AB711: Bill Text

AB711,22 Section 22. 102.16 (1m) (a) of the statutes is amended to read:

AB711,21,2 102.16 (1m) (a) If an insurer or self-insured employer concedes by compromise under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured employer is liable under this chapter for any health services provided to an injured employee by a health service provider, but disputes the reasonableness of the fee charged by the health service provider, the department may include in its order confirming the compromise or stipulation a determination as to the reasonableness of the fee or the department may notify, or direct the insurer or self-insured employer to notify, the health service provider under sub. (2) (b) that the reasonableness of the fee is in dispute. The department shall deny payment of a health service fee that the department determines under this paragraph to be unreasonable. A health service provider and an insurer or self-insured employer that are parties to a fee dispute under this paragraph are bound by the department's determination under this paragraph on the reasonableness of the disputed fee, unless that determination is set aside, reversed, or modified by the department under sub. (2) (f) or is set aside on judicial review as provided in sub. (2) (f). This paragraph does not apply to a health service provided to an injured employee beginning on the date on which the notice under s. 102.423 (1) (a) is published in the Wisconsin Administrative Register.

AB711,23 Section 23. 102.16 (2) (d) of the statutes is amended to read:

AB711,21,19 102.16 (2) (d) The department shall analyze the information provided to the department under par. (c) according to the criteria provided in this paragraph to determine the reasonableness of the disputed fee. Except as provided in 2011 Wisconsin Act 183, section 30 (2) (b), the The department shall determine that a disputed fee is reasonable and order that the disputed fee be paid if that fee is at or below the mean fee for the health service procedure for which the disputed fee was charged, plus 1.2 0.7 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h). Except as provided in 2011 Wisconsin Act 183, section 30 (2) (b), the The department shall determine that a disputed fee is unreasonable and order that a reasonable fee be paid if the disputed fee is above the mean fee for the health service procedure for which the disputed fee was charged, plus 1.2 0.7 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h), unless the health service provider proves to the satisfaction of the department that a higher fee is justified because the service provided in the disputed case was more difficult or more complicated to provide than in the usual case.

AB711,24 Section 24. 102.16 (2) (i) of the statutes is created to read:

AB711,21,23 102.16 (2) (i) This subsection does not apply to a health service provided to an injured employee beginning on the date on which the notice under s. 102.423 (1) (a) is published in the Wisconsin Administrative Register.

AB711,25 Section 25. 102.17 (1) (a) 3. of the statutes is amended to read:

AB711,22,5 102.17 (1) (a) 3. If a party in interest claims that the employer or insurer has acted with malice or bad faith as described in s. 102.18 (1) (b) 3. or (bp), that party shall provide written notice stating with reasonable specificity the basis for the claim to the employer, the insurer, and the department before the department schedules a hearing on the claim of malice or bad faith.

AB711,26 Section 26. 102.17 (4) of the statutes is amended to read:

AB711,23,4 102.17 (4) Except as provided in this subsection and s. 102.555 (12) (b), in the case of occupational disease, the right of an employee, the employee's legal representative, or a dependent to proceed under this section shall not extend beyond 12 years after the date of the injury or death or after the date that compensation, other than for treatment or burial expenses, was last paid, or would have been last payable if no advancement were made, whichever date is latest, and in the case of traumatic injury, that right shall not extend beyond 9 years after that date. In the case of occupational disease; a traumatic injury resulting in the loss or total impairment of a hand or any part of the rest of the arm proximal to the hand or of a foot or any part of the rest of the leg proximal to the foot, any loss of vision, or any permanent brain injury; or a traumatic injury causing the need for an artificial spinal disc or a total or partial knee or hip replacement, there shall be no statute of limitations, except that benefits or treatment expense for an occupational disease becoming due 12 years after the date of injury or death or last payment of compensation, other than for treatment or burial expenses, shall be paid from the work injury supplemental benefit fund under s. 102.65 and in the manner provided in s. 102.66 and benefits or treatment expense for such a traumatic injury becoming due 12 9 years after that date shall be paid from that fund and in that manner if the date of injury or death or last payment of compensation, other than for treatment or burial expenses, is before April 1, 2006. Payment of wages by the employer during disability or absence from work to obtain treatment shall be considered payment of compensation for the purpose of this section if the employer knew of the employee's condition and its alleged relation to the employment.

