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SB21,2750 19Section 2750 . 102.077 (1) of the statutes, as affected by 2015 Wisconsin Act
20.... (this act), is amended to read:
SB21,1084,721 102.077 (1) A school district, private school, or institution of higher education
22may elect to name as its employee for purposes of this chapter a student described
23in s. 102.07 (12m) (b) by an endorsement on its policy of worker's compensation
24insurance or, if the school district, private school, or institution of higher education
25is exempt from the duty to insure under s. 102.28 (2) (a), by filing a declaration with

1the department office in the manner provided in s. 102.31 (2) (a) naming the student
2as an employee of the school district, private school, or institution of higher education
3for purposes of this chapter. A declaration under this subsection shall list the name
4of the student to be covered under this chapter, the name and address of the employer
5that is providing the work training or work experience for that student, and the title,
6if any, of the work training, work experience, or work study program in which the
7student is participating.
SB21,2751 8Section 2751. 102.077 (2) of the statutes is amended to read:
SB21,1084,149 102.077 (2) A school district or, private school, or institution of higher
10education
may revoke a declaration under sub. (1) by providing written notice to the
11department in the manner provided in s. 102.31 (2) (a), the student , and the employer
12who is providing the work training or work experience for that student. A revocation
13under this subsection is effective 30 days after the department receives notice of that
14revocation.
SB21,2752 15Section 2752 . 102.077 (2) of the statutes, as affected by 2015 Wisconsin Act
16.... (this act), is amended to read:
SB21,1084,2217 102.077 (2) A school district, private school, or institution of higher education
18may revoke a declaration under sub. (1) by providing written notice to the
19department office in the manner provided in s. 102.31 (2) (a), the student, and the
20employer who is providing the work training or work experience for that student.
21A revocation under this subsection is effective 30 days after the department office
22receives notice of that revocation.
SB21,2753 23Section 2753. 102.08 of the statutes is amended to read:
SB21,1085,11 24102.08 Administration for state employees. The department of
25administration has responsibility for the timely delivery of benefits payable under

1this chapter to employees of the state and their dependents and other functions of
2the state as an employer under this chapter. The department of administration may
3delegate this authority that responsibility to employing departments and agencies
4and require such reports as it deems considers necessary to accomplish this purpose.
5The department of administration or its delegated authorities shall file with the
6department of workforce development office the reports that are required of all
7employers. The department of workforce development office shall monitor the
8delivery of benefits payable under this chapter to state employees and their
9dependents and shall consult with and advise the department of administration in
10the manner and at the times necessary to ensure prompt and proper delivery of those
11benefits
.
SB21,2754 12Section 2754. 102.11 (1) (am) 1. of the statutes is amended to read:
SB21,1085,1913 102.11 (1) (am) 1. The employee is a member of a class of employees that does
14the same type of work at the same location and, in the case of an employee in the
15service of the state, is employed in the same office, department, independent agency,
16authority, institution, association, society, or other body in state government or, if the
17department office determines appropriate, in the same subunit of an office,
18department, independent agency, authority, institution, association, society, or other
19body in state government.
SB21,2755 20Section 2755. 102.12 of the statutes is amended to read:
SB21,1086,15 21102.12 Notice of injury, exception, laches. No claim for compensation may
22be maintained unless, within 30 days after the occurrence of the injury or within 30
23days after the employee knew or ought to have known the nature of his or her
24disability and its relation to the employment, actual notice was received by the
25employer or by an officer, manager, or designated representative of an employer. If

1no representative has been designated by posters placed in one or more conspicuous
2places where notices to employees are customarily posted, then notice received by
3any superior is sufficient. Absence of notice does not bar recovery if it is found that
4the employer was not misled thereby by that absence. Regardless of whether notice
5was received, if no payment of compensation, other than medical treatment or burial
6expense, is made, and and if no application is filed with the department office within
72 years from after the date of the injury or death, or from or the date the employee
8or his or her dependent knew or ought to have known the nature of the disability and
9its relation to the employment, the right to compensation therefor for the injury or
10death
is barred, except that the right to compensation is not barred if the employer
11knew or should have known, within the 2-year period, that the employee had
12sustained the injury on which the claim is based. Issuance of notice of a hearing on
13the department's division's own motion has the same effect for the purposes of this
14section as the filing of an application. This section does not affect any claim barred
15under s. 102.17 (4).
SB21,2756 16Section 2756. 102.125 of the statutes is amended to read:
SB21,1087,5 17102.125 Fraudulent claims reporting and investigation. If an insurer or
18self-insured employer has evidence that a claim is false or fraudulent in violation of
19s. 943.395 and if the insurer or self-insured employer is satisfied that reporting the
20claim to the department office will not impede its ability to defend the claim, the
21insurer or self-insured employer shall report the claim to the department office. The
22department office may require an insurer or self-insured employer to investigate an
23allegedly false or fraudulent claim and may provide the insurer or self-insured
24employer with any records of the department office relating to that claim. An insurer
25or self-insured employer that investigates a claim under this section shall report on

