146.89(3)(d)2. 2. Except as provided in sub. (3m), Medical Assistance under subch. IV of ch. 49.
146.89(3)(e) (e) Under this section, the nonprofit agency shall assume responsibility for approving individuals to be volunteer health care providers.
146.89(3)(f) (f) Under this section, the nonprofit agency shall research and validate an individual's credentials before submitting the joint application to be a volunteer health care provider.
146.89(3)(g) (g) The nonprofit agency shall enter the list of volunteer health care providers providing services at that nonprofit agency into an online, electronic system developed by the department of administration.
146.89(3)(h) (h) The nonprofit agency shall monitor volunteer health care providers providing services at that nonprofit agency and shall terminate a provider's participation in the program under this section with that nonprofit agency when the agency questions the credentials of that provider or when the agency disapproves of the practices of that provider.
146.89(3)(i) (i) The nonprofit agency shall prepare and submit to the department of administration an annual report that includes the types and number of health care services provided by the nonprofit agency under this section.
146.89(3)(j) (j) The nonprofit agency shall prepare and submit to the department an annual report that includes the types and number of health care services provided by the nonprofit agency under this section.
146.89 Note NOTE: Par. (j) was created as par. (i) by 2013 Wis. Act 344 and renumbered to par. (j) by the legislative reference bureau under s. 13.92 (1) (bm) 2.
146.89(3m) (3m) A volunteer health care provider who is a dentist may provide dental services or a volunteer health care provider who is a dental hygienist may provide dental hygiene services, to persons who are recipients of Medical Assistance, if all of the following apply:
146.89(3m)(a) (a) The nonprofit agency's fees for these services apply to the recipients and to persons who are not recipients of Medical Assistance.
146.89(3m)(b) (b) The agency accepts discounted payments, based on ability to pay, from the persons who are not Medical Assistance recipients.
146.89(3m)(c) (c) The volunteer health care provider is certified under s. 49.45 (2) (a) 11. a., the department has waived the requirement for certification, or the volunteer health care provider is not required to be certified under s. 49.45 (2) (a) 11. a.
146.89(3r) (3r) All of the following apply to a volunteer health care provider whose joint application with a school board or relevant governing body is approved under sub. (2):
146.89(3r)(a) (a) Before first providing health care services in a school, the volunteer health care provider shall provide to the school board or relevant governing body proof of satisfactory completion of any competency requirements that are relevant to the volunteer health care provider, as specified by the department of public instruction by rule, and shall consult with the school nurse, if any, of the school.
146.89(3r)(b) (b) Under this subsection, the volunteer health care provider may provide only to students from 4-year-old kindergarten to grade 6 the following health care services:
146.89(3r)(b)1. 1. Except as specified in par. (c), the health care services specified in sub. (3) (b) 1. to 5. and 7., other than referrals to reproductive health care specialists, and in sub. (3) (b) 8. and 9.
146.89(3r)(b)2. 2. First aid for illness or injury.
146.89(3r)(b)3. 3. Except as specified in par. (c), the administration of drugs, as specified in s. 118.29 (2) (a) 1. to 3.
146.89(3r)(b)4. 4. Health screenings.
146.89(3r)(b)5. 5. Any other health care services designated by the department of public instruction by rule.
146.89(3r)(c) (c) Under this subsection, the volunteer health care provider may not provide any of the following:
146.89(3r)(c)1. 1. Hospitalization.
146.89(3r)(c)2. 2. Surgery, except as provided in par. (b) 2. and 5. and sub. (3) (b) 9.
146.89(3r)(c)3. 3. A referral for abortion, as defined in s. 48.375.
146.89(3r)(c)4. 4. A contraceptive article, as defined in s. 450.155 (1) (a).
146.89(3r)(c)5. 5. A pregnancy test.
146.89(3r)(d) (d) Any health care services provided under par. (b) shall be provided without charge at the school and shall be available to all students from 4-year-old kindergarten to grade 6 regardless of income.
146.89(3r)(e) (e) Under this subsection, a volunteer health care provider may not provide instruction in human growth and development under s. 118.019.
146.89(4) (4) Except as provided in sub. (5), volunteer health care providers who provide services under this section are, for the provision of these services, state agents of the department for purposes of ss. 165.25 (6), 893.82 (3) and 895.46. This state agency status does not apply to a volunteer health care provider for whom the department has withdrawn approval of the application under sub. (2) (d). This state agency status applies regardless of whether the volunteer health care provider has coverage under a policy of health care liability insurance that would extend to services provided by the volunteer health care provider under this section; and the limitations under s. 895.46 (1) (a) on the payment by the state of damages and costs in excess of any insurance coverage applicable to the agent and on the duty of a governmental unit to provide or pay for legal representation do not apply. Any policy of health care liability insurance providing coverage for services of a health care provider may exclude coverage for services provided by the health care provider under this section.
146.89 Note NOTE: Sub. (4) is shown as affected by 2013 Wis. Acts 241 and 344 and as merged by the legislative reference bureau under s. 13.92 (2) (i).
