153.05 (5) (a) Unless sub. (13) applies, subject to s. 153.455, the department may require health care providers other than hospitals and ambulatory surgery centers to submit to the department health care information specified by rule under s. 153.75 (1) (n) for the preparation of reports, plans, and recommendations in the form specified by the department by rule.
228,24
Section
24. 153.05 (5) (c) of the statutes is created to read:
153.05 (5) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request insurers and administrators to submit to the data organization health care claims information for the preparation of reports, plans, and recommendations in the form specified by the data organization, including in standard electronic format. If s. 153.455 (4) applies, the department may request submission of the health care claims information from insurers and administrators in the form specified by the department, including in standard electronic format.
228,25
Section
25. 153.05 (6r) of the statutes is repealed.
228,26
Section
26. 153.05 (8) (a) of the statutes is amended to read:
153.05 (8) (a) Unless sub. (13) applies, subject to s. 153.455, the department shall collect, analyze and disseminate, in language that is understandable to laypersons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, as determined by rules promulgated by the department, from health care providers, other than hospitals and ambulatory surgery centers, specified by rules promulgated by the department. Data from those health care providers may be obtained through sampling techniques in lieu of collection of data on all patient encounters and data collection procedures shall minimize unnecessary duplication and administrative burdens. If the department collects from health care plans data that is specific to health care providers other than hospitals and ambulatory surgery centers, the department shall attempt to avoid collecting the same data from those health care providers.
228,27
Section
27. 153.05 (8) (c) of the statutes is created to read:
153.05 (8) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request, analyze, and publicly report, in language that is understandable to laypersons, health care claims information, as adjusted for case mix and severity, from insurers and administrators. Data from these sources may be obtained through sampling techniques in lieu of collection of data on all insureds, and data collection procedures shall minimize unnecessary duplication and administrative burdens. If s. 153.455 (4) applies, the department may request health care claims information, which may be voluntarily provided by insurers and administrators, and may perform or contract for the performance of the other duties specified for the data organization under this paragraph.
228,28
Section
28. 153.05 (9) (a) of the statutes is amended to read:
153.05 (9) (a) The Subject to s. 153.455, the department shall provide orientation and training to health care providers, other than hospitals and ambulatory surgery centers, who submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release.
228,29
Section
29. 153.05 (9) (c) of the statutes is created to read:
153.05 (9) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) shall provide orientation and training to insurers and administrators that submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.
228,30
Section
30. 153.05 (12) (a) of the statutes is amended to read:
153.05 (12) (a) The Subject to s. 153.455, the department shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the department.
228,31
Section
31. 153.05 (12) (c) of the statutes is created to read:
153.05 (12) (c) The data organization under contract under sub. (2r) shall, subject to s. 153.455 (1) to (3), to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the data organization. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.
228,32
Section
32. 153.07 of the statutes is repealed.
228,33
Section
33. 153.10 (1) of the statutes is amended to read:
153.10 (1) The Subject to s. 153.455, the department shall prepare, and submit to the governor and the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2), standard reports concerning health care providers other than hospitals and ambulatory surgery centers that the department prepares and shall collect information necessary for preparation of those reports. If s. 153.455 (4) applies, the department shall include in the reports under this subsection reports concerning any health care claims information the department collects or contracts to collect under s. 153.05.
228,34
Section
34. 153.22 (1) of the statutes is renumbered 153.22.
228,35
Section
35. 153.45 (intro.) of the statutes is created to read:
153.45 (intro.) Subject to s. 153.455:
228,36
Section
36
. 153.45 (1) (b) 9. of the statutes is amended to read:
153.45 (1) (b) 9. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center, if the independent review board department first reviews and approves the release
or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release.
228,37
Section
37. 153.45 (1) (b) 11. of the statutes is amended to read:
153.45 (1) (b) 11. Information other than patient-identifiable data, as defined in s. 153.50 (1) (b), as approved by the independent review board department.