1the results of that investigation to the department office. If based on the
2investigation the department office has a reasonable basis to believe that a violation
3of s. 943.395 has occurred, the department office shall refer the results of the
4investigation to the district attorney of the county in which the alleged violation
5occurred for prosecution.
SB21,2757 6Section 2757. 102.13 (1) (c) of the statutes is amended to read:
SB21,1087,147 102.13 (1) (c) So long as the employee, after a written request of the employer
8or insurer which that complies with par. (b), refuses to submit to or in any way
9obstructs the examination, the employee's right to begin or maintain any proceeding
10for the collection of compensation is suspended, except as provided in sub. (4). If the
11employee refuses to submit to the examination after direction by the department
12division or an examiner, or in any way obstructs the examination, the employee's
13right to the weekly indemnity which that accrues and becomes payable during the
14period of that refusal or obstruction, is barred, except as provided in sub. (4).
SB21,2758 15Section 2758. 102.13 (1) (d) 2. of the statutes is amended to read:
SB21,1087,2016 102.13 (1) (d) 2. Any physician, chiropractor, psychologist, dentist, physician
17assistant, advanced practice nurse prescriber, or podiatrist who attended a worker's
18compensation claimant for any condition or complaint reasonably related to the
19condition for which the claimant claims compensation may be required to testify
20before the department division when the department division so directs.
SB21,2759 21Section 2759. 102.13 (1) (d) 3. of the statutes is amended to read:
SB21,1088,322 102.13 (1) (d) 3. Notwithstanding any statutory provisions except par. (e), any
23physician, chiropractor, psychologist, dentist, physician assistant, advanced
24practice nurse prescriber, or podiatrist attending a worker's compensation claimant
25for any condition or complaint reasonably related to the condition for which the

1claimant claims compensation may furnish to the employee, employer, worker's
2compensation insurer, or the department the office, or the division information and
3reports relative to a compensation claim.
SB21,2760 4Section 2760. 102.13 (1) (f) of the statutes is amended to read:
SB21,1088,75 102.13 (1) (f) If an employee claims compensation under s. 102.81 (1), the
6department office may require the employee to submit to physical or vocational
7examinations under this subsection.
SB21,2761 8Section 2761. 102.13 (2) (a) of the statutes is amended to read:
SB21,1088,199 102.13 (2) (a) An employee who reports an injury alleged to be work-related
10or who files an application for hearing waives any physician-patient,
11psychologist-patient or chiropractor-patient privilege with respect to any condition
12or complaint reasonably related to the condition for which the employee claims
13compensation. Notwithstanding ss. 51.30 and 146.82 and any other law, any
14physician, chiropractor, psychologist, dentist, podiatrist, physician assistant,
15advanced practice nurse prescriber, hospital, or health care provider shall, within a
16reasonable time after written request by the employee, employer, worker's
17compensation insurer, or department office, or division, or its representative, provide
18that person with any information or written material reasonably related to any
19injury for which the employee claims compensation.
SB21,2762 20Section 2762. 102.13 (2) (c) of the statutes is amended to read:
SB21,1089,1021 102.13 (2) (c) Except as provided in this paragraph, if an injured employee has
22a period of temporary disability that exceeds 3 weeks or a permanent disability, if the
23injured employee has undergone surgery to treat his or her injury, other than surgery
24to correct a hernia, or if the injured employee sustained an eye injury requiring
25medical treatment on 3 or more occasions off the employer's premises, the