AB711,27 Section 27. 102.18 (1) (b) of the statutes is renumbered 102.18 (1) (b) 1. and amended to read:

AB711,23,12 102.18 (1) (b) 1. Within 90 days after the final hearing and close of the record, the department shall make and file its findings upon the ultimate facts involved in the controversy, and its order, which shall state its determination as to the rights of the parties. Pending the final determination of any controversy before it, the department may in its discretion after any hearing make interlocutory findings, orders, and awards, which may be enforced in the same manner as final awards.

AB711,23,17 2. The department may include in any interlocutory or final award or order an order directing the employer or insurer to pay for any future treatment that may be necessary to cure and relieve the employee from the effects of the injury or to pay for a future course of instruction or other rehabilitation training services provided under a rehabilitation training program developed under s. 102.61 (1) or (1m).

AB711,23,22 3. If the department finds that the employer or insurer has not paid any amount that the employer or insurer was directed to pay in any interlocutory order or award and that the nonpayment was not in good faith, the department may include in its final award a penalty not exceeding 25% 25 percent of each amount that was not paid as directed.

AB711,24,3 4. When there is a finding that the employee is in fact suffering from an occupational disease caused by the employment of the employer against whom the application is filed, a final award dismissing the application upon the ground that the applicant has suffered no disability from the disease shall not bar any claim the employee may thereafter have after the date of the award for disability sustained after the that date of the award.

AB711,28 Section 28. 102.18 (1) (bg) 1. of the statutes is amended to read:

AB711,24,21 102.18 (1) (bg) 1. If the department finds under par. (b) that an insurer or self-insured employer is liable under this chapter for any health services provided to an injured employee by a health service provider, but that the reasonableness of the fee charged by the health service provider is in dispute, the department may include in its order under par. (b) a determination as to the reasonableness of the fee or the department may notify, or direct the insurer or self-insured employer to notify, the health service provider under s. 102.16 (2) (b) that the reasonableness of the fee is in dispute. The department shall deny payment of a health service fee that the department determines under this subdivision to be unreasonable. An insurer or self-insured employer and a health service provider that are parties to a fee dispute under this subdivision are bound by the department's determination under this subdivision on the reasonableness of the disputed fee, unless that determination is set aside, reversed, or modified by the department under sub. (3) or by the commission under sub. (3) or (4) or is set aside on judicial review under s. 102.23. This subdivision does not apply to a health service provided to an injured employee beginning on the date on which the notice under s. 102.423 (1) (a) is published in the Wisconsin Administrative Register.

AB711,29 Section 29. 102.18 (3) of the statutes is amended to read:

AB711,25,15 102.18 (3) A party in interest may petition the commission for review of an examiner's decision awarding or denying compensation if the department or commission receives the petition within 21 days after the department mailed a copy of the examiner's findings and order to the party's last-known address. The commission shall dismiss a petition which that is not timely filed within those 21 days unless the petitioner shows probable good cause that the petition was filed late for a reason for failure to timely file that was beyond the petitioner's control. If no petition is filed within those 21 days from the date that a copy of the findings or order of the examiner is mailed to the last-known address of the parties in interest, the findings or order shall be considered final unless set aside, reversed , or modified by the examiner within that time. If the findings or order are set aside by the examiner, the status shall be the same as prior to the setting aside of the findings or order set aside. If the findings or order are reversed or modified by the examiner, the time for filing a petition commences with on the date that notice of the reversal or modification is mailed to the last-known address of the parties in interest. The commission shall either affirm, reverse, set aside, or modify the findings or order in whole or in part, or direct the taking of additional evidence. This The commission's action shall be based on a review of the evidence submitted.

AB711,30 Section 30. 102.18 (4) (b) of the statutes is amended to read:

AB711,25,19 102.18 (4) (b) Within 28 days after the date of a decision of the commission is mailed to the last-known address of each party in interest, the commission may, on its own motion, set aside the decision for further consideration.

