AB925,14,1816 (a) The need to reduce the rate of hospital cost increases while preserving the
17quality of health care in all parts of the state and taking into account the financial
18viability of economically and efficiently operated hospitals.
AB925,14,2319 (b) Comparisons with prudently administered hospitals of similar size or
20providing similar services that offer quality health care with sufficient staff. In
21classifying hospitals according to size and services, the commission shall consider
22volume, intensity, and educational programs and special services provided by
23hospitals.
AB925,14,2524 (c) A variety of cost-related trend factors based on nationally or regionally
25recognized economic models.
AB925,15,1
1(d) Special circumstances of rural hospitals and teaching hospitals.
AB925,15,22 (e) Past budget and rate experiences of the hospital.
AB925,15,43 (f) Findings of the utilization review program under s. 150.66 (3) concerning
4the hospital that submits the rate request.
AB925,15,6 5(2) After reviewing a hospital's proposed financial requirements, the
6commission may disallow any of the following:
AB925,15,87 (a) Costs associated with medical services that a utilization review program
8under s. 150.66 determines are medically unnecessary or inappropriate.
AB925,15,149 (b) 1. Except as provided in subd. 2., 40% of the amount by which patient
10revenue generated by the hospital during its previous fiscal year exceeds 104% of the
11hospital's budgeted patient revenue for that year, if the hospital's annual gross
12patient revenue, as adjusted under s. 150.68, is less than $5,000,000, or exceeds
13102% of the hospital's budgeted patient revenue for that year, if the hospital's annual
14gross patient revenue, as adjusted under s. 150.68, equals or exceeds $5,000,000.
AB925,15,1715 2. The commission shall promulgate rules to specify a procedure under which
16hospitals whose variable costs exceed 65% are subject to a lesser disallowance under
17subd. 1.
AB925,15,1918 (c) Rate overcharges of the hospital that occurred in a prior year and for which
19payers have not been reimbursed.
AB925,15,2320 (d) The amount by which incremental expenses that are associated with the
21cost of a project that must be approved under s. 150.71 (1) exceed 105% of the
22expenses projected in the hospital's application for approval of the project. This
23paragraph does not apply if any of the following applies:
AB925,15,2524 1. The hospital demonstrates to the satisfaction of the commission that the
25excess was due to conditions beyond its control.
AB925,16,1
12. The excess occurs more than 3 years after completion of the project.
AB925,16,22 (e) Costs that the commission determines are unreasonable.
AB925,16,93 (f) Excessive wages. In determining whether wages are excessive under this
4paragraph, the commission shall consider the wage levels of hospitals located in a
5relevant geographic area surrounding the hospital that submitted the rate request
6as well as wage levels of hospitals that are similar in size or that provide similar
7services. In addition, the commission shall consider the hospital's ability to attract
8adequate staff and the wage trends in nonregulated, related sectors of the state
9economy.
AB925,16,1010 (g) Amounts paid for services regulated under s. 111.18 (2) (a) 1.
AB925,16,16 11(3) (a) After reviewing the hospital's financial requirements and rate request,
12the commission staff shall suggest to the commission any disallowances authorized
13under sub. (2) and shall submit a rate recommendation to the hospital and
14commission. If the rate recommended by the commission staff differs from the rate
15request submitted by the hospital, the commission staff shall provide an explanation
16for the difference.
AB925,16,2217 (b) 1. Except as provided in subd. 2., the commission staff shall submit its
18recommendations under par. (a) no later than 60 days after the date that review
19commences under s. 150.62 (1), even if the commission staff determines that the data
20provided by the hospital for a scheduled review are incomplete. The commission staff
21may, however, recommend a disallowance or an alternate rate, including no rate
22increase, on the grounds of insufficient data.
AB925,16,2523 2. a. The commission staff may extend the deadline specified in subd. 1. by 15
24days if it determines that the rate request submitted involves particularly complex
25issues of fact.
AB925,17,2
1b. The deadline specified in subd. 1. may be extended with the consent of the
2hospital and the commission staff.
AB925,17,11 3150.635 Review of rate recommendations. (1) A hospital that disputes
4any part of a recommendation of the commission staff under s. 150.63 shall, no later
5than 10 days after the recommendations are submitted under s. 150.63 (3), request
6a settlement conference with the commission staff for the purpose of resolving the
7differences in the hospital's rate request and the commission staff's
8recommendation. The chairperson of the commission, or a commissioner designated
9by the chairperson, shall preside over the settlement conference. No later than 20
10days after the hospital requests a settlement conference, the settlement conference
11shall be completed.
