(1) PURPOSE. This
section implements s.
655.27(3),
Stats.
(2) SCOPE. This section
applies to fees charged to providers for participation in the fund, but does
not apply to fees charged for operation of the mediation system under s.
655.61, Stats.
(3) DEFINITIONS. In this section:
(a) "Annual fee" means the amount established
under sub. (6) for each class or type of provider.
(b) "Begin operation" means for a provider
other than a natural person to start providing health care services in this
state.
(bm) "Begin practice" means
to start practicing in this state as a medical or osteopathic physician or
nurse anesthetist or to become ineligible for an exemption from ch. 655,
Stats.
(c) "Class" means a group of
physicians whose specialties or types of practice are similar in their degree
of exposure to loss. The specialties and types of practice and the applicable
Insurance Services Office, Inc., codes included in each fund class are the
following:
1. Class 1:
Administrative Medicine
|
80120
|
Aerospace Medicine
|
80230
|
Allergy
|
80254
|
Allergy (D.O.)
|
84254
|
Cardiovascular Disease - no surgery or
catheterization
|
80255
|
Cardiovascular Disease - no surgery or catheterization
(D.O.)
|
84255
|
Dermatology - no surgery
|
80256
|
Dermatology - no surgery (D.O.)
|
84256
|
Diabetes - no surgery
|
80237
|
Endocrinology - no surgery
|
80238
|
Endocrinology - no surgery (D.O.)
|
84238
|
Family or General Practice - no surgery
|
80420
|
Family or General Practice - no surgery (D.O.)
|
84420
|
Forensic Medicine - Legal Medicine
|
80240
|
Forensic Medicine - Legal Medicine (D.O.)
|
84240
|
Gastroenterology - no surgery
|
80241
|
Gastroenterology - no surgery (D.O.)
|
84241
|
General Preventive Medicine - no surgery
|
80231
|
General Preventive Medicine - no surgery (D.O.)
|
84231
|
Geriatrics - no surgery
|
80243
|
Geriatrics - no surgery (D.O.)
|
84243
|
Gynecology - no surgery
|
80244
|
Gynecology - no surgery (D.O.)
|
84244
|
Hematology - no surgery
|
80245
|
Hematology - no surgery (D.O.)
|
84245
|
Hypnosis
|
80232
|
Infectious Diseases - no surgery
|
80246
|
Infectious Diseases - no surgery (D.O.)
|
84246
|
Internal Medicine - no surgery
|
80257
|
Internal Medicine - no surgery (D.O.)
|
84257
|
Laryngology - no surgery
|
80258
|
Manipulator (D.O.)
|
84801
|
Neoplastic Disease - no surgery
|
80259
|
Nephrology - no surgery
|
80260
|
Nephrology - no surgery (D.O.)
|
84260
|
Neurology - no surgery
|
80261
|
Neurology - no surgery (D.O.)
|
84261
|
Nuclear Medicine
|
80262
|
Nuclear Medicine (D.O.)
|
84262
|
Nutrition
|
80248
|
Occupation Medicine
|
80233
|
Occupation Medicine (D.O.)
|
84233
|
Oncology - no surgery
|
80302
|
Oncology - no surgery (D.O.)
|
84302
|
Ophthalmology - no surgery
|
80263
|
Ophthalmology - no surgery (D.O.)
|
84263
|
Osteopathy - manipulation only
|
84801
|
Otology - no surgery
|
80264
|
Otorhinolaryngology - no surgery
|
80265
|
Otorhinolaryngology - no surgery (D.O.)
|
84265
|
Pain Management - no surgery
|
80208
|
Pain Management - no surgery (D.O.)
|
84208
|
Pathology - no surgery
|
80266
|
Pathology - no surgery (D.O.)
|
84266
|
Pediatrics - no surgery
|
80267
|
Pediatrics - no surgery (D.O.)
|
84267
|
Pharmacology - Clinical
|
80234
|
Physiatry - Physical Medicine (D.O.)
|
84235
|
Physiatry - Physical Medicine &
Rehabilitation
|
80235
|
Physicians - no surgery
|
80268
|
Physicians - no surgery (D.O.)
|
84268
|
Psychiatry
|
80249
|
Psychiatry - (D.O.)
