15,284Section 284. 86.30 (9) (c) of the statutes is amended to read: 86.30 (9) (c) For the purpose of calculating and distributing aids under sub. (2), the amounts for aids to municipalities are $398,996,800 in calendar year 2023. In calendar year 2024, the amounts for aids to municipalities are $406,976,700. In calendar year 2025 and thereafter, the amounts for aids to municipalities are $415,116,200 in calendar year 2025. The amounts for aids to municipalities are $434,165,700 in calendar year 2026. The amounts for aids to municipalities are $447,190,700 in calendar year 2027 and thereafter. These amounts, to the extent practicable, shall be used to determine the statewide municipal average cost-sharing percentage in the particular calendar year.
15,285Section 285. 86.31 (3o) (m) 1. of the statutes is renumbered 86.31 (3o) (m) 1m. a. and amended to read: 86.31 (3o) (m) 1m. a. After June 23, 2026, the The department may not award a grant under this subsection from moneys appropriated in the 2023-25 fiscal biennium after June 23, 2026.
15,286Section 286. 86.31 (3o) (m) 2. of the statutes is renumbered 86.31 (3o) (m) 1m. b. and amended to read: 86.31 (3o) (m) 1m. b. After June 23, 2028, the The department may not reimburse any costs incurred under this subsection after June 23, 2028, with moneys appropriated in the 2023-25 fiscal biennium.
15,287Section 287. 86.31 (3o) (m) 2m. of the statutes is created to read: 86.31 (3o) (m) 2m. a. The department may not award a grant under this subsection from moneys appropriated in the 2025-27 fiscal biennium after 3 years after the effective date of this subd. 2m. a. .... [LRB inserts date].
b. The department may not reimburse any costs incurred under this subsection after 5 years after the effective date of this subd. 2m. b. .... [LRB inserts date] with moneys appropriated in the 2025-27 fiscal biennium.
15,288Section 288. 86.31 (3o) (n) of the statutes is amended to read: 86.31 (3o) (n) Except as provided in pars. (k) and (m) 2., this subsection does not apply after June 23, 2028 5 years after the effective date of this paragraph .... [LRB inserts date].
15,289Section 289. 86.31 (3s) (bm) of the statutes is amended to read: 86.31 (3s) (bm) From the appropriation under s. 20.395 (2) (fq), in 2025-26, the department shall allocate in 2023-24 amounts for county trunk highway improvements, town road improvements, and municipal street improvements so that the total funding in 2025-26 under s. 20.395 (2) (fq) in 2023-24 is distributed among these groups at the same percentage that each group is allocated from the total funding allocated under par. (b).
15,290Section 290. 86.32 (1m) of the statutes is created to read: 86.32 (1m) Notwithstanding sub. (1), the city of Menasha shall be eligible for aids payments under sub. (2) (a) for the actual costs of maintenance and operation of the lift bridge on Racine Street in the city of Menasha.
15,291Section 291. 86.32 (2) (a) of the statutes is amended to read: 86.32 (2) (a) Cities, villages, and towns shall be reimbursed for actual costs, as approved by the department, incurred in maintaining and operating lift bridges under subs. (1) and (1m). Documentation of costs shall be submitted by each city, village, and town by January 31 and reimbursement shall be made, starting in 1982-83, on the first Monday in July for costs incurred during the prior calendar year. If the amount appropriated under s. 20.395 (1) (ft) is insufficient to pay the actual costs approved by the department for the maintenance and operation of lift bridges, the department shall prorate the amount appropriated in the manner it deems desirable.
15,292Section 292. 102.03 (4) of the statutes is amended to read: 102.03 (4) The right to compensation and the amount of the compensation shall in all cases be determined in accordance with the provisions of law in effect as of the date of the injury except as to employees whose rate of compensation is changed as provided in s. 102.43 (5) (c) or (7) or 102.44 (1), (2) (a) 2., or (5) and employees who are eligible to receive private rehabilitative counseling and rehabilitative training under s. 102.61 (1m) and except as provided in s. 102.555 (12) (b).
15,293Section 293. 102.16 (1m) (a) of the statutes is amended to read: 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 or the division may include in its order confirming the compromise or stipulation a determination made by the department under sub. (2) as to the reasonableness of the fee or, if such a determination has not yet been made, the department or the division 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 or the division shall deny payment of a health service fee that the department determines is unreasonable or not allowable under sub. (2) 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 sub. (2) 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).