228,38
Section
38. 153.45 (1) (c) (intro.) of the statutes is amended to read:
153.45 (1) (c) (intro.) Custom-designed reports containing portions of the data under par. (b). Of information submitted by health care providers that are not hospitals or ambulatory surgery centers, requests under this paragraph for data elements other than those available for public use data files under par. (b), including the patient's month and year of birth, require review and approval by the independent review board before the data elements may be released. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center may be released only if the independent review board department first reviews and approves the release or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release. Reports under this paragraph may include the patient's zip code only if at least one of the following applies:
228,39
Section
39. 153.45 (6) of the statutes is repealed.
228,40
Section
40. 153.455 of the statutes is created to read:
153.455 Data organization; contract contingency. (1) Except as provided in subs. (2), (3), and (4), beginning on the date, if any, that is 60 days after the contract under s. 153.05 (2r) takes effect, the department shall cease collecting, for calendar quarters that occur after that date, health care information as specified under s. HFS 120.14 (1), 2005 Wis. Adm. Code, in effect on the effective date of this subsection .... [revisor inserts date].
(2) Subsection (1) does not apply to ss. 153.21 (1) and 153.60 (1).
(3) Beginning on the date, if any, that the secretary of health and family services and the secretary of employee trust funds determine that the data organization is not in compliance with the contract under s. 153.05 (2r) with respect to the performance of the collection and public reporting of information regarding the cost, quality, and effectiveness of health care, including the development and maintenance of a centralized data repository, or determine that there is insufficient statewide participation under the requirements of the contract, the secretaries may modify or terminate the contract. If the secretaries terminate the contract, they shall recommend to the department of administration that that department use a competitive request-for-proposal process to solicit offers from other organizations for performance of the services required of the data organization under the terminated contract. If no organization responds to the request for proposals or if a successor contract cannot be achieved, sub. (4) applies.
(4) If the contract with the data organization is terminated under sub. (3) and no organization responds to the request for proposals or a successor contract cannot be achieved, the department, in its capacity as a public health authority, shall collect health care information, including as specified under s. HFS 120.14 (1), Wis. Adm. Code, in effect on the effective date of this subsection .... [revisors inserts date], and may request health care claims information, which may be voluntarily provided by insurers or administrators, under this chapter; shall analyze and disseminate, or contract for the performance of analysis and dissemination of, the health care information; and may analyze and disseminate, or may contract for the performance of analysis and dissemination of, the health care claims information.
228,41
Section
41. 153.50 (intro.) of the statutes is created to read:
153.50 (intro.) Subject to s. 153.455:
228,42
Section
42. 153.50 (1) (b) 1m. of the statutes is created to read:
153.50 (1) (b) 1m. "Patient-identifiable data" does not include calculated variables that are derived from patient-identifiable data and the dissemination of which does not permit patient identification.
228,43
Section
43. 153.50 (1) (b) 2. (intro.) of the statutes is amended to read:
153.50 (1) (b) 2. (intro.) "Patient-identifiable data", for information submitted by health care providers who are not hospitals or ambulatory surgery centers and by insurers and administrators, means all of the following data elements:
228,44
Section
44. 153.50 (3) (intro.) of the statutes is amended to read:
153.50 (3) Measures to ensure protection of patient identity. (intro.) To ensure that the identity of patients is protected when information obtained by the department or, by the entity under contract under s. 153.05 (2m) (a), or by the data organization under contract under s. 153.05 (2r) is disseminated, the department and, the entity, and the data organization shall do all of the following:
228,45
Section
45. 153.50 (3) (a) of the statutes is amended to read:
153.50 (3) (a) Aggregate any data element category containing small numbers. The department, in so doing, shall use procedures that are developed by the department and approved by the board and that follow commonly accepted statistical methodology.
228,46
Section
46. 153.50 (3) (b) (intro.) of the statutes is amended to read:
153.50 (3) (b) (intro.) Remove and destroy all of the following data elements on the uniform patient billing forms that are received by the department or by, the entity, or the data organization under the requirements of this chapter:
228,47
Section
47. 153.50 (3) (d) of the statutes is amended to read:
153.50 (3) (d) Require that a purchaser of data under this chapter sign and have notarized the data use agreement of the department or of, the entity
specified in par. (c), or the data organization, as applicable.