|
84249
|
Psychoanalysis
|
80250
|
Psychosomatic Medicine
|
80251
|
Psychosomatic Medicine (D.O.)
|
84251
|
Public Health
|
80236
|
Pulmonary Disease - no surgery
|
80269
|
Pulmonary Disease - no surgery (D.O.)
|
84269
|
Radiology - diagnostic
|
80253
|
Radiology - diagnostic (D.O.)
|
84253
|
Radiology - includes Mammography w/ Telemed
|
80472
|
Radiopaque dye
|
80449
|
Radiopaque dye (D.O.)
|
84449
|
Rheumatology - no surgery
|
80252
|
Rheumatology - no surgery (D.O.)
|
84252
|
Rhinology - no surgery
|
80247
|
Shock Therapy
|
80431
|
Shock Therapy (D.O.)
|
84431
|
Shock Therapy - insured
|
80162
|
Urgent Care - Walk-in or After Hours
|
80424
|
Urgent Care - Walk-in or After Hours (D.O.)
|
84424
|
Urology - no surgery
|
80121
|
2.
Class 2:
Acupuncture
|
80437
|
Acupuncture (D.O.)
|
84437
|
Anesthesiology
|
80151
|
Anesthesiology (D.O.)
|
84151
|
Angiography-Arteriography - catheterization
|
80422
|
Angiography-Arteriography - catheterization (D.O.)
|
84422
|
Broncho-Esophagology
|
80101
|
Cardiovascular Disease - minor surgery
|
80281
|
Cardiovascular Disease - minor surgery (D.O.)
|
84281
|
Colonoscopy-ERCP-Pneu or mech esoph dil (D.O.)
|
84443
|
Colonoscopy-ERCP-pneu. or mech.
|
80443
|
Dermatology - minor surgery
|
80282
|
Dermatology - minor surgery (D.O.)
|
84282
|
Diabetes - minor surgery
|
80271
|
Diabetes - minor surgery (D.O.)
|
84271
|
Emergency Medicine - No Major Surgery
|
80102
|
Emergency Medicine - No Major Surgery (DO)
|
84102
|
Employed Physician or Surgeon
|
80177
|
Employed Physician or Surgeon (D.O.)
|
84177
|
Endocrinology - minor surgery
|
80272
|
Endocrinology - minor surgery (D.O.)
|
84272
|
Family Practice - and general practice minor surgery - No
OB
|
80423
|
Family Practice - and general practice minor surgery - No
OB (D.O.)
|
84423
|
Family or General Practice - including OB (D.O.)
|
84421
|
Family or General Practice - including OB
|
80421
|
Gastroenterology - minor surgery
|
80274
|
Gastroenterology - minor surgery (D.O.)
|
84274
|
Geriatrics - minor surgery
|
80276
|
Geriatrics - minor surgery (D.O.)
|
84276
|
Gynecology - minor surgery
|
80277
|
Gynecology - minor surgery (D.O.)
|
84277
|
Hematology - minor surgery
|
80278
|
Hematology - minor surgery (D.O.)
|
84278
|
Hospitalist
|
80296
|
Hospitalist (D.O.)
|
84296
|
Infectious Diseases - minor surgery
|
80279
|
Intensive Care Medicine
|
80283
|
Intensive Care Medicine (D.O.)
|
84283
|
Internal Medicine - minor surgery
|
80284
|
Internal Medicine - minor surgery (D.O.)
|
84284
|
Laparoscopy
|
80440
|
Laparoscopy (D.O.)
|
84440
|
Laryngology - minor surgery
|
80285
|
Myelography-Discogram-Pneumoencephalo
|
80428
|
Myelography-Discogram-Pneumoencephalo (D.O.)
|
84428
|
Needle Biopsy
|
80446
|
Needle Biopsy (D.O.)
|
84446
|
Nephrology - minor surgery
|
80287
|
Neonatology
|
80804
|
Neonatology (D.O.)
|
84804
|
Neoplastic Disease - minor surgery
|
80286
|
Neurology - minor surgery
|
80288
|
Neurology - minor surgery (D.O.)
|
84288
|
Oncology - minor surgery
|
80301
|
Oncology - minor surgery (D.O.)
|
84301
|
Ophthalmology - minor surgery
|
80289
|
Ophthalmology - minor surgery (D.O.)
