met.

SB306-AA6,20,21 (b) The report under par. (a) shall include, at a minimum, the following information:

SB306-AA6,20,22 1. The number and rate of infant deaths in each county.

SB306-AA6,20,23 2. The causes of infant deaths in each county.

SB306-AA6,20,24 3. The number and rate of very premature births in each county.

SB306-AA6,21,2 4. The number of low birth weight infants born in each county and of the rate of those births in each county.

SB306-AA6,21,4 5. The number of very low birth weight infants born in each county and the rate of those births in each county.

SB306-AA6,21,6 6. The race or ethnicity of the infant provided on the birth certificate for births identified in subd. 1., 3., 4., or 5.

SB306-AA6,21,9 (c) The department, in collaboration with the groups identified in par. (a), shall consider including in the report data related to the type of prenatal care, if any, received by the mother of each infant whose birth data is included in the report.

SB306-AA6,21,11 (d) Beginning June 30, 2013, and on every June 30 after that, the department shall do all of the following:

SB306-AA6,21,13 1. Submit the report to the appropriate standing committees of the legislature under s. 13.172 (3).

SB306-AA6,21,14 2. Post the report on its Internet Web site.

SB306-AA6,21,18 3. Post, on its Internet Web site, the raw data collected in the previous calendar year for purposes of the annual report. The data shall be presented in a manner that does not disclose or enable the identification of any individual infant, mother, or birth attendant.

SB306-AA6,21,21 (3) The department shall explore whether any of the costs of collecting the data and creating the report under sub. (2) may be funded by the Medical Assistance program.

SB306-AA6, s. 10e Section 10e. 441.15 (1) (a) of the statutes is repealed.

SB306-AA6, s. 10f Section 10f. 441.15 (1) (am) of the statutes is created to read:

SB306-AA6,21,25 441.15 (1) (am) "Nurse-midwife" means a person licensed under this section to engage in the practice of nurse-midwifery.

SB306-AA6, s. 10g Section 10g. 441.15 (1) (c) of the statutes is created to read:

SB306-AA6,22,4 441.15 (1) (c) "Qualified health care professional" means a health care professional as defined in s. 180.1901 (1m) who is performing services within his or her scope of practice.

SB306-AA6, s. 10h Section 10h. 441.15 (2) (b) of the statutes is amended to read:

SB306-AA6,22,8 441.15 (2) (b) The practice occurs in a health care facility approved by the board by rule under sub. (3) (c), in collaboration with a physician with postgraduate training in obstetrics, and pursuant to a written agreement with that physician.

SB306-AA6, s. 10i Section 10i. 441.15 (3) (c) of the statutes is amended to read:

SB306-AA6,22,15 441.15 (3) (c) The board shall promulgate rules necessary to administer this section, including the establishment of appropriate limitations on the scope of the practice of nurse-midwifery, the facilities in which such practice may occur, the definition of "elective" for purposes of the prohibition in sub. (4m), and the granting of temporary permits to practice nurse-midwifery pending qualification for certification.

SB306-AA6, s. 10j Section 10j. 441.15 (4) of the statutes is amended to read:

SB306-AA6,22,21 441.15 (4) A nurse-midwife who discovers evidence that any aspect of care involves any complication which jeopardizes the health or life of a newborn or mother shall consult with the collaborating physician under sub. (2) (b) or the physician's designee, or make a referral as specified in a written agreement under sub. (2) (b) a qualified health care professional or make a referral.

SB306-AA6, s. 10k Section 10k. 441.15 (4m) of the statutes is created to read:

SB306-AA6,23,4 441.15 (4m) No nurse-midwife may perform an elective procedure intended to induce labor in a pregnant woman before the completion of a gestational period of 39 weeks unless the nurse-midwife has first obtained the informed consent of the woman. A woman's consent is informed for purposes of this subsection only if she receives timely information orally and in person from the nurse-midwife regarding potential negative effects to the fetus of early delivery, including long-term learning and behavioral problems.