AB925,17,18 12(2) No later than 10 days after completion of the settlement conference under
13sub. (1), the hospital may request a hearing before the commission under sub. (3).
14Upon receipt of a request, the commission shall grant a hearing to the hospital. The
15hospital may present testimony based on any standard for decision making specified
16in s. 150.63 (1). All questions of fact shall be determined without ascribing greater
17weight to evidence presented by commission staff than to evidence presented by any
18other party solely due to its presentation by the staff.
AB925,17,24 19(3) (a) Informal hearings shall be conducted before at least 2 commissioners.
20Sworn testimony is required only if the presiding commissioners so specify. The
21commissioners may establish time limits for cross-examination of witnesses and
22rebuttal arguments and may limit the number of persons who may appear at the
23hearing. Rules of evidence, except the rule that evidence be relevant to the issues
24presented, do not apply to informal hearings.
AB925,18,8
1(b) A hospital that requests an informal hearing shall present the reasons
2supporting its proposed rate increase and financial requirements. Commission staff
3shall respond by explaining the alternate recommendations. Within the time limits
4established under par. (a), the hospital, parties to the review, and commission staff
5may cross-examine witnesses and rebut arguments presented. The hospital, parties
6to the review, and the commission staff may employ experts to present their position.
7The presiding commissioners may impose an overall time limit on the length of the
8hearing.
AB925,18,109 (c) The commission may conduct a class 1 contested case proceeding under ch.
10227 in place of an informal hearing under pars. (a) and (b).
AB925,18,15 11(4) The commission shall keep a complete written record of all hearings and
12investigations conducted under sub. (3). The commission shall provide a
13transcribed, certified copy of all or any part of the record at the request of any person
14who is a party to the hearing or investigation. The commission may charge a fee to
15cover the costs of providing copies of the record.
AB925,18,20 16(5) (a) Any person may request a hearing under s. 227.44, regardless of whether
17any other hearing is authorized by law or is authorized at the discretion of the
18commission or whether any other proceeding is authorized by rule of the commission,
19except that no person may receive more than one contested case hearing concerning
20a particular act or failure to act by the commission.
AB925,18,2221 (b) Notwithstanding par. (a), no person may request a hearing under s. 227.44
22pertaining to the subject matter of a hearing under sub. (3).
AB925,18,2423 (c) The right to a hearing under s. 227.44, as specified in this subsection, applies
24only to subject matter pertaining to this subchapter.
AB925,19,13
1150.64 Commission orders. (1) (a) The commission shall determine
2allowable financial requirements and disallowances under s. 150.63 (1) and (2) for
3the hospital. From the difference between these amounts, the commission shall
4subtract the hospital's estimated relief payments and medical assistance payments
5under ch. 49 and medicare payments under 42 USC 1395 to 1395ccc, unless the
6commission determines that the hospital's estimates are incorrect, in which case the
7commission shall subtract its own estimates of the hospital's relief, medical
8assistance, and medicare payments. The commission shall, by order, establish
9maximum rates that allow the hospital to generate revenue sufficient to provide this
10remainder. The commission shall, by rule, establish acceptable methods for
11hospitals to use in estimating payments by relief, medical assistance, and medicare
12under this paragraph. Each hospital shall choose one of the methods and use it
13consistently unless the commission authorizes the hospital to change the method.
AB925,19,2214 (b) Unless the hospital requests a hearing under s. 150.635 (2), the commission
15shall issue an order under par. (a) no later than 15 days after the commission staff
16submits its recommendations under s. 150.63 (3) (b) or, if the hospital requests a
17settlement conference under s. 150.635 (1), no later than 15 days after the
18commission determines that the hospital will not seek a hearing following the
19conclusion of the settlement conference. If the hospital disputes only part of the
20recommendations of the commission staff, the commission may establish maximum
21rates under par. (a) concerning the recommendations that the hospital agrees with
22prior to the conclusion of the hearing under s. 150.635 (3).
AB925,20,223 (c) If the commission conducts a hearing under s. 150.635 (3) (c), the
24commission shall establish by order maximum rates for the hospital's year under
25review at the conclusion of the hearing. If the commission conducts an informal

1hearing under s. 150.635 (3) (a) and (b), the commission shall issue its order no later
2than 50 days after the date on which the hospital requested the hearing.
AB925,20,63 (d) Each order that the commission issues concerning financial requirements
4and rates shall state findings of fact and the reasons supporting the order. If the
5commission denies any part of a rate request, the order shall also specify any
6financial requirements that were disallowed.
