153.21 Consumer guide. The department 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) an annual guide to assist consumers in selecting health care providers and health care plans. The guide shall be written in language that is understandable to lay persons. The department shall widely publicize and distribute the guide to consumers.
231,37
Section 37
. 153.25 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,38
Section 38
. 153.30 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,39
Section 39
. 153.35 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,40
Section 40
. 153.40 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,41
Section 41
. 153.45 (1) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.45 (1) (intro.) After completion of data verification, comment and review procedures under s. 153.40 specified by the department by rule, the department shall release data, together with comments, if any, in the following forms:
231,42
Section 42
. 153.45 (1) (a) of the statutes is amended to read:
153.45 (1) (a) Standard reports in accordance with ss. 153.10 to 153.35.
231,43
Section 43
. 153.45 (1) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.45 (1) (b) Public use tapes
data files which do not permit the identification of specific patients, physicians, employers or other health care providers
, as defined by rules promulgated by the department. The identification of these groups shall be protected by all necessary means, including the deletion of patient identifiers and the use of calculated variables and aggregated variables.
231,44
Section 44
. 153.45 (1) (c) of the statutes is amended to read:
153.45 (1) (c) Custom-designed subfile tapes, other electronic media, special data compilations or reports containing portions of the public use tape data under par. (b).
231,44d
Section 44d. 153.45 (1m) of the statutes is created to read:
153.45 (1m) After completion of data verification and review procedures specified by the department by rule, the department may, but is not required to, release special data compilations.
231,45
Section 45
. 153.45 (3) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.45 (3) The department shall
may, but is not required to, release physician-specific health care provider-specific and employer-specific data, except in public use tapes data files as specified under sub. (1) (b), in a manner that is specified in rules promulgated by the department.
231,46
Section 46
. 153.45 (4) of the statutes is created to read:
153.45 (4) The department shall prohibit purchasers of data from rereleasing individual data elements of health care data files.
231,47
Section 47
. 153.45 (5) of the statutes is created to read:
153.45 (5) The department may not release any health care information that is subject to rules promulgated under s. 153.75 (1) (b) until the verification, comment and review procedures required under those rules have been complied with. Nothing in this subsection prohibits release of health care provider-specific information to the health care provider to whom the information relates.
231,48m
Section 48m. 153.50 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed and recreated to read:
153.50 Protection of patient confidentiality. (1) Definitions. In this section:
(a) “Data element" means an item of information from a uniform patient billing form.
(b) “Patient-identifiable data" means all of the following data elements:
1. Patient medical record or chart number.
2. Patient control number.
3. Patient date of birth.
4. Date of patient admission.
5. Date of patient discharge.
6. Date of patient's principal procedure.
7. Encrypted case identifier.
8. Insured's policy number.
9. Patient's employer's name.
10. Insured's date of birth.
11. Insured's identification number.
12. Medicaid resubmission code.
13. Medicaid prior authorization number.
(c) “Small number" means a number that is insufficiently large to be statistically significant, as determined by the department.
(2) Prohibition on release. Patient-identifiable data obtained under this chapter is not subject to inspection, copying or receipt under s. 19.35 (1) and may not be released by the department except as provided in sub. (4).
(3) Departmental measures to ensure protection of patient identity. To ensure that the identity of patients is protected when information obtained by the department is disseminated, the department shall do all of the following:
(a) Aggregate any data element category containing small numbers, using procedures that are developed by the department and approved by the board and that follow commonly accepted statistical methodology.
(b) Remove and destroy all of the following data elements on the uniform patient billing forms that are received by the department under the requirements of this chapter:
1. The patient's name and street address.
2. The insured's name, address and telephone number.
3. Any other insured's name, employer name and date of birth.
4. The signature of the patient or other authorized signature.
5. The signature of the insured or other authorized signature.
6. The signature of the physician.
(4) Release of patient-identifiable data. Under the procedures specified in sub. (5), release of patient-identifiable data may be made to any of the following:
(a) The patient or a person granted permission in writing by the patient for release of the patient's patient-identifiable data.
(b) 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 data base of the department.
(c) A health care provider or the agent of a health care provider, to ensure the accuracy of the information in the data base of the department.
(d) The department, for purposes of epidemiological investigation or to eliminate the need for duplicative data bases.
(e) An entity that is required by federal or state statute to obtain patient-identifiable data for purposes of epidemiological investigation or to eliminate the need for duplicative data bases.