1department office may by rule require the insurer or self-insured employer to submit
2to the department office a final report of the employee's treating practitioner. The
3department office may not require an insurer or self-insured employer to submit to
4the department office a final report of an employee's treating practitioner when the
5insurer or self-insured employer denies the employee's claim for compensation and
6the employee does not contest that denial. A treating practitioner may charge a
7reasonable fee for the completion of the final report, but may not require prepayment
8of that fee. An insurer or self-insured employer that disputes the reasonableness of
9a fee charged for the completion of a treatment practitioner's final report may submit
10that dispute to the department office for resolution under s. 102.16 (2).
SB21,2763 11Section 2763. 102.13 (3) of the statutes is amended to read:
SB21,1089,2412 102.13 (3) If 2 or more physicians, chiropractors, psychologists, dentists or
13podiatrists disagree as to the extent of an injured employee's temporary disability,
14the end of an employee's healing period, an employee's ability to return to work at
15suitable available employment, or the necessity for further treatment or for a
16particular type of treatment, the department division may appoint another
17physician, chiropractor, psychologist, dentist or podiatrist to examine the employee
18and render an opinion as soon as possible. The department division shall promptly
19notify the parties of this appointment. If the employee has not returned to work,
20payment for temporary disability shall continue until the department division
21receives the opinion. The employer or its insurance carrier or both shall pay for the
22examination and opinion. The employer or insurance carrier or both shall receive
23appropriate credit for any overpayment to the employee determined by the
24department division after receipt of the opinion.
SB21,2764 25Section 2764. 102.13 (4) of the statutes is amended to read:
SB21,1090,15
1102.13 (4) The rights of employees right of an employee to begin or maintain
2proceedings for the collection of compensation and to receive weekly indemnities
3which that accrue and become payable shall not be suspended or barred under sub.
4(1) when an the employee refuses to submit to a physical examination, upon the
5request of the employer or worker's compensation insurer or at the direction of the
6department division or an examiner, which that would require the employee to travel
7a distance of 100 miles or more from his or her place of residence, unless the employee
8has claimed compensation for treatment from a practitioner whose office is located
9100 miles or more from the employee's place of residence or the department division
10or examiner determines that any other circumstances warrant the examination. If
11the employee has claimed compensation for treatment from a practitioner whose
12office is located 100 miles or more from the employee's place of residence, the
13employer or insurer may request, or the department division or an examiner may
14direct, the employee to submit to a physical examination in the area where the
15employee's treatment practitioner is located.
SB21,2765 16Section 2765. 102.13 (5) of the statutes is amended to read:
SB21,1090,2517 102.13 (5) The department division may refuse to receive testimony as to
18conditions determined from an autopsy if it appears that the party offering the
19testimony had procured the autopsy and had failed to make reasonable effort to
20notify at least one party in adverse interest or the department division at least 12
21hours before the autopsy of the time and place it at which the autopsy would be
22performed, or that the autopsy was performed by or at the direction of the coroner
23or medical examiner or at the direction of the district attorney for purposes not
24authorized by under ch. 979. The department division may withhold findings until
25an autopsy is held in accordance with its directions.
SB21,2766
1Section 2766. 102.14 (title) of the statutes is amended to read:
SB21,1091,2 2102.14 (title) Jurisdiction of department office; advisory committee.
SB21,2767 3Section 2767. 102.14 (1) of the statutes is amended to read:
SB21,1091,54 102.14 (1) This Except as otherwise provided, this chapter shall be
5administered by the department office.
SB21,2768 6Section 2768. 102.14 (2) of the statutes is amended to read:
SB21,1091,157 102.14 (2) The council on worker's compensation shall advise the department
8office in carrying out the purposes of this chapter . Such council, shall submit its
9recommendations with respect to amendments to this chapter to each regular
10session of the legislature, and shall report its views upon any pending bill relating
11to this chapter to the proper legislative committee. At the request of the chairpersons
12of the senate and assembly committees on labor, the department office shall schedule
13a meeting of the council with the members of the senate and assembly committees
14on labor to review and discuss matters of legislative concern arising under this
15chapter.
SB21,2769 16Section 2769. 102.15 (1) of the statutes is amended to read:
SB21,1091,1817 102.15 (1) Subject to this chapter, the department division may adopt its own
18rules of procedure and may change the same from time to time.
SB21,2770 19Section 2770. 102.15 (2) of the statutes is amended to read:
SB21,1091,2220 102.15 (2) The department division may provide by rule the conditions under
21which transcripts or electronic recordings of testimony and proceedings shall be
22furnished.
SB21,2771 23Section 2771. 102.15 (3) of the statutes is amended to read:
SB21,1092,524 102.15 (3) All testimony at any hearing held under this chapter shall be taken
25down by a stenographic reporter, except that in case of an emergency, as determined

