2003 - 2004 LEGISLATURE
February 23, 2004 - Introduced by Representatives Miller, Underheim, Zepnick,
M. Lehman, Musser, Turner, J. Lehman, Pope-Roberts, Taylor
and Shilling,
cosponsored by Senators Robson and Roessler. Referred to Committee on
Aging and Long-Term Care.
AB895,1,2 1An Act to create 146.385 of the statutes; relating to: health care provider
2service rates and insurer health care services reimbursement rates.
Analysis by the Legislative Reference Bureau
This bill requires the Department of Health and Family Services (DHFS)
annually by April 1 to make available, on the DHFS website and, upon request, by
mail, the current Medical Assistance (MA) fee schedule for services of health care
providers (as defined in the bill). The bill requires health care providers, annually
by April 15, to provide to DHFS a statement of the providers' rates for health care
services for the following May 1 to April 30. Health care providers must also inform
DHFS, during this period, of any increase in any of their rates over the amounts
provided to DHFS. The rates must be stated in a form, as determined by DHFS, that
may include statement as a percentage of the MA fee schedule. In addition, health
care providers, annually beginning on May 1, must post their rates on an Internet
website, if the health care provider has such a website, and take reasonable steps to
ensure that their health care services consumers are aware that rate information is
available and are informed about how to obtain the information. Any increase in a
health care provider's rates is chargeable only after the health care provider has
notified DHFS and, if the health care provider has a website, has posted information
on the website about the rate increase.
The bill requires insurers, annually by April 15, to provide to DHFS and to the
insurers' insureds a statement of the insurers' rates of reimbursement for health
care provider services for the following May 1 to April 30, stated as a percentage of
the MA fee schedule. Insurers must also inform DHFS, during this period, of any
increase in any of their rates over the amounts provided to DHFS.

DHFS may make available, on the DHFS website and, upon request, by mail,
the health care provider rate and insurer reimbursement rate information, including
increases, provided to DHFS. DHFS is also authorized to contract for the receipt and
posting of this information and the current MA fee schedule for health care provider
services, in accordance with DHFS request-for-proposal procedures.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB895, s. 1 1Section 1. 146.385 of the statutes is created to read:
AB895,2,3 2146.385 Health care provider service rate charges; limitations. (1) In
3this section:
AB895,2,54 (a) "Health care provider" means any of the following that receives income from
5the provision of health care or mental health services, items, or supplies in this state:
AB895,2,86 1. An individual who is licensed, registered, permitted, or certified by the
7department of health and family services or by the department of regulation and
8licensing to provide health care or mental health services, items, or supplies.
AB895,2,109 2. A partnership, corporation, or limited liability company of individuals
10specified in subd. 1.
AB895,2,1211 3. A facility or agency that provides health care or mental health services,
12items, or supplies.
AB895,2,1513 (b) "Insurer" means an insurer that is authorized to do business in this state,
14in one or more lines of insurance that includes health insurance, and that offers
15health care plans, as defined in s. 628.36 (2) (a) 1., covering individuals in this state.
AB895,3,2 16(2) (a) By April 1 annually, the department shall make available on the
17department's website, in a form that is downloadable, and, upon request, by mail, the

1current Medical Assistance fee schedule for health care services of health care
2providers.
AB895,3,43 (b) The department may make available on the department's website, in a form
4that is downloadable, and, upon request, by mail, all of the following:
AB895,3,75 1. The current insurer rates of health care providers provided to the
6department under sub. (3) (a), including any rate increases about which the
7department is informed under sub. (3 (a).
AB895,3,108 2. The current rates of reimbursement for health care services of health care
9providers provided to the department under sub. (5), including any rate increases
10about which the department is informed under sub. (5).
AB895,3,1311 (c) The department may contract for the receipt of information under sub. (3)
12(a) or (5) and for the posting of the information under par. (a) or (b), in accordance
13with the department's request-for-proposal procedures.
AB895,3,22 14(3) (a) By April 15 annually, a health care provider shall provide to the
15department, on a form provided by the department, a statement of the provider's
16rates for health care services for the period from the following May 1 to April 30. If
17during this period the health care provider increases any of the rates from the
18amount stated, the health care provider shall so inform the department, on a form
19provided by the department. The rates shall be stated in a form determined by the
20department that may include statement as a percentage of the Medical Assistance
21fee schedule for services of providers, as specified by the department under sub. (2)
22(a).
AB895,3,2523 (b) Beginning on May 1 annually, a health care provider shall, with respect to
24the provider's rates for the period from that date to April 30 of the following year, do
25all of the following:
AB895,4,2
11. If the health care provider has an Internet website, post the rates, including
2any rate increases, on the website, in a form that is downloadable.
AB895,4,63 2. Take reasonable steps to ensure that health care consumers of services of the
4health care provider are aware that information on the provider's rates for health
5care services is available and are informed about the means by which the rate
6information may be obtained.
AB895,4,10 7(4) Any increase in a rate for the health care service of a health care provider
8is chargeable only after the health care provider has, under sub. (3) (a), informed the
9department of the increase and has, if applicable, posted the rate increase under sub.
10(3) (b) 1.
AB895,4,19 11(5) By April 15 annually, an insurer shall provide to the department, on a form
12provided by the department, and to the insurer's insureds a statement of the
13insurer's rates of reimbursement for health care services of health care providers for
14the period from the following May 1 to April 30. If during this period the insurer
15increases any of the rates of reimbursement from the amount stated, the insurer
16shall so inform the department, on a form provided by the department. The rates of
17reimbursement shall be stated as a percentage of the Medical Assistance fee
18schedule for health care services of health care providers, as specified by the
19department under sub. (2) (a).
AB895,4,2020 (End)
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