State of Legislation

Wisconsin

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Our comprehensive return to work program ensures collaboration and communication with all interested parties including the injured worker, employer, human resources, medical and safety teams, and healthcare providers.  We use technology, compassionate case management for employees and cost containment measures, to give Wisconsin employers a superior program.

As a service to our clients, CorVel is providing links to information related to the COVID-19 pandemic provided by the states.

 

Legislature Status: Reconvened for a special session April 14 regarding COVID-19 recovery bill.

Legislation

  • AB 1035 Exempts pharmaceutical, treatment, and other medical supplies used for treating COVID-19 from the Unfair Sales Act, also called the minimum markup law, during the public health emergency declared on March 12, 2020. Failed.
  • SB 927 Exempts pharmaceutical, treatment, and other medical supplies used for treating coronavirus from the Unfair Sales Act, also called the minimum markup law, during the public health emergency due to coronavirus. Failed.
  • SB 11 Provides that amounts due for an injury resulting in death are required to be paid in advance of when they would otherwise be due, including as a single, lump-sum payment. Enacted.

Wisconsin Regulatory Updates  11/03/2023

AB 474 – An Act to Renumber and Amend 108.221 (1) (A) and 108.221 (2); to Amend 102.85 (1) (A), 102.85 (1) (B) and 102.85 (2) (Intro.); and to Create 16.40 (24), 102.85 (1) (C), 102.85 (1) (D), 102.85 (2J), 102.85 (2K), 103.005 (4M), 108.221 (1) (A) 2., 108.221 (2) (B), 182.01 (8) and 601.41 (12) of the Statutes; Relating To: Employee Misclassification and Providing a Penalty. (Fe)

Issues: Workers’ Compensation: Any Proposal

Summary:

This measure impacts insurers, employers, employees, and independent contractors.
This measure requires the Department of Administration to direct all departments to provide educational outreach regarding worker misclassification in languages with a significant number of speakers in Wisconsin. The Department of Financial Institutions is also required to provide informational resources on worker misclassification to persons filing with the department documents forming a business corporation, nonstock corporation, limited liability corporation, limited liability partnership, or limited partnership.
This measure requires the Department of Workforce Development to design and make available a notice regarding worker classification laws and their requirements to employers for display in a conspicuous place. The measure penalizes employers less than $100 for failing to post the notice.
The Department of Workforce Development must also establish and maintain on its website information regarding worker classification laws and associated requirements, penalties, and contact information.
This measure adjusts penalties for employers who provide false information in misclassifying employees as nonemployees. The measure removes maximum penalties and provides that for each act occurring before the first determination of a violation and employer will be fined $1,000. For each act occurring after an employer’s first determination of violation, the employer shall be fined $2,000. The measure also expands these penalties to all employers rather than prior limitations to employers in construction, painting, and drywall finishing.
This measure increases the penalty of subsequent violations for employers who require employees to pay any part of worker’s compensation or fail to provide mandatory worker’s compensation coverage. Penalties after the third violation incur a $3,000 fine or a fine three times the amount of the insurance premium that would have been payable, whichever is greater. Penalties after the fourth violation incur a $4,000 fine or a fine four times the amount of the insurance premium that would have been payable, whichever is greater
This measure increases the penalty of subsequent violations for employers who provide false information about coverage to their employees when requested or else fail to notify a contractor whose coverage has been canceled under their contract. Penalties after the third violation incur a $3,000 fine or a fine three times the amount of the insurance premium that would have been payable, whichever is greater. Penalties after the fourth violation incur a $4,000 fine or a fine four times the amount of the insurance premium that would have been payable, whichever is greater.
This measure is effective the day after enactment.

Most Recent Update:

  • 10/11/2023 – Introduced; Referred to Assembly Committee on Labor and Integrated Employment

AB 475 – An Act to Amend 102.125 (2) and 102.125 (3); and to Create 102.125 (1M) and 943.395 (1) (E) of the Statutes; Relating To: Worker Misclassification and Providing a Penalty. 

