Ins 17.28(6)(n)2.
2. 2.5% of the total annual fees assessed against all of the employed physicians.
Ins 17.28(6)(n)3.
3. The following fee for each full-time equivalent allied health care professional employed by the operational cooperative sickness plan as of the most recent completed survey submitted:
Employed Health Care Professionals Fund Fee
Nurse Practitioners $ 364
Advanced Nurse Practitioners 510
Nurse Midwives 3,205
Advanced Nurse Midwives 3,351
Advanced Practice Nurse Prescribers 510
Chiropractors 583
Dentists 291
Oral Surgeons 2,186
Podiatrists-Surgical 6,192
Optometrists 291
Physician Assistants 291
Ins 17.28(6)(o)
(o) For a freestanding ambulatory surgery center, as defined in s.
DHS 120.03 (13), per 100 outpatient visits during the last calendar year for which totals are available:
$ 22.73
Ins 17.28(6)(p)
(p) For an entity affiliated with a hospital, the greater of $100 or whichever of the following applies:
Ins 17.28(6)(p)1.
1. 7.0% of the amount the entity pays as premium for its primary health care liability insurance, if it has occurrence coverage.
Ins 17.28(6)(p)2.
2. 10.0% of the amount the entity pays as premium for its primary health care liability insurance, if it has claims-made coverage.
Ins 17.28(6)(q)
(q) For an organization or enterprise not specified as a partnership or corporation that is organized and operated in this state for the primary purpose of providing the medical services of physicians or nurse anesthetists, all of the following fees:
Ins 17.28(6)(q)1.a.a. If the total number of employed physicians and nurse anesthetists is from 1 to 10
$ 51
Ins 17.28(6)(q)1.b.
b. If the total number of employed physicians and nurse anesthetists is from 11 to 100
$ 503
Ins 17.28(6)(q)1.c.
c. If the total number of employed physicians or nurse anesthetists exceeds 100
$ 1,252
Ins 17.28(6)(q)2.
2. The following for each full-time equivalent allied health care professional employed by the organization or enterprise not specified as a partnership, corporation, or an operational cooperative health care plan as of the most recent completed survey submitted:
Employed Health Care Professionals Fund Fee
Nurse Practitioners $ 364
Advanced Nurse Practitioners 510
Nurse Midwives 3,205
Advanced Nurse Midwives 3,351
Advanced Practice Nurse Prescribers 510
Chiropractors 583
Dentists 291
Oral Surgeons 2,186
Podiatrists-Surgical 6,192
Optometrists 291
Physician Assistants 291
Ins 17.28(6d)(a)
(a) A corporation organized and operated in this state of which 50% or more of its shareholders are physicians or nurse anesthetists is organized and operated in this state for the primary purpose of providing the medical services of physicians or nurse anesthetists.
Ins 17.28(6d)(b)
(b) Conclusively that a corporation organized and operated in this state of which less than 50% of its shareholders are physicians or nurse anesthetists is not organized and operated in this state for the primary purpose of providing the medical services of physicians or nurse anesthetists.
Ins 17.28 Note
Note: A person who disputes the application of this presumption to the person may be entitled to a hearing on the issue in accordance with s.
227.42, Stats.
Ins 17.28(6e)(a)(a) The fund shall calculate the total amount of fees for all medical college of Wisconsin affiliated hospitals, inc., and UW hospital and clinics, residents on a full-time-equivalent basis, taking into consideration the proportion of time spent by the residents in practice which is not covered by the fund, including practice in federal, state, county and municipal facilities, as determined and documented by the medical college of Wisconsin affiliated hospitals, inc., and UW hospital and clinics, respectively.
Ins 17.28(6e)(b)
(b) Notwithstanding sub.
(4) (h), the fund's initial bill for each fiscal year shall be the amount the medical college of Wisconsin affiliated hospitals, inc., estimates will be due for the next fiscal year for all its residents. At the end of the fiscal year, the fund shall adjust the fee to reflect the residents' actual exposure during the fiscal year, as determined by the medical college of Wisconsin affiliated hospitals, inc., and shall bill the medical college of Wisconsin affiliated hospitals, inc., for the balance due, if any, plus accrued interest, as calculated under sub.
