Amendment ASA2-AB50

AB50-ASA2,338,3 102.16 (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.

AB50-ASA2,296 Section 296. 102.16 (2) (d) of the statutes is renumbered 102.16 (2) (d) 1. and amended to read:

AB50-ASA2,338,22 102.16 (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.

AB50-ASA2,297 Section 297. 102.16 (2) (d) 2. of the statutes is created to read:

AB50-ASA2,339,4 102.16 (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.

AB50-ASA2,339,8 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.

AB50-ASA2,298 Section 298. 102.16 (2) (e) 2. of the statutes is amended to read:

AB50-ASA2,339,12 102.16 (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.

AB50-ASA2,299 Section 299. 102.16 (2) (e) 3. of the statutes is created to read:

AB50-ASA2,339,15 102.16 (2) (e) 3. This paragraph does not apply to a fee to which s. 102.423 applies.

AB50-ASA2,300 Section 300. 102.16 (2) (h) of the statutes is renumbered 102.16 (2) (h) 1. and amended to read:

AB50-ASA2,339,20 102.16 (2) (h) 1. The department shall promulgate rules establishing procedures and requirements for the fee dispute resolution process under this subsection, including.

AB50-ASA2,340,6 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.

AB50-ASA2,301 Section 301. 102.18 (1) (bg) 1. of the statutes is amended to read:

AB50-ASA2,340,16 102.18 (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.

AB50-ASA2,302 Section 302. 102.423 of the statutes is created to read:

AB50-ASA2,340,18 102.423 Health service fee schedule. (1) Definitions. In this section:

AB50-ASA2,340,19 (a) “Eligible hospital” has the meaning given under s. 50.38 (1).

AB50-ASA2,340,21 (b) “Items or services” means hospital facility services that are “items and services,” as defined under 45 CFR 180.20.

AB50-ASA2,340,23 (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:

AB50-ASA2,340,24 1. The fee is for an item or service that was provided by an eligible hospital.

AB50-ASA2,341,3 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.

AB50-ASA2,341,4 3. The fee was paid within the applicable period under par. (c).

AB50-ASA2,341,9 (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.

AB50-ASA2,341,15 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.

AB50-ASA2,341,19 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.

AB50-ASA2,342,2 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.

AB50-ASA2,342,6 (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:

AB50-ASA2,342,10 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.

AB50-ASA2,342,12 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.

AB50-ASA2,342,15 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.

AB50-ASA2,342,18 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.

AB50-ASA2,343,2 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 periods specified under subds. 1. and 2.

AB50-ASA2,343,13 (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:

AB50-ASA2,343,18 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.

AB50-ASA2,343,23 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.

AB50-ASA2,344,5 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.

AB50-ASA2,344,7 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.

AB50-ASA2,344,9 (am) The department shall contract with a 3rd party to perform the duties specified under pars. (a) 1. and 2.

AB50-ASA2,344,11 (b) Every year, the department shall redetermine the schedule of maximum fees using the procedures specified in par. (a), subject to par. (am).

AB50-ASA2,344,14 (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.

AB50-ASA2,344,21 (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.

AB50-ASA2,345,2 (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.

AB50-ASA2,345,5 (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).

AB50-ASA2,345,7 (5) Rules. The department shall, subject to sub. (3) (d), promulgate rules to implement this section.

AB50-ASA2,303 Section 303. 102.44 (2) of the statutes is renumbered 102.44 (2) (a) 1. and amended to read:

AB50-ASA2,345,12 102.44 (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.

AB50-ASA2,345,15 (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

AB50-ASA2,345,17 2. The enumeration under subd. 1. is not exclusive, but in other cases the division shall find the facts.

AB50-ASA2,304 Section 304. 102.44 (2) (a) 2., 3. and 4. of the statutes are created to read:

AB50-ASA2,345,22 102.44 (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:

AB50-ASA2,346,2 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).

AB50-ASA2,346,7 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.

AB50-ASA2,346,12 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.

AB50-ASA2,346,18 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.

AB50-ASA2,346,23 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.

AB50-ASA2,347,5 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.

AB50-ASA2,305 Section 305. 106.276 (1) (c) 4. of the statutes is amended to read:

AB50-ASA2,347,8 106.276 (1) (c) 4. The application is received by the department before July 1, 2025 2027.

AB50-ASA2,306 Section 306. 118.40 (2r) (e) 2p. a. of the statutes is amended to read:

AB50-ASA2,347,15 118.40 (2r) (e) 2p. a. Add the amounts appropriated in the current fiscal year under s. 20.255 (2), except s. 20.255 (2) (ac), (aw), (az), (bb), (dj), (du), (fc), (fm), (fp), (fq), (fr), (fu), (k), and (m); and s. 20.505 (4) (es); and the amount, as determined by the secretary of administration, of the appropriation under s. 20.505 (4) (s) allocated for payments to telecommunications providers under contracts with school districts and cooperative educational service agencies under s. 16.971 (13).

AB50-ASA2,307 Section 307. 118.51 (16) (a) 3. b. of the statutes is amended to read:

AB50-ASA2,347,24 118.51 (16) (a) 3. b. Beginning with the amount in the 2015-16 school year and, except as provided in subd. 3. c., in each school year thereafter, the sum of the amount determined under this subdivision for the previous school year; the amount of the per pupil revenue limit adjustment under s. 121.91 (2m) for the current school year, if positive; and the change in the amount of statewide categorical aid per pupil between the previous school year and the current school year, as determined under s. 118.40 (2r) (e) 2p., if positive; and in the 2025-26 school year, $1,578.