AB925,20,257 (e) A hospital may apply an increase in its rates selectively, if the aggregate
8increase in its rates does not exceed the amount authorized by the commission. No
9hospital may change a method of applying its rate increase that has received the
10commission's approval without submitting the changes to the commission for its
11approval under this paragraph. Prior to increasing rates or changing a method of
12applying a rate increase, the hospital shall explain to the commission the method of
13applying the rate increase. If, after 5 working days, as defined in s. 227.01 (14), the
14commission does not notify the hospital that it has not approved the hospital's rate
15increase, the hospital may increase its rates as proposed and the commission may
16not challenge the method prior to the date of a succeeding review under s. 150.62 (1)
17except as provided in sub. (4) (a). If the commission does not approve the hospital's
18method of applying the rate increase, the commission shall recommend an alternate
19method. If the hospital does not modify its method of applying the rate increase, the
20commission may challenge the method in circuit court. If the hospital's method
21generates an aggregate increase in the hospital's rates that is inconsistent with the
22amount authorized by the commission, the hospital is subject to a forfeiture equal
23to 50% of the amount overcharged and shall comply with the alternate method
24recommended by the commission or with any other method ordered by the court that
25the court finds more consistent with the commission's order.
AB925,21,5
1(f) A hospital that receives approval of a rate increase that may commence only
2between the 2nd and 7th months of its fiscal year may make an adjustment to the
3rate increase for that fiscal year only to generate an amount of revenue equal to the
4amount that would have been generated if the hospital could have commenced the
5rate increase beginning with the first month of its fiscal year.
AB925,21,96 (g) Except as provided in s. 150.65, if a party seeks judicial review of a
7commission order, the affected hospital may continue to bill payers at the rates
8established by the commission. No hospital that bills payers under this paragraph
9adversely affects its right to contest the rates established by the commission.
AB925,21,12 10(2) Notwithstanding sub. (1) and ss. 150.62, 150.63, and 150.635, at the request
11of a hospital the commission may waive the procedures for review of a rate request
12and issue an interim order if the commission determines that an emergency exists.
AB925,21,17 13(3) The commission may promulgate rules to establish a system that defines
14rates as aggregate charges based on case mix measurements if the commission
15submits its proposed system to the joint committee on finance for review and if the
16committee approves the system. The system shall be consistent with the standards
17specified under s. 150.63 (1).
AB925,21,18 18(4) The commission may not do any of the following:
AB925,21,2219 (a) Reduce rates established prior to the date the commission schedules a
20review under s. 150.62 (1), unless the hospital misstated a material fact at a prior
21rate-setting proceeding. Projections on the volume of hospital services utilized do
22not constitute material facts under this paragraph.
AB925,21,2423 (b) Reduce rates established in a previous review under s. 150.62 (1) unless any
24of the following apply:
AB925,22,2
11. The hospital implements an unauthorized rate increase in its approved
2rates, unless the increase is trivial.
AB925,22,43 2. The hospital uses moneys that it has prospectively accumulated for an
4authorized capital project for purposes other than the authorized project.
AB925,22,65 3. The hospital's actual total revenue for its fiscal year exceeds its actual total
6financial requirements by more than 10%.
AB925,22,87 (c) Interfere directly in the personal or decision-making relationships between
8a patient and the patient's physician, except as provided in s. 150.66.
AB925,22,109 (d) Control directly the volume or intensity of hospital utilization, except as
10provided in s. 150.66.
AB925,22,1411 (e) Restrict the freedom of patients to receive care at a hospital consistent with
12their religious preferences or request a hospital that is affiliated with a religious
13group to act in a manner contrary to the mission and philosophy of the religious
14group.
AB925,22,1715 (f) Restrict directly the freedom of a hospital to exercise management decisions
16in complying with the rates established by the commission, unless the hospital
17agrees to a condition attached to the establishment of the rates.
AB925,22,1918 (g) Require the submission of unrelated financial data from religious groups
19affiliated with a hospital.
AB925,22,22 20150.65 Injunctions of commission orders. No injunction may be issued to
21suspend or stay enforcement of an order of the commission unless all of the following
22occur:
AB925,23,2 23(1) All parties to the review under s. 150.62 (1) (b) from which the commission's
24order was issued are notified of the petition seeking an injunction, are given an

1opportunity to appear at a hearing prior to the issuance of the injunction, and are
2made parties to the proceeding in circuit court.
AB925,23,7 3(2) If the party seeking the injunction is not the hospital that was a party to
4the proceeding from which the commission's order was issued, the party enters into
5an undertaking by at least 2 sureties at a level that the circuit court finds sufficient
6to guarantee the payment of all damages that the hospital may sustain by delaying
7the effect of the commission's order.