|
84289
|
Otology - minor surgery
|
80290
|
Otorhinolaryngology - minor surgery
|
80291
|
Otorhinolaryngology - minor surgery (D.O.)
|
84291
|
Pain Management - Basic procedures
|
80182
|
Pain Management - Basic procedures (D.O.)
|
84182
|
Pathology - minor surgery
|
80292
|
Pathology - minor surgery (D.O.)
|
84292
|
Pediatrics - minor surgery
|
80293
|
Pediatrics - minor surgery (D.O.)
|
84293
|
Phlebography-Lymphangeography
|
80434
|
Phlebography-Lymphangeography (D.O.)
|
84434
|
Physicians - minor surgery
|
80294
|
Physicians - minor surgery (D.O.)
|
84294
|
Radiation Therapy - lasers
|
80425
|
Radiation Therapy - lasers (D.O.)
|
84425
|
Radiation Therapy - other than lasers
|
80165
|
Radiology - diagnostic-interventional procedures
|
80280
|
Radiology - diagnostic-interventional procedures
(D.O.)
|
84280
|
Rhinology - minor surgery
|
80270
|
Surgery - Colon & Rectal
|
80115
|
Surgery - Endocrinology
|
80103
|
Surgery - Gastroenterology
|
80104
|
Surgery - Gastroenterology (D.O.)
|
84104
|
Surgery - General Practice or Family Practice
|
80117
|
Surgery - General Practice or Family Practice
(D.O.)
|
84117
|
Surgery - Geriatrics
|
80105
|
Surgery - Neoplastic
|
80107
|
Surgery - Nephrology
|
80108
|
Surgery - Ophthalmology
|
80114
|
Surgery - Ophthalmology (D.O.)
|
84114
|
Surgery - Urological
|
80145
|
Surgery - Urological (D.O.)
|
84145
|
3. Class 3:
4. Class 4:
(d) "Fiscal year" means each period beginning
each July 1 and ending each June 30.
(e) "Permanently cease operation" means for a
provider other than a natural person to stop providing health care services
with the intent not to resume providing such services in this state.
(f) "Permanently cease practice" means to
stop practicing as a medical or osteopathic physician or nurse anesthetist with
the intent not to resume that type of practice in this state.
(g) "Primary coverage" means health care
liability insurance meeting the requirements of subch. III of ch. 655,
Stats.
(h) "Provider" means a
health care provider, as defined in s.
655.001(8),
Stats.
(hm) "Resident" means a
licensed physician engaged in an approved postgraduate medical education or
fellowship program in any specialty specified in par. (c) 1. to 4.
(i) "Temporarily cease practice" means to
stop practicing in this state for any period of time because of the suspension
or revocation of a provider's license, or to stop practicing for at least 90
consecutive days for any other reason.
(3e) PRIMARY COVERAGE REQUIRED. Each provider
shall ensure that primary coverage for the provider and the provider's
employees other than employees excluded from fund coverage under par. (b), is
in effect on the date the provider begins practice or operation and for all
periods during which the provider practices or operates in this state. A
provider does not have fund coverage for any of the following:
(a) Any period during which primary coverage
is not in effect.
(b) Any employee
who is a health care practitioner under the circumstances described in s.
655.005(2),
Stats.
(3h) SUPERVISION
AND DIRECTION. For the purposes of clarifying s.
655.005(2)
(a), Stats., health care services that are
"under the direction and supervision of a physician or nurse anesthetist"
include, but are not limited to the health care services being provided
pursuant to and within the scope of the health care practitioner's professional
license and:
(a) The health care practitioner
is subject to a quality assurance program, peer review process, or other
similar program or process that is implemented for and designed to ensure the
provision of competent and quality patient care and that program or process
also includes participation by a physician or a nurse anesthetist; or
(b) The health care services are provided by
the health care practitioner within the scope of standing orders, protocols,
procedures or clinical practice guidelines established or approved by a
physician or nurse anesthetist.
(3m) EXEMPTIONS; ELIGIBILITY. A medical or
osteopathic physician licensed under ch. 448, Stats., or a nurse anesthetist
licensed under ch. 441, Stats., may claim an exemption from ch. 655, Stats., if
at least one of the following conditions applies:
(a) The provider will not practice more than
240 hours in the fiscal year.
