SB762: Bill Text

SB762,40,20 (d) Submits evidence satisfactory to the affiliated credentialing board establishing all of the following:

SB762,40,23 1. That the applicant has practiced as a licensed chiropractor in good standing with the chiropractic examining board for at least two years and remains a licensed chiropractor in good standing with the chiropractic examining board under ch. 446.

SB762,41,3 2. That the applicant is a graduate of a master of science degree program in spinal medicine approved by the affiliated credentialing board under s. 448.973 and possesses a diploma from that program conferring the degree of primary spinal care practitioner or equivalent degree as determined by the affiliated credentialing board.

SB762,41,6 (2) The affiliated credentialing board may waive the requirements under sub. (1) (d) for an applicant who establishes, to the satisfaction of the affiliated credentialing board, all of the following:

SB762,41,7 (a) That the applicant is a graduate of a spinal medicine school or program.

SB762,41,9 (b) That the applicant is licensed as a primary spinal care practitioner or its equivalent by another licensing jurisdiction in the United States.

SB762,41,13 (c) That the jurisdiction in which the applicant is licensed required the applicant to be a graduate of a school or program approved by the licensing jurisdiction or of a school or program that the licensing jurisdiction evaluated for education equivalency.

SB762,41,17 (d) That the applicant has actively practiced spinal medicine, under the license issued by the other licensing jurisdiction in the United States, for at least 3 years immediately preceding the date of his or her application for a license under this subchapter.

SB762,41,19 (3) The affiliated credentialing board may promulgate rules providing for various classes of temporary licenses to practice spinal medicine.

SB762,41,24 (4) If the affiliated credentialing board finds, based upon considerations of public health and safety, that an applicant has not demonstrated adequate education, training, or performance on examinations or in past practice, if any, to qualify for full licensure under sub. (1), the board may grant the applicant a limited license and shall so notify the applicant.

SB762,42,4 448.973 Education. The affiliated credentialing board shall approve a master of science degree program in spinal medicine that is accredited by the Higher Learning Commission or an equivalent accrediting body, as determined by the affiliated credentialing board, and that includes all of the following:

SB762,42,6 (1) At least 60 hours of instruction, including classroom instruction, in the following subjects:

SB762,42,7 (a) Causes of spinal pain and differential diagnosis.

SB762,42,8 (b) Case management and coordination of care in spinal pain patients.

SB762,42,9 (c) Spinal injuries, correlated with diagnostic imaging.

SB762,42,10 (d) Public health issues and epidemiology of spinal pain conditions.

SB762,42,11 (e) Pharmacology.

SB762,42,12 (f) Nutrition for musculoskeletal health.

SB762,42,13 (g) Interpreting research and applying evidence in spinal care practice.

SB762,42,14 (2) At least 500 clinical rotation hours under the supervision of a physician.

SB762,42,16 (3) An examination in spinal medicine approved by the affiliated credentialing board.

SB762,42,19 448.9735 Issuance of license; expiration and renewal; duplicate license. (1) The department shall issue a certificate of licensure to each person who is licensed under this subchapter.

SB762,42,22 (2) (a) The renewal date for a license granted under this subchapter, other than a temporary license granted under rules promulgated under s. 448.9725 (3), is specified under s. 440.08 (2) (a).

SB762,42,24 (b) Renewal applications shall be submitted to the department on a form provided by the department and shall be accompanied by all of the following:

SB762,42,25 1. The renewal fee determined by the department under s. 440.03 (9) (a).

SB762,43,1 2. Proof of completion of continuing education requirements in s. 448.975.

SB762,43,4 3. Proof of current licensure by the chiropractic examining board under ch. 446, unless the affiliated credentialing board waives that requirement under s. 448.9725 (2).

SB762,43,11 (3) A licensee whose license is lost, stolen, or destroyed may apply to the department for a duplicate license. Duplicate license applications shall be submitted to the department on a form provided by the department and shall be accompanied by the fee specified under s. 440.05 (7) and an affidavit describing the circumstances of the loss, theft, or destruction of the license. Upon receipt of an application under this subsection, the department shall issue a duplicate license bearing on its face the word "duplicate".

SB762,43,14 448.974 Malpractice liability insurance. (1) Each licensee shall annually submit to the affiliated credentialing board evidence satisfactory to the affiliated credentialing board that the licensee satisfies any of the following:

SB762,43,17 (a) The licensee has in effect malpractice liability insurance coverage in the amount of at least $1,000,000 per occurrence and $1,000,000 for all occurrences in one year.

