FEE SCHEDULE NEWS:

• The certified radiology database has been updated with an effective date of July 1, 2017.  The next update is scheduled for January 1, 2018.

REGULATORY ACTIVITY:

• Posted an emergency rule related to Operation of the prescription drug monitoring program.

FEE SCHEDULE NEWS:

• The certified radiology database has been updated with an effective date of January 1, 2017.  The next update is scheduled for July 1, 2017.

FEE SCHEDULE NEWS:

• The certified physician database has been updated with an effective date of January 1, 2017. The next update is scheduled for July 2017.

REGULATORY ACTIVITY:

• Issued a Governor's Executive Order #228 relating to the implementation of the recommendations of the Co-Chairs of the Governor's Task Force on Opioid Abuse.

FEE SCHEDULE NEWS:

• The certified physician database has been updated with an effective date of July 1, 2016. The next update is scheduled for January 2017.
• The certified radiology database has been updated with an effective date of July 1, 2016.  The next update is scheduled for January 1, 2017.

REGULATORY ACTIVITY:

• Wisconsin adopted emergency rule Chapter DWD 131 Pre-Employment Drug Testing, Substance Abuse Treatment Program and Job Skills Assessment. The rule is a new rule chapter effective immediately.  The rule can have an impact on workers’ compensation benefits.
• The state’s Controlled Substances Board has posted rules related to the Prescription Drug Monitoring Program. The posted rules are both emergency and permanent.   The posted rules revise Chapter CSB 4.  A correction was also filed regarding the revised rules.  The correction is: The effective date of the creation of section CSB 4.04 (2) (p) is April 8, 2017. It was incorrectly shown as May 1, 2016. The corrected Chapter CSB 4 will be published in Register 724B on May 31, 2016.

LEGISLATIVE ACTIONS:

• Assembly Bill 724
  Wisconsin enacted Assembly Bill 724 into law.  The bill contains a number of changes to the state’s workers’ compensation system.  For all but two sections of the law the legislation became effective on March 2, 2016.  Two Sections of the statute; those sections dealing with administrative review of a workers’ compensation decision and judicial review of a worker’s compensation decision become effective on July 1, 2016.  The enacted legislation deals with a number of aspects of the state’s workers’ compensation system including: general coverage, payment of benefits, hearing and procedures; and program administration.

Below summarize those sections of the statute that became effective on March 2, 2016.

General Coverage:

This bill changes the term “municipality” to “local governmental unit” for purposes of the workers’ compensation law and redefines that term to mean a political subdivision of this state; a special purpose district or taxing jurisdiction in this state; an instrumentality, corporation, combination, or subunit of any of the foregoing; or any other public or quasi-public corporation.  Under current law, cities, villages, towns, and counties are political subdivisions of this state; special purpose districts include school districts, sewer districts, drainage districts, and other districts created for special purposes; and taxing jurisdictions are entities, not including the state, that are authorized by law to levy property taxes. This bill provides that an individual who is performing services for a person receiving long-term care benefits under certain long-term care programs administered by the Department of Health Services, including the Community Options Program, the Community Integration Program, Family Care, the Family Care Partnership Program, a self-directed program commonly referred to as IRIS, or the Children’s Long-Term Support Home and Community-Based Medicaid Waiver Program, on a self-directed basis and who does not otherwise have worker’s compensation coverage for those services is considered to be an employee of the entity that is providing financial management services for the person who is receiving the benefits.  As such, the financial management services entity is liable for any injury sustained by the individual while performing those services and is required to insure payment of that liability either by purchasing insurance from an insurer authorized to do business in this state or, if permitted by DWD, by self-insuring for that liability.  The bill also prohibits an individual providing long-term care services who is considered an employee of a financial management services entity for purposes of worker’s compensation coverage and who files a claim for worker’s compensation from bringing an action in tort against the person who received the long-term care services from which the claim arose.

Payment of Benefits

This bill provides that if an employee violates an employer policy against drug or alcohol use and such violation is causal to the employee’s injury, then neither the employee nor the employee’s dependents may receive, under the workers’ compensation law, any compensation, including the death benefit, relating to that injury.  The bill specifies, however, that this provision does not reduce or eliminate an employer’s liability for the cost of treating the employee’s injury.  Under current law, if an employee is injured as a result of intoxication by alcohol, controlled substances, or controlled substance analogs, the compensation, including the death benefit, is reduced by 15 percent. This bill provides that 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 misconduct, as defined in the unemployment insurance law, or substantial fault, as defined in the unemployment insurance law, by the employee connected with the employee’s work. The unemployment insurance law defines misconduct” as action or conduct evincing such willful or wanton disregard of an employer’s interests as is found in 1) deliberate violation or disregard of standards of behavior that an employer has a right to expect of his or her employees; or 2) carelessness or negligence of such degree or recurrence as to manifest culpability, wrongful intent, or evil design in disregard of the employer’s interests or to show an intentional and substantial disregard of an employer’s interests or of an employee’s duties and obligations to his or her employer.