Issues: Workers’ Compensation: Any Proposal 

Summary:

This measure impacts insurers, employers, employees, and independent contractors.

This measure requires that insurers with evidence that an application for worker’s compensation insurance coverage is fraudulent report the claim to the Department of Workforce Development. Additionally, if an insurer has evidence that an employer has fraudulently misclassified employees to lower the employer’s worker’s compensation insurance premiums they are required to report the claim to the Department of Workforce Development.

This measure is effective one day after enactment.

Most Recent Update:

  • 10/11/2023 – Introduced; Referred to Assembly Committee on Labor and Integrated Employment

Wisconsin Regulatory Updates 9/1/2021

SB 11 – An Act to Renumber and Amend 102.17 (4) and 102.58; to Amend 102.04 (2M), 102.13 (2) (A), 102.29 (6M) (A) 3., 102.315 (1) (C), 102.315 (2), 102.42 (1), 102.49 (5) (B), 102.49 (5) (C) and 102.49 (5) (E); and to Create 102.04 (2G), 102.17 (9), 102.29 (6M) (A) 1M., 102.315 (2E), 102.315 (2M), 102.315 (2S), 102.42 (1P), 102.44 (7) and 102.49 (5) (Cm) of the Statutes; Relating To: Various Changes to the Worker’s Compensation Law. (Fe)

Issues: Workers’ Compensation (General)

Summary:

This measure amends various provisions of the Wisconsin Workers’ Compensation Code. This measure applies to workers’ compensation. This measure provides that amounts due for an injury resulting in death are required to be paid in advance of when they would otherwise be due, including as a single, lump-sum  payment. If an employer or insurer makes an advance or lump-sum payment, the measure compensates the employer or insurer with an interest credit. Additionally, no compensation is required to the work injury supplemental benefit fund if the employee who has died is found to have been in violation of the employer’s policy against drug or alcohol use. This measure takes effect on April 29, 2021.

Most Recent Update:

This measure was signed by the Governor. This measure takes effect on April 29, 2021.

SB 111 – An Act Relating To: State Finances and Appropriations, Constituting the Executive Budget Act of the 2021 Legislature.

Issues: Utilization Review and Appeals, Dental Coverage, Workers’ Compensation (General), Behavioral Health Coverage, Mandated Benefits

Summary:

Summary for Coverage of Individuals with Preexisting Conditions and Other Insurance Market Regulations for 05/20/2021 Version