SB762,43,18 (b) The licensee meets all of the following conditions:

SB762,43,19 1. The licensee's principal place of practice is not in this state.

SB762,43,21 2. The licensee will not be engaged in the practice of spinal medicine in this state for more than 240 hours during the following 12 months.

SB762,43,24 3. The licensee has in effect malpractice liability insurance coverage that covers services provided by the licensee to patients in this state and that is in any of the following amounts:

SB762,44,3 a. At least the minimum amount of malpractice liability insurance coverage that is required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located.

SB762,44,9 b. If the licensee is not required under the laws of the state in which the affiliated credentialing board determines that the licensee's principal place of practice is located to have in effect a minimum amount of malpractice liability insurance coverage, at least the minimum amount of malpractice liability insurance coverage that the affiliated credentialing board determines is necessary to protect the public.

SB762,44,12 (2) A licensee's principal place of practice is not in this state for purposes of sub. (1) (b) if the affiliated credentialing board determines that, during the following 12 months, any of the following applies:

SB762,44,14 (a) More than 50 percent of the licensee's practice will be performed outside this state.

SB762,44,16 (b) More than 50 percent of the income from the licensee's practice will be derived from outside this state.

SB762,44,18 (c) More than 50 percent of the licensee's patients will be treated by the licensee outside this state.

SB762,44,21 (3) The affiliated credentialing board may suspend, revoke, or refuse to issue or renew the license of a person who fails to procure or to submit proof of the malpractice liability insurance coverage required under sub. (1).

SB762,45,2 448.9745 Malpractice. Except as provided in s. 257.03, a person who practices spinal medicine without a license under s. 448.9725 may be liable for malpractice, and the person's ignorance of a duty ordinarily performed by a primary spinal care practitioner shall not limit his or her liability for an injury arising from his or her practice of spinal medicine.

SB762,45,6 448.975 Continuing education. (1) (a) 1. The affiliated credentialing board shall promulgate rules establishing requirements and procedures for licensees to complete continuing education programs or courses of study in order to qualify for renewal of a license granted under this subchapter.

SB762,45,8 2. The rules shall allow for program sponsors, as defined in s. 446.028, to conduct continuing education programs.

SB762,45,11 3. The rules shall require each licensee to complete at least 50 hours of approved continuing education within each 2-year period immediately preceding the renewal date specified under s. 440.08 (2) (a).

SB762,45,14 (b) 1. A licensee may apply up to 40 of the 50 continuing education hours required under par. (a) toward the continuing education requirements for chiropractors under ch. 446, as determined by the chiropractic examining board.

SB762,45,16 2. At least 25 of the 50 continuing education hours required under par. (a) shall include evidence-based pharmacology and medical procedures-based training.

SB762,45,20 (2) The affiliated credentialing board may waive all or part of the requirements under sub. (1) if the affiliated credentialing board determines that prolonged illness, disability, or other exceptional circumstances prevented a licensee from completing the requirements.

SB762,46,2 448.9755 Fee splitting and billing requirements. (1) Fee splitting. No licensee may give or receive, directly or indirectly, to or from any other person any fee, commission, rebate, or other form of compensation or anything of value for sending, referring, or otherwise inducing a person to communicate with a licensee in a professional capacity, or for any professional services not actually rendered personally by the licensee or at the licensee's direction.

SB762,46,13 (2) Separate billing required. Except as provided in sub. (4), a licensee who renders any spinal medicine service or assistance, or gives any spinal medicine advice or any similar advice or assistance, to any patient, primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber certified under s. 441.16 (2), partnership, or corporation, or to any other institution or organization, including a hospital, for which a charge is made to a patient, shall, except as authorized by Title 18 or Title 19 of the federal Social Security Act, render an individual statement or account of the charge directly to the patient, distinct and separate from any statement or account by any other primary spinal care practitioner, chiropractor, physician, physician assistant, advanced practice nurse prescriber, or other person.

SB762,46,18 (3) Billing for tests performed by the state laboratory of hygiene. A licensee who charges a patient, other person, or 3rd-party payer for services performed by the state laboratory of hygiene shall identify the actual amount charged by the state laboratory of hygiene and shall restrict charges for those services to that amount.

SB762,46,23 (4) Billing by entity. If 2 or more licensees form an entity for the practice of spinal medicine, the entity may not render a single bill for health care services provided in the name of the entity unless each individual licensed, registered, or certified under this chapter or ch. 446, 449, 450, 455, 457, or 459, who provides services is individually identified on the bill as having rendered those services.