(c)
During the fiscal year, the provider will derive more than 50% of the income
from his or her practice from outside this state or will attend to more than
50% of his or her patients outside this state.
(3s) LATE ENTRY TO FUND.
(a) A provider that begins or resumes
practice or operation during a fiscal year, has claimed an exemption or has
failed to comply with sub. (3e) may obtain fund coverage during a fiscal year
by giving the fund advance written notice of the date on which fund coverage
should begin.
(b) The board may
authorize retroactive fund coverage for a provider who submits a timely request
for retroactive coverage showing that the failure to procure coverage occurred
through no fault of the provider and despite the fact that the provider acted
reasonably and in good faith. The provider shall furnish the board with an
affidavit describing the necessity for the retroactive coverage and stating
that the provider has no notice of any pending claim alleging malpractice or
knowledge of a threatened claim or of any occurrence that might give rise to
such a claim. The authorization shall be in writing, specifying the effective
date of fund coverage.
(4) ANNUAL FEES; BILLING PROCEDURES.
(a)
Definition. In this
subsection, "semimonthly period" means the 1st through the 14th day of a month
or the 15th day through the end of a month.
(b)
Entry during fiscal year;
prorated annual fee. If a provider begins practice or operation or
enters the fund under sub. (3s) (b) after the beginning of a fiscal year, the
fund shall charge the provider one twenty-fourth of the annual fee for each
semimonthly period or part of a semimonthly period from the date fund coverage
begins to the next June 30.
(c)
Ceasing practice or operation; refunds. A provider or person
acting on the provider's behalf shall notify the fund in the form specified by
the fund if any of the following occurs:
1.
The provider is exempt under sub. (3m) (a) or (c).
2. The provider is no longer eligible to
participate in the fund under s.
655.003(1)
or (3), Stats.
3. This state is no longer a principal place
of practice for the provider.
4.
The provider has temporarily or permanently ceased practice or has ceased
operation.
5. The provider's
classification under sub. (6) has changed.
(cm)
Eligibility for exemption;
refund. If a provider claims an exemption after paying all or part of
the annual fee, the fund shall issue a refund equal to one twenty-fourth of the
provider's annual fee for each full semi-monthly period from the date the
provider becomes eligible for the exemption to the due date of the next
payment. The refund for any past exemption period will be limited to the
current fiscal year and the immediate prior fiscal year.
(cs)
Ineligibility for fund coverage;
refund.
1. If a provider who has paid
all or part of the annual fee is or becomes ineligible to participate in the
fund under s.
655.003(1)
or (3), Stats., or because he or she does not
practice in this state, the fund shall issue a full refund of any amount the
provider paid for fund coverage for which he or she was not eligible.
2. If a provider that has paid all or part of
the annual fee is ineligible for fund coverage because the provider is not in
compliance with sub. (3e), the fund shall issue a full refund of the amount
paid for the period of noncompliance, beginning with the date the noncompliance
began.
(d)
Change
of classification; increased annual fee.
1. If a provider's change of classification
under sub. (6) during a fiscal year results in an increased annual fee, the
fund shall adjust the provider's annual fee to equal the sum of the following:
a. One twenty-fourth of the annual fee for
the provider's former classification for each full semimonthly period from the
due date of the provider's first payment during the current fiscal year to the
date of the change.
b. One
twenty-fourth of the annual fee for the provider's new classification for each
full or partial semimonthly period from the date of the change to the next June
30.
2. The fund shall
bill the provider for the total amount of the increase under subd. 1. if the
provider has already paid the total annual fee, or shall prorate the increase
over the remaining installment payments.
(e)
Change of classification;
decreased annual fee.
1. If a
provider's change of classification under sub. (6) during a fiscal year results
in a decreased annual fee, the fund shall adjust the provider's annual fee to
equal the sum of the following:
a. One
twenty-fourth of the annual fee for the provider's former classification for
each full or partial semimonthly period from the due date of the provider's
first payment during the current fiscal year to the date of the
change.
b. One twenty-fourth of the
annual fee for the provider's new classification for each full semimonthly
period from the date of the change to the next June 30.