228,48
Section
48. 153.50 (3m) of the statutes is amended to read:
153.50 (3m) Health care provider Provider, administrator, or insurer measures to ensure patient identity protection. A health care provider that is not a hospital or ambulatory surgery center or an insurer or an administrator shall, before submitting information required by the department, or by the data organization under contract under s. 153.05 (2r), under this chapter, convert to a payer category code as specified by the department or the data organization, as applicable, any names of an insured's payer or other insured's payer.
228,49
Section
49. 153.50 (4) (a) (intro.) of the statutes is amended to read:
153.50 (4) (a) (intro.) Except as specified in par. pars. (b) and (c), under the procedures specified in sub. (5), release of patient-identifiable data may be made only to any of the following:
228,50
Section
50. 153.50 (4) (a) 1. a. of the statutes is amended to read:
153.50 (4) (a) 1. a. An agent of the department who is responsible for the patient-identifiable data in the department, in order to store the data and ensure the accuracy of the information in the database of the department or to create a calculated variable that is derived from the patient-identifiable data.
228,51
Section
51. 153.50 (4) (a) 1. b. of the statutes is amended to read:
153.50 (4) (a) 1. b. An agent of the entity under contract under s. 153.05 (2m) (a) who is responsible for the patient-identifiable data of the entity, in order to store the data and ensure the accuracy of the information in the database of the entity or to create a calculated variable that is derived from the patient-identifiable data.
228,52
Section
52. 153.50 (4) (a) 1. c. of the statutes is created to read:
153.50 (4) (a) 1. c. An agent of the data organization under contract under s. 153.05 (2r) who is responsible for the patient-identifiable data of the data organization, in order to store the data and ensure the accuracy of the information in the database of the data organization or to create a calculated variable that is derived from the patient-identifiable data.
228,53
Section
53. 153.50 (4) (a) 2. of the statutes is amended to read:
153.50 (4) (a) 2. A health care provider that is not a hospital or ambulatory surgery center or the agent of such a health care provider, to ensure the accuracy of the information in the database of the department or the data organization under contract under s. 153.05 (2r), or a health care provider that is a hospital or ambulatory surgery center or the agent of such a health care provider, to ensure the accuracy of the information in the database of the entity under contract under s. 153.05 (2m) (a).
228,54
Section
54. 153.50 (4) (a) 3. of the statutes is amended to read:
153.50 (4) (a) 3. The department or its agent, for purposes of epidemiological investigation, or, with respect to information from health care providers that are not hospitals or ambulatory surgery centers, the department or the data organization under contract under s. 153.05 (2r), to eliminate the need for duplicative databases.
228,55
Section
55. 153.50 (4) (c) of the statutes is created to read:
153.50
(4) (c) The data organization under contract under s. 153.05 (2r) may not share health care claims data collected by the data organization unless the sharing is in compliance with
42 USC 1320d-2 and
1320d-4 and
45 CFR 164.
228,56
Section
56. 153.50 (5) (a) (intro.) of the statutes is amended to read:
153.50 (5) (a) (intro.) The department or
, an entity that is under contract under s. 153.05 (2m) (a), or a data organization that is under contract under s. 153.05 (2r) may not release or provide access to patient-identifiable data to a person authorized under sub. (4) (a) unless the authorized person requests the department or, entity, or data organization, in writing, to release the patient-identifiable data. The request shall include all of the following:
228,57
Section
57. 153.50 (5) (b) (intro.) of the statutes is amended to read:
153.50 (5) (b) (intro.) Upon receipt of a request under par. (a), the department or, entity
under contract under s. 153.05 (2m) (a) , or data organization, whichever is appropriate applicable, shall, as soon as practicable, comply with the request or notify the requester, in writing, of all of the following:
228,58
Section
58. 153.50 (5) (b) 1. of the statutes is amended to read:
153.50 (5) (b) 1. That the department or
, entity, or data organization, as applicable, is denying the request in whole or in part.