SB762,47,3 448.976 Disciplinary proceedings and actions. (1) In this section, "unprofessional conduct" means an act or attempted act of commission or omission, as defined by the affiliated credentialing board by rule, or an act by a primary spinal care practitioner otherwise in violation of this subchapter or in violation of ch. 446, 450, or 961.

SB762,47,10 (2) Investigation; hearing; action. (a) 1. The affiliated credentialing board shall investigate allegations of unprofessional conduct and negligence in the practice of spinal medicine. The affiliated credentialing board shall refer an allegation of a violation of ch. 446 to the chiropractic examining board for investigation, unless the alleged conduct also involves a violation of this subchapter or ch. 450 or 961, in which case the affiliated credentialing board and the chiropractic examining board shall consult concerning the investigation.

SB762,47,13 2. The affiliated credentialing board shall investigate information contained in reports filed with the affiliated credentialing board under s. 49.45 (2) (a) 12r., 50.36 (3) (b), 609.17, or 632.715, or under 42 CFR 1001.2005.

SB762,47,16 3. The affiliated credentialing board may use information contained in a report filed with the affiliated credentialing board under s. 50.36 (3) (c) as the basis of an investigation of a person named in the report.

SB762,47,21 4. The affiliated credentialing board may require a person to undergo and may consider the results of a physical, mental, or professional competency examination if the affiliated credentialing board believes that the results of the examination may be useful to the affiliated credentialing board in conducting an investigation under this paragraph.

SB762,47,25 (b) 1. After an investigation, if the affiliated credentialing board finds that there is probable cause to believe that a person is guilty of unprofessional conduct or negligence in the practice of spinal medicine, the affiliated credentialing board shall hold a hearing.

SB762,48,5 2. The affiliated credentialing board may require a person to undergo and may consider the results of a physical, mental, or professional competency examination if the affiliated credentialing board believes that the results of the examination may be useful to the affiliated credentialing board in conducting a hearing under subd. 1.

SB762,48,9 3. A finding by a court that a person has acted negligently in the practice of spinal medicine is conclusive evidence that the person is guilty of that negligence. A certified copy of the order of a court is presumptive evidence that the finding of negligence was made.

SB762,48,13 4. The affiliated credentialing board shall render a decision within 90 days after the date on which a hearing is held under subd. 1. or, if subsequent proceedings are conducted under s. 227.46 (2), within 90 days after the date on which those proceedings are completed.

SB762,48,19 (c) 1. After a disciplinary hearing under par. (b), the affiliated credentialing board may, when it determines that a court has found that a person has been negligent in the practice of spinal medicine or when it finds a person guilty of unprofessional conduct or negligence in the practice of spinal medicine, warn or reprimand that person, or limit, suspend, or revoke the person's license granted by the affiliated credentialing board.

SB762,48,25 2. The affiliated credentialing board may condition the removal of limitations on a license, or the restoration of a suspended or revoked license, upon obtaining minimum results specified by the affiliated credentialing board on a physical, mental, or professional competency examination if the affiliated credentialing board believes that obtaining the minimum results is related to correcting one or more of the bases upon which the limitation, suspension, or revocation was imposed.

SB762,49,2 (d) A person whose license under this subchapter is limited shall be permitted to continue practice if the he or she agrees to do all of the following:

SB762,49,3 1. Refrain from engaging in unprofessional conduct.

SB762,49,5 2. Appear before the affiliated credentialing board or its officers or agents at such times and places designated by the affiliated credentialing board.

SB762,49,7 3. Fully disclose to the affiliated credentialing board or its officers or agents the nature of the person's practice and conduct.

SB762,49,9 4. Fully comply with the limits placed on the person's practice and conduct by the affiliated credentialing board.

SB762,49,11 5. Obtain additional training, education or supervision required by the affiliated credentialing board.

SB762,49,12 6. Cooperate with the affiliated credentialing board.

SB762,49,17 (e) Unless a suspended license is revoked during the period of suspension, upon expiration of the period of suspension the affiliated credentialing board shall reinstate the person's license, except that the affiliated credentialing board may, as a condition precedent to the reinstatement of the license, require the person to pass any examination required for the original grant of the license.

SB762,49,20 (f) The affiliated credentialing board shall comply with rules of procedure for the investigation, hearing, and action promulgated by the department under s. 440.03 (1).