AB711,31 Section 31. 102.21 of the statutes is amended to read:

AB711,26,9 102.21 Payment of awards by municipalities. Whenever When an award is made by the department under this chapter or s. 66.191, 1981 stats., against any municipality local governmental unit, the person in whose favor it the award is made shall file a certified copy thereof of the award with the municipal clerk of the local governmental unit. Within 20 days thereafter, unless an appeal is taken, such after the filing of the award, the clerk shall draw an order on the municipal treasurer of the local governmental unit for the payment of the award, unless an appeal is taken. If upon appeal such the award is affirmed in whole or in part, the order for payment shall be drawn within 10 days after a certified copy of such the judgment on appeal is filed with the proper clerk. If more than one payment is provided for in the award or judgment, orders shall be drawn as the payments become due. No statute relating to the filing of claims against, and or the auditing, allowing and, or payment of claims by municipalities, local governmental units shall apply to the payment of an award or judgment under this section.

AB711,32 Section 32. 102.23 (1) (a) of the statutes is renumbered 102.23 (1) (a) 1. and amended to read:

AB711,26,17 102.23 (1) (a) 1. The findings of fact made by the commission acting within its powers shall, in the absence of fraud, be conclusive. The order or award granting or denying compensation, either interlocutory or final, whether judgment has been rendered on it or not, is subject to review only as provided in this section and not under ch. 227 or s. 801.02. The commission shall identify in the order or award the persons that must be made parties to an action for the review of the order or award.

AB711,27,8 2. Within 30 days after the date of an order or award made by the commission either originally or after the filing of a petition for review with the department under s. 102.18, any party aggrieved thereby by the order or award may commence an action in circuit court for the review of the order or award by serving a complaint as provided in par. (b) and filing the summons and complaint with the clerk of the circuit court commence, in circuit court, an action against the commission for the review of the order or award, in which action the adverse party shall also be made a defendant. The summons and complaint shall name the party commencing the action as the plaintiff and shall name as defendants the commission and all persons identified by the commission under subd. 1. If the circuit court determines that any other person is necessary for the proper resolution of the action, the circuit court may join that person as a party to the action, unless joinder of the person would unduly delay the resolution of the action. If the circuit court is satisfied that a party in interest has been prejudiced because of an exceptional delay in the receipt of a copy of any finding or order, it the circuit court may extend the time in within which an action may be commenced by an additional 30 days.

AB711,27,12 3. The proceedings shall be in the circuit court of the county where the plaintiff resides, except that if the plaintiff is a state agency, the proceedings shall be in the circuit court of the county where the defendant resides. The proceedings may be brought in any circuit court if all parties stipulate and that court agrees.

AB711,33 Section 33. 102.23 (1) (c) of the statutes is amended to read:

AB711,27,21 102.23 (1) (c) Except as provided in par. (cm), the The commission shall serve its answer within 20 days after the service of the complaint, and, within the like time, the adverse party. Except as provided in par. (cm), any other defendant may serve an answer to the complaint within 20 days after the service of the complaint, which answer may, by way of counterclaim or cross complaint, ask for the review of the order or award referred to in the complaint, with the same effect as if the party defendant had commenced a separate action for the review thereof of the order or award.

AB711,34 Section 34. 102.23 (1) (cm) of the statutes is amended to read:

AB711,27,25 102.23 (1) (cm) If an adverse party to the proceeding a defendant in an action brought under par. (a) is an insurance company, the insurance company may serve an answer to the complaint within 45 days after the service of the complaint.

AB711,35 Section 35. 102.28 (2) (a) of the statutes is amended to read:

AB711,28,11 102.28 (2) (a) Duty to insure payment for compensation. Unless exempted by the department under par. (b) or (bm) or sub. (3), every employer, as described in s. 102.04 (1), shall insure payment for that compensation under this chapter in an insurer authorized to do business in this state. A joint venture may elect to be an employer under this chapter and obtain insurance for payment of compensation. If a joint venture that is subject to this chapter only because the joint venture elected to be an employer under this chapter is dissolved and cancels or terminates its contract for the insurance of compensation under this chapter, that joint venture is deemed to have effected withdrawal, which shall be effective on the day after the contract is canceled or terminated.

AB711,36 Section 36. 102.28 (2) (b) (title) of the statutes is amended to read:

AB711,28,13 102.28 (2) (b) (title) Exemption from duty to insure; employers generally.

