This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
5Section 2866. 459.24 (5) (b) of the statutes is amended to read:
6459.24 (5) (b) Proof that the applicant completed, within the 2 years
7immediately preceding the date of his or her application, 20 hours of satisfied
8continuing education programs or courses of study approved or required under
9requirements specified in rules promulgated under sub. (5m). This paragraph does
10not apply to an applicant for renewal of a license that expires on the first renewal
11date after the date on which the examining board initially granted the license.
12Section 2867. 459.24 (5m) (a) 1. of the statutes is amended to read:
13459.24 (5m) (a) 1. Promulgate rules establishing continuing education
14requirements for individuals licensed under this subchapter. The rules shall
15require the completion of 20 hours in programs or courses of study approved under
16this subsection. The examining board shall, for up to a 2-year period, exempt new
17licensees from the requirements under this subdivision. The rules shall establish
18the criteria for approval of continuing education programs or courses of study
19required for renewal of a license under sub. (5) and the criteria for approval of the
20sponsors and cosponsors of continuing education programs or courses of study.
21Section 2868. 460.07 (2) (intro.) of the statutes is amended to read:
22460.07 (2) (intro.) Renewal applications shall be submitted to the department
23on a form provided by the department on or before the applicable renewal date

1specified determined by the department under s. 440.08 (2) (a) and shall include all
2of the following:
3Section 2869. 460.10 (1) (a) of the statutes is amended to read:
4460.10 (1) (a) Requirements and procedures for a license holder to complete
5continuing education programs or courses of study to qualify for renewal of his or
6her license. The rules promulgated under this paragraph may not require a license
7holder to complete more than 24 hours of continuing education programs or courses
8of study in order to qualify for renewal of his or her license per 2-year period.
9Section 2870. 462.04 of the statutes is amended to read:
10462.04 Prescription or order required. A person who holds a license or
11limited X-ray machine operator permit under this chapter may not use diagnostic
12X-ray equipment on humans for diagnostic purposes unless authorized to do so by
13prescription or order of a physician licensed under s. 448.04 (1) (a), a naturopathic
14doctor licensed under s. 466.04 (1), a dentist who is licensed under s. 447.04 (1) or
15who holds a compact privilege under subch. II of ch. 447, a dental therapist licensed
16under s. 447.04 (1m), a podiatrist licensed under s. 448.63, a chiropractor licensed
17under s. 446.02, an advanced practice registered nurse certified licensed under s.
18441.16 (2) 441.09, a physician assistant who is licensed under s. 448.974 or who
19holds a compact privilege under subch. XIII of ch. 448, or, subject to s. 448.56 (7) (a),
20a physical therapist who is licensed under s. 448.53 or who holds a compact
21privilege under subch. XI of ch. 448.
22Section 2871. 462.05 (1) of the statutes is amended to read:
23462.05 (1) The renewal date for licenses and limited X-ray machine operator
24permits granted under this chapter is specified in shall be as determined by the

1department under s. 440.08 (2) (a). Renewal applications shall be submitted to the
2department on a form provided by the department and shall include the renewal fee
3determined by the department under s. 440.03 (9) (a).
4Section 2872. 466.04 (3) (a) (intro.) of the statutes is amended to read:
5466.04 (3) (a) (intro.) The renewal date for licenses granted under this chapter
6is specified shall be as determined by the department under s. 440.08 (2) (a).
7Renewal applications shall be submitted to the department on a form provided by
8the department. The application shall include all of the following in order for the
9license to be renewed:
10Section 2873. 470.045 (3) (b) of the statutes is amended to read:
11470.045 (3) (b) The renewal date for certificates of authorization under this
12section is specified shall be as determined by the department under s. 440.08 (2) (a),
13and the renewal fee for such certificates is determined by the department under s.
14440.03 (9) (a).
15Section 2874. 470.07 of the statutes is amended to read:
16470.07 Renewal of licenses. The renewal dates for licenses granted under
17this chapter are specified shall be as determined by the department under s. 440.08
18(2) (a). Renewal applications shall be submitted to the department on a form
19provided by the department and shall include the renewal fee determined by the
20department under s. 440.03 (9) (a) and evidence satisfactory to the appropriate
21section of the examining board that the applicant has completed any continuing
22education requirements specified in rules promulgated under s. 470.03 (2).
23Section 2875. 480.08 (5) of the statutes is amended to read:

1480.08 (5) Expiration and renewal. The renewal date for certificates
2granted under this chapter, other than temporary certificates granted under sub.
3(7), is specified shall be as determined by the department under s. 440.08 (2) (a),
4and the renewal fee for certificates granted under this chapter, other than
5temporary certificates granted under sub. (7), is determined by the department
6under s. 440.03 (9) (a). Renewal applications shall include evidence satisfactory to
7the department that the applicant holds a current permit issued under s. 77.52 (9).
8A renewal application for an auctioneer certificate shall be accompanied by proof of
9completion of continuing education requirements under sub. (6).
10Section 2876. 563.13 (4) of the statutes is amended to read:
11563.13 (4) A $10 $20 license fee for each bingo occasion proposed to be
12conducted and $5 $10 for an annual license for the designated member responsible
13for the proper utilization of gross receipts. All moneys received under this
14subsection shall be credited to the appropriation account under s. 20.505 (8) (jn).
15Section 2877. 563.135 (1) (intro.) of the statutes is amended to read:
16563.135 (1) (intro.) An application for a license to conduct bingo for an
17organization listed under s. 563.11 (1) (b) to (d) shall be accompanied by a $5 $10
18license fee and a sworn statement by the owner or operator of the organization that
19all of the following rules shall apply to bingo conducted by the organization:
20Section 2878. 563.80 (1) (intro.) and (b) of the statutes are consolidated,
21renumbered 563.80 (1) and amended to read:
22563.80 (1) An occupational tax is imposed on those gross receipts of any
23licensed organization which are derived from the conduct of bingo, in the following

1amounts: (b) Two amount of 2 percent of the gross receipts received by a licensed
2organization during a year that exceed $30,000.
3Section 2879. 563.80 (1) (a) of the statutes is repealed.
4Section 2880. 563.92 (2) of the statutes is amended to read:
5563.92 (2) The fee for a raffle license shall be $25 $50 and shall be remitted
6with the application. A raffle license shall be valid for 12 months and may be
7renewed as provided in s. 563.98 (1g). The department shall issue the license
8within 30 days after the filing of a complete application if the applicant qualifies
9under s. 563.907 and has not exceeded the limits of s. 563.91. The department shall
10notify the applicant within 15 days after it is filed if the raffle license application is
11incomplete or the application shall be considered complete. A complete license
12application that is not denied within 30 days after its filing shall be considered
13approved. All moneys received by the department under this subsection shall be
14credited to the appropriation account under s. 20.505 (8) (jn).
15Section 2881. 601.25 of the statutes is created to read:
16601.25 Office of the public intervenor. (1) The office of the public
17intervenor shall assist individuals with insurance claims, policies, appeals, and
18other legal actions to pursue insurance coverage for medical procedures,
19prescription medications, and other health care services.
20(2) The office of the public intervenor may levy an assessment on each insurer
21that is authorized to engage in the business of insurance in this state. The
22assessment levied under this subsection shall be based on the insurers premium
23volume for disability insurance policies, as defined in s. 632.895 (1) (a), written in
24this state.

1(3) The commissioner may provide by rule for the governance, duties, and
2administration of the office of the public intervenor.
3Section 2882. 601.31 (1) (mv) of the statutes is created to read:
4601.31 (1) (mv) For initial issuance or renewal of a license as a pharmacy
5benefit management broker or consultant under s. 628.495, amounts set by the
6commissioner by rule.
7Section 2883. 601.31 (1) (nv) of the statutes is created to read:
8601.31 (1) (nv) For issuing or renewing a license as a pharmaceutical
9representative under s. 632.863, an amount to be set by the commissioner by rule.
10Section 2884. 601.31 (1) (nw) of the statutes is created to read:
11601.31 (1) (nw) For issuing or renewing a license as a pharmacy services
12administrative organization under s. 632.864, an amount to be set by the
13commissioner by rule.
14Section 2885. 601.41 (14) of the statutes is created to read:
15601.41 (14) Value-based diabetes medication pilot project. The
16commissioner shall develop a pilot project to direct a pharmacy benefit manager, as
17defined in s. 632.865 (1) (c), and a pharmaceutical manufacturer to create a value-
18based, sole-source arrangement to reduce the costs of prescription medication used
19to treat diabetes. The commissioner may promulgate rules to implement this
20subsection.
21Section 2886. 601.45 (1) of the statutes is amended to read:
22601.45 (1) Costs to be paid by examinees. The reasonable costs of
23examinations and audits under ss. 601.43, 601.44, 601.455, and 601.83 (5) (f) shall
24be paid by examinees except as provided in sub. (4), either on the basis of a system

1of billing for actual salaries and expenses of examiners and other apportionable
2expenses, including office overhead, or by a system of regular annual billings to
3cover the costs relating to a group of companies, or a combination of such systems,
4as the commissioner may by rule prescribe. Additional funding, if any, shall be
5governed by s. 601.32. The commissioner shall schedule annual hearings under s.
6601.41 (5) to review current problems in the area of examinations.
7Section 2887. 601.455 of the statutes is created to read:
8601.455 Fair claims processing, health insurance transparency, and
9claim denial rate audits. (1) Definitions. In this section:
10(a) Claim denial means the refusal by an insurer to provide payment under
11a disability insurance policy for a service, treatment, or medication recommended
12by a health care provider. Claim denial includes the prospective refusal to pay for
13a service, treatment, or medication when a disability insurance policy requires
14advance approval before a prescribed medical service, treatment, or medication is
15provided.
16(b) Disability insurance policy has the meaning given in s. 632.895 (1) (a).
17(c) Health care provider has the meaning given in s. 146.81 (1) (a) to (p).
18(2) Claims processing. (a) Insurers shall process each claim for a disability
19insurance policy within a time frame that is reasonable and prevents an undue
20delay in an insureds care, taking into account the medical urgency of the claim.
21(b) If an insurer determines additional information is needed to process a
22claim for a disability insurance policy, the insurer shall request the information
23from the insured within 5 business days of making the determination and shall
24provide at least 15 days for the insured to respond.

