609.34 Clinical decision-making; medical director.
(1) A defined network plan that is not a preferred provider plan shall appoint a physician as medical director. The medical director shall be responsible for clinical protocols, quality assurance activities, and utilization management policies of the plan.
(2) A preferred provider plan may contract for services related to clinical protocols and utilization management. A preferred provider plan or its designee is required to appoint a medical director only to the extent that the preferred provider plan or its designee assumes direct responsibility for clinical protocols and utilization management policies of the plan. The medical director, who shall be a physician, shall be responsible for such protocols and policies of the plan.
History: 1997 a. 237; 2001 a. 16.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 609 - Defined network plans.
609.001 - Joint ventures; legislative findings.
609.03 - Indication of operations.
609.05 - Primary provider and referrals.
609.10 - Standard plan and point-of-service option plan required.
609.17 - Reports of disciplinary action.
609.20 - Rules for preferred provider and defined network plans.
609.205 - Public health emergency for COVID-19.
609.30 - Provider disclosures.
609.34 - Clinical decision-making; medical director.
609.35 - Applicability of requirements to preferred provider plans.
609.36 - Data systems and confidentiality.
609.65 - Coverage for court-ordered services for the mentally ill.
609.655 - Coverage of certain services provided to dependent students.
609.70 - Chiropractic coverage.
609.71 - Disclosure of payments.
609.715 - Coverage of alcoholism and other diseases.
609.717 - Mental health services provided by a recovery charter school.
609.75 - Adopted children coverage.
609.755 - Coverage of dependents.
609.76 - Coverage of student on medical leave.
609.77 - Coverage of breast reconstruction.
609.78 - Coverage of treatment for the correction of temporomandibular disorders.
609.79 - Coverage of hospital and ambulatory surgery center charges and anesthetics for dental care.
609.80 - Coverage of mammograms.
609.805 - Coverage of contraceptives.
609.81 - Coverage related to HIV infection.
609.82 - Coverage without prior authorization for emergency medical condition treatment.
609.83 - Coverage of drugs and devices.
609.837 - Copayment equality for oral and injected chemotherapy.
609.84 - Experimental treatment.
609.846 - Discrimination based on COVID-19 prohibited.
609.85 - Coverage of lead screening.
609.87 - Coverage of treatment for autism spectrum disorders.
609.875 - Coverage of colorectal cancer screening.
609.88 - Coverage of immunizations.
609.885 - Coverage of COVID-19 testing.
609.89 - Written reason for coverage denial.
609.90 - Restrictions related to domestic abuse.
609.91 - Restrictions on recovering health care costs.
609.92 - Hospitals, individual practice associations and providers of physician services.
609.925 - Election to be subject to restrictions.
609.93 - Scope of election by an individual practice association or clinic.
609.935 - Notices of election and termination.
609.94 - Summary of restrictions.
609.95 - Minimum covered liabilities.
609.96 - Initial capital and surplus requirements.