AB711,37 Section 37. 102.28 (2) (bm) of the statutes is created to read:

AB711,28,24 102.28 (2) (bm) Exemption from duty to insure; governmental employers. 1. Subject to subds. 2. to 4., if the state or a local governmental unit that has independent taxing authority is not partially insured or fully insured for its liability for the payment of compensation under this chapter, or to the extent that the state or a local governmental unit that has independent taxing authority is not partially insured for that liability under one or more contracts issued with the consent of the department under s. 102.31 (1) (b), and if the state or local governmental unit agrees to report faithfully all compensable injuries and to comply with this chapter and all rules of the department, the state or local governmental unit may elect to self-insure that liability without further order of the department.

AB711,29,7 2. Notwithstanding the absence of an order of exemption from the duty to insure under par. (a), the state or a local governmental unit that elects to self-insure as provided in subd. 1. is exempt from that duty. Notwithstanding that exemption, if the state or a local governmental unit that elects to self-insure as provided in subd. 1. desires partial insurance or divided insurance, the state or local governmental unit shall obtain the consent of the department under s. 102.31 (1) (b) to the issuance of a contract providing such insurance.

AB711,29,14 3. a. A local governmental unit that elects to self-insure its liability for the payment of compensation under this chapter shall notify the department of that election in writing before commencing to self-insure that liability and shall notify the department of its intent to continue to self-insure that liability every 3 years after that initial notice. A local government unit that wishes to withdraw that election shall notify the department of that withdrawal not less than 30 days before the effective date of that withdrawal.

AB711,29,21 b. A notice under subd. 3. a. shall be accompanied by a resolution adopted by the governing body of the local governmental unit and signed by the elected or appointed chief executive of the local governmental unit stating that the governing body intends and agrees to self-insure the liability of the local governmental unit for the payment of compensation under this chapter and that the local government unit agrees to report faithfully all compensable injuries and to comply with this chapter and all rules of the department.

AB711,30,4 4. An election to self-insure under subd. 1. is subject to revocation under par. (c) 2. Once such an election is revoked, the employer whose election is revoked may not elect to self-insure its liability for the payment of compensation under this chapter unless at least 3 calendar years have elapsed since the revocation and the department finds that the employer's financial condition is adequate to pay its employees' claims for compensation, that the employer has not received an excessive number of claims for compensation, and that the employer has faithfully discharged its obligations under this chapter and the rules of the department.

AB711,38 Section 38. 102.28 (2) (c) (title) of the statutes is amended to read:

AB711,30,6 102.28 (2) (c) (title) Revocation of exemption or election.

AB711,39 Section 39. 102.28 (2) (c) of the statutes is renumbered 102.28 (2) (c) 1. and amended to read:

AB711,30,15 102.28 (2) (c) 1. The department, after seeking the advice of the self-insurers council, may revoke an exemption granted to an employer under par. (b), upon giving the employer 10 days' written notice, if the department finds that the employer's financial condition is inadequate to pay its employees' claims for compensation, that the employer has received an excessive number of claims for compensation , or that the employer has failed to discharge faithfully its obligations according to the agreement contained in the application for exemption. The employer may, within

AB711,31,2 3. Within 10 days after receipt of the a notice of revocation, under subd. 1. or 2., the employer may request in writing a review of the revocation by the secretary or the secretary's designee and the secretary or the secretary's designee shall review the revocation within 30 days after receipt of the request for review. If the employer is aggrieved by the determination of the secretary or the secretary's designee, the employer may, within 10 days after receipt of notice of that determination, request a hearing under s. 102.17. If the secretary or the secretary's designee determines that the employer's exemption or election should be revoked, the employer shall obtain insurance coverage as required under par. (a) immediately upon receipt of notice of that determination and, notwithstanding the pendency of proceedings under ss. 102.17 to 102.25, shall keep that coverage in force until another exemption under par. (b) is granted or another election under par. (bm) is made.

AB711,40 Section 40. 102.28 (2) (c) 2. of the statutes is created to read:

AB711,31,9 102.28 (2) (c) 2. The department may revoke an election made by an employer under par. (bm), upon giving the employer 10 days' written notice, if the department finds that the employer's financial condition is inadequate to pay its employees' claims for compensation, that the employer has received an excessive number of claims for compensation, or that the employer has failed to discharge faithfully its obligations under this chapter and the rules of the department.