SB762,50,3 (3) Suspension pending hearing. (a) The affiliated credentialing board may summarily suspend a license granted by the affiliated credentialing board for a period not to exceed 30 days pending hearing if the affiliated credentialing board has in its possession evidence establishing probable cause to believe that the licensee has violated the provisions of this subchapter and that it is necessary to suspend the license immediately to protect the public health, safety, or welfare. The licensee shall be granted an opportunity to be heard before the affiliated credentialing board decides whether probable cause exists.

SB762,50,6 (b) The affiliated credentialing board may designate any of its officers to exercise the authority to suspend summarily a license, for a period not exceeding 72 hours.

SB762,50,12 (c) If a license has been summarily suspended under par. (a) or (b), the affiliated credentialing board may, while the hearing is in progress, extend the initial period of suspension for not more than an additional 30 days, except that if the licensee has caused a delay in the hearing process, the affiliated credentialing board may suspend the license from the time the hearing is commenced until a final decision is issued or may delegate such authority to the hearing examiner.

SB762,50,14 (4) Voluntary surrender. The affiliated credentialing board may negotiate stipulations in consideration for accepting the surrender of a license under s. 440.19.

SB762,50,17 (5) Restoration of a license. The affiliated credentialing board may restore a license that has been voluntarily surrendered or revoked on such terms and conditions as it considers appropriate.

SB762,50,24 448.9765 Hospital reports. (1) Within 30 days after receipt of a report under s. 50.36 (3) (c), the affiliated credentialing board shall notify the licensee, in writing, of the substance of the report. The licensee and the licensee's authorized representative may examine the report and may place into the record a statement, of reasonable length, of the licensee's view of the correctness or relevance of any information in the report. The licensee may institute an action in circuit court to amend or expunge any part of the licensee's record related to the report.

SB762,51,6 (2) If the affiliated credentialing board determines that a report submitted under s. 50.36 (3) (c) is without merit or that the licensee has sufficiently improved his or her conduct, the affiliated credentialing board shall remove the report from the licensee's record. If no report about a licensee is filed under s. 50.36 (3) (c) for 2 consecutive years, the licensee may petition the affiliated credentialing board to remove any prior reports not resulting in disciplinary action from his or her record.

SB762,51,7 (3) (a) In this subsection, "hospital" has the meaning specified in s. 50.33 (2).

SB762,51,12 (b) Upon the request of a hospital, the affiliated credentialing board shall provide the hospital with all information relating to a licensee's loss, reduction, or suspension of staff privileges from other hospitals and all information relating to the licensee's being found guilty of unprofessional conduct or negligence in the practice of chiropractic medicine under s. 448.976.

SB762,51,18 448.977 Injunctive relief. If the affiliated credentialing board has reason to believe that a person is violating this subchapter or a rule promulgated under this subchapter, the affiliated credentialing board, the department, the attorney general, or the district attorney of the proper county may investigate and may, in addition to all other remedies, bring an action in the name and on behalf of this state to enjoin the person from the violation.

SB762,51,19 448.9775 Penalties; appeal.

SB762,51,22 (1) Penalties. (a) Except as provided in par. (b), a person who violates a provision of this subchapter or a rule promulgated under this subchapter may be fined not more than $10,000 or imprisoned for not more than 9 months or both.

SB762,51,23 (b) A person who violates s. 448.9755 (3) may be fined not more than $250.

SB762,52,3 (2) Appeal. A person aggrieved by an action taken under this subchapter by the affiliated credentialing board, its officers, or its agents may apply for judicial review as provided in ch. 227, and shall file notice of such appeal with the affiliated credentialing board within 30 days. No court of this state may enter an ex parte stay of an action taken by the affiliated credentialing board under this subchapter.

SB762,52,6 448.978 Rules. The affiliated credentialing board shall promulgate rules defining the acts or attempted acts of commission or omission that constitute unprofessional conduct under s. 448.976 (1).

SB762,52,15 448.9785 Informed consent. Any primary spinal care practitioner who treats a patient shall inform the patient about the availability of reasonable alternate modes of treatment and about the benefits and risks of these treatments. The reasonable primary spinal care practitioner standard is the standard for informing a patient under this section. The reasonable primary spinal care practitioner standard requires disclosure only of information that a reasonable primary spinal care practitioner would know and disclose under the circumstances. The primary spinal care practitioner's duty to inform the patient under this section does not require disclosure of any of the following:

SB762,52,17 (1) Detailed technical information that in all probability a patient would not understand.