AB 1074

This bill makes various changes to the worker's compensation law, as

administered by the Department of Workforce Development and the Division of

Hearings and Appeals in the Department of Administration.

Health service fee schedule

This bill requires DWD, by July 1, 2025, to establish a schedule of the maximum

fees that a health care provider may charge an employer or insurer for health

services provided to an injured employee who claims worker's compensation

benefits. Under the bill, DWD must, when that schedule is established, send a notice

to the Legislative Reference Bureau, and the LRB must publish that notice in the

Wisconsin Administrative Register. The reasonableness of the health service fee

dispute resolution process under current law does not apply to health services

provided on or after the date specified in the notice. The liability of an employer or

insurer for a health service included in the fee schedule is then limited to the

maximum fee allowed under the schedule for the health service as of the date on

which the health service was provided, any fee agreed to by contract between the

employer or insurer and health care provider for the health service as of that date,

or the health care provider's actual fee for the health service as of that date,

whichever is less.

The bill requires DWD, in determining those maximum fees, to divide the state

into five regions based on geographical and economic similarity, including similarity

in the cost of health services, and, for each region, to do the following: 1) determine

the average payment made by insured and self-insured group health plans, and the

average copayment, coinsurance, and deductible payment made by persons covered

under those plans, for each health service included in the schedule and 2) set the

maximum fee for each health service included in the schedule at 110 percent of the

sum of that average payment and that average copayment, coinsurance, and

deductible payment.

The bill also requires DWD to adjust those maximum fees annually by the

change in the consumer price index for medical care services and, no less often than

every two years, to redetermine the average payment made by group health plans

for the services included in the schedule and revise those maximum fees based on

that redetermined average.

The bill provides, however, that DWD may not implement the initial fee

schedule or a revised fee schedule unless the schedule or revised schedule is

approved by the Council on Worker's Compensation.

Indexing of permanent total disability benefits

Under current law, subject to certain exceptions, the amount of an injured

employee's worker's compensation benefits is determined in accordance with the law

that is in effect as of the date of injury, regardless of the length of time that has

elapsed since that date. For permanent total disability benefits, the amount of