2. The fund shall credit the amount of the
decrease under subd. 1. over any remaining installment payments. If the
provider has already paid the total annual fee, the fund shall issue a refund
if the amount of the refund is more than $10. The fund shall credit any amount
of $10 or less to the provider's account. If the provider no longer
participates in the fund, a credit of $10 or less shall lapse to the fund.
(f)
Refund of
other charges. If a provider is entitled to a refund or credit under
this subsection, the fund shall also issue a refund or credit of the unearned
portion of any amounts paid as surcharges using the same method used to
calculate a refund or credit of an annual fee. A mediation fund fee is
refundable only if the provider did not participate in the injured patients and
families compensation fund for any part of the fiscal year.
(g)
Refund for administrative
error. In addition to any refund authorized under par. (c), (cm),
(cs), (e) or (f), the fund may issue a refund to correct an administrative
error in the current or any previous fiscal year.
(h)
Billing; entire fiscal
year. Except as provided in sub. (6e) (b), for each fiscal year, the
fund shall issue to each provider participating in the fund an initial bill
which shall include all of the following:
1.
The total annual fee due for the fiscal year.
2. Any applicable surcharge imposed under s.
Ins 17.285.
3. The balance and
accrued interest, if any, due from a prior fiscal year.
4. Notice of the provider's right to pay the
amount due in full or in instalments.
5. The minimum amount due if the provider
elects installment payments.
6. The
payment due date.
(i)
Billing; partial fiscal year. The fund shall issue each
provider entering the fund after the beginning of a fiscal year an initial bill
which shall include all of the following;
1.
The total amount due calculated under par. (b).
2. Notice of the provider's right to pay the
amount due in full or in instalments.
3. The minimum amount due if the provider
elects installment payments.
4. The
payment due date.
(j)
Balance billing. If a provider pays at least the minimum
amount due but less than the total amount due by the due date, the fund shall
calculate the remainder due by subtracting the amount paid from the amount due
and shall bill the provider for the remainder on a quarterly installment basis.
Each subsequent bill shall include all of the following:
1. The total of the remainder due.
2. Interest on the remainder due. The daily
rate of interest shall be the average annualized rate earned by the fund on its
short-term funds for the first 3 quarters of the preceding fiscal year, as
determined by the state investment board, divided by 360.
3. A $3 administrative service
charge.
4. The minimum amount
due.
5. The payment due
date.
(k)
Prompt
payment required. A provider shall pay at least the minimum amount due
on or before each due date. If the fund receives payment later than the due
date specified in the late payment notice sent to the provider by certified
mail, the fund, notwithstanding par. (n) 5., may not apply the payment
retroactively to the annual fee unless the board has authorized retroactive
coverage under sub. (3s) (b).
(n)
Application of payments. Except as provided in par. (k), all
payments to the fund shall be applied in chronological order first to previous
fiscal years for which a balance is due and then to the current fiscal year.
The amounts for each fiscal year shall be credited in the following order:
1. Mediation fund fee imposed under s. Ins
17.01.
2. Administrative service
charge under par. (j) 3.
3.
Interest under par. (j) 2.
4.
Surcharge imposed under s. Ins 17.285.
5. Annual fee under sub. (6).
(o)
Waiver of
balance. The fund may waive any balance of $50 or less, if it is in
the economic interest of the fund to do so.
(5) FILING OF CERTIFICATES OF INSURANCE.
(a)
Electronic filing.
Except as provided in par. (b), each insurer and self-insured provider required
under s.
655.23(3)
(b) or (c), Stats., to file a certificate of
insurance shall file the certificate electronically in the format specified by
the commissioner by the 15th day of the month following the month of original
issuance or renewal or a change of class under sub. (6).
(b)
Exemption. An insurer or
self-insured provider may file a written request for an exemption from the
requirement of par. (a). The commissioner may grant the exemption if he or she
finds that compliance would constitute a financial or administrative hardship.
An insurer or self-insured provider granted an exemption under this paragraph
shall file a paper certificate in the format specified by the commissioner
within 45 days after original issuance or renewal or a change of class under
sub. (6).
(c)
Late filing
fee. A late fee in the amount of $100.00 per certificate shall be paid
to the fund by each insurer and self-insured provider who fails to file a
certificate of insurance in accordance with the requirements of this
subsection. An additional $100.00 late fee shall be paid per certificate for
each additional week, or portion thereof, the certificate is not in compliance
with this subsection.