AB711,41 Section 41. 102.28 (2) (d) of the statutes is amended to read:

AB711,31,16 102.28 (2) (d) Effect of insuring with unauthorized insurer. An employer who procures an exemption under par. (b) and thereafter If an employer that is exempted under par. (b) or (bm) from the duty to insure under par. (a) enters into any agreement for excess insurance coverage with an insurer not authorized to do business in this state, the employer shall report that agreement to the department immediately. The placing of such coverage shall not by itself be grounds for revocation of the exemption.

AB711,42 Section 42. 102.28 (7) (a) of the statutes is amended to read:

AB711,32,7 102.28 (7) (a) If an employer who is currently or was formerly exempted by written order of the department under sub. (2) (b) is unable to pay an award, judgment is rendered in accordance with s. 102.20 against that employer, and execution is levied and returned unsatisfied in whole or in part, payments for the employer's liability shall be made from the fund established under sub. (8). If a currently or formerly exempted employer files for bankruptcy and not less than 60 days after that filing the department has reason to believe that compensation payments due are not being paid, the department in its discretion may make payment for the employer's liability from the fund established under sub. (8). The secretary of administration shall proceed to recover such those payments from the employer or the employer's receiver or trustee in bankruptcy, and may commence an action or proceeding or file a claim therefor for those payments. The attorney general shall appear on behalf of the secretary of administration in any such action or proceeding. All moneys recovered in any such action or proceeding shall be paid into the fund established under sub. (8).

AB711,43 Section 43. 102.28 (7) (b) of the statutes is renumbered 102.28 (7) (b) 1. and amended to read:

AB711,32,22 102.28 (7) (b) 1. Each employer exempted by written order of the department under sub. (2) (b) shall pay into the fund established by sub. (8) a sum equal to that assessed against each of the other such exempt employers upon the issuance of an initial order. The order an initial assessment based on orders of the department as provided in subd. 2. An order of the department requiring exempt employers to pay into that fund shall provide for a sum an amount that is sufficient to secure estimated payments of the an insolvent exempt employer due for the period up to the date of the order and for one year following the date of the order and to pay the estimated cost of insurance carrier or insurance service organization services under par. (c). Payments ordered to be made to the fund shall be paid to the department within 30 days after the date of the order. If additional moneys are required, further assessments shall be made based on orders of the department with as provided under subd. 2.

AB711,33,6 2. An initial or further assessment under subd. 1. shall be prorated on the basis of the gross payroll for this state of the exempt employer, as reported to the department for the previous calendar year for unemployment insurance purposes under ch. 108. If the or, if an exempt employer is not covered under ch. 108, then the department shall determine on the basis of the comparable gross payroll for the exempt employer as determined by the department. If payment of any assessment made under this subsection subd. 1. is not made within 30 days of after the date of the order of the department, the attorney general may appear on behalf of the state to collect the assessment.

AB711,44 Section 44. 102.28 (7) (bm) of the statutes is created to read:

AB711,33,8 102.28 (7) (bm) The department may not do any of the following:

AB711,33,11 1. Require an employer that elects under sub. (2) (bm) to self-insure its liability for the payment of compensation under this chapter to pay into the fund established under sub. (8).

AB711,33,15 2. Make any payments from the fund established under sub. (8) for the liability under this chapter of an employer that elects under sub. (2) (bm) to self-insure its liability for the payment of compensation under this chapter, whether currently or formerly exempt from the duty to insure under sub. (2) (a).

AB711,45 Section 45. 102.29 (1) (b) 2. of the statutes is amended to read:

AB711,33,24 102.29 (1) (b) 2. Out of the balance remaining after the deduction and payment specified in subd. 1., the employer, the insurance carrier, or, if applicable, the uninsured employers fund or the work injury supplemental benefit fund shall be reimbursed for all payments made by the employer, insurance carrier, or department, or which the employer, insurance carrier, or department may be obligated to make in the future, under this chapter, except that the employer, insurance carrier, or department shall not be reimbursed for any payments made or to be made under s. 102.18 (1) (b) 3. or (bp), 102.22, 102.35 (3), 102.57, or 102.60.