228,59
Section
59. 153.60 (title) of the statutes is amended to read:
153.60 (title) Assessments to fund operations of department and board.
228,60
Section
60. 153.60 (intro.) of the statutes is created to read:
153.60 (intro.) Subject to s. 153.455:
228,61
Section
61
. 153.60 (1) of the statutes, as affected by Wisconsin Act 25, is amended to read:
153.60 (1) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures under this chapter for the department and the board for that fiscal year for data collection, database development and maintenance, generation of data files and standard reports, orientation and training provided under s. 153.05 (9) (a) and, maintaining the board, and contracting with the data organization under s. 153.05 (2r). The department shall assess the estimated total amount for that fiscal year, less the estimated total amount to be received for purposes of administration of this chapter under s. 20.435 (1) (hi) during the fiscal year and the unencumbered balance of the amount received for purposes of administration of this chapter under s. 20.435 (1) (hi) from the prior fiscal year, to health care providers, other than hospitals and ambulatory surgery centers, who are in a class of health care providers from whom the department collects data under this chapter in a manner specified by the department by rule. The department shall obtain approval from the board for the amounts of assessments for health care providers other than hospitals and ambulatory surgery centers. The department shall work together with the department of regulation and licensing to develop a mechanism for collecting assessments from health care providers other than hospitals and ambulatory surgery centers. No health care provider that is not a facility may be assessed under this subsection an amount that exceeds $75 per fiscal year. All payments of assessments shall be credited to the appropriation under s. 20.435 (1) (hg).
228,62
Section
62
. 153.60 (1) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
153.60 (1) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures under this chapter for the department and the board for that fiscal year for data collection, database development and maintenance, generation of data files and standard reports, orientation and training provided under s. 153.05 (9) (a), maintaining the board, and contracting with the data organization under s. 153.05 (2r). The department shall assess the estimated total amount for that fiscal year, less the estimated total amount to be received for purposes of administration of this chapter under s. 20.435 (1) (hi) during the fiscal year and the unencumbered balance of the amount received for purposes of administration of this chapter under s. 20.435 (1) (hi) from the prior fiscal year, to health care providers, other than hospitals and ambulatory surgery centers, who are in a class of health care providers from whom the department collects data under this chapter in a manner specified by the department by rule. The department shall work together with the department of regulation and licensing to develop a mechanism for collecting assessments from health care providers other than hospitals and ambulatory surgery centers. No health care provider that is not a facility may be assessed under this subsection an amount that exceeds $75 per fiscal year. All payments of assessments shall be credited to the appropriation under s. 20.435 (1) (hg).
153.65 (1) The Subject to s. 153.455, the department may, but is not required to, provide, upon request from a person, a data compilation or a special report based on the information collected by the department. The department shall establish user fees for the provision of these compilations or reports, payable by the requester, which shall be sufficient to fund the actual necessary and direct cost of the compilation or report. All moneys collected under this subsection shall be credited to the appropriation under s. 20.435 (1) (hi).
228,65
Section
65. 153.67 of the statutes is repealed.
228,66
Section
66
. 153.75 (1) (intro.) of the statutes is amended to read:
153.75 (1) (intro.) Following approval by the board, the The department shall promulgate the following rules:
228,67
Section
67
. 153.75 (1) (intro.) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
153.75 (1) (intro.) The department shall promulgate the following rules, of which pars. (a), (b), (f), (h), (m), (n), (o), (r), (t), and (u) shall apply only if the contract under s. 153.05 (2r) is terminated under s. 153.455 (3) and s. 153.455 (4) applies:
228,68
Section
68
. 153.75 (2) (intro.) of the statutes is amended to read:
153.75 (2) (intro.) Following approval by the board, the The department may promulgate all of the following rules:
228,69
Section
69
. 153.75 (2) (intro.) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