(4) (j) 2., from the beginning of the fiscal year. The fund shall refund the amount of an overpayment, if any.
Ins 17.28(6m)(a)
(a) The fund may require any provider to report, at the times and in the manner prescribed by the fund, any information necessary for the determination of a fee specified under sub.
(6).
Ins 17.28(6m)(b)
(b) For purposes of sub.
(6) (k) to
(m), a partnership or corporation shall report the number of partners, shareholders and employed physicians and nurse anesthetists on July 1 of the previous fiscal year.
Ins 17.28(6s)(a)
(a) This subsection implements s.
655.27 (3) (bg) 1., Stats., requiring the establishment of an automatic increase in a provider's fund fee based on loss and expense experience.
Ins 17.28(6s)(c)
(c) The following tables shall be used in making the determinations required under s.
Ins 17.285 as to the percentage increase in a provider's fund fee:
Ins 17.28 History
History: Cr.
Register, June, 1980, No. 294, emerg. r. and recr. (6) and am. (6a), eff. 7-1-00; r. and recr. (6) and am. (6a),
Register, August, 2000, No. 536, eff. 9-1-00; emerg. r. and recr. (6) and am. (6a), eff. 7-1-01;
CR 01-035: r. and recr. (6) and am. (6a),
Register September 2001 No. 549, eff. 10-1-01; emerg. r. and recr. (6), r. (6a), eff. 7-1-02;
CR 02-035: r. and recr. (6), r. (6a),
Register September 2002 No. 561, eff. 10-1-02;
CR 03-039: r. and recr. (6)
Register October 2003 No. 574, eff. 11-1-03;
CR 04-032: r. and recr. (6)
Register January 2005 No. 589, eff. 2-1-05; emerg. r. and recr. (6), eff. 7-1-05;
CR 05-028: r. and recr. (6)
Register October 2005 No. 598, eff. 11-1-05;
CR 06-002: am. (3) (c) 1. and 2. and r. and recr. (6)
Register June 2006 No. 606, eff. 7-1-06;
CR 07-002: am. (6),
Register June 2007 No. 618, eff. 7-1-07;
CR 07-002: am. (6e),
Register June 2007 No. 618, eff. 7-1-07;
CR 08-006: am. (6) (intro.), (k) 2., (L) 2., (m) 2., (n) 3. and (q) 2.
Register June 2008 No. 630, eff. 7-1-08;
CR 09-004: am. (3) (c), r. and recr. (6)
Register June 2009 No. 642, eff. 7-1-09; correction in (6) (o) made under s.
13.92 (4) (b) 7., Stats.,
Register June 2009 No. 642;
CR 09-055: cr. (3h)
Register March 2010 No. 651, eff. 4-1-10;
EmR1020: emerg. r. and recr. eff. 6-15-10;
CR 10-065: r. and recr.
Register November 2010 No. 659, eff. 12-1-10; correction in (6) (o) made under s.
13.92 (4) (b) 7., Stats.,
Register November 2010 No. 659;
EmR1108: emerg. am. (3) (c), r. and recr. (6) eff. 6-10-11;
CR 11-015: am. (3) (c), r. and recr. (6) and
Register August 2011 No. 668, eff. 9-1-11;
EmR1306: emerg. am. (3) (c) 1. to 3., r. and recr. (6), eff. 6-3-13;
CR 13-044: am. (3) (c) 1. to 3., r. and recr. (6)
Register June 2014 No. 702, eff. 7-1-14;
CR 19-119 am. (3) (c) 1. to 3., (4) (f) Register July 2020 No. 775, eff. 8-1-20.
Ins 17.285(2)(a)
(a) “Aggregate indemnity" means the total amount attributable to an individual provider that is paid or owing to or on behalf of claimants for all closed claims arising out of one incident or course of conduct, including amounts held by the fund under s.
655.015, Stats. “Aggregate indemnity" does not include any expenses paid in the defense of the claim.
Ins 17.285(2)(b)
(b) “Closed claim" means a medical malpractice claim against a provider, or a claim against an employee of a health care provider for which the provider is vicariously liable, for which there has been either of the following:
Ins 17.285(2)(b)1.