1by
recorded by electronic means. That testimony need not be transcribed, unless the
2examiner conducting the hearing, testimony may be recorded by a recording machine
3orders otherwise. The division shall furnish a copy of an electronic recording made
4under this subsection or a transcript ordered under this subsection to the parties
5upon payment of any fee required by the division by rule
.
SB21,2772 6Section 2772. 102.16 (1) of the statutes is amended to read:
SB21,1092,237 102.16 (1) Any controversy concerning compensation or a violation of sub. (3),
8including controversies a controversy in which the state may be a party, shall be
9submitted to the department division in the manner and with the effect provided in
10this chapter. Every compromise of any claim for compensation may be reviewed and
11set aside, modified or confirmed by the department within
Within one year from after
12the date the on which a compromise of any claim for compensation is filed with the
13department, or from division or the date on which an award has been entered, based
14thereon, or the department may take that action
based on a compromise, the
15division, on its own motion or
upon application made within one year that period,
16may review and set aside, modify, or confirm the compromise
. Unless the word
17"compromise" appears in a stipulation of settlement, the settlement shall not be
18deemed considered a compromise, and further claim is not barred except as provided
19in s. 102.17 (4) regardless of whether an award is made. The employer, insurer, or
20dependent under s. 102.51 (5) shall have equal rights with the employee to have
21review of a compromise or any other stipulation of settlement reviewed under this
22subsection
. Upon petition filed with the department division, the department
23division may set aside the award or otherwise determine the rights of the parties.
SB21,2773 24Section 2773. 102.16 (1m) (a) of the statutes is amended to read:
SB21,1093,16
1102.16 (1m) (a) If an insurer or self-insured employer concedes by compromise
2under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
3employer is liable under this chapter for any health services provided to an injured
4employee by a health service provider, but disputes the reasonableness of the fee
5charged by the health service provider, the department division may include in its
6order confirming the compromise or stipulation a determination made by the office
7under sub. (2)
as to the reasonableness of the fee or the department, if such a
8determination has not yet been made, the division
may notify, or direct the insurer
9or self-insured employer to notify, the health service provider under sub. (2) (b) that
10the reasonableness of the fee is in dispute. The department shall deny payment of
11a health service fee that the department determines under this paragraph to be
12unreasonable. A health service provider and an insurer or self-insured employer
13that are parties to a fee dispute under this paragraph are bound by the department's
14determination under this paragraph on the reasonableness of the disputed fee,
15unless that determination is set aside, reversed, or modified by the department
16under sub. (2) (f) or is set aside on judicial review as provided in sub. (2) (f).
SB21,2774 17Section 2774. 102.16 (1m) (b) of the statutes is amended to read:
SB21,1094,1518 102.16 (1m) (b) If an insurer or self-insured employer concedes by compromise
19under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
20employer is liable under this chapter for any treatment provided to an injured
21employee by a health service provider, but disputes the necessity of the treatment,
22the department division may include in its order confirming the compromise or
23stipulation a determination made by the office under sub. (2m) as to the necessity of
24the treatment or the department, if such a determination has not yet been made, the
25division
may notify, or direct the insurer or self-insured employer to notify, the

1health service provider under sub. (2m) (b) that the necessity of the treatment is in
2dispute. Before determining under this paragraph the necessity of treatment
3provided to an injured employee, the department may, but is not required to, obtain
4the opinion of an expert selected by the department who is qualified as provided in
5sub. (2m) (c). The standards promulgated under sub. (2m) (g) shall be applied by an
6expert and by the department in rendering an opinion as to, and in determining,
7necessity of treatment under this paragraph. In cases in which no standards
8promulgated under sub. (2m) (g) apply, the department shall find the facts regarding
9necessity of treatment. The department shall deny payment for any treatment that
10the department determines under this paragraph to be unnecessary. A health
11service provider and an insurer or self-insured employer that are parties to a dispute
12under this paragraph over the necessity of treatment are bound by the department's
13determination under this paragraph on the necessity of the disputed treatment,
14unless that determination is set aside, reversed, or modified by the department
15under sub. (2m) (e) or is set aside on judicial review as provided in sub. (2m) (e).
SB21,2775 16Section 2775. 102.16 (1m) (c) of the statutes is amended to read:
SB21,1095,1017 102.16 (1m) (c) If an insurer or self-insured employer concedes by compromise
18under sub. (1) or stipulation under s. 102.18 (1) (a) that the insurer or self-insured
19employer is liable under this chapter for the cost of a prescription drug dispensed
20under s. 102.425 (2) for outpatient use by an injured employee, but disputes the
21reasonableness of the amount charged for the prescription drug, the department
22division may include in its order confirming the compromise or stipulation a
23determination made by the office under s. 102.425 (4m) as to the reasonableness of
24the prescription drug charge or the department, if such a determination has not yet
25been made, the division
may notify, or direct the insurer or self-insured employer to