These provisions have been removed by the May 6 and 13 amendments. See below for previous language. (This provision has been removed by the May 6 and 13 amendments) This measure requires certain health plans to guarantee access to coverage; prohibits plans from imposing preexisting condition exclusions; prohibits plans from setting premiums or cost-sharing amounts based on health status-related factors; prohibits plans from setting lifetime or annual limits on benefits; requires plans to cover certain essential health benefits; requires coverage of certain preventive services by plans without a cost- sharing contribution by an enrollee; sets a maximum annual amount of cost sharing for enrollees; and designates risk pool, medical loss ratio, and actuarial value requirements. This measure requires every individual health insurance policy, known in this measure as a health benefit plan, to accept every individual who, and every group health insurance policy to accept every employer that, applies for coverage, regardless of sexual orientation, gender identity, or whether an employee or individual has a preexisting condition. (This provision has been removed by the May 6 and 13 amendments) This measure allows health benefit plans to restrict enrollment in coverage to open or special enrollment periods and requires the commissioner of insurance to establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan. This measure prohibits a group health insurance policy, including a self-insured governmental health plan, from imposing a preexisting condition exclusion. This measure also prohibits an individual health insurance policy from reducing or denying a claim or loss incurred or disability commencing under the policy on the ground that a disease or physical condition existed prior to the effective date of coverage. A health benefit plan offered on the individual or small employer market or a self-insured governmental health plan may not vary premium rates for a specific plan except on the basis of whether the plan covers an individual or family, area in the state, age, and tobacco use as specified in this measure. An individual health benefit plan or self-insured health plan is prohibited under this measure from establishing rules for the eligibility of any individual to enroll based on health-status related factors, which are specified in the bill. A self-insured health plan or an insurer offering an individual health benefit plan is also prohibited from requiring an enrollee to pay a greater premium, contribution, deductible, copayment, or coinsurance amount than is required of a similarly situated enrollee based on a health-status related factor. (This provision has been removed by the May 6 and 13 amendments) Current state law prohibits group health benefit plans from establishing rules of eligibility or requiring greater premium or contribution amounts based on a health-status related factor. This measure adds to these current law requirements for group health benefit plans that the plan may not require a greater deductible, copayment, or coinsurance amount based on a health-status related factor. Under this measure, an individual or group health benefit plan or a self-insured governmental health plan may not establish lifetime or annual limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan. (This provision has been removed by the May 6 and 13 amendments) This measure specifies a maximum amount of cost-sharing that a plan may impose as the amount calculated under the federal Patient Protection and Affordable Care Act (ACA). This measure requires individual and small employer plans to have either a single statewide risk pool for the individual market and a single pool for the small employer market or a single statewide risk pool for a combination of the individual and small employer markets. This measure requires individual and small employer plans to have a medical loss ratio of at least 80 percent and larger group plans to have a medical loss ratio of at least 85 percent. The medical loss ratio is the proportion of premium revenues that the plan spends on clinical services and quality improvement. The measure also requires individual and small employer plans to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to at least 60 percent of the full actuarial value of the benefits provided under the plan. An actuarial value of 60 percent corresponds to a bronze tier plan under the ACA. (This provision has been removed by the May 6 and 13 amendments) This measure requires certain health insurance policies, known in this measure as disability insurance policies, and self-insured governmental health plans to cover essential health benefits that will be specified by the commissioner of insurance by rule. This measure specifies a list of requirements that the commissioner must follow when establishing the essential health benefits including certain limitations on cost-sharing and the following general categories of benefits, items, or services in which the commissioner must require coverage: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, laboratory services, preventive and wellness services and chronic disease management, and pediatric services. (This provision has been removed by the May 6 and 13 amendments) If an essential health benefit specified by the commissioner is also subject to its own mandated coverage requirement, this measure requires the disability insurance policy or self-insured health plan to provide coverage under whichever requirement provides the insured or plan participant with more comprehensive coverage. This measure requires health insurance policies and self-insured governmental health plans to cover certain preventive services and to provide coverage of those preventive services without subjecting that coverage to deductibles, copayments, or coinsurance. The preventive services for which coverage is required are specified in this measure. This measure also specifies certain instances when cost-sharing amounts may be charged for an office visit associated with a preventive service. (Pg. 1521-1525)

Summary for Balance Billing for Emergency Medical Services and Other Items and Services for 05/20/2021 Version

