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:
AB1039, s. 1 1Section 1. 446.04 (6) of the statutes is created to read:
AB1039,3,42 446.04 (6) Conducting an independent evaluation under s. 632.875 that is not
3conducted under generally acceptable community standards or guidelines, or
4standards approved by the chiropractic examining board by rule.
AB1039, s. 2 5Section 2. 601.31 (1) (kr) of the statutes is created to read:
AB1039,3,86 601.31 (1) (kr) For maintaining, processing, and providing public access to the
7written statements under s. 632.875 (4m), an amount set by the commissioner, not
8to exceed actual costs.
AB1039, s. 3 9Section 3. 632.27 of the statutes is created to read:
AB1039,3,13 10632.27 Persons to whom settlement checks payable. If an insurer under
11a liability insurance policy settles a claim made under the policy by an insured or
12injured 3rd party and pays the settlement amount in a lump sum, the insurer shall
13pay by a check or other draft that is made payable to all of the following:
AB1039,3,14 14(1) The insured or injured 3rd party making the claim.
AB1039,3,16 15(2) Any attorney representing the insured or injured 3rd party with respect to
16the claim.
AB1039,3,17 17(3) Any person with respect to whom all of the following apply:
AB1039,3,1918 (a) The person provided services to the insured or injured 3rd party on account
19of the injury to which the claim relates and the services are covered under the policy.
AB1039,4,3
1(b) Before payment of the settlement, the person sent to the insurer by certified
2mail an assignment of benefits form with respect to the services provided and the
3insurer received the assignment of benefits form.
AB1039,4,54 (c) The assignment of benefits form was completed, signed by the insured or
5injured 3rd party, and in substantially the following form:
AB1039,4,66 ASSIGNMENT OF BENEFITS OR PAYMENT
AB1039,4,87 I, .... (insured or injured 3rd party), (have insurance with) (have a claim against)
8the .... insurance company. I have received services from .....
AB1039,4,109 Describe the services provided, including the date(s), and the reason(s) for the
10services:
AB1039,4,1513 I hereby assign to .... (provider of the services) any right that I have to payment,
14including interest from the above insurance company for the services provided. I
15understand that I am still ultimately responsible for payment for the services.
AB1039,4,1616 Date: ....
AB1039,4,1717 Signature of insured or injured 3rd party: ....
AB1039,4,1818 I hereby accept the above assignment.
AB1039,4,1919 Signature of service provider: ....
AB1039, s. 4 20Section 4. 632.726 of the statutes is created to read:
AB1039,4,24 21632.726 Current procedural terminology code changes. (1) In this
22section, "current procedural terminology code" means a number established by the
23American Medical Association that a health care provider puts on a health insurance
24claim form to describe the services that he or she performed.
AB1039,5,5
1(2) If an insurer changes a current procedural terminology code that was
2submitted by a health care provider on a health insurance claim form, the insurer
3shall include on the explanation of benefits form the reason for the change to the
4current procedural terminology code and shall cite on the explanation of benefits
5form the source for the change.
AB1039, s. 5 6Section 5. 632.87 (3) (b) 1. of the statutes is amended to read:
AB1039,5,117 632.87 (3) (b) 1. Restrict or terminate coverage for the treatment of a condition
8or a complaint by a licensed chiropractor within the scope of the chiropractor's
9professional license on the basis of other than an examination or independent
10evaluation by or a recommendation of a licensed chiropractor or a peer review
11committee that includes a licensed chiropractor
, as defined in s. 632.875 (1) (b).
AB1039, s. 6 12Section 6. 632.87 (3) (b) 5. of the statutes is created to read:
AB1039,5,1513 632.87 (3) (b) 5. Establish copayment or coinsurance requirements for the
14services of a chiropractor that are higher than copayment or coinsurance
15requirements for the services of a licensed physician or osteopath.
AB1039, s. 7 16Section 7. 632.874 of the statutes is created to read:
AB1039,5,21 17632.874 Payments to chiropractors. An insurer under a health care plan,
18as defined in s. 628.36, shall pay a chiropractor directly for any covered services the
19chiropractor provides to an insured under the health care plan who has assigned to
20the chiropractor his or her claim for payment, reimbursement, or benefits under the
21health care plan.
AB1039, s. 8 22Section 8. 632.875 (1) (am) of the statutes is created to read:
AB1039,5,2523 632.875 (1) (am) "Evaluating chiropractor" means a chiropractor who has been
24in practice at least 10 years and, unless the chiropractor is unable due to disability,
25is practicing, on an annual basis, an average of 20 hours per week.
AB1039, s. 9
1Section 9. 632.875 (1) (b) of the statutes is amended to read:
AB1039,6,52 632.875 (1) (b) "Independent evaluation" means an examination or evaluation
3by or recommendation of a an evaluating chiropractor or a peer review committee
4under s. 632.87 (3) (b) 1. whose membership includes at least one evaluating
5chiropractor.
AB1039, s. 10 6Section 10. 632.875 (2) (g) of the statutes is amended to read:
AB1039,6,97 632.875 (2) (g) A reasonable detailed explanation of the factual basis clinical
8rationale
and of the basis in the policy, plan, or contract or in applicable law for the
9insurer's restriction or termination of coverage.
AB1039, s. 11 10Section 11. 632.875 (2) (i) of the statutes is created to read:
AB1039,6,1311 632.875 (2) (i) The name of the evaluating chiropractor or, if a peer review
12committee conducted the independent evaluation, the names of all of the evaluating
13chiropractors on the peer review committee.
AB1039, s. 12 14Section 12. 632.875 (4m) of the statutes is created to read:
AB1039,6,1715 632.875 (4m) (a) Following an independent evaluation or any decision made
16during an appeal, an insurer shall prepare a written statement, containing all of the
17following:
AB1039,6,1918 1. All treatment and costs of the treatment, if any, for which coverage was
19approved.
AB1039,6,2120 2. All treatment and costs of the treatment, if any, for which coverage was
21restricted.
AB1039,6,2322 3. All treatment and costs of the treatment, if any, for which coverage was
23terminated.
AB1039,6,2424 4. The name of the insurer.
AB1039,7,3
15. The name of the evaluating chiropractor or, if a peer review committee
2conducted the independent evaluation, the names of all of the evaluating
3chiropractors on the peer review committee.
AB1039,7,74 (b) The insurer shall submit annually a summary, for each evaluating
5chiropractor or peer review committee that conducted an independent evaluation in
6the previous year, of all of the written statements required under this subsection to
7the office on a date that the office determines.
AB1039,7,108 (c) The office shall make the information submitted under par. (b) available to
9the public on the office's Internet site within a reasonable time period after the
10insurer submits it.
AB1039,7,1211 (d) Every insurer required under this subsection to submit a written statement
12shall pay the fee required by s. 601.31 (1) (kr).
AB1039, s. 13 13Section 13. Initial applicability.
AB1039,7,1614 (1) Settlement checks. The treatment of section 632.27 of the statutes first
15applies to settlements of claims made under liability insurance policies that are
16issued or renewed on the effective date of this subsection.
AB1039,7,1717 (End)
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