AB50-ASA2,308 Section 308. 121.58 (2) (a) 4. of the statutes is amended to read:

AB50-ASA2,348,7 121.58 (2) (a) 4. For each pupil so transported whose residence is more than 12 miles from the school attended, $300 per school year in the 2016-17 school year and $365 for the 2020-21 school year. The amount for the 2021-22 school year and the 2022-23 school year is $375. The amount for each the 2023-24 and 2024-25 school year thereafter years is $400. For the 2025-26 school year and each school year thereafter, the amount is four hundred fifty dollars.

AB50-ASA2,309 Section 309. 121.59 (2) (a) of the statutes is amended to read:

AB50-ASA2,348,11 121.59 (2) (a) Divide the statewide school district transportation costs in the previous school year by the statewide membership in the previous school year and multiply 1.35 by the quotient by 1.4.

AB50-ASA2,310 Section 310. 121.90 (2) (am) 2. of the statutes is amended to read:

AB50-ASA2,348,15 121.90 (2) (am) 2. Amounts under ss. 79.095 (4) and, 79.096, and 79.0965 for the current school year, not including payments received under s. 79.096 (3) or 79.0965 (3) for a tax incremental district that has been terminated.

AB50-ASA2,311 Section 311. 125.025 (5) of the statutes is created to read:

AB50-ASA2,348,19 125.025 (5) Fees. Except as provided in ss. 125.28 (4) and 125.535 (2), all fees collected by the division in connection with permits issued under this chapter shall be credited to the appropriation account under s. 20.566 (9) (g).

AB50-ASA2,312 Section 312. 125.28 (4) of the statutes is amended to read:

AB50-ASA2,349,2 125.28 (4) The amount of the permit fee shall be established by the division and shall be an amount that is sufficient to fund one special agent position dedicated to alcohol and tobacco enforcement in the division, but the permit fee may not exceed $2,500 per year or fractional part thereof. All permit fees received under this subsection shall be credited to the appropriation account under s. 20.566 (1) (9) (hd).

AB50-ASA2,313 Section 313. 125.535 (2) of the statutes is amended to read:

AB50-ASA2,349,7 125.535 (2) Annual permit fee. The division may, by rule, establish an annual fee, not to exceed $100, for each permit issued under this section. All permit fees collected under this subsection shall be credited to the appropriation account under s. 20.566 (1) (9) (ha).

AB50-ASA2,314 Section 314. 125.69 (4) (e) of the statutes is amended to read:

AB50-ASA2,349,14 125.69 (4) (e) Costs. The cost of administering this subsection shall be charged to the manufacturer, rectifier and wholesaler permittees. The division shall determine the costs and shall establish the procedure for apportioning the cost against the permittees and provide for the method of payment to the division. All moneys collected by the division under this paragraph shall be credited to the appropriation account under s. 20.566 (9) (g).

AB50-ASA2,315 Section 315. 139.06 (1) (a) of the statutes is amended to read:

AB50-ASA2,349,22 139.06 (1) (a) The taxes imposed under s. 139.03 (intro.) on intoxicating liquor at the rates under s. 139.03 (2m) shall be paid to, and a monthly return filed with, the department of revenue on or before the 15th of the month following the month in which the tax liability is incurred. An administrative fee of 11 cents per gallon on intoxicating liquor taxed at the rates under s. 139.03 (2m) is imposed, shall be paid along with the taxes and shall be deposited in credited to the appropriation under s. 20.566 (1) (9) (ha).

AB50-ASA2,316 Section 316. 146.69 of the statutes is created to read:

AB50-ASA2,350,2 146.69 Grants for the Surgical Collaborative of Wisconsin. The department shall award grants totaling $150,000 per fiscal year to the Surgical Collaborative of Wisconsin to support surgical care quality improvements.

AB50-ASA2,317 Section 317. 165.85 (5x) of the statutes is amended to read:

AB50-ASA2,350,11 165.85 (5x) Officer training reimbursement. Notwithstanding sub. (5), in each fiscal year, the department of justice shall determine the amount of additional costs, including but not limited to tuition, lodging, travel, meals, salaries and fringe benefits, to each political subdivision as a result of the enactment of 1993 Wisconsin Act 460. In each fiscal year, the department shall pay each political subdivision the amount determined under this subsection for that political subdivision from the appropriation appropriations under s. 20.455 (2) (am) and (q), subject to the limitations under s. 20.455 (2) (am).

AB50-ASA2,318 Section 318. 230.125 of the statutes is created to read:

AB50-ASA2,350,14 230.125 Cash payment for compensatory time off prohibited. Accrued compensatory time cannot be paid in cash.

AB50-ASA2,319 Section 319. 238.14 of the statutes is created to read:

AB50-ASA2,350,16 238.14 Talent recruitment grants. (1) Definitions. In this section:

AB50-ASA2,350,18 (a) “Household” means a group of one or more individuals who dwell together within the same dwelling.

AB50-ASA2,350,21 (b) “Household goal” means the total number of households that a talent recruitment program under this section seeks to successfully incentivize to relocate or commit to relocate from outside this state to a municipality in this state.