153.07 Board powers and duties.
153.08 Hospital rate increases or charges in excess of rates.
153.10 Health care data reports.
153.15 Small area analysis reports.
153.20 Uncompensated health care services report.
153.25 Mortality and morbidity report.
153.30 Health care insurance report.
153.35 Report by the office.
153.40 Procedures for data verification and review.
153.50 Protection of patient confidentiality.
153.60 Assessments to fund operations of office and board.
153.65 Provision of special information; user fees.
153.01
153.01
Definitions. In this chapter:
153.01(2)
(2) "Board" means the board on health care information.
153.01(3)
(3) "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 for the uniform billing form HCFA-1450.
153.01(4m)
(4m) "Commissioner" means the commissioner of insurance of this state.
153.01(6)
(6) "Office" means the office of health care information.
153.01(7)
(7) "Patient" means a person who receives health care services from a health care provider.
153.01(8)
(8) "Payer" means a 3rd party payer, including an insurer, federal, state or local government or another who is responsible for payment of a hospital charge.
153.01(9)
(9) "Uniform patient billing form" means, for a hospital, the uniform billing form HCFA-1450 developed by the national uniform billing committee, or the equivalent electronic billing format, or, for an ambulatory surgery center or noninstitutional or outpatient health care provider, the health insurance claim form HCFA-1500 or the equivalent electronic billing format.
153.01 History
History: 1987 a. 399;
1993 a. 16,
185,
491.
153.05
153.05
Collection and dissemination of health care and related information. 153.05(1)
(1) In order to provide to hospitals, health care providers, insurers, consumers, governmental agencies and others information concerning hospital service utilization, charges, revenues, expenditures, mortality and morbidity rates and uncompensated health care services, and in order to provide information to assist in peer review for the purpose of quality assurance, the office shall collect, analyze and disseminate, in language that is understandable to lay persons, health care information obtained from the following data sources:
153.05(1)(c)
(c) Hospital reports that include all of the following:
153.05(1)(c)1.
1. Identification of charges in each hospital's most recent entire fiscal year for up to 100 charge elements, as selected by the office, and identification of the increase or decrease in charges for each of these charge elements from amounts charged during the hospital's entire fiscal year that is nearest in time to the hospital's most recent entire fiscal year.
153.05(1)(c)2.
2. The dollar amount of total gross and net revenue increases or decreases from each hospital's most recent entire fiscal year.
153.05(1)(c)3.
3. The dollar amount of gross and net revenue increases or decreases from each hospital's most recent entire fiscal year that is attributable to the sum of increases or decreases in all charge elements.
153.05(1)(d)
(d) Hospital-specific uncompensated health care services reports, plans and projections.
153.05(1)(e)
(e) Final audited financial statements of hospitals that include, for a hospital's most recent entire fiscal year, as dollar amounts, the amounts of revenue and expenditures for the hospital, in categories specified in rules promulgated by the commissioner.
153.05(2)
(2) The office shall provide copies of reports published under
ss. 153.10 to
153.35 at no charge to hospitals assessed under
s. 153.60 (1) and, if assessed, at no charge to ambulatory surgery centers assessed under
s. 153.60 (2). The office shall provide copies of the reports to any person, upon the person's request, and the board shall advise the office as to whether the copies shall be provided at no charge or at a charge not to exceed the cost of printing, copying and mailing the report to the person.
153.05(3)
(3) Upon request of the office, state agencies shall provide health care information to the office for use in preparing reports under
ss. 153.10 to
153.35.
153.05(4)(a)(a) The office, under rules promulgated by the commissioner, shall require hospitals to use, and private-pay patients and payers who are insurers to accept, uniform patient billing forms, shall require hospitals to submit to the office the information provided on the billing forms, including, for an injury, the external cause of the event, and may require payers who are insurers to use a standard set of definitions for base data reporting under a uniform patient billing form.
153.05(4)(b)
(b) The office, under rules promulgated by the commissioner, may require ambulatory surgery centers to use uniform patient billing forms and other information, and, if so requiring, shall require ambulatory surgery centers to submit to the office the information provided on the billing forms, including, for an injury, the external cause of the event, using a standard set of definitions for base data reporting.