146.89(5) (5)
146.89(5)(a)(a) A volunteer health care provider who meets all of the following criteria is not a state agent under sub. (4):
146.89(5)(a)1. 1. The volunteer health care provider is described in sub. (1) (r) 5.
146.89(5)(a)2. 2. The volunteer health care provider has sufficient liability insurance coverage, as determined by the department of health services.
146.89(5)(a)3. 3. The volunteer health care provider submits a joint application with a nonprofit agency that has sufficient liability coverage, as determined by the department of health services.
146.89(5)(b) (b) A volunteer health care provider described in par. (a) is not liable for any civil damages for any act or omission resulting from providing services under this section, unless any of the following are true:
146.89(5)(b)1. 1. The act or omission is the result of the volunteer health care provider's gross negligence or willful misconduct.
146.89(5)(b)2. 2. The act or omission violates a state statute or rule.
146.89(6) (6)
146.89(6)(a)(a) While serving as a volunteer health care provider under this section, an advanced practice nurse who has a certificate to issue prescription orders under s. 441.16 (2) is considered to meet the requirements of s. 655.23, if required to comply with s. 655.23.
146.89(6)(b) (b) While serving as a volunteer health care provider under this section, an advanced practice nurse who has a certificate to issue prescription orders under s. 441.16 (2) is not required to maintain in effect malpractice insurance.
146.89 Note NOTE: Sub. (6) was created as sub. (5) by 2013 Wis. Act 344 and renumbered to sub. (6) by the legislative reference bureau under s. 13.92 (1) (bm) 2.
146.903 146.903 Disclosures required of health care providers and hospitals.
146.903(1)(1) Definitions. In this section:
146.903(1)(a) (a) "Ambulatory surgical center" has the meaning given in 42 CFR 416.2.
146.903(1)(b) (b) "Clinic" means a place, other than a residence or a hospital, that is used primarily for the provision of nursing, medical, podiatric, dental, chiropractic, or optometric care and treatment.
146.903(1)(br) (br) "Health care information organization" means an organization that gathers data from health care providers or hospitals regarding utilization and quality of health care services and that produces reports on the comparative quality of health care services provided by health care providers or hospitals.
146.903(1)(c) (c) "Health care provider" has the meaning given in s. 146.81 (1) (a) to (L) and includes a clinic and an ambulatory surgical center but does not include a nursing home, as defined in s. 50.01 (3).
146.903(1)(d) (d) "Hospital" has the meaning given in s. 50.33 (2).
146.903(1)(e) (e) "Median billed charge" means one of the following:
146.903(1)(e)1. 1. For a health care provider, the amount the health care provider charged, before any discount or contractual rate applicable to certain patients or payers was applied, during the first 2 calendar quarters of the most recently completed calendar year, as calculated by arranging the charges in that reporting period from highest to lowest and selecting the middle charge in the sequence or, for an even number of charges, selecting the 2 middle charges in the sequence and calculating the average of the 2.
146.903(1)(e)2. 2. For a hospital, the amount the hospital charged, before any discount or contractual rate applicable to certain patients or payers was applied, during the 4 calendar quarters for which the hospital most recently reported data under ch. 153, as calculated by arranging the charges in the reporting period from highest to lowest and selecting the middle charge in the sequence or, for an even number of charges, selecting the 2 middle charges in the sequence and calculating the average of the 2.
146.903(1)(f) (f) "Medicare" means coverage under part A or part B of Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395dd.
146.903(1)(g) (g) "Public information" means information that any person may access from a health care information organization, regardless of whether the organization charges a fee for the information.
146.903(2) (2)Department duties.
146.903(2)(a)(a) The department shall do all of the following:
146.903(2)(a)1. 1. Categorize health care providers by type.
146.903(2)(a)2. 2. For each type of health care provider, annually identify the 25 presenting conditions for which that type of health care provider most frequently provides health care services.
146.903(2)(a)3. 3. Prescribe the methods by which health care providers shall calculate and present median billed charges and Medicare and private 3rd-party payer payments under sub. (3) (b).
146.903(2)(b) (b) In performing the duties under par. (a), the department shall consult with organizations in this state that do all of the following:
146.903(2)(b)1. 1. Develop performance measures for assessing the quality of health care services.
146.903(2)(b)2. 2. Guide the collection, validation, and analysis of data related to measures described under subd. 1.
146.903(2)(b)3. 3. Report results of assessments of the quality of health care services.
146.903(2)(b)4. 4. Share best practices of organizations that provide health care services.
146.903(3) (3)Health care provider disclosure of charges.
146.903(3)(a)(a) Except as provided in par. (g), a health care provider or the health care provider's designee shall, upon request by and at no cost to a health care consumer, disclose to the consumer within a reasonable period of time after the request, the median billed charge, assuming no medical complications, for a health care service, diagnostic test, or procedure that is specified by the consumer and that is provided by the health care provider.