SB306-AA6, s. 10L Section 10L. 448.02 (3) (a) of the statutes is amended to read:

SB306-AA6,23,24 448.02 (3) (a) The board shall investigate allegations of unprofessional conduct and negligence in treatment by persons holding a license, certificate , or limited permit granted by the board. An allegation that a physician has violated s. 253.10 (3), 448.30, 448.35, or 450.13 (2); or has failed to mail or present a medical certification required under s. 69.18 (2) within 21 days after the pronouncement of death of the person who is the subject of the required certificate ; or that a physician has failed at least 6 times within a 6-month period to mail or present a medical certificate required under s. 69.18 (2) within 6 days after the pronouncement of death of the person who is the subject of the required certificate is an allegation of unprofessional conduct. Information contained in reports filed with the board under s. 49.45 (2) (a) 12r., 50.36 (3) (b), 609.17, or 632.715, or under 42 CFR 1001.2005, shall be investigated by the board. Information contained in a report filed with the board under s. 655.045 (1), as created by 1985 Wisconsin Act 29, which is not a finding of negligence or in a report filed with the board under s. 50.36 (3) (c) may, within the discretion of the board, be used as the basis of an investigation of a person named in the report. The board may require a person holding a license, certificate, or limited permit to undergo, and may consider the results of , one or more physical, mental, or professional competency examinations if the board believes that the results of any such examinations may be useful to the board in conducting its investigation.

SB306-AA6, s. 10m Section 10m. 448.35 of the statutes is created to read:

SB306-AA6,24,8 448.35 Informed consent for certain elective procedures. No physician may perform an elective Caesarean section or an elective procedure intended to induce labor in a pregnant woman before the completion of a gestational period of 39 weeks unless the physician has first obtained the informed consent of the woman. A woman's consent is informed for purposes of this section only if she receives timely information orally and in person from the physician regarding potential negative effects to the fetus of early delivery, including long-term learning and behavioral problems.

SB306-AA6, s. 10n Section 10n. 448.40 (2) (am) of the statutes is created to read:

SB306-AA6,24,11 448.40 (2) (am) Defining "elective" for purposes of s. 448.35 and implementing that section.

SB306-AA6, s. 10p Section 10p. 619.04 (3) of the statutes is amended to read:

SB306-AA6,24,25 619.04 (3) The plan shall operate subject to the supervision and approval of a board of governors consisting of 3 representatives of the insurance industry appointed by and to serve at the pleasure of the commissioner, a person to be named by the State Bar Association, a person to be named by the Wisconsin Academy of Trial Lawyers, 2 persons to be named by the Wisconsin Medical Society, a person to be named by the Wisconsin Hospital Association, the commissioner or a designated representative employed by the office of the commissioner, and 4 public members at least one of whom is named by the Wisconsin Nurses Association and at least 2 of whom are not attorneys or physicians and are not professionally affiliated with any hospital or insurance company, appointed by the governor for staggered 3-year terms. The commissioner or the commissioner's representative shall be the chairperson of the board of governors. Board members shall be compensated at the rate of $50 per diem plus actual and necessary travel expenses.

SB306-AA6, s. 10q Section 10q. 655.001 (7t) of the statutes is renumbered 655.001 (7t) (a) and amended to read:

SB306-AA6,25,8 655.001 (7t) (a) "Health Except as provided in par. (b), "health care practitioner" means a health care professional, as defined in s. 180.1901 (1m), who is an employee of a health care provider described in s. 655.002 (1) (d), (e), (em), or (f) and who has the authority to provide health care services that are not in collaboration with a physician under s. 441.15 (2) (b) or under the direction and supervision of a physician or nurse anesthetist.

SB306-AA6, s. 10r Section 10r. 655.001 (7t) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is renumbered 655.001 (7t) and amended to read:

SB306-AA6,25,15 655.001 (7t) Except as provided in par. (b), "health "Health care practitioner" means a health care professional, as defined in s. 180.1901 (1m), who is an employee of a health care provider described in s. 655.002 (1) (d), (e), (em), or (f) and who has the authority to provide health care services that are not under the direction and supervision of a physician or, nurse anesthetist, or nurse-midwife.

SB306-AA6, s. 10s Section 10s. 655.001 (7t) (b) of the statutes is created to read:

SB306-AA6,25,18 655.001 (7t) (b) "Health care practitioner" does not include a person licensed to practice nurse-midwifery under s. 441.15.

SB306-AA6, s. 10t Section 10t. 655.001 (7t) (b) of the statutes, as created by 2011 Wisconsin Act .... (this act), is repealed.

SB306-AA6, s. 10u Section 10u. 655.001 (9c) of the statutes is created to read:

SB306-AA6,25,23 655.001 (9c) "Nurse-midwife" means a person who is licensed to practice nurse-midwifery under s. 441.15.