AB711,46 Section 46. 102.29 (8) of the statutes is amended to read:

AB711,34,7 102.29 (8) No student of a public school, as described in s. 115.01 (1), or a private school, as defined in s. 115.001 (3r), or an institution of higher education who is named under s. 102.077 as an employee of the school district or, private school, or institution of higher education for purposes of this chapter and who makes a claim for compensation under this chapter may make a claim or maintain an action in tort against the employer that provided the work training or work experience from which the claim arose.

AB711,47 Section 47. 102.31 (2) (b) 2. of the statutes is amended to read:

AB711,34,14 102.31 (2) (b) 2. Regardless of whether the notices required under par. (a) have been given, a cancellation or termination is effective upon the effective date of replacement insurance coverage obtained by the employer or , of an order under s. 102.28 (2) (b) exempting the employer from carrying the duty to carry insurance under s. 102.28 (2) (a), or of an election by an employer under s. 102.28 (2) (bm) to self-insure its liability for the payment of compensation under this chapter.

AB711,48 Section 48. 102.315 (2) of the statutes is amended to read:

AB711,34,23 102.315 (2) Employee leasing company liable. An employee leasing company is liable under s. 102.03 for all compensation payable under this chapter to a leased employee, including any payments required under s. 102.16 (3), 102.18 (1) (b) 3. or (bp), 102.22 (1), 102.35 (3), 102.57, or 102.60. Except as permitted under s. 102.29, an employee leasing company may not seek or receive reimbursement from another employer for any payments made as a result of that liability. An employee leasing company is not liable under s. 102.03 for any compensation payable under this chapter to an employee of a client who is not a leased employee.

AB711,49 Section 49 . 102.423 of the statutes is created to read:

AB711,35,10 102.423 Health service fee schedule. (1) Establishment of schedule. (a) By July 1, 2015, the department shall establish a schedule of the maximum fees that a health care provider may charge an employer or insurer for health services provided to an injured employee who claims benefits under this chapter. When that schedule is established, the department shall notify the legislative reference bureau and the legislative reference bureau shall publish that notice in the Wisconsin Administrative Register. In determining those maximum fees, the department shall divide the state into 5 regions based on geographical and economical similarity, including similarity in the cost of health services, and, for each region, shall do all of the following:

AB711,35,19 1. Determine the average payment made by group health benefit plans, as defined in s. 632.745 (9), group health plans, as defined in s. 632.745 (10), and self-insured health plans, as defined in s. 632.745 (24), and the average copayment, coinsurance, and deductible payment made by persons covered under those plans, for each health service included in the schedule based on health service payment data obtained from the Wisconsin Health Information Organization, the Workers Compensation Research Institute, health insurers and health plan sponsors, the group health insurance plan under subch. IV of ch. 40, and other sources determined by the department to be credible.

AB711,35,23 2. Set the maximum fee for each health service included in the schedule at 110 percent of the sum of the average payment for that service and the average copayment, coinsurance, and deductible payment for that service, as determined under subd. 1.

AB711,36,2 (b) 1. In this paragraph, "consumer price index" means the average of the consumer price index for medical care services over each 12-month period for all urban consumers, U.S. city average, as determined by the bureau of labor statistics of the federal department of labor.

AB711,36,7 2. On each July 1, beginning on July 1, 2016, the department shall adjust the maximum fees established under par. (a) by the percentage difference between the consumer price index for the 12-month period ending on December 31 of the preceding year and the consumer price index for the 12-month period ending on December 31 of the year before the preceding year.

AB711,36,11 (c) No less often than every 2 years, the department shall obtain health service payment data from the sources specified in par. (a) 1., redetermine the average payments specified in par. (a) 1., and revise the maximum fees established under par. (a) 2. based on that redetermined average.

AB711,36,14 (d) The department may not implement the fee schedule established under par. (a) or revise that schedule under par. (c) unless the schedule or revised schedule is approved by the council on worker's compensation.

AB711,36,17 (e) The department shall post a link to the fee schedule established under par. (a) on the department's Internet site. Notwithstanding s. 227.10 (1), the fee schedule need not be promulgated as a rule.