1. A final determination based on a settlement, award or judgment that indemnity will be paid to or on behalf of a claimant.
Ins 17.285(2)(b)2.
2. A payment to a claimant by the provider or another person on the provider's behalf.
Ins 17.285(2)(d)
(d) “Provider," when used without further qualification, means a health care provider subject to ch.
655, Stats., who is a natural person. “Provider" does not include a hospital or other facility or entity that provides health care services.
Ins 17.285(2)(e)
(e) “Review period" means the 5-year period ending with the date of the first payment on the most recent closed claim reported under s.
655.26, Stats., for a specific provider.
Ins 17.285(2m)
(2m) Time for reporting. In reporting claims paid under s.
655.26, Stats., each insurer or self-insurer shall report the required information by the 15th day of the month following the date on which there has been a final determination of the aggregate indemnity to be paid to or on behalf of any claimant.
Ins 17.285(2s)
(2s) Information for provider. Upon receipt of a report under sub.
(2m), the council shall mail to the provider who is the subject of the report all of the following:
Ins 17.285(2s)(a)
(a) A copy of the report, with a statement that the provider may contact the insurer that filed the report if the provider believes it contains inaccurate information.
Ins 17.285(2s)(b)
(b) A statement that the council may use its authority under s.
146.82 (2) (a) 5., Stats., to obtain any patient health care records necessary for use in making determinations under this section.
Ins 17.285(2s)(c)
(c) A request that the provider sign and return to the council an authorization for release of information form, authorizing the provider's insurer to provide the council with relevant factual information about the closed claim for use in making determinations under this section. A copy of the form shall be enclosed with the mailing.
Ins 17.285(2s)(d)
(d) If necessary, a request that the provider verify the council's closed claim record and furnish the council with information on any additional closed claims not known to the council that have been paid by or on behalf of the provider during the review period.
Ins 17.285(2s)(e)
(e) Notice that if the provider does not comply with a request under par.
(c) or
(d) within 40 days after the date of the request, the provider is in violation of s.
601.42 (4), Stats., and may be subject to a forfeiture of up to $1,000 for each week of continued violation, as provided in s.
601.64 (3), Stats.
Ins 17.285(3)
(3) Determination of need for review. Based on reports received under sub.
(2m) and any additional closed claims reported in response to a request under sub.
(2s) (d), the council, using the tables under ss.
Ins 17.25 (12m) (c) and
17.28 (6s) (c), shall determine when a provider has, during a review period, accumulated enough closed claims and aggregate indemnity to consider the imposition of a surcharge.
Ins 17.285(4)(a)(a) When the council makes a determination under sub.
(3), it may request any of the following:
Ins 17.285(4)(a)2.
2. From the provider's insurer, relevant factual information about each closed claim subject to review. This subdivision applies only if the provider has complied with the request under sub.
(2s) (c).
Ins 17.285(4)(b)
(b) A request under par.
(a) shall be in writing and shall specify a reasonable time for response. Each person receiving a request shall provide the council with the records and information requested, unless the person no longer maintains or has access to them. If a person is unable to comply with a request, the person shall notify the council in writing of the reason for the inability to comply.
Ins 17.285(4)(c)
(c) The council shall notify a provider for whom a determination is made under sub.
(3) that, after reviewing the patient health care records, consultants' opinions and other relevant information submitted by the provider and the provider's insurer, the council may recommend that a surcharge be imposed on the provider's plan premium, fund fee or both, and that the surcharge may be reduced or eliminated following a review as provided in this section. The notice shall include a description of the procedures specified in this section and a statement that the provider may submit in writing relevant information about any closed claim involved in the review and a description of mitigating circumstances that may reduce the future risk to the plan, the fund or both.
Ins 17.285(5)(a)
(a) The council or a single council member may conduct a preliminary review of the records and information relating to each of a provider's closed claims. If the council or council member is able to determine, without a consultant, that the provider met the appropriate standard of care with respect to any closed claim, the council shall not refer that closed claim to a consultant and shall not use that closed claim in determining whether to impose a surcharge on that provider.