These provisions have been removed by the May 6 and 13 amendments. See below for previous language. (This provision has been removed by the May 6 and  13 amendments) This measure requires defined network plans, such as health maintenance organizations, and certain preferred provider plans and  self-insured governmental plans that cover benefits or services provided in either an emergency department of a hospital or independent freestanding emergency department to cover emergency benefits without requiring a prior authorization determination and without regard to whether or not the health care provider providing the emergency medical services is a participating provider or facility. (This provision has been removed by the May 6 and 13 amendments) If the emergency medical services for which coverage is required are provided by a nonparticipating provider, the plan must 1) not impose a prior authorization requirement or other limitation that is more restrictive than if the service was provided by a participating provider, 2) not impose cost-sharing on the enrollee that is greater than the cost-sharing required if the service was provided by a participating provider, 3) calculate the cost-sharing amount to be equal to the amount that would have been charged if the service was provided by a participating provider, 4) provide, within 30 days of the provider’s or facility’s bill, an initial payment or denial notice to the provider or facility and then pay a total amount to the provider or facility that is equal to the amount by which the  provider’s or facility’s rate exceeds the amount it received in cost-sharing from the enrollee, and 5) count any cost-sharing payment made by the enrollee for the emergency medical services toward any in-network deductible or out-of-pocket maximum as if the cost-sharing payment were made for services provided by a participating provider or facility. (This provision has been removed by the May 6 and 13 amendments) The provider or facility may not bill or hold liable an enrollee of the plan for any amount for the emergency medical service that is more than the cost-sharing amount that is determined as described in the bill for the emergency medical service. (This provision has been removed by the May 6 and 13 amendments) For coverage of an item or service that is provided by a nonparticipating provider in a participating facility, a plan must 1) not impose a cost-sharing requirement for the item or service that is greater than the cost-sharing requirement that would have been imposed if the item or service was provided by a participating provider, 2) calculate the cost-sharing amount to be equal to the amount that would have been charged if the service was provided by a participating provider, 3) provide, within 30 days of the provider’s bill, an initial payment or denial notice to the provider and then pay a total amount to the provider that is equal to the amount by which the provider’s rate exceeds the amount it received in cost-sharing from the enrollee, and 4) count any cost-sharing payment made by the enrollee for the emergency medical services toward any in-network deductible or out-of-pocket maximum as if the cost-sharing payment were made for services provided by a participating provider. A nonparticipating provider providing an item or service in a participating facility may not bill or hold liable an enrollee for more than the cost-sharing amount unless the provider provides notice and obtains consent as described in this measure. However, if the nonparticipating provider is providing an ancillary item or service that is specified in this measure and the commissioner of insurance has not specifically allowed balance billing for that item or service by rule, the nonparticipating provider providing the ancillary item or service in a participating facility may not bill or hold liable an enrollee for more than the cost-sharing amount.(This provision has been removed by the May 6 and 13 amendments) A provider or facility that is entitled to a payment under this measure for an emergency medical service or other item or service may initiate open negotiations with the plan to determine the amount of payment. If the open negotiation period terminates without determination of the payment amount, the provider, facility, or plan may initiate the independent dispute resolution process as specified by the commissioner of insurance. If an enrollee of a plan is a continuing care patient, as defined in this measure, and is obtaining services from a participating provider or facility and the contract is terminated or the coverage of benefits is going to be terminated, the plan must notify an enrollee of the enrollee’s right to elect to continue transitional care, provide the enrollee an opportunity to notify the plan of the need for transitional care, and allow the enrollee to continue to have the benefits provided under the plan under the same terms and conditions as would have applied without the termination until either 90 days after the termination notice date or the date on which the enrollee is no longer a continuing care patient, whichever is earlier.

Summary for Telehealth Parity for 05/20/2021 Version

These provisions have been removed by the May 6 and 13 amendments. See below for previous language. (This provision has been removed by the May 6 and 13 amendments) This measure requires health insurance policies and self-insured governmental health plans to cover a treatment or service that is provided through telehealth if the treatment or service is covered by the policy or plan when provided in person. A policy or plan may limit its coverage to those treatments or services that are medically necessary. “Telehealth” is defined in this measure as a practice of health care delivery, diagnosis, consultation, treatment, or transfer of medically relevant data by means of audio, video, or data communications that are used either during a patient visit or consultation or are used to transfer medically relevant data about a patient. Health insurance policies are referred to as disability insurance policies in this measure, and a self-insured governmental health plan is a self-funded health plan of the state or a county, city, village, town, or school district. (This provision has been removed by the May 6 and 13 amendments) This measure also sets parameters on the coverage of telehealth treatments and services that is required in this measure. A policy or plan may not subject a telehealth treatment or service to a greater deductible, copayment, or coinsurance than if provided in person. Similarly, a policy or plan may not impose a policy or calendar year or a lifetime benefit limit or other maximum limitation or a prior authorization requirement on a telehealth treatment or service that is not imposed on treatments or services provided through manners other than telehealth. A policy or plan also may not place unique location requirements on telehealth treatment or services. If a policy or plan covers a telehealth treatment or service that has no in-person equivalent, the policy or plan must disclose this in the policy or plan materials.