AB711,37,4 (2) Liability of employer or insurer. The liability of an employer or insurer for a health service included in the fee schedule established under sub. (1) (a) is limited to the maximum fee allowed under the schedule for that health service as of the date on which the health service was provided, any fee agreed to by contract between the employer or insurer and health care provider for that health service as of that date, or the health care provider's actual fee for the health service as of that date, whichever is less. A health care provider that provides health services to an injured employee under this chapter may not collect, or bring an action to collect, from the injured employee any charge that is in excess of the liability of the employer or insurer under this subsection. This subsection first applies to a health service provided to an injured employee on the date on which the notice under sub. (1) (a) is published in the Wisconsin Administrative Register.

AB711,37,5 (3) Rules. The department shall promulgate rules to implement this section.

AB711,50 Section 50. 102.425 (3) (am) of the statutes is created to read:

AB711,37,18 102.425 (3) (am) 1. Subject to subd. 2., if a prescription drug dispensed under sub. (2) (a) for outpatient use by an injured employee is a repackaged prescription drug, the liability of an employer or insurer for the cost of the repackaged prescription drug is limited to the average wholesale price, as determined under par. (a) 1., of the prescription drug set by the original manufacturer of the prescription drug, plus any dispensing fee that may be payable under par. (a) 2. and any taxes that may be applicable under par. (a) 3., except that if the national drug code number of the prescription drug as packaged by the original manufacturer of the prescription drug cannot be determined from the billing statement under par. (c), that liability is limited to the average wholesale price, as determined under par. (a) 1., of the lowest-priced drug product equivalent, plus any dispensing fee under par. (a) 2. and any taxes under par. (a) 3. that would be payable for the drug product equivalent.

AB711,37,20 2. Subdivision 1. does not apply to a repackaged prescription drug dispensed from a retail, mail-order, or institutional pharmacy.

AB711,51 Section 51. 102.425 (3) (b) of the statutes is amended to read:

AB711,37,25 102.425 (3) (b) In addition to the liability under par. (a) or (am), whichever is applicable, an employer or insurer is also liable for reimbursement to an injured employee for all out-of-pocket expenses incurred by the injured employee in obtaining the prescription drug dispensed.

AB711,52 Section 52. 102.425 (4) (a) of the statutes is amended to read:

AB711,38,6 102.425 (4) (a) Except as provided in par. (b), a pharmacist or practitioner who dispenses a prescription drug under sub. (2) to an injured employee may not collect, or bring an action to collect, from the injured employee any charge that is in excess of the liability of the injured employee under sub. (2) (c) 2. or the liability of the employer or insurer under sub. (3) (a) or (am), whichever is applicable.

AB711,53 Section 53. 102.425 (4) (b) of the statutes is amended to read:

AB711,38,19 102.425 (4) (b) If an employer or insurer denies or disputes liability for the cost of a drug prescribed to an injured employee under sub. (2), the pharmacist or practitioner who dispensed the drug may collect, or bring an action to collect, from the injured employee the cost of the prescription drug dispensed, subject to the limitations specified in sub. (3) (a) or (am), whichever is applicable. If an employer or insurer concedes liability for the cost of a drug prescribed to an injured employee under sub. (2), but disputes the reasonableness of the amount charged for the prescription drug, the employer or insurer shall provide notice under sub. (4m) (b) to the pharmacist or practitioner that the reasonableness of the amount charged is in dispute and the pharmacist or practitioner who dispensed the drug may not collect, or bring an action to collect, from the injured employee the cost of the prescription drug dispensed after receiving that notice.

AB711,54 Section 54. 102.425 (4m) (b) of the statutes is amended to read:

AB711,39,5 102.425 (4m) (b) An employer or insurer that disputes the reasonableness of the amount charged for a prescription drug dispensed under sub. (2) for outpatient use by an injured employee or the department under sub. (4) (b) or s. 102.16 (1m) (c) or 102.18 (1) (bg) 3. shall provide, within 30 days after receiving a completed bill for the prescription drug, reasonable written notice to the pharmacist or practitioner that the charge is being disputed. After receiving reasonable written notice under this paragraph or under sub. (4) (b) or s. 102.16 (1m) (c) or 102.18 (1) (bg) 1. 3. that a prescription drug charge is being disputed, a pharmacist or practitioner may not collect the disputed charge from, or bring an action for collection of the disputed charge against, the employee who received the prescription drug.