AB925,23,11 8150.655 Expedited review, expedited cases and exempt hospitals. (1)
9Notwithstanding s. 150.635, the commission may promulgate rules under which
10hospitals meeting specific criteria receive expedited review of rate requests under
11this subchapter.
AB925,23,15 12(2) (a) Notwithstanding s. 150.62, a hospital that has gross annual patient
13revenue of less than $10,000,000, adjusted as provided in s. 150.67, for the hospital's
14last fiscal year is eligible to receive automatic approval of its rate request if all of the
15following criteria are met:
AB925,23,1716 1. The commission has conducted a complete review of the hospital's rates and
17has set the hospital's rates in a preceding year.
AB925,23,2018 2. The hospital requests a rate increase that is less than an inflationary index
19consisting of the average of the consumer price index and the hospital market basket
20index.
AB925,23,2521 (b) A hospital that is eligible for automatic approval of its rate-increase request
22under this subsection shall, prior to implementing the increase, publish a class 1
23notice under ch. 985, in one or more newspapers likely to give notice to its patients
24and payers, a list of the price adjustments it is making to 100 of its charge elements
25as specified by the commission.
AB925,24,2
1(c) The commission may, by rule, extend automatic approval status under this
2subsection to other hospitals.
AB925,24,8 3(3) Notwithstanding s. 150.62 (1), the commission may grant hospitals whose
4gross annual patient revenue is less than $10,000,000, adjusted as provided in s.
5150.67, a rate increase that takes effect over a 2-year period with an automatic
6escalation clause taking effect at the end of the first year. A hospital that receives
7a 2-year rate increase is not required to request a rate increase at the end of the first
8year.
AB925,24,10 9150.66 Utilization review program. (1) The commission shall approve and
10evaluate all-patient utilization review programs for each hospital.
AB925,24,16 11(2) The commission shall contract with one or more independent utilization
12review programs to develop review standards, and the commission may contract
13with any person to monitor implementation of these programs by hospitals and to
14perform peer review functions for hospitals that fail to meet the performance
15standards adopted by the commission. The commission may not contract with state
16agencies, other than the University of Wisconsin System, under this subsection.
AB925,24,19 17(3) Each utilization review program the commission approves shall include a
18general summary of utilization within the hospital. The programs shall meet
19minimum standards established by the commission and do all of the following:
AB925,24,2120 (a) Evaluate the medical necessity or appropriateness of care relative to
21admissions, lengths of stay, and ancillary services.
AB925,24,2422 (b) Report to the commission, in conjunction with each hospital's submission
23of proposed financial requirements, any unnecessary or inappropriate medical care
24utilization and associated costs.
AB925,25,6
1(4) No hospital or physician may be paid for a service that a utilization review
2program under this section determines is medically unnecessary or inappropriate.
3If the hospital or physician has already been paid, the hospital or physician shall
4reimburse the payer within 30 days. The commission may commence an action to
5enforce this subsection in the circuit court for the county in which the hospital is
6located.
AB925,25,10 7150.665 Enforcement and penalties. (1) (a) Until the commission
8establishes different rates under this subchapter, no hospital may charge any payer
9an amount exceeding the rates in effect as of the effective date of this paragraph ....
10[revisor inserts date].
AB925,25,1811 (b) The attorney general may petition a court to enforce compliance with par.
12(a) and s. 150.612 (2) if the attorney general first notifies the hospital and provides
13the hospital a reasonable time to correct the violation. The commission may petition
14a court to enforce compliance with any statutory requirement or with any rule or
15order of the commission if it first notifies the hospital and provides the hospital a
16reasonable time to correct the violation. The commission shall commence any action
17under this paragraph in the circuit court for the county in which the hospital is
18located.
AB925,25,2119 (c) A hospital that intentionally violates s. 150.612 (2) may be subject to a
20forfeiture of up to $5,000. Each week that a hospital intentionally violates s. 150.612
21(2) is a separate violation.
AB925,25,24 22(2) Any person who intentionally violates an order of a hearing examiner
23issued under s. 227.46 (7) to protect trade secrets in a contested case brought under
24this subchapter shall be subject to a forfeiture of $5,000.
AB925,26,4
1150.67 Annual adjustments. The commission shall adjust annually the
2limits on gross annual patient revenue in ss. 150.63 (2) (b) and 150.65 (2) (a) and (3)
3to reflect annual changes in the average of the consumer price index and the hospital
4market basket index.