Summary Reimbursement for Dental Services for 05/20/2021 Version

This measure requires DHS to provide enhanced reimbursement payments under the Medical Assistance program to dental providers who meet certain  qualifications. For qualified providers serving individuals in managed care under the Medical Assistance program, DHS must increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the provider had the individual not been enrolled in managed care. This measure requires DHS to provide enhanced reimbursement payments under the Medical Assistance program to dental providers who meet certain qualifications. In order to qualify, a provider must meet quality of care standards established by DHS. In addition, at least 50 percent of individuals served by a nonprofit or public provider must be without dental insurance or enrolled in the Medical Assistance program for the provider to qualify for enhanced reimbursement, and a for-profit provider must have at least 5 percent of patients enrolled in the Medical Assistance program. For services rendered by a qualified nonprofit or public dental provider, DHS must increase reimbursement by 50 percent above the reimbursement rate otherwise paid to that provider. For services provided by a qualified for-profit provider, DHS must increase reimbursement by 30 percent above the reimbursement rate otherwise paid to that provider. For qualified providers serving individuals in managed care under the Medical Assistance program, DHS must increase reimbursement to pay an additional amount on the basis of the rate that would have been paid to the provider had the individual not been enrolled in managed care. If a provider has more than one service location, reimbursement is determined separately for each location. Under the bill, any providers receiving reimbursement through the existing dental reimbursement pilot project are not eligible for critical access reimbursement payments. (Pg. 750-751)

Summary Workers’ Compensation for 05/20/2021 Version

This provision has been removed by the May 6 and 13 amendments. See below for previous provisions. (This provision has been removed by the May 6 and 13 amendments) Under current law, DWD is required to assess an administrative penalty against an employer who requires an employee to pay for any part of worker’s compensation insurance or who fails to provide mandatory worker’s compensation insurance coverage. If the employer violates those requirements, for the first 10 days, the penalty under current law is not less than $100 and not more than $1,000 for such a violation. If the employer violates those requirements for more than 10 days, the penalty under current law is not less than $10 and not more than $100 for each day of such a violation.
(This provision has been removed by the May 6 and 13 amendments) This measure provides that the penalty for violations occurring after the second such violation is $3,000 per violation, or three times the amount of the insurance premium that would have been payable, whichever is greater. This measure also
provides that the penalty for violations occurring after the third such violation is $4,000 per violation, or four times the amount of the insurance premium that would have been payable, whichever is greater. (Pg. 986) (This provision has been removed by the May 6 and 13 amendments) Currently, under the worker’s compensation law, an employer is not liable for temporary disability benefits during an employee’s healing period if the employee is suspended or terminated from employment due to substantial fault by the employee connected with the employee’s work. With certain exceptions, current law defines “substantial fault” to include those acts or omissions of an employee over which the claimant exercised reasonable control and that violate reasonable requirements of the claimant’s employer. This measure repeals this provision on substantial fault. (Pg. 983)

Summary for Mental Health/Substance Abuse Reimbursements/Grants for 05/20/2021 Version