15,294Section 294. 102.16 (2) (c) of the statutes is renumbered 102.16 (2) (c) 1. and amended to read: 102.16 (2) (c) 1. After Except as provided in subd. 2., after a fee dispute is submitted to the department, the insurer or self-insured employer that is a party to the dispute shall provide to the department information on that fee and information on fees charged by other health service providers for comparable services. The insurer or self-insured employer shall obtain the information on comparable fees from a database that is certified by the department under par. (h) 2. Except as provided in par. (e) 1., if the insurer or self-insured employer does not provide the information required under this paragraph subdivision, the department shall determine that the disputed fee is reasonable and order that it be paid. If the insurer or self-insured employer provides the information required under this paragraph subdivision, the department shall use that information to determine the reasonableness of the disputed fee under par. (d).
15,295Section 295. 102.16 (2) (c) 2. of the statutes is created to read: 102.16 (2) (c) 2. After a dispute is submitted to the department concerning the the applicability of s. 102.423 to the fee or the amount of the fee under s. 102.423, the insurer or self-insured employer that is a party to the dispute shall provide to the department information on that fee, information on the medical records and bill provided to the insurer or self-insured employer in connection with that fee, and any other information requested by the department. If the insurer or self-insured employer does not provide the information required under this subdivision to confirm the applicability of s. 102.423, the department shall determine that s. 102.423 does not apply to the fee and may adjudicate the fee under subd. 1. If the insurer or self-insured employer does not provide the information required under this subdivision to determine that the amount of the fee exceeds the allowable amount under s. 102.423, as applicable, the department shall determine that the disputed fee is allowable and order that it be paid. If the insurer or self-insured employer provides the information required under this subdivision, the department shall use that information to determine if s. 102.423 applies to the disputed fee and whether the amount of the fee otherwise comports with s. 102.423.
15,296Section 296. 102.16 (2) (d) of the statutes is renumbered 102.16 (2) (d) 1. and amended to read: 102.16 (2) (d) 1. The department shall analyze the information provided to the department under par. (c) 1. 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 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 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h) 2. Except as provided in 2011 Wisconsin Act 183, section 30 (2) (b), 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 standard deviations from that mean, as shown by data from a database that is certified by the department under par. (h) 2., 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. This subdivision does not apply to a fee to which s. 102.423 applies.
15,297Section 297. 102.16 (2) (d) 2. of the statutes is created to read: 102.16 (2) (d) 2. a. The department shall analyze the information provided to the department under par. (c) 2. and determine whether s. 102.423 applies to the disputed fee and, if s. 102.423 applies, whether the amount of the fee otherwise comports with s. 102.423.
b. If the department determines that s. 102.423 does not apply to the disputed fee, the department shall evaluate the fee under subd. 1. The department may request additional information described under par. (c) 1. as needed to make that determination.
15,298Section 298. 102.16 (2) (e) 2. of the statutes is amended to read: 102.16 (2) (e) 2. Notwithstanding subd. 1., the department may use only a hospital radiology database that has been certified by the department under par. (h) 2. to determine the reasonableness of a hospital fee for radiology services.
15,299Section 299. 102.16 (2) (e) 3. of the statutes is created to read: 102.16 (2) (e) 3. This paragraph does not apply to a fee to which s. 102.423 applies.
15,300Section 300. 102.16 (2) (h) of the statutes is renumbered 102.16 (2) (h) 1. and amended to read: 102.16 (2) (h) 1. The department shall promulgate rules establishing procedures and requirements for the fee dispute resolution process under this subsection, including.
2. The rules specifying promulgated under subd. 1. shall specify the standards that health service fee databases must meet for certification under this paragraph subdivision. Using those standards, the department shall certify databases of the health service fees that various health service providers charge. In certifying databases under this paragraph subdivision, the department shall certify at least one database of hospital fees for radiology services, including diagnostic and interventional radiology, diagnostic ultrasound and nuclear medicine. The databases certified under this subdivision shall not be used for purposes of establishing the fee schedule under s. 102.423 (3) or for determining the reasonableness of a fee that is governed by the provisions of s. 102.423.
15,301Section 301. 102.18 (1) (bg) 1. of the statutes is amended to read: 102.18 (1) (bg) 1. If the division 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 division may include in its order under par. (b) a determination made by the department under s. 102.16 (2) as to the reasonableness of the fee or, if such a determination has not yet been made, the division 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.
15,302Section 302. 102.423 of the statutes is created to read: 102.423 Health service fee schedule. (1) Definitions. In this section:
(a) “Eligible hospital” has the meaning given under s. 50.38 (1).
(b) “Items or services” means hospital facility services that are “items and services,” as defined under 45 CFR 180.20.
(2) Applicability. (a) Subject to par. (b), this section shall apply to a fee for an item or service only if all of the following apply:
1. The fee is for an item or service that was provided by an eligible hospital.
2. The fee is for an item or service for which the eligible hospital may receive hospital inpatient or hospital outpatient reimbursement from the Medical Assistance program under subch. IV of ch. 49.