1notify, the pharmacist or practitioner dispensing the prescription drug under s.
2102.425 (4m) (b) that the reasonableness of the prescription drug charge is in
3dispute. The department shall deny payment of a prescription drug charge that the
4department determines under this paragraph to be unreasonable. A pharmacist or
5practitioner and an insurer or self-insured employer that are parties to a dispute
6under this paragraph over the reasonableness of a prescription drug charge are
7bound by the department's determination under this paragraph on the
8reasonableness of the disputed prescription drug charge, unless that determination
9is set aside, reversed, or modified by the department under s. 102.425 (4m) (e) or is
10set aside on judicial review as provided in s. 102.425 (4m) (e).
SB21,2776 11Section 2776. 102.16 (2) (a) of the statutes is amended to read:
SB21,1095,2512 102.16 (2) (a) Except as provided in this paragraph, the department office has
13jurisdiction under this subsection, sub. (1m) (a), and s. 102.17 to resolve a dispute
14between a health service provider and an insurer or self-insured employer over the
15reasonableness of a fee charged by the health service provider for health services
16provided to an injured employee who claims benefits under this chapter. A health
17service provider may not submit a fee dispute to the department office under this
18subsection before all treatment by the health service provider of the employee's
19injury has ended if the amount in controversy, whether based on a single charge or
20a combination of charges for one or more days of service, is less than $25. After all
21treatment by a health service provider of an employee's injury has ended, the health
22service provider may submit any fee dispute to the department office, regardless of
23the amount in controversy. The department office shall deny payment of a health
24service fee that the department office determines under this subsection to be
25unreasonable.
SB21,2777
1Section 2777. 102.16 (2) (am) of the statutes is amended to read:
SB21,1096,62 102.16 (2) (am) A health service provider and an insurer or self-insured
3employer that are parties to a fee dispute under this subsection are bound by the
4department's office's determination under this subsection on the reasonableness of
5the disputed fee, unless that determination is set aside on judicial review as provided
6in par. (f).
SB21,2778 7Section 2778. 102.16 (2) (b) of the statutes is amended to read:
SB21,1096,158 102.16 (2) (b) An insurer or self-insured employer that disputes the
9reasonableness of a fee charged by a health service provider or the department office
10under sub. (1m) (a) or s. 102.18 (1) (bg) 1. shall provide reasonable written notice to
11the health service provider that the fee is being disputed. After receiving reasonable
12written notice under this paragraph or under sub. (1m) (a) or s. 102.18 (1) (bg) 1. that
13a health service fee is being disputed, a health service provider may not collect the
14disputed fee from, or bring an action for collection of the disputed fee against, the
15employee who received the services for which the fee was charged.
SB21,2779 16Section 2779. 102.16 (2) (c) of the statutes is amended to read:
SB21,1097,217 102.16 (2) (c) After a fee dispute is submitted to the department office, the
18insurer or self-insured employer that is a party to the dispute shall provide to the
19department office information on that fee and information on fees charged by other
20health service providers for comparable services. The insurer or self-insured
21employer shall obtain the information on comparable fees from a database that is
22certified by the department office under par. (h). Except as provided in par. (e) 1., if
23the insurer or self-insured employer does not provide the information required
24under this paragraph, the department office shall determine that the disputed fee
25is reasonable and order that it be paid. If the insurer or self-insured employer