AB925,26,13 5150.68 Assessments. Beginning July 1, 2002, the commission shall, within
690 days after the beginning of each fiscal year, estimate the total amount of revenue
7required for administration by the commission of this subchapter during that fiscal
8year and assess that estimated total amount to hospitals in proportion to each
9hospital's respective gross private-pay patient revenues during the hospital's most
10recently concluded fiscal year. The commission shall promulgate rules to establish
11the rate of the assessments under this section. Each hospital shall pay the
12assessment by December 1 of the year in which the assessment is made. The
13assessments shall be credited to the appropriation account under s. 20.438 (1) (g).
AB925,26,17 14150.71 Approval required. (1) Beginning on the effective date of this
15subsection .... [revisor inserts date], no person may do any of the following unless the
16person applies for and receives the department's approval as specified under this
17subchapter:
AB925,26,2118 (a) Except as provided in s. 150.713 and subject to sub. (2), by or on behalf of
19a hospital, obligate for a capital expenditure more than $1,000,0000, unless the
20capital expenditure is to convert a hospital to a new use or to renovate part or all of
21a hospital.
AB925,26,2422 (b) Except as provided in s. 150.713 and subject to sub. (2), by or on behalf of
23a hospital, obligate for a capital expenditure more than $1,500,000 to convert a
24hospital to a new use or to renovate part or all of a hospital.
AB925,27,3
1(c) Implement an organ transplant program, a burn center, a neonatal
2intensive care program, a cardiac program, or air transport services or add
3psychiatric or chemical dependency beds.
AB925,27,44 (d) Purchase or otherwise acquire a hospital.
AB925,27,55 (e) Construct or operate an ambulatory surgery center or a home health agency.
AB925,27,12 6(2) The cost of studies, surveys, plans, and other activities essential to a
7proposed capital expenditure specified under sub. (1) (a) or (b) shall be included in
8determining the value of the capital expenditure. A capital expenditure includes any
9donation of equipment or facilities that, if acquired directly, would be subject to
10review under this subchapter and any transfer of equipment or facilities for less than
11fair market value that, if transferred at fair market value, would be subject to review
12under this subchapter.
AB925,27,17 13150.713 Exceptions. (1) A person who has, prior to the effective date of this
14subsection .... [revisor inserts date], entered into a legally enforceable contract,
15promise, or agreement to do any of the activities specified in s. 150.71 (1), is not
16required to apply for or receive the department's approval under this subchapter to
17do any of the activities agreed to in the contract, promise, or agreement.
AB925,27,23 18(2) A person may obligate for a capital expenditure, by or on behalf of a hospital,
19without first obtaining the department's approval under this subchapter, not more
20than 20% of the hospital's gross annual patient revenue for its last fiscal year if the
21expenditure is for heating, air conditioning, ventilation, electrical systems, energy
22conservation, telecommunications, computer systems, or nonsurgical outpatient
23services and is not a component of another project specified in s. 150.71 (1).
AB925,28,2 24(3) A person who receives an exemption from the department under s. 150.715
25is not required to apply for or receive the department's approval to obligate a capital

1expenditure on behalf of a hospital or to make a substantial change in a health
2service as specified in the exemption.
AB925,28,3 3150.715 Innovative medical technology exemption. (1) In this section:
AB925,28,84 (a) "Clinical trial" means clinical research conducted under approved protocols
5in compliance with federal requirements that are applicable to investigations
6involving human subjects, including the requirements for an informed consent
7advising the patient clearly of the risks associated with participating in the clinical
8research.
AB925,28,119 (b) "Innovative medical technology" means equipment or procedures that are
10potentially useful for diagnostic or therapeutic purposes and that introduce new
11technology in the diagnosis and treatment of an illness.
AB925,28,15 12(2) The department may grant any person who intends to undertake a capital
13expenditure of more than $500,000, or who intends to make a substantial change in
14a health service, an exemption from the requirements of s. 150.71 if the person meets
15all of the following requirements:
AB925,28,1916 (a) The capital expenditure or substantial change in a health service is for the
17research, development, and evaluation of innovative medical technology, the
18development of clinical applications of the technology, or the research, development,
19and evaluation of a major enhancement to existing medical technology.
AB925,28,2020 (b) The person submits an application for an exemption to the department.
AB925,28,2421 (c) The person demonstrates that, prior to applying for an exemption,
22preliminary animal studies or preliminary clinical investigations establish that the
23innovative medical technology or major enhancement to existing medical technology
24has a reasonable probability of advancing clinical diagnosis or therapy.
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