The unemployment insurance law defines “substantial fault” as acts or omissions of an employee over which the employee exercised reasonable control that violate reasonable requirements of the employee’s employer, but not including minor infractions, inadvertent errors, or failure to perform work due to insufficient skill, ability, or equipment.

This bill provides that if an injured employee has incurred permanent disability, but a percentage of that disability was caused by an accidental injury sustained in the course of employment and a percentage of that disability was caused by other factors, whether occurring before or after the time of the accidental injury, the employer is liable only for the percentage of permanent disability that was caused by the accidental injury.  If, however, previous permanent disability is attributable to occupational exposure with the same employer, the employer is also liable for that previous permanent disability.

This bill increases the maximum weekly compensation rate for permanent partial disability from $322 to $342 for injuries occurring before January 1, 2017, and to $362 for injuries occurring on or after that date.

This bill provides that an injured employee who is receiving the maximum weekly benefit in effect at the time of the injury for permanent total disability or continuous temporary total disability resulting from an injury that occurred before January 1, 2003, is entitled to receive supplemental benefits for a week of disability beginning after the effective date of the bill in an amount that, when added to the employee’s regular benefits, equals $669.  Under current law, supplemental benefits are payable only for an injury occurring prior to January 1, 2001, and the maximum supplemental benefit amount for a week of disability is an amount that, when added to the employee’s regular benefits, equals $582.

This bill provides that an application for workers’ compensation for a traumatic injury filed more than six years after the date of injury or date that worker’s compensation was last paid is barred by the statute of limitations and that, for traumatic injuries for which there is no statute of limitations, benefits or treatment expenses for traumatic injury becoming due six years after the date of injury or the date that compensation was last paid are paid by DWD from the Work Injury Supplemental Benefit (WISB) fund, if that date is before April 1, 2006.  Under current law, an application for worker’s compensation that is not filed within 12 years from the date of the injury or from the date that worker’s compensation was last paid is barred by the statute of limitations and, in cases in which there is no statute of limitations, benefits or treatment expenses for traumatic injury becoming due 12 years after the date of injury or the date that compensation was last paid are paid by DWD from the WISB fund if that date is before April 1, 2006.

This bill eliminates an April 30, 2014, sunset date for a provision under which compensation for temporary disability on account of receiving vocational rehabilitation services is not reduced on account of any wages earned for the first 24 hours worked by an employee during a week in which the employee is receiving those services and only hours worked in excess of 24 during that week are offset against the employee’s average weekly wage in calculating compensation for temporary disability.  Generally, under current law, all hours worked by an employee who has incurred partial disability are offset against the employee’s average weekly wage in calculating compensation for temporary disability.

This bill specifies that the current law that limits the liability of an employer or insurer for the cost of a prescription drug to the average wholesale price of the prescription drug, as quoted in the Drug Topics Red Book (average wholesale price), applies to a prescription drug dispensed outside of a licensed pharmacy. The bill also provides that DWD may use an alternative nationally recognized prescription drug pricing source for determining average wholesale prices of prescription drugs if the Drug Topics Red Book is discontinued and becomes unavailable.

This bill requires DWD, at least once every eight years, to review and revise the minimum permanent partial disability ratings that DWD has promulgated by rule for certain amputation levels, losses of motion, sensory losses, and surgical procedures resulting from injuries for which permanent partial disability is claimed. Before revising those ratings, DWD must appoint a medical advisory committee, composed of physicians practicing on one or more areas of specialization or treating disciplines within the medical profession, to review those ratings and recommend revisions of those ratings, based on typical loss of function, to DWD and the Council on Workers’ Compensation.

Hearing and Procedures

This bill permits a physician, chiropractor, psychologist, podiatrist, dentist, physician assistant, advance practice nurse prescriber, hospital, or health service provider, upon request by an injured employee, employer, insurer, or DWD, to provide that person with any written material that is reasonably related to an injury for which the employee claims worker’s compensation in electronic format upon payment of $26 per request.  Current law requires those practitioners to provide that material to those requesters upon payment of the actual cost of providing those materials, not to exceed the greater of 45 cents per page or $7.50 per request, plus the actual costs of postage, but does not address providing those materials in electronic format. This bill prohibits DWD from requiring a treating practitioner to submit a final report to DWD if 1) an injured employee has a period of temporary disability of more than three weeks or a permanent disability, has undergone surgery to treat an injury, other than surgery to correct a hernia, or sustains an eye injury requiring medical treatment on three or more occasions off the employer’s premises; 2) the employer or insurer denies the employee’s claim for workers’ compensation in its entirety; and 3) the employee does not contest that denial.  Current law prohibits DWD from requiring submission of a final report under those circumstances, but does not specify that the employee’s claim for compensation must be denied in its entirety.  The bill also requires a treating practitioner to complete a final report on a timely basis and permits a treating practitioner to charge no more than $100 for completing a final report. This bill permits DHA to include in an interlocutory or final award or order an order directing the employer or insurer to pay for a future course of instruction or other rehabilitation training services provided under a rehabilitation training program.  Current law specifically permits DHA to include in an interlocutory or final award or order an order directing the employer or insurer to pay for any future treatment that may be necessary to cure and relieve an injured employee from the effects of the employee’s injury, but does not specifically permit DHA to include in such an order or award an order directing payment for a future course of instruction or other services provided under a rehabilitation training program.