153.05(5)(a)
(a) Shall require hospitals to submit information regarding medical malpractice, staffing levels and patient case-mix, and expenditures related to labor relations consultants, as specified by the office.
153.05(5)(b)
(b) May require hospitals to submit to the office information from sources identified under
sub. (1) (a) to
(e) that the office deems necessary for the preparation of reports, plans and recommendations under
ss. 153.10 to
153.35 and any other reports required of the office in the form specified by the office.
153.05(5)(bm)
(bm) Shall require a hospital to submit to the office information from sources identified under
sub. (1) (e) by the date that is 4 months following the close of the hospital's fiscal year unless the office grants an extension of time to file the information.
153.05(6)
(6) If the requirements of
s. 153.07 (2) are first met, the office may contract with a public or private entity that is not a major purchaser, payer or provider of health care services in this state for the provision of data processing services for the collection, analysis and dissemination of health care information under
sub. (1) or the department of health and family services shall provide the services under
s. 153.07 (2).
153.05(6m)
(6m) If the requirements of
s. 153.07 (2) are first met, the office may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employes or the commissioner shall provide the services under
s. 153.07 (2). The office shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under
s. 20.145 (8) (kx).
153.05(7)
(7) The office may require each insurer authorized to write disability insurance to submit to the office information obtained on uniform patient billing forms regarding reported claims for health care services which insureds who are residents of this state obtain in another state.
153.05(8)
(8) Beginning April 1, 1992, the office shall collect, analyze and disseminate, in language that is understandable to lay persons, health care information under the provisions of this chapter, as determined by rules promulgated by the commissioner, from health care providers, as defined by rules promulgated by the commissioner, other than hospitals and ambulatory surgery centers. Data from physicians shall 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.
153.05(9)
(9) The office shall provide orientation and training to physicians, hospital personnel and other health care providers to explain the process of data collection and analysis and the procedures for data verification, interpretation and release.
153.05(11)
(11) In order to elicit public comment concerning the reports required under
ss. 153.10 to
153.35, the office shall, following the release of the reports and by a date that is determined by the board provide notice of and hold public hearings.
153.05(12)
(12) The office shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the office.
153.07
153.07
Board powers and duties. 153.07(1)
(1) The board shall advise the director of the office with regard to the collection, analysis and dissemination of health care information required by this chapter.
153.07(2)
(2) The board, upon advice of the office, shall first determine whether to contract for services pursuant to
s. 153.05 (6) or
(6m). If the board determines to contract for such services, it shall approve specifications for a contract including the length of the contract and the standards for determining potential contractor conflicts with the purposes of the office as specified under
s. 153.05 (1). In the alternative, the board may direct the office to have the department of health and family services provide the services under
s. 153.05 (6) or
(6m). The board may subsequently determine to contract for these services in subsequent years. If the board decides to bid the contract for services under
s. 153.05 (6) or
(6m), the department of health and family services may offer a bid as would any other potential contractor. The board shall evaluate a contractor's performance 6 months prior to the close of each existing contract.
153.07(3)
(3) The board shall approve all rules which are proposed by the commissioner for promulgation to implement this chapter.
153.08
153.08
Hospital rate increases or charges in excess of rates. 153.08(1)(b)
(b) Notwithstanding
s. 153.01 (5), "hospital" has the meaning given in
s. 50.33 (2), except that "hospital" does not include a center for the developmentally disabled as defined in
s. 51.01 (3).
153.08(1)(c)
(c) "Rates" means individual charges of a hospital for the services that it provides.
153.08(2)
(2) No hospital may increase its rates or charge any payer an amount exceeding its rates that are in effect on May 12, 1992, unless the hospital first does all of the following:
153.08(2)(a)
(a) Causes to be published a class 1 notice under
ch. 985 in the official newspaper designated under
s. 985.04 or
985.05 or in a newspaper likely to give notice in the area where the hospital is located, no sooner than 45 days and no later than 30 days before the proposed rate change is to take effect. The notice shall describe the proposed rate change and the time and place for the public hearing required under
sub. (2).