146.903(3)(am) (am) A health care provider that submits data to a health care information organization shall, when it makes a disclosure to a consumer under par. (a), make available to the consumer any public information reported by the health care information organization regarding the quality of health care services provided by the health care provider compared to the quality of health care services provided by other health care providers that is relevant to the health care service, diagnostic test, or procedure specified by the consumer under par. (a). A health care provider may make the information available to the consumer by providing the consumer a paper copy of the information or by providing the consumer the address of an Internet site where the information is posted. If the health care provider submits data to more than one health care information organization and more than one of the health care information organizations reports to the health care provider public information on comparative quality that is relevant to the health care service, diagnostic test, or procedure, the health care provider is required under this paragraph to make available to the consumer public information reported by only one of the health care information organizations.
146.903(3)(b) (b) Except as provided in par. (g), a health care provider shall prepare a single document that lists the following charge information, assuming no medical complications, for diagnosing and treating each of the 25 presenting conditions identified for the health care provider's provider type under sub. (2):
146.903(3)(b)1. 1. The median billed charge.
146.903(3)(b)2. 2. If the health care provider is certified as a provider of Medicare, the Medicare payment to the provider.
146.903(3)(b)3. 3. The average allowable payment from private, 3rd-party payers.
146.903(3)(bm) (bm) A health care provider that submits data to a health care information organization shall make available with the document required under par. (b) any public information reported by the health care information organization regarding the quality of health care services provided by the health care provider compared to the quality of health care services provided by other health care providers that is relevant to a presenting condition for which the provider is required to list charge information under par. (b). A health care provider may make the information available by attaching it to the document or by including the address of an Internet site where the information is posted with the document. If the health care provider submits data to more than one health care information organization and more than one of the health care information organizations reports to the health care provider public information on comparative quality that is relevant to a presenting condition, the health care provider is required under this paragraph to make available public information reported by only one of the health care information organizations for the presenting condition.
146.903(3)(c) (c) Except as provided in par. (g), a health care provider or the health care provider's designee shall, upon request by and at no cost to a health care consumer, provide the consumer a copy of the document prepared under par. (b) and the information described under par. (bm).
146.903(3)(d) (d) Except as provided in par. (g), a health care provider shall annually update the document under par. (b).
146.903(3)(e) (e) Information provided upon request under par. (a) or included on the document under par. (b) does not constitute a legally binding estimate of the charge for a specific patient or the amount that a 3rd-party payer will pay on behalf of the patient.
146.903(3)(f) (f) Except as provided in par. (g), a health care provider shall prominently display, in the area of the health care provider's practice or facility that is most commonly frequented by health care consumers, a statement informing the consumers that they have the right to receive charge information as provided in pars. (a) and (b) and, if applicable, the information described under par. (bm), from the health care provider and, if the requirements, if any, under s. 632.798 (2) (d) are met, a good faith estimate, from their insurers or self-insured health plans, of the insured's total out-of-pocket cost according to the insured's benefit terms for the specified health care service in the geographic region in which the health care service will be provided.
146.903(3)(g) (g) The requirements under pars. (a) to (f) do not apply to any of the following:
146.903(3)(g)1. 1. A health care provider that practices individually or in association with not more than 2 other individual health care providers.
146.903(3)(g)2. 2. A health care provider that is an association of 3 or fewer individual health care providers.
146.903(4) (4)Hospital disclosure of charges.
146.903(4)(a)(a) Each hospital shall prepare a single document that lists the following charge information, assuming no medical complications, for inpatient care for each of the 75 diagnosis related groups identified under s. 153.21 (3) and the following charge information for each of the 75 outpatient surgical procedures identified under s. 153.21 (3):
146.903(4)(a)1. 1. The median billed charge.
146.903(4)(a)2. 2. The average allowable payment under Medicare.
146.903(4)(a)3. 3. The average allowable payment from private, 3rd-party payers.
146.903(4)(am) (am) A hospital that submits data to a health care information organization shall make available with the document required under par. (a) any public information reported by the health care information organization regarding the quality of health care services provided by the hospital compared to the quality of health care services provided by other hospitals that is relevant to a diagnosis related group or outpatient surgical procedure for which the hospital is required to list charge information under par. (a). A hospital may make the information available by attaching it to the document or by including the address of an Internet site where the information is posted with the document. If a hospital submits data to more than one health care information organization and more than one of the health care information organizations reports to the hospital public information on comparative quality that is relevant to a diagnosis related group or outpatient surgical procedure, the hospital is required under this paragraph to make available public information reported by only one of the health care information organizations for the diagnosis related group or outpatient surgical procedure.
146.903(4)(b) (b) A hospital shall, upon request by and at no cost to a health care consumer, provide the consumer a copy of the document prepared under par. (a) and the information described under par. (am).
146.903(4)(c) (c) A hospital shall update the document under par. (a) every calendar quarter.
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2011-12 Wisconsin Statutes updated through 2013 Wis. Act 380 and all Supreme Court Orders entered before Dec. 13, 2014. Published and certified under s. 35.18. Changes effective after Dec. 13, 2014 are designated by NOTES. (Published 12-13-14)