Program Administration

This bill permits DWD to request the Department of Justice (DOJ) to assist DWD in an investigation of a false or fraudulent workers’ compensation claim or any other suspected fraudulent activity on the part of an employer, employee, insurer, health care provider, or other person related to workers’ compensation.  If, based on the investigation, DWD has a reasonable basis to believe that theft, forgery, fraud, or any other criminal violation has occurred, DWD must refer the matter to the district attorney or DOJ for prosecution.

Election by governmental employer to self-insure.  This bill codifies into statute certain DWD rules that permit the state or a local governmental unit to self-insure its workers’ compensation liability without further order of DWD. Specifically, the bill permits the state or a local governmental unit that has independent taxing authority (governmental employer) to elect to self-insure its workers’ compensation liability without further order of DWD if the governmental employer agrees to report all compensable injuries and to comply with the workers’ compensation law and the rules of DWD.  Under the bill, a local governmental unit that elects to self-insure its liability for the payment of worker’s compensation must notify DWD of that election in writing before commencing to self-insure that liability, must notify DWD of its intent to continue to self-insure that liability every three years after that initial notice, and must notify DWD of its intent to withdraw that election not less than 30 days before the effective date of that withdrawal. This bill permits DWD to revoke an election by a governmental employer to self-insure its liability for workers’ compensation, without seeking the advice of the Self-Insurer’s Council, if DWD finds that the governmental employer’s financial condition is inadequate to pay its employees’ claims for compensation, that the governmental employer has received an excessive number of claims for compensation, or that the governmental employer has failed to discharge faithfully its obligations under the workers’ compensation law and the rules of DWD.  Under the bill, once such an election is revoked, the governmental employer whose election is revoked may not elect to self-insure its liability for the payment of worker’s compensation unless at least three calendar years have elapsed since the revocation and DWD finds that the governmental employer’s financial condition is adequate to pay its employees’ claims for compensation, that the governmental employer has not received an excessive number of claims for compensation, and that the governmental employer has faithfully discharged its obligations under the worker’s compensation law and the rules of DWD.

This bill requires an initial assessment for the self-insurer’s fund, which is a fund that is used to pay the worker’s compensation liability of self-insured employers that cannot pay that liability, to be prorated on the basis of the gross payroll for this state of the self-insured employer, as reported to DWD for the previous calendar year for purposes of unemployment insurance.  Current law requires subsequent assessments for the self-insurer’s fund to be so prorated and requires an initial assessment for that fund to be equal to the amount assessed upon each other self-insured employer.

The bill also clarifies that governmental employers are not covered under the self-insurer’s fund.  Specifically, the bill prohibits DWD from 1) requiring a governmental employer that elects to self-insure its liability for the payment of worker’s compensation to pay into the self-insurer’s fund; and 2) making payments from that fund for the liability under the workers’ compensation law of such an employer, whether currently or formerly exempt from the duty to insure.

Below summarize those sections of the statute that become effective on July 1, 2016.

Hearing and Procedures 

Administrative Review of a workers’ compensation decision:  This bill requires the Labor and Industry Review Commission (LIRC) to dismiss a petition for review that is not filed within 21 days after DWD or DHA mailed a copy of the examiner’s findings and order to the petitioner’s last-known address unless the petitioner shows that the petition was filed late for a reason that was beyond the petitioner’s control.  Currently, LIRC must dismiss a petition for review that is not “timely” filed unless the petitioner shows probable good cause that the reason for failure to timely file the petition was beyond the petitioner’s control.  The bill also allows LIRC to set aside a decision for further consideration within 28 days after the date of the decision, not within 28 days after the date of its mailing as under current law.

Judicial Review of a workers’ compensation decision:  This bill requires LIRC to identify in an order or award made by LIRC the persons that must be made parties to an action for judicial review of the order or award.  The bill also requires the summons and complaint in the action to name those persons as defendants.  In addition, the bill permits the circuit court to join as a party to the action any other person determined necessary for the proper resolution of the action, unless joiner of the person would unduly delay the resolution of the action.

Effective Date for Administrative and Judicial Review is July 1, 2016.  Effective Date for the other sections of the legislation is March 2, 2016.

• Senate Bill 21
  The enacted legislation relates to state finances and appropriations, constituting the executive budget act.  The act does address workers’ compensation coverage for students at institutions of higher education who are a part of school work training or work study program. Effective Date May 18, 2016.