3. The fee was paid within the applicable period under par. (c).
(b) 1. a. If a notice from the department of health services under s. 50.38 (7m) (a) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (a) 1. a. or b. applies, then this section shall not apply from the day the notice is published until subd. 2. applies.
b. Except as provided in subd. 1. a., if a notice from the department of health services under s. 50.38 (7m) (a) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (a) 1. c. or d. applies, then this section shall not apply beginning on the first day of the calendar year following the calendar year in which the notice is published until subd. 2. applies.
2. a. Notwithstanding subd. 1., if a notice from the department of health services under s. 50.38 (7m) (b) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (b) 1. a. or b. applies, then this section applies from the day the notice is published.
b. Notwithstanding subd. 1. and except as provided in subd. 2. a., if a notice from the department of health services under s. 50.38 (7m) (b) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (b) 1. c. or d. applies, then this section applies beginning on the first day of the calendar year following the calendar year in which the notice is published.
(c) 1. In order for this section to apply to a fee, an insurer or self-insured employer must remit payment for the fee to the eligible hospital within the period specified in subd. 2., which shall begin to run on the day after whichever of the following dates is latest:
a. The date the eligible hospital electronically sends to the insurer or self-insured employer the medical records to substantiate the submitted hospital bill or, if such records are sent by mail, the 3rd day after the date the records are postmarked.
b. The date the eligible hospital electronically sends the bill described in subd. 1. a. or, if the bill is sent by mail, the 3rd day after the date the bill is postmarked.
2. a. If the aggregate amount billed is equal to or greater than $65,000, the period within which an insurer or self-insured employer must remit payment shall be 90 calendar days after the date determined under subd. 1.
b. If the aggregate amount billed is less than $65,000, the period within which an insurer or self-insured employer must remit payment shall be 60 calendar days after the date determined under subd. 1.
3. An insurer or self-insured employer may request that an eligible hospital send additional medical records to the insurer or self-insured employer that the insurer or self-insured employer reasonably believes are necessary to substantiate the claim. The eligible hospital shall provide the requested records to the extent practicable or within 10 days after the request is received, but a request under this subdivision by an insurer or self-insured employer shall not operate to extend the period specified under subd. 2. a. or b.
4. a. An insurer or self-insured employer may submit a request to the department for an extension to the period specified in subd. 2. if the insurer or self-insured employer has not yet determined whether an injury is compensable under this chapter. The department may, pursuant to rules promulgated under subd. 4. e., authorize such an extension if the department determines that the insurer or self-insured employer has not yet determined compensability despite its good faith effort to do so. A single extension granted by the department shall not exceed 30 calendar days. There is no limit to the number of extensions that an insurer or self-insured employer may request or that the department may grant under this subdivision, but an insurer or self-insured employer may not request another extension after a denial.
b. If the department denies a request for extension under this subdivision, the insurer or self-insured employer shall, notwithstanding subds. 1. and 2., have 14 calendar days after the denial to remit payment for the fee to the eligible hospital. If the insurer or self-insured employer remits payment for the fee to the eligible hospital within that 14-day period, then this section applies to that fee.
c. A request by an insurer or self-insured employer for an extension under this subdivision or a denial by the department of a request for extension under this subdivision shall not be used as evidence of bad faith by the insurer or self-insured employer.
d. Any information provided by an insurer or self-insured employer pursuant to this subdivision shall not be used as evidence of bad faith by the insurer or self-insured employer.
e. The department shall promulgate rules specifying requirements and procedures for requesting and granting extensions under this subdivision. The rules shall specify requirements or procedures to ensure that notice is provided to an eligible hospital when a request is made under this subdivision.
(3) Establishment of schedule. (a) By July 1, 2027, the department shall establish a schedule of the maximum fees that the eligible hospital may charge an insurer or self-insured employer for an item or service provided to an injured employee who claims benefits under this chapter. When the schedule under this subsection is established, the department shall send a notice to the legislative reference bureau for publication in the Wisconsin Administrative Register of the date that the schedule will be effective, which shall be no earlier than the date the notice is published. In determining the maximum fees, the department shall divide the state into 5 regions based on geographical and economic similarity, including similarity in the cost of items and services, and, for each region, shall do all of the following:
1. a. Determine, for each item or service included in the schedule, the amount that represents the 75th percentile of the commercial, in-network negotiated amounts, across all commercial health insurance plans, issuers, and administrators in that region. The department shall make the determinations under this subd. 1. a. in accordance with subd. 1. b. and c.
b. In order to determine the amounts under this subdivision, the department shall utilize the machine-readable files of all health insurance plans, issuers, administrators, and hospitals made public pursuant to 26 CFR 54.9815-2715A3, 29 CFR 2590.715-2715A3, 45 CFR 147.212, and 45 CFR 180.40 (a) that contain in-network negotiated rates for each eligible hospital in that region.
c. In determining the amounts under this subdivision, the department shall not use any amounts from Medicare advantage, services provided under a managed care system under the Medical Assistance program under subch. IV of ch. 49, databases certified by the department under s. 102.16 (2) (h), or any sources other than those specified in subd. 1. b.