(6)
FEE SCHEDULE. The following fee schedule is in effect from July 1, 2013 to June
30, 2014:
(a) Except as provided in pars. (b)
to (f) and sub. (6e), for a physician for whom this state is a principal place
of practice:
Class 1......
|
$1,457
|
Class 2......
|
$2,623
|
Class 3....
|
$5,828
|
Class 4....
|
$9,616
|
(b) For
a resident acting within the scope of a residency or fellowship program:
Class 1.....
|
$ 729
|
Class 2......
|
$1,312
|
Class 3....
|
$2,916
|
Class 4....
|
$4,811
|
(c) For
a resident practicing part-time outside the scope of a residency or fellowship
program:
(d) For
a Medical College of Wisconsin, Inc., full-time faculty member:
Class 1.....
|
$583
|
Class 2.....
|
$1,049
|
Class 3....
|
$2,332
|
Class 4....
|
$3,848
|
(e) For
physicians who practice part-time:
1. For a
physician who practices fewer than 500 hours during the fiscal year, limited to
office practice and nursing home and house calls, and who does not practice
obstetrics or surgery or assist in surgical procedures: $ 364
2. For a physician who practices 1,040 hours
or less during the fiscal year, including those who practice fewer than 500
hours during the fiscal year whose practice is not limited to office practice,
nursing homes or house calls or who do practice obstetrics, surgery or assist
in surgical procedures:
Class 1......
|
$ 874
|
Class 2......
|
$1,573
|
Class 3.....
|
$3,496
|
Class 4.....
|
$5,768
|
(f) For a physician for whom this state is
not a principal place of practice:
Class 1......
|
$ 729
|
Class 2......
|
$1,312
|
Class 3.....
|
$2,916
|
Class 4......
|
$4,811
|
(g) For
a nurse anesthetist for whom this state is a principal place of practice: $
358
(h) For a nurse anesthetist for
whom this state is not a principal place of practice: $ 179
(i) For a hospital, all of the following
fees:
1. Per occupied bed $ 87
2. Per 100 outpatient visits during the last
calendar year for which totals are available: $ 4.35
(j) For a nursing home, as described under s.
655.002(1)
(j), Stats., that is wholly owned and
operated by a hospital and that has health care liability insurance separate
from that of the hospital by which it is owned and operated:
Per occupied bed $ 17
(k) For a partnership comprised of physicians
or nurse anesthetists, organized for the primary purpose of providing the
medical services of physicians or nurse anesthetists, all of the following
fees:
1.
a.
If the total number of partners and employed physicians and nurse anesthetists
is from 2 to 10 $ 51
b. If the
total number of partners and employed physicians and nurse anesthetists is from
11 to 100 $ 503
c. If the total
number of partners and employed physicians and nurse anesthetists exceeds 100
$1,252
2. The following
fee for each full-time equivalent allied health care professional employed by
the partnership 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
|
(l) For a corporation, including a service
corporation, with more than one shareholder organized under ch. 180, Stats.,
for the primary purpose of providing the medical services of physicians or
nurse anesthetists, all of the following fees:
1.
a. If
the total number of shareholders and employed physicians and nurse anesthetists
is from 2 to 10 $ 51
b. If the
total number of shareholders and employed physicians and nurse anesthetists is
from 11 to 100 $ 503
c. If the
total number of shareholders and employed physicians or nurse anesthetists
exceeds 100 $1,252
2. The
following fee for each full-time equivalent allied health care professional
employed by the corporation 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
|
(m) For a corporation organized under ch.
181, Stats., for the primary purpose of providing the medical services of
physicians or nurse anesthetists, all of the following fees:
1.
a. If
the total number of employed physicians and nurse anesthetists is from 1 to 10
$ 51
b. If the total number of
employed physicians and nurse anesthetists is from 11 to 100 $ 503
c. If the total number of employed physicians
or nurse anesthetists exceeds 100 $1,252
2. The following fee for each full-time
equivalent allied health care professional employed by the corporation 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
|
(n) For an operational cooperative sickness
care plan as described under s.
655.002(1)
(f), Stats., all of the following fees:
1. Per 100 outpatient visits during the last
calendar year for which totals are available...... $0.11
2. 2.5% of the total annual fees assessed
against all of the employed physicians.