153.08(2)(b)
(b) No sooner than 15 days after a notice is published under
par. (a) and no later than 15 days before the date of the proposed rate change, conducts a public hearing on the proposed rate change. The hearing shall be on the expected impact of the proposed rate change on health care costs, the expected improvement, if any, in the local health care delivery system, and any other issue related to the proposed rate change. Management staff, if any, of the hospital proposing the rate change and, if possible, at least 3 members of the governing board of any not-for-profit hospital proposing the rate change shall attend the public hearing to review public testimony. The hospital shall record accurate minutes of the meeting and shall provide copies of the minutes and any written testimony presented at the hearing to the office of health care information in the office of the commissioner of insurance within 10 days after the date of the public hearing.
153.08(3)
(3) This section does not apply to a hospital that proposes to increase its rates during the course of the hospital's fiscal year by any amount or amounts that, in the aggregate, do not exceed the percentage amount that is the percentage difference between the consumer price index reported for the 12-month period ending on December 31 of the preceding year and the consumer price index reported for the 12-month period ending on December 31 of the year prior to the preceding year.
153.08(4)
(4) A hospital shall publish a class 1 notice under
ch. 985 at least 10 days prior to the institution by the hospital of a rate increase.
153.08 History
History: 1993 a. 16 ss.
2644 to
2646;
1993 a. 104 ss.
3,
5m,
7,
8,
9;
1993 a. 491.
153.10
153.10
Health care data reports. 153.10(1)
(1) Beginning in 1990 and quarterly thereafter, the office 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), in a manner that permits comparisons among hospitals, a report setting forth all of the following for every hospital for the preceding quarter:
153.10(1)(a)
(a) The charges for up to 100 health care services or diagnostic-related groups selected by the office.
153.10(1)(b)
(b) The utilization and charge information for ambulatory surgery and other outpatient health care services selected by the office.
153.10(2)
(2) Beginning in 1990 and annually thereafter, the office 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) a report analyzing the relative rate of growth of health care costs in this state compared to the rest of the nation and compared to the midwest region. The report shall include, to the extent the data are available, comparisons among this state, the rest of the nation and the midwest region of all of the following for the preceding year:
153.10(2)(b)
(b) Hospital revenues and expenditures per person.
153.10(2)(c)
(c) Changes in total hospital revenues and expenditures.
153.10(2)(d)
(d) Average charges for health care services provided by hospitals and for diagnostic-related groups provided by hospitals.
153.10 History
History: 1987 a. 399.
153.15
153.15
Small area analysis reports. Beginning in 1990 and annually thereafter, the office 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) reports identifying health care services or procedures provided by one or more hospitals in specific areas of the state for which the rate of utilization of the service or procedure is significantly different than the state or area average.
153.15 History
History: 1987 a. 399.
153.20
153.20
Uncompensated health care services report. 153.20(1)(1) Beginning in 1990 and annually thereafter, the office shall prepare and submit to the governor and to the chief clerk of each house of the legislature for distribution to the legislature under
s. 13.172 (2) a report setting forth the number of patients to whom uncompensated health care services were provided by each hospital and the total charges for the uncompensated health care services provided to the patients for the preceding year, together with the number of patients and the total charges that were projected by the hospital for that year in the plan filed under
sub. (2).
153.20(2)
(2) Beginning in 1990 and annually thereafter, every hospital shall file with the office a plan setting forth the projected number of patients to whom uncompensated health care services will be provided by the hospital and the projected total charges for the uncompensated health care services to be provided to the patients for the ensuing year.
153.20 History
History: 1987 a. 399;
1989 a. 18.
153.25
153.25
Mortality and morbidity report. Beginning in 1990 and annually thereafter, the office shall prepare and submit to the governor and to the chief clerk of each house of the legislature for distribution to the legislature under
s. 13.172 (2) reports setting forth mortality and morbidity rates for every hospital. Before the release of a report under this section, the office shall provide the physicians, hospitals or other health care providers identified in the report with the opportunity to review and comment under
s. 153.40 (6).