This measure allows reimbursement on behalf of recipients of Medical Assistance for room and board for residential substance use disorder treatment. This measure allows DHS to award grants to organizations with comprehensive harm reduction strategies for the development or support of substance use harm reduction programs. This measure makes several changes to the TAD grant program, including match requirements. This measure directs DHS to pay allowable charges on behalf of recipients of Medical Assistance for room and board for residential substance use disorder treatment. (Pg. 754) This measure allows DHS to also provide community-based psychosocial services to Medical Assistance recipients and provide reimbursement for those services through providers other than those made available by a county. Reimbursement to providers that are not county-based will be both the federal and nonfederal share based on a fee schedule that is determined by DHS. For a county that elects to provide the services, DHS must reimburse the county for the federal and nonfederal amount of allowable charges under the Medical Assistance program. (Pg. 752) This measure allows DHS, as part of the grants DHS is required to award for community programs, to annually award up to $250,000 to organizations with comprehensive harm reduction strategies for the development or support of substance use harm reduction programs, as determined by DHS. (Pg. 670) This measure appropriates general purpose revenue to DHS to provide grants to provide trainings to substance use disorder treatment providers on treatment models for methamphetamine addiction. (Pg. 550) Under current law, DOJ, in collaboration with DOC and DHS, awards grants to counties or tribes that have established qualifying treatment alternatives and diversion (TAD) programs that offer substance abuse or mental health treatment services as alternatives to prosecution or incarceration in order to reduce recidivism, promote public safety, and reduce prison and jail populations. Under current law, in order to qualify for a TAD grant, a county’s or tribe’s program is required to match 25 percent of the grant, and a program is required to charge participants a fee to participate. A county or tribe that receives a TAD grant must create an oversight committee to administer and evaluate its program. DOJ is required to make grants available to any county or tribe on a competitive basis every five years. At the end of the five-year grant cycle, DOJ is required to prepare a comprehensive report on the grant program based on annual reports and other data it collects from the counties and tribes. This measure makes several changes to the TAD grant program. Under this measure, a program funded by a TAD grant need not focus solely on alcohol and other drug treatment, but must employ evidence-based practices targeted to the population served by the program. This measure changes the match  requirement from 25 percent to 10 percent and changes the competitive grant process to a four-year cycle. This measure allows, but does not require, an eligible program to charge participants a fee for their treatment. This measure also eliminates certain requirements pertaining to exposure of genitals during drug testing. (Pg. 1281-1283)

Summary for Mental Health Services for 05/20/2021 Version

This measure requires DHS to award grants to entities to provide a continuum of mental health crisis services, including crisis urgent care and observation centers, crisis stabilization and inpatient psychiatric beds, and crisis stabilization facilities. This measure requires DHS to award grants to entities to provide a continuum of mental health crisis services, including crisis urgent care and observation centers, crisis stabilization and inpatient psychiatric beds, and crisis stabilization facilities. DHS must also award up to five grants for services at facilities providing crisis stabilization services. The measure also allows DHS to create a certification for crisis urgent care and observation centers and establish criteria for that certification by rule. If DHS creates the certification, then no one may operate a crisis urgent care and observation center without a certification. (Pg. 764-765) This amendment provides $100,000 annually to promote suicide prevention and awareness by providing outreach, mental health services, and support to individuals who are members of traditionally underserved
population, including minority groups and individuals who reside in rural areas of the state. (May 13 Veteran’s Affairs Amendment)

Summary for Crisis Program Enhancement Grants for 05/20/2021 Version

This measure expands the crisis program enhancement grant program to include grants to establish and enhance law enforcement and behavioral health emergency response collaboration services and grants to Milwaukee County to enhance mobile crisis teams. This measure directs DHS to annually award grants to support mental health professionals to provide supervision and consultation to individuals who support crisis call center services. This measure expands the crisis program enhancement grant program to include grants to establish and enhance law enforcement and behavioral health emergency response  collaboration services and grants to Milwaukee County to enhance mobile crisis teams. This measure instructs DHS to annually award at least $1,250,000 to establish and enhance law enforcement and behavioral health services emergency response collaboration programs, and at least $850,000 to Milwaukee County to enhance mobile crisis teams. This measure also requires any entity, including a county or region, that receives a grant to establish and enhance law enforcement and behavioral health services emergency response collaboration programs to contribute at least 25 percent of the grant amount awarded for the purpose that the grant money is received. (Pg. 670-671) This measure directs DHS to annually award grants to support mental health professionals to provide supervision and consultation to individuals who support crisis call center services. The bill specifies that each county or multicounty program that receives supervision and consultation services from a mental health professional awarded a grant under this program shall contribute at least 10 percent of the costs of the services that the mental health professional incurs for the purpose that the grant is received.

Most Recent Update: On June 30, this measure was laid on the table and substituted by its companion in the Assembly (AB 68).
Since this measure has been substituted, it is unlikely to receive further consideration.

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