1provides the information required under this paragraph, the department office shall
2use that information to determine the reasonableness of the disputed fee.
SB21,2780 3Section 2780. 102.16 (2) (d) of the statutes is amended to read:
SB21,1097,194 102.16 (2) (d) The department office shall analyze the information provided to
5the department office under par. (c) according to the criteria provided in this
6paragraph to determine the reasonableness of the disputed fee. Except as provided
7in 2011 Wisconsin Act 183, section 30 (2) (b), the department office shall determine
8that a disputed fee is reasonable and order that the disputed fee be paid if that fee
9is at or below the mean fee for the health service procedure for which the disputed
10fee was charged, plus 1.2 standard deviations from that mean, as shown by data from
11a database that is certified by the department office under par. (h). Except as
12provided in 2011 Wisconsin Act 183, section 30 (2) (b), the department office shall
13determine that a disputed fee is unreasonable and order that a reasonable fee be paid
14if the disputed fee is above the mean fee for the health service procedure for which
15the disputed fee was charged, plus 1.2 standard deviations from that mean, as shown
16by data from a database that is certified by the department office under par. (h),
17unless the health service provider proves to the satisfaction of the department office
18that a higher fee is justified because the service provided in the disputed case was
19more difficult or more complicated to provide than in the usual case.
SB21,2781 20Section 2781. 102.16 (2) (e) 1. of the statutes is amended to read:
SB21,1098,321 102.16 (2) (e) 1. Subject to subd. 2., if an insurer or self-insured employer that
22disputes the reasonableness of a fee charged by a health service provider cannot
23provide information on fees charged by other health service providers for comparable
24services because the database to which the insurer or self-insured employer
25subscribes is not able to provide accurate information for the health service

1procedure at issue, the department office may use any other information that the
2department office considers to be reliable and relevant to the disputed fee to
3determine the reasonableness of the disputed fee.
SB21,2782 4Section 2782. 102.16 (2) (e) 2. of the statutes is amended to read:
SB21,1098,75 102.16 (2) (e) 2. Notwithstanding subd. 1., the department office may use only
6a hospital radiology database that has been certified by the department office under
7par. (h) to determine the reasonableness of a hospital fee for radiology services.
SB21,2783 8Section 2783. 102.16 (2) (f) of the statutes is amended to read:
SB21,1098,169 102.16 (2) (f) Within 30 days after a determination under this subsection, the
10department office may set aside, reverse, or modify the determination for any reason
11that the department office considers sufficient. Within 60 days after a determination
12under this subsection, the department office may set aside, reverse, or modify the
13determination on grounds of mistake. A health service provider, insurer, or
14self-insured employer that is aggrieved by a determination of the department office
15under this subsection may seek judicial review of that determination in the same
16manner that compensation claims are reviewed under s. 102.23.
SB21,2784 17Section 2784. 102.16 (2) (h) of the statutes is amended to read:
SB21,1099,218 102.16 (2) (h) The department office shall promulgate rules establishing
19procedures and requirements for the fee dispute resolution process under this
20subsection, including rules specifying the standards that health service fee
21databases must meet for certification under this paragraph. Using those standards,
22the department office shall certify databases of the health service fees that various
23health service providers charge. In certifying databases under this paragraph, the
24department office shall certify at least one database of hospital fees for radiology

1services, including diagnostic and interventional radiology, diagnostic ultrasound,
2and nuclear medicine.
SB21,2785 3Section 2785. 102.16 (2m) (a) of the statutes is amended to read:
SB21,1099,164 102.16 (2m) (a) Except as provided in this paragraph, the department office
5has jurisdiction under this subsection, sub. (1m) (b), and s. 102.17 to resolve a dispute
6between a health service provider and an insurer or self-insured employer over the
7necessity of treatment provided for an injured employee who claims benefits under
8this chapter. A health service provider may not submit a dispute over necessity of
9treatment to the department office under this subsection before all treatment by the
10health service provider of the employee's injury has ended if the amount in
11controversy, whether based on a single charge or a combination of charges for one or
12more days of service, is less than $25. After all treatment by a health service provider
13of an employee's injury has ended, the health service provider may submit any
14dispute over necessity of treatment to the department office, regardless of the
15amount in controversy. The department office shall deny payment for any treatment
16that the department office determines under this subsection to be unnecessary.
SB21,2786 17Section 2786. 102.16 (2m) (am) of the statutes is amended to read:
SB21,1099,2218 102.16 (2m) (am) A health service provider and an insurer or self-insured
19employer that are parties to a dispute under this subsection over the necessity of
20treatment are bound by the department's office's determination under this
21subsection on the necessity of the disputed treatment, unless that determination is
22set aside on judicial review as provided in par. (e).
SB21,2787 23Section 2787. 102.16 (2m) (b) of the statutes is amended to read:
SB21,1100,724 102.16 (2m) (b) An insurer or self-insured employer that disputes the
25necessity of treatment provided by a health service provider or the department