1(c) All claim denials shall include all of the following:
21. A specific and detailed explanation of the reason for the denial that cites
3the exact medical or policy basis for the denial.
42. A copy of or a publicly accessible link to any policy, coverage rules, clinical
5guidelines, or medical evidence relied upon in making the denial decision, with
6specific citation to the provision justifying the denial.
73. Additional documentation, medical rationale, or criteria that must be met
8or provided for approval of the claim, including alternative options available under
9the policy.
10(d) If an insurer uses artificial intelligence or algorithmic decision-making in
11processing a claim for a disability insurance policy, the insurer must notify the
12insured in writing of that fact. The notice shall include all of the following:
131. A disclosure that artificial intelligence or algorithmic decision-making was
14used at any stage in reviewing the claim, even if a human later reviewed the
15outcome.
162. A detailed explanation of how the artificial intelligence or algorithmic
17decision-making reached its decision, including any factors the artificial
18intelligence or algorithmic decision-making weighed.
193. A contact point for requesting a human review of the claim if the claim was
20denied.
21(3) Independent review of denials. In addition to an insureds right to an
22independent review under s. 632.835, as applicable, insureds have the right to
23request a review by the office of the public intervenor of any claim denial.

1(4) Prohibited practices. An insurer may not do any of the following with
2respect to a disability insurance policy:
3(a) Use vague or misleading policy terms to justify a claim denial.
4(b) Fail to provide a specific and comprehensible reason for a claim denial.
5(c) Cancel coverage under the policy after a claim is submitted due to alleged
6misstatements on the policy application.
7(d) Deny a claim based on hidden or ambiguous exclusions in a disability
8insurance policy.
9(e) Stall review of a claim to avoid timely payment.
10(f) Reject a claim without reviewing all relevant medical records or consulting
11qualified experts.
12(g) Fail to properly review or respond to an insureds appeal in a timely
13manner.
14(h) Allow non-physician personnel to determine whether care is medically
15necessary.
16(i) Apply different medical necessity criteria based on financial interests
17rather than patient needs.
18(j) Disregard a treating health care providers medical assessment without a
19valid clinical reason.
20(k) Mandate prior approval for routine or urgent procedures in a manner that
21causes harmful delays.
22(L) For a disability insurance policy that provides coverage of emergency
23medical services, refuse to cover emergency medical services provided by out-of-
24network providers.

1(m) List a health care provider as in-network on a provider directory and then
2deny a claim by stating the health care provider is out-of-network.
3(n) Deny coverage based on age, gender, disability, or a chronic condition
4rather than medical necessity.
5(o) Apply stricter standards in reviewing claims related to mental health
6conditions than claims related to physical health conditions.
7(p) Perform a blanket denial of claims for high-cost conditions without an
8individualized review of each claim.
9(r) Reclassify a claim to a lower-cost treatment to reduce insurer payout.
10(s) Require an insured to fail a cheaper treatment before approving coverage
11for necessary care.
12(t) Manipulate cost-sharing rules to shift higher costs to insureds.
13(5) Transparency and reporting. (a) Beginning on January 1, 2027, an
14insurer shall annually publish a report detailing the insurers claim denial rates,
15reasons for claim denials, and the outcome of any appeal of a claim denial for the
16previous year for all disability insurance policies under which the insurer provides
17coverage.
18(b) The commissioner shall maintain a public database of insurers claim
19denial rates and the outcomes of independent reviews under s. 632.835.
20(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence
21or algorithmic decision-making in claims processing shall annually publish a report
22detailing all of the following for the previous year for all disability insurance policies
23under which the insurer provides coverage:

11. The percentage of claims submitted to the insurer that were reviewed by
2artificial intelligence or algorithmic decision-making.
32. The claim denial rate of claims reviewed by artificial intelligence or
4algorithmic decision-making compared to the claim denial rate of claims reviewed
5by humans.
63. The steps the insurer takes to ensure fairness and accuracy in decisions
7made by artificial intelligence or algorithmic decision-making.
8(6) Claim denial rate audits. (a) The commissioner may conduct an audit
9of an insurer if the insurers claim denials are of such frequency as to indicate a
10general business practice. This paragraph is supplemental to and does not limit
11any other powers or duties of the commissioner.
12(b) The commissioner may collect any relevant information from an insurer
13that is necessary to conduct an audit under par. (a).
14(c) The commissioner may contract with a 3rd party to conduct an audit under
15par. (a).
16(d) The commissioner may, based on the findings of an audit under par. (a),
17order the insurer who is the subject of the audit to comply with a corrective action
18plan approved by the commissioner. The commissioner shall specify in any
19corrective action plan under this paragraph the deadline by which an insurer must
20be in compliance with the corrective action plan.
Loading...
Loading...