SB306-AA6, s. 10v Section 10v. 655.002 (1) (a) of the statutes is amended to read:

SB306-AA6,26,3 655.002 (1) (a) A physician or , a nurse anesthetist, or a nurse-midwife for whom this state is a principal place of practice and who practices his or her profession in this state more than 240 hours in a fiscal year.

SB306-AA6, s. 10w Section 10w. 655.002 (1) (b) (intro.) of the statutes is amended to read:

SB306-AA6,26,6 655.002 (1) (b) (intro.) A physician or , a nurse anesthetist, or a nurse-midwife for whom Michigan is a principal place of practice, if all of the following apply:

SB306-AA6, s. 10x Section 10x. 655.002 (1) (b) 1. of the statutes is amended to read:

SB306-AA6,26,9 655.002 (1) (b) 1. The physician or, nurse anesthetist, or nurse-midwife is a resident of this state.

SB306-AA6, s. 10y Section 10y. 655.002 (1) (b) 2. of the statutes is amended to read:

SB306-AA6,26,13 655.002 (1) (b) 2. The physician or, nurse anesthetist, or nurse-midwife practices his or her profession in this state or in Michigan or a combination of both more than 240 hours in a fiscal year.

SB306-AA6, s. 10z Section 10z. 655.002 (1) (b) 3. of the statutes is amended to read:

SB306-AA6,26,19 655.002 (1) (b) 3. The physician or, nurse anesthetist, or nurse-midwife performs more procedures in a Michigan hospital than in any other hospital. In this subdivision, "Michigan hospital" means a hospital located in Michigan that is an affiliate of a corporation organized under the laws of this state that maintains its principal office and a hospital in this state.

SB306-AA6, s. 11a Section 11a. 655.002 (1) (c) of the statutes is amended to read:

SB306-AA6,27,3 655.002 (1) (c) A physician or, nurse anesthetist, or nurse-midwife who is exempt under s. 655.003 (1) or (3), or a nurse-midwife who is exempt under s. 655.003 (4), but who practices his or her profession outside the scope of the exemption and who fulfills the requirements under par. (a) in relation to that practice outside the scope of the exemption. For a physician or a, nurse anesthetist, or nurse-midwife who is subject to this chapter under this paragraph, this chapter applies only to claims arising out of practice that is outside the scope of the exemption under s. 655.003 (1) or, (3), or (4).

SB306-AA6, s. 11b Section 11b. 655.002 (1) (d) of the statutes is amended to read:

SB306-AA6,27,8 655.002 (1) (d) A partnership comprised of physicians or, nurse anesthetists, or nurse-midwives and organized and operated in this state for the primary purpose of providing the medical services of physicians or, nurse anesthetists, or nurse-midwives.

SB306-AA6, s. 11c Section 11c. 655.002 (1) (e) of the statutes is amended to read:

SB306-AA6,27,12 655.002 (1) (e) A corporation organized and operated in this state for the primary purpose of providing the medical services of physicians or, nurse anesthetists, or nurse-midwives.

SB306-AA6, s. 11d Section 11d. 655.002 (1) (em) of the statutes is amended to read:

SB306-AA6,27,16 655.002 (1) (em) Any organization or enterprise not specified under par. (d) or (e) that is organized and operated in this state for the primary purpose of providing the medical services of physicians or, nurse anesthetists, or nurse-midwives.

SB306-AA6, s. 11e Section 11e. 655.002 (2) (a) of the statutes is amended to read:

SB306-AA6,27,21 655.002 (2) (a) A physician or, nurse anesthetist, or nurse-midwife for whom this state is a principal place of practice but who practices his or her profession fewer than 241 hours in a fiscal year, for a fiscal year, or a portion of a fiscal year, during which he or she practices his or her profession.

SB306-AA6, s. 11f Section 11f. 655.002 (2) (b) of the statutes is amended to read:

SB306-AA6,28,4 655.002 (2) (b) Except as provided in sub. (1) (b), a physician or, nurse anesthetist, or nurse-midwife for whom this state is not a principal place of practice, for a fiscal year, or a portion of a fiscal year, during which he or she practices his or her profession in this state. For a health care provider who elects to be subject to this chapter under this paragraph, this chapter applies only to claims arising out of practice that is in this state and that is outside the scope of an exemption under s. 655.003 (1) or (3) or (4).