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
|
(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
(p) For an entity affiliated
with a hospital, the greater of $100 or whichever of the following applies:
1. 7.0% of the amount the entity pays as
premium for its primary health care liability insurance, if it has occurrence
coverage.
2. 10.0% of the amount
the entity pays as premium for its primary health care liability insurance, if
it has claims-made coverage.
(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:
1.
a. If
the total number of employed physicians and nurse anesthetists is from 1 to 10
....... $ 51
b. If the total number
of employed physicians and nurse anesthetists is from 11 to 100 ..........$
503
c. If the total number of
employed physicians or nurse anesthetists exceeds 100 .........$
1,252
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
|
(6d) PRIMARY PURPOSE PRESUMPTION. For
purposes of s.
655.002(1)
(e), Stats., and this section, it is
presumed:
(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.
(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.
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.
(6e)
MEDICAL COLLEGE RESIDENTS' FEES.
(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.
(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.
(6m) REPORTING.
(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).
(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.
(6s) SURCHARGE.
(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.
(b) In this subsection:
1. "Aggregate indemnity" has the meaning
given under s. Ins 17.285(2) (a).
2. "Closed claim" has the meaning given under
s. Ins 17.285(2) (b).
3. "Provider"
has the meaning given under s. Ins 17.285(2) (d).
4. "Review period" has the meaning given
under s. Ins 17.285(2) (e).
(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:
1. For a
class 1 physician or a nurse anesthetist:
Aggregate Indemnity During Review Period
|
Number of Closed Claims During Review Period
|
1
|
2
|
3
|
4 or more
|
Up to $118,000
|
0%
|
0%
|
0%
|
0%
|
$118,001 to $585,000
|
0%
|
10%
|
25%
|
50%
|
$585,001 to $1,571,000
|
0%
|
25%
|
50%
|
100%
|
Greater Than $1,571,000
|
0%
|
75%
|
100%
|
200%
|
2. For
a class 2 physician:
Aggregate Indemnity During Review Period
|
Number of Closed Claims During Review Period
|
1
|
2
|
3
|
4 or more
|
Up to $226,000
|
0%
|
0%
|
0%
|
0%
|
$226,001 to $859,000
|
0%
|
10%
|
25%
|
50%
|
$859,001 to $2,212,000
|
0%
|
25%
|
50%
|
100%
|
Greater Than $2,212,000
|
0%
|
50%
|
100%
|
200%
|
3. For
a class 3 physician:
Aggregate Indemnity During Review Period
|
Number of Closed Claims During Review Period
|
1
|
2
|
3
|
4
|
5 or more
|
Up to $676,000
|
0%
|
0%
|
0%
|
0%
|
0%
|
$676,001 to $1,066,000
|
0%
|
0%
|
10%
|
25%
|
50%
|
$1,066,001 to $1,822,000
|
0%
|
0%
|
25%
|
50%
|
75%
|
$1,822,001 to $3,996,000
|
0%
|
0%
|
50%
|
75%
|
100%
|
Greater Than $3,996,000
|
0%
|
0%
|
75%
|
100%
|
200%
|
4. For
a class 4 physician:
Aggregate Indemnity During Review Period
|
Number of Closed Claims During Review Period
|
1
|
2
|
3
|
4
|
5 or more
|
Up to $931,000
|
0%
|
0%
|
0%
|
0%
|
0%
|
$931,001 to $1,451,000
|
0%
|
0%
|
10%
|
25%
|
50%
|
$1,451,001 to $2,467,000
|
0%
|
0%
|
25%
|
50%
|
75%
|
$2,467,001 to $5,179,000
|
0%
|
0%
|
50%
|
75%
|
100%
|
Greater Than $5,179,000
|
0%
|
0%
|
75%
|
100%
|
200%
|
Notes
Wis. Admin. Code Office of the Commissioner of Insurance § Ins 17.28
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.
Amended by, CR
19-119 am. (3) (c) 1. to 3., (4) (f)
Register
July 2020 No. 775, eff. 8/1/2020
For a complete history of s. Ins 17.28 from June 1980 through
August 31, 2000, see the History note following s. Ins 17.28 published in
Register August 2000 No. 536.