AB518: Bill Text

AB518,13,25 6. Standards, in addition to those in sub. (6), addressing conflicts of interest by independent review organizations.

AB518,14,2 7. Standards for contracts between insurers and independent review organizations.

AB518,14,6 (b) The commissioner shall annually submit a report to the legislature under s. 13.172 (2) that specifies the number of independent reviews requested under this section in the preceding year, the insurers and health benefit plans involved in the independent reviews and the dispositions of the independent reviews.

AB518,14,9 (c) To reflect changes in the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor, the commissioner shall at least annually adjust the amounts specified in sub. (1) (a) 4. and (b) 4.

AB518,14,11 (6) Conflict of interest standards. (a) An independent review organization may not be affiliated with any of the following:

AB518,14,12 1. A health benefit plan.

AB518,14,14 2. A national, state or local trade association of health benefit plans, or an affiliate of any such association.

AB518,14,16 3. A national, state or local trade association of health care providers, or an affiliate of any such association.

AB518,14,20 (b) An independent review organization appointed to conduct an independent review and a clinical peer reviewer assigned by an independent review organization to conduct an independent review may not have a material professional, familial or financial interest with any of the following:

AB518,14,22 1. The insurer that issued the health benefit plan that is the subject of the independent review.

AB518,14,24 2. Any officer, director or management employe of the insurer that issued the health benefit plan that is the subject of the independent review.

AB518,15,3 3. The health care provider that recommended or provided the health care service or treatment that is the subject of the independent review, or the health care provider's medical group or independent practice association.

AB518,15,5 4. The facility at which the health care service or treatment that is the subject of the independent review was or would be provided.

AB518,15,7 5. The developer or manufacturer of the principal procedure, equipment, drug or device that is the subject of the independent review.

AB518,15,8 6. The insured or his or her authorized representative.

AB518,15,11 (6m) Qualifications of clinical peer reviewers. A clinical peer reviewer who conducts a review on behalf of a certified independent review organization must satisfy all of the following requirements:

AB518,15,14 (a) Be a health care provider who is expert in treating the medical condition that is the subject of the review and who is knowledgeable about the treatment that is the subject of the review through actual clinical experience.

AB518,15,20 (b) Hold a credential, as defined in s. 440.01 (2) (a), that is not limited or restricted; or hold a license, certificate, registration or permit that authorizes or qualifies the health care provider to perform acts substantially the same as those acts authorized by a credential, as defined in s. 440.01 (2) (a), that was issued by a governmental authority in a jurisdiction outside this state and that is not limited or restricted.

AB518,15,22 (c) If a physician, hold a current certification by a recognized American medical specialty board in the area or areas appropriate to the subject of the review.

AB518,15,25 (d) Have no history of disciplinary sanctions, including loss of staff privileges, taken or pending by the medical examining board or another regulatory body or by any hospital or government.

AB518,16,4 (7) Immunity. (a) A certified independent review organization and a clinical peer reviewer who conducts reviews on behalf of a certified independent review organization shall not be liable in damages to any person for any opinion rendered during or at the completion of an independent review.

AB518,16,8 (b) A health benefit plan that is the subject of an independent review and the insurer that issued the health benefit plan shall not be liable in damages to any person for complying with any decision rendered by a certified independent review organization during or at the completion of an independent review.

AB518,16,15 (8) Notice of sufficient independent review organizations. The commissioner shall make a determination that a sufficient number of independent review organizations have been certified under sub. (4) to effectively provide the independent reviews required under this section and shall publish a notice in the Wisconsin Administrative Register that states a date that is 6 months after the commissioner makes that determination. The date stated in the notice shall be the date on which the independent review procedure under this section begins operating.

AB518,17,2 (9) Applicability. The independent review required under this section shall be available to an insured who receives notice of the disposition of his or her grievance under s. 632.83 (3) (d) on or after the first day of the 7th month beginning after the effective date of this subsection .... [revisor inserts date]. Notwithstanding sub. (2) (c), an insured who receives notice of the disposition of his or her grievance under s. 632.83 (3) (d) on or after the first day of the 7th month beginning after the effective date of this subsection .... [revisor inserts date], but before the date stated in the notice published by the commissioner in the Wisconsin Administrative Register under sub. (8) .... [revisor inserts date], must request an independent review no later than 4 months after the date stated in the notice published by the commissioner in the Wisconsin Administrative Register under sub. (8) .... [revisor inserts date].

AB518, s. 20 Section 20 . Nonstatutory provisions.

AB518,17,4 (1) Rules regarding independent review.

AB518,17,8 (a) The commissioner of insurance shall submit in proposed form the rules required under section 632.835 (5) (a) of the statutes, as created by this act, to the legislative council staff under section 227.15 (1) of the statutes no later than the first day of the 7th month beginning after the effective date of this paragraph.

AB518,17,18 (b) Using the procedure under section 227.24 of the statutes, the commissioner of insurance shall promulgate rules required under section 632.835 (5) (a) of the statutes, as created by this act, for the period before the effective date of the permanent rules promulgated under section 632.835 (5) (a) of the statutes, as created by this act, but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) (a), (2) (b) and (3) of the statutes, the commissioner is not required to provide evidence that promulgating a rule under this paragraph as an emergency rule is necessary for the preservation of the public peace, health, safety or welfare and is not required to provide a finding of emergency for a rule promulgated under this paragraph.

AB518, s. 21 Section 21. Effective dates. This act takes effect on the day after publication, except as follows:

AB518,17,23 (1) The treatment of sections 609.15 (1) (intro.), (a), (b) and (c) and (2) (intro.), (a), (b), (c), (d) and (e) and 632.83 of the statutes takes effect on the first day of the 7th month beginning after publication.

AB518,18,2 (2) The treatment of section 632.835 (2), (3), (3m) and (5) (b) and (c) of the statutes takes effect on the date stated in the notice published by the commissioner of insurance in the Wisconsin Administrative Register under section 632.835 (8) of the statutes, as created by this act.

AB518,18,3 (End)