SB306-AA6, s. 11g Section 11g. 655.003 (1) of the statutes is amended to read:

SB306-AA6,28,9 655.003 (1) A physician or, a nurse anesthetist, or a nurse-midwife who is a state, county, or municipal employee, or federal employee or contractor covered under the federal tort claims act, as amended, and who is acting within the scope of his or her employment or contractual duties.

SB306-AA6, s. 11h Section 11h. 655.003 (3) of the statutes is amended to read:

SB306-AA6,28,15 655.003 (3) A physician or, a nurse anesthetist, or a nurse-midwife who provides professional services under the conditions described in s. 146.89 or 257.03 (1), with respect to those professional services provided by the physician or, nurse anesthetist, or nurse-midwife for which he or she is covered by s. 165.25 and considered an agent of the department, as provided in s. 165.25 (6) (b).

SB306-AA6, s. 11i Section 11i. 655.003 (4) of the statutes is created to read:

SB306-AA6,28,18 655.003 (4) A nurse-midwife who is considered to be an employee of the federal public health service under 42 USC 233 (g).

SB306-AA6, s. 11j Section 11j. 655.005 (2) (a) of the statutes is amended to read:

SB306-AA6,28,23 655.005 (2) (a) An employee of a health care provider if the employee is a physician or a nurse anesthetist or is a health care practitioner who is providing health care services that are not in collaboration with a physician under s. 441.15 (2) (b) or under the direction and supervision of a physician or nurse anesthetist.

SB306-AA6, s. 11k Section 11k. 655.005 (2) (a) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

SB306-AA6,29,4 655.005 (2) (a) An employee of a health care provider if the employee is a physician or a, nurse anesthetist, or nurse-midwife or is a health care practitioner who is providing health care services that are not under the direction and supervision of a physician or, nurse anesthetist, or nurse-midwife.

SB306-AA6, s. 11m Section 11m. 655.005 (2) (b) of the statutes is amended to read:

SB306-AA6,29,14 655.005 (2) (b) A service corporation organized under s. 180.1903 by health care professionals, as defined under s. 180.1901 (1m), if the board of governors determines that it is not the primary purpose of the service corporation to provide the medical services of physicians or, nurse anesthetists, or nurse-midwives. The board of governors may not determine under this paragraph that it is not the primary purpose of a service corporation to provide the medical services of physicians or, nurse anesthetists, or nurse-midwives unless more than 50% of the shareholders of the service corporation are neither not physicians nor, nurse anesthetists, or nurse-midwives.

SB306-AA6, s. 11n Section 11n. 655.23 (5m) of the statutes is amended to read:

SB306-AA6,29,18 655.23 (5m) The limits set forth in sub. (4) shall apply to any joint liability of a physician or, nurse anesthetist, or nurse-midwife and his or her corporation, partnership, or other organization or enterprise under s. 655.002 (1) (d), (e), or (em).

SB306-AA6, s. 11p Section 11p. 655.27 (3) (a) 4. of the statutes is amended to read:

SB306-AA6,29,23 655.27 (3) (a) 4. For a health care provider described in s. 655.002 (1) (d), (e), (em), or (f), risk factors and past and prospective loss and expense experience attributable to employees of that health care provider other than employees licensed as a physician or, nurse anesthetist , or nurse-midwife.

SB306-AA6, s. 11q Section 11q. 655.27 (3) (b) 2f. of the statutes is created to read:

SB306-AA6,30,5 655.27 (3) (b) 2f. With respect to fees paid by nurse-midwives, the rule may provide for a separate payment classification or for a payment classification that is combined with one or more other categories of health care providers, as the commissioner, after approval by the board of governors, determines is appropriate for pooling risks under the fund.

SB306-AA6, s. 11r Section 11r. 655.27 (3) (b) 2m. of the statutes is amended to read:

SB306-AA6,30,13 655.27 (3) (b) 2m. In addition to the fees and payment classifications described under subds. 1. and 2. to 2f., the commissioner, after approval by the board of governors, may by rule establish a separate payment classification for physicians satisfying s. 655.002 (1) (b) and, a separate fee for nurse anesthetists satisfying s. 655.002 (1) (b), and a separate fee for nurse-midwives satisfying s. 655.002 (1) (b) which take into account the loss experience of health care providers for whom Michigan is a principal place of practice.