2. Set the maximum fee for each item or service included in the schedule at 120 percent of the amount determined under subd. 1. for that region.
(am) The department shall contract with a 3rd party to perform the duties specified under pars. (a) 1. and 2.
(b) Every year, the department shall redetermine the schedule of maximum fees using the procedures specified in par. (a), subject to par. (am).
(d) The department shall publish the current fee schedule established under this subsection on the department’s website. Notwithstanding s. 227.10 (1), the fee schedule need not be promulgated as a rule.
(4) Liability of insurer or self-insured employer. (a) The liability of an insurer or self-insured employer for an item or service included in a fee schedule established under sub. (3) is limited to the maximum fee allowed under the schedule for the item or service as of the date on which the item or service was provided, any fee agreed to by contract between the insurer or self-insured employer and eligible hospital for the item or service as of that date, or the eligible hospital’s actual fee for the item or service as of that date, whichever is least.
(b) An eligible hospital that provides items or 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 insurer or self-insured employer under this subsection.
(c) A schedule of maximum fees established under sub. (3) first applies to an item or service provided to an injured employee on the effective date specified in the notice published under sub. (3) (a).
(d) Payment of a claim pursuant to this section is not an admission of causality or responsibility with respect to any future payments or obligations.
(5) Rules. The department shall, subject to sub. (3) (d), promulgate rules to implement this section.
15,303Section 303. 102.44 (2) of the statutes is renumbered 102.44 (2) (a) 1. and amended to read: 102.44 (2) (a) 1. In case of permanent total disability, aggregate indemnity shall be weekly indemnity for the period that the employee may live, subject to increase under subd. 2.
(b) 1. Total impairment for industrial use of both eyes, the loss of both arms at or near the shoulder, the loss of both legs at or near the hip, or the loss of one arm at the shoulder and one leg at the hip constitutes permanent total disability. This
2. The enumeration under subd. 1. is not exclusive, but in other cases the division shall find the facts.
15,304Section 304. 102.44 (2) (a) 2., 3. and 4. of the statutes are created to read: 102.44 (2) (a) 2. For injuries occurring on or after January 1, 2026, weekly indemnity for permanent total disability shall, beginning with the 6th anniversary of the date of injury and then annually thereafter on that anniversary, be increased as follows:
a. If the employee was receiving the maximum compensation rate, the employee’s weekly indemnity shall be increased to the maximum compensation rate then in effect for that year, as determined under s. 102.11 (1).
b. If the employee was receiving less than the maximum compensation rate, the employee’s weekly indemnity shall be increased to an amount that bears the same proportion to the maximum compensation rate then in effect for that year, as determined under s. 102.11 (1), as the employee’s compensation rate bore to the maximum compensation rate that was in effect at the time of the injury.
3. a. If a notice from the department of health services under s. 50.38 (7m) (a) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (a) 1. a. or b. applies, then no further increases under subd. 2. shall be applied after the date that notice is published until subd. 4. applies.
b. Except as provided in subd. 3. a., if a notice from the department of health services under s. 50.38 (7m) (a) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (a) 1. c. or d. applies, then no further increases under subd. 2. shall be applied beginning on the first day of the calendar year following the calendar year in which the notice is published until subd. 4. applies.
4. a. Notwithstanding subd. 3., if a notice from the department of health services under s. 50.38 (7m) (b) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (b) 1. a. or b. applies, then increases under subd. 2. shall be applied beginning on from the day the notice is published.
b. Notwithstanding subd. 3. and except as provided in subd. 4. a., if a notice from the department of health services under s. 50.38 (7m) (b) 1. is published by the legislative reference bureau in the Wisconsin Administrative Register indicating that either s. 50.38 (7m) (b) 1. c. or d. applies, then increases under subd. 2. shall be applied beginning on the first day of the calendar year following the calendar year in which the notice is published.
15,305Section 305. 106.276 (1) (c) 4. of the statutes is amended to read: 106.276 (1) (c) 4. The application is received by the department before July 1, 2025 2027.