1division under sub. (1m) (b) or s. 102.18 (1) (bg) 2. shall provide reasonable written
2notice to the health service provider that the necessity of that treatment is being
3disputed. After receiving reasonable written notice under this paragraph or under
4sub. (1m) (b) or s. 102.18 (1) (bg) 2. that the necessity of treatment is being disputed,
5a health service provider may not collect a fee for that disputed treatment from, or
6bring an action for collection of the fee for that disputed treatment against, the
7employee who received the treatment.
SB21,2788 8Section 2788. 102.16 (2m) (c) of the statutes is amended to read:
SB21,1100,259 102.16 (2m) (c) Before determining under this subsection the necessity of
10treatment provided for an injured employee who claims benefits under this chapter,
11the department office shall obtain a written opinion on the necessity of the treatment
12in dispute from an expert selected by the department office. To qualify as an expert,
13a person must be licensed to practice the same health care profession as the
14individual health service provider whose treatment is under review and must either
15be performing services for an impartial health care services review organization or
16be a member of an independent panel of experts established by the department office
17under par. (f). The standards promulgated under par. (g) shall be applied by an
18expert and by the department office in rendering an opinion as to, and in
19determining, necessity of treatment under this paragraph. In cases in which no
20standards promulgated under sub. (2m) (g) apply, the department office shall find
21the facts regarding necessity of treatment. The department office shall adopt the
22written opinion of the expert as the department's office's determination on the issues
23covered in the written opinion, unless the health service provider or the insurer or
24self-insured employer present clear and convincing written evidence that the
25expert's opinion is in error.
SB21,2789
1Section 2789. 102.16 (2m) (d) of the statutes is amended to read:
SB21,1101,122 102.16 (2m) (d) The department office may charge a party to a dispute over the
3necessity of treatment provided for an injured employee who claims benefits under
4this chapter for the full cost of obtaining the written opinion of the expert under par.
5(c). The department office shall charge the insurer or self-insured employer for the
6full cost of obtaining the written opinion of the expert for the first dispute that a
7particular individual health service provider is involved in, unless the department
8office determines that the individual health service provider's position in the dispute
9is frivolous or based on fraudulent representations. In a subsequent dispute
10involving the same individual health service provider, the department office shall
11charge the losing party to the dispute for the full cost of obtaining the written opinion
12of the expert.
SB21,2790 13Section 2790. 102.16 (2m) (e) of the statutes is amended to read:
SB21,1101,2114 102.16 (2m) (e) Within 30 days after a determination under this subsection, the
15department office may set aside, reverse, or modify the determination for any reason
16that the department office considers sufficient. Within 60 days after a determination
17under this subsection, the department office may set aside, reverse, or modify the
18determination on grounds of mistake. A health service provider, insurer, or
19self-insured employer that is aggrieved by a determination of the department office
20under this subsection may seek judicial review of that determination in the same
21manner that compensation claims are reviewed under s. 102.23.
SB21,2791 22Section 2791. 102.16 (2m) (f) of the statutes is amended to read:
SB21,1102,323 102.16 (2m) (f) The department office may contract with an impartial health
24care services review organization to provide the expert opinions required under par.
25(c), or establish a panel of experts to provide those opinions, or both. If the

1department office establishes a panel of experts to provide the expert opinions
2required under par. (c), the department office may pay the members of that panel a
3reasonable fee, plus actual and necessary expenses, for their services.
SB21,2792 4Section 2792. 102.16 (2m) (g) of the statutes is amended to read:
SB21,1102,135 102.16 (2m) (g) The department office shall promulgate rules establishing
6procedures and requirements for the necessity of treatment dispute resolution
7process under this subsection, including rules setting the fees under par. (f) and rules
8establishing standards for determining the necessity of treatment provided to an
9injured employee. Before the department office may amend the rules establishing
10those standards, the department office shall establish an advisory committee under
11s. 227.13 composed of health care providers providing treatment under s. 102.42 to
12advise the department office and the council on worker's compensation on amending
13those rules.
SB21,2793 14Section 2793. 102.16 (4) of the statutes is amended to read:
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