A person, a trust, a multiple employer trust, a multiple employer welfare association, an employee benefit plan administrator or a labor organization that purchases health benefits, which provides health care benefits or services for more than 500 of its full-time equivalent employees, or members in the case of a labor organization, either through an insurer or by means of a self-funded program of benefits.
An insurer that writes accident and health insurance and is among the 20 leading insurers for either group or individual accident and health insurance, as specified in the market shares table of the most recent annual Wisconsin insurance report of the state commissioner of insurance. "Major purchaser, payer or provider of health care services" does not include an insurer that writes only disability income insurance.
A trust, a multiple employer trust, a multiple employer welfare association or an employee benefit plan administrator, including an insurer, that administers health benefits for more than 29,000 individuals.
A person that provides health care services and has 100 or more full-time equivalent employees.
(2) Eligible contractors.
If the department designates a contractor for the provision of data processing services for this chapter, including the collection, analysis and dissemination of health care information, the contractor may not be one of the following types of public or private organizations:
A major purchaser, payer or provider of health care services in this state.
A subsidiary or affiliate of an organization in par. (a)
in which a controlling interest is held and may be exercised by that organization either independently or in concert with any other organization in par. (a)
The department may grant the contractor authority to examine confidential materials and perform other specified functions. The contractor shall comply with all confidentiality requirements established under this chapter. The release of confidential information by the contractor without the department's written consent shall constitute grounds for the department to terminate the contract and subjects the contractor to all pertinent penalties and liabilities described in this chapter.
DHS 120.06 History
Cr. Register, December, 2000, No. 540
, eff. 1-1-01.
The department shall conduct throughout the state a series of training sessions for data submitters to explain its policies and procedures and to provide assistance in implementing the requirements of ch. 153, Stats.
, and this chapter.
(2) Data submission training associated with ss. DHS 120.12 (5), (5m) and (6), 120.13 and 120.14 (1). DHS 120.07(2)(a)(a)
The department shall sponsor data submission training each time the department establishes a major change in the data submission process.
Each data submitting entity shall authorize appropriate staff to attend the department's data submission training.
If a data submitting entity replaces its department-trained data submission designee, the data submitting entity shall either transfer the knowledge required to submit data to another designee or make arrangements with the department for the replacement designee to obtain department training.
Reporting status changes required.
A facility shall report to the department any of the following within 45 days after the event occurs:
A change in the identity of the chief executive officer or chief administrative officer of the facility.
A change in the beginning and ending dates of the facility's fiscal year.
DHS 120.08 Note
Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.
DHS 120.08 History
Cr. Register, December, 2000, No. 540
, eff. 1-1-01.
Notice of hospital rate increases or charges in excess of rates. DHS 120.09(1)(a)
"Annualized percentage" means an estimate of the percentage increase in a hospital's gross revenue due to a price increase in charges for patient services for the 12-month period beginning with the effective date of the price increase.
"Change in the consumer price index" means the percentage difference between the consumer price index, as defined in s. 16.004 (8) (e) 1.
, Stats., for the 12-month period ending on December 31 of the preceding year and the consumer price index for the 12-month period ending on December 31 of the year prior to the preceding year.
"Charge element" means any service, supply or combination of services or supplies that is specified in the categories for payment under the charge revenue code of the uniform patient billing form.
"Class 1 notice" means, in accordance with s. 985.07 (1)
, Stats., the publication of a notice at least once in a newspaper likely to give notice to interested persons in the area where the hospital is located.
"Room and board" means the charges associated with all services provided to the patient in a private or semi-private room.
(2) Notice required.
No sooner than 45 calendar days and no later than 30 calendar days before a hospital implements a reportable price increase, it shall publish a class 1 notice of the proposed price increase as provided in this section.
Each notice under sub. (2)
shall include a boldface heading printed in capital letters of at least 18-point type. The text of the notice shall be printed in at least 10-point type. Any numbers printed in the notice shall be expressed as numerals.
Notice of price increase.
A notice under sub. (2)
shall include, at a minimum, all of the following in the following order:
A heading entitled, "NOTICE OF PROPOSED HOSPITAL PRICE INCREASE FOR (name of hospital)."
The total anticipated amount of the price increase, expressed as an annualized percentage.
The effective date of the hospital's last reportable price increase and the amount of that increase, expressed as an annualized percentage.
The effective date of any other reported price increases within one year prior to the increase in subd. 6.
and the amount of each increase, expressed as an annualized percentage.
The name of each charge element listed in table DHS 120.09 for which the hospital proposes to increase the price. A hospital may, but need not, include any charge element for which no price increase is proposed. For each charge element listed, the hospital shall include all of the following information, formatted as follows:
Table DHS 120.09
HOSPITAL CHARGE ELEMENTS
ROOM AND BOARD – PRIVATE
ROOM AND BOARD – SEMIPRIVATE TWO BED
Neonatal intensive care unit
Post-intensive care unit