(5) Procedures for release of patient-identifiable data. (a) The department may not release or provide access to patient-identifiable data to a person authorized under sub. (4) (a), (c), (d) or (e) unless the authorized person requests the department, in writing, to release the patient-identifiable data. The request shall include all of the following:
1. The requester's name and address.
2. The reason for the request.
3. For a person who is authorized under sub. (4) (a), (c) or (d) to receive or have access to patient-identifiable data, evidence, in writing, that indicates that authorization.
4. For an entity that is authorized under sub. (4) (e) to receive or have access to patient-identifiable data, evidence, in writing, of all of the following:
a. The federal or state statutory requirement to obtain the patient-identifiable data.
b. Any federal or state statutory requirement to uphold the patient confidentiality provisions of this chapter or patient confidentiality provisions that are more restrictive than those of this chapter; or, if the latter evidence is inapplicable, an agreement, in writing, to uphold the patient confidentiality provisions of this chapter.
(b) Upon receipt of a request under par. (a), the department shall, as soon as practicable, comply with the request or notify the requester, in writing, of all of the following:
1. That the department is denying the request in whole or in part.
2. The reason for the denial.
3. For a person who believes that he or she is authorized under sub. (4), the action provided under s. 19.37.
(6) Information submitted. The department may not require a health care provider submitting health care information under this chapter to include the patient's name, street address or social security number.
231,48r
Section 48r. 153.55 of the statutes is created to read:
153.55 Protection of health care provider confidentiality. Health care provider-identifiable data obtained under this chapter is not subject to inspection, copying or receipt under s. 19.35 (1).
231,49
Section 49
. 153.60 (1) of the statutes, as affected by 1997 Wisconsin Act 27, 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, data base development and maintenance, generation of data files and standard reports, orientation and training provided under s. 153.05 (9) and maintaining the board. 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 hospitals in proportion to each hospital's respective gross private-pay patient revenues during the hospital's most recently concluded entire fiscal year health care providers 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. Each
hospital health care provider shall pay the assessment on or before December 1. All payments of assessments shall be deposited in the appropriation under s. 20.435 (1) (hg).
231,50
Section 50
. 153.60 (2) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,51
Section 51
. 153.60 (3) of the statutes is created to read:
153.60 (3) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures required for the collection, database development and maintenance and generation of public data files and standard reports for health care plans that voluntarily agree to supply health care data under s. 153.05 (6r). The department shall assess the estimated total amount for that fiscal year to health care plans in a manner specified by the department by rule and may enter into an agreement with the office of the commissioner of insurance for collection of the assessments. Each health plan that voluntarily agrees to supply this information shall pay the assessments on or before December 1. All payments of assessments shall be deposited in the appropriation under s. 20.435 (1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
231,52
Section 52
. 153.65 of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.65 Provision of special information; user fees. 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 under s. 153.05 (1), (3), (4) (b), (5), (7) or (8) or 153.08. 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 section shall be credited to the appropriation under s. 20.435 (1) (hi).
231,53
Section 53
. 153.75 (1) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.75 (1) (b) Establishing procedures under which hospitals and health care providers are permitted to review and, verify patient-related and comment on information prior to its submission to the department
and include the comments with the information.
231,54
Section 54
. 153.75 (1) (c), (d), (e), (i) and (j) of the statutes are repealed.
231,55
Section 55
. 153.75 (1) (f), (k) and (L) of the statutes are amended to read:
153.75 (1) (f) Governing the release of physician-specific health care provider-specific and employer-specific data under s. 153.45 (1m) and (3).
(k) Establishing methods and criteria for assessing hospitals and ambulatory surgery centers health care providers under s. 153.60 (1).
(L) Defining the term “uncompensated health care services" for the purposes of ss. 153.05 (1) (d) and
s. 153.20.
231,56
Section 56
. 153.75 (1) (m), (n), (o), (p), (q), (r), (s), (t) and (u) of the statutes are created to read:
153.75 (1) (m) Specifying the classes of health care providers from whom claims data and other health care information will be collected.
(n) Specifying the uniform data set of health care information, as adjusted for case mix and severity, to be collected.
(o) Specifying the means by which the information in par. (b) will be collected, including the procedures for submission of data by electronic means.
(p) Specifying the methods for using and disseminating health care data in order for health care providers to provide health care that is effective and economically efficient and for consumers and purchasers to make informed decisions in selecting health care plans and health care providers.
(q) Specifying the information to be provided in the consumer guide under s. 153.21.
