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.
AB925,29,3
1(d) In developing and evaluating the clinical applications of the technology or
2research, the person uses scientifically sound studies to determine clinical efficacy,
3safety, cost-effectiveness, and appropriate utilization levels in a clinical setting.
AB925,29,74 (e) The person conducts the clinical trials, evaluation, or research according to
5scientifically sound protocols that are subject to peer review and approval and meets
6the requirements that are applicable to investigations and clinical evaluation
7involving human subjects.
AB925,29,98 (f) The innovative medical technology will be used to conduct necessary
9research, development, and evaluation.
AB925,29,1810 (g) The person does not include any recovery of capital expenses that are
11incurred as part of the capital expenditure or substantial change in a health service
12exempted under this section in the expense and revenue budget for purposes of rate
13setting under ss. 150.61 to 150.68 until after the person receives the approval of the
14federal food and drug administration and the department for general medical use of
15the innovative medical technology or major enhancement to existing medical
16technology. The person may recover operating expenses only after the federal food
17and drug administration approves the expenses for safety and efficacy and a third
18party agrees to pay for the expenses.
AB925,29,21 19(3) No more than 2 exemptions may be granted under this section for each type
20of innovative medical technology and major enhancement to existing medical
21technology.
AB925,30,2 22150.717 Notification requirement. A person who intends to undertake an
23activity specified in s. 150.71 (1) shall notify the department in writing at least 30
24days prior to submitting an application for review. An application expires one year

1from the date the applicant notifies the department under this section unless the
2department declares the application complete as provided under s. 150.719 (1).
AB925,30,10 3150.719 Review requirements. (1) The department's review of an
4application begins on the date that a completed application is received. On or before
5the 20th day of the month that immediately follows the receipt of a completed
6application, the department shall send a notice of receipt of the completed
7application to the applicant and shall publish a class 2 notice under ch. 985 in a daily
8newspaper with general circulation in the area where the proposed activity will be
9located. No application for review that is received from a hospital is complete until
10the commission receives a proposed capital budget under s. 150.73.
AB925,30,20 11(2) The department may group applications for the same or similar types of
12facilities or services or for activities that are proposed within the same health
13planning area, as defined by the department under s. 150.33 (1), for concurrent
14review. The department shall base its review under this subsection on a comparative
15analysis of the applications, using the criteria specified in s. 150.72 and a ranking
16of priorities determined by the department. In reviewing an application, the
17department shall first consider cost containment in applying the criteria under s.
18150.72 (1) and shall also consider the comments of any affected parties. The
19department shall promulgate rules specifying the requirements for review under
20this subsection.
AB925,30,24 21150.72 Review criteria. (1) No application for an activity specified in s.
22150.71 (1) (a) to (e) may be approved by the department unless the applicant proves
23by a preponderance of the evidence that each of the following criteria has been met
24or does not apply to the activity:
AB925,31,2
1(a) The activity is consistent with the state medical facilities plan adopted
2under s. 150.733.
AB925,31,43 (b) A need for the activity, as determined by current and projected utilization,
4exists.
AB925,31,75 (c) The activity will efficiently and economically use resources, including
6financing for capital investment and operating expenses, when measured against
7alternative use of resources.
AB925,31,98 (d) The applicant has sufficient cash reserves and cash flow to pay operating
9and capital costs.
AB925,31,1510 (e) Increases in operating and capital costs that will result from the activity are
11reasonable, including the direct charge to the consumer, the applicant's projected
12request for rate increases under ss. 150.61 to 150.67, and the charges to be paid by
13medical assistance and disability insurers. In considering whether the increases are
14reasonable, the department shall consider the analysis provided by the commission
15under sub. (2).
AB925,31,1616 (f) Financing for the activity is available at market rates.
AB925,31,1817 (g) Health care personnel needed to provide the proposed services are available
18and will be effectively used.
AB925,31,1919 (h) Proposed construction costs are consistent with industry averages.
AB925,31,2120 (i) Any proposed expansion and construction or renovation alternatives are
21cost-effective.
AB925,31,2222 (j) The activity is consistent with efficiency standards and criteria.
AB925,32,323 (k) The applicant is participating in a utilization review program that is
24applicable to a statistical sampling of all hospital patients regardless of payment
25source, that requires public disclosure of all review data in a form useful to the

1department but protects the identities of individual patients and health care
2professionals, and that is conducted by persons who are free of any substantial
3conflict of interest.
AB925,32,54 (L) The applicant has prepared a plan to provide health care to low-income
5individuals, and the department has approved the plan.
AB925,32,8 6(2) The commission shall determine the effect of any rate change the applicant
7has requested on the applicant's activity and provide a report to the department no
8later than 45 days after the department receives a completed application.
AB925,32,13 9150.723 Review process. (1) Upon the request of an affected party, the
10department shall hold a public meeting to review activities for which an application
11for review has been received. All affected parties may present testimony at the public
12meeting. The department shall keep minutes or other record of testimony presented
13at the public meeting.
AB925,32,21 14(2) (a) The department shall issue an initial finding to approve or reject the
15application no later than 75 days after the date on which the notice under s. 150.719
16(1) is published unless the applicant consents to an extension of this period. The
17department may not require substantial modifications of any project as a condition
18of approval without the applicant's consent. The department shall submit the initial
19finding to the applicant. Unless the applicant makes a timely request for a hearing
20under sub. (3), an initial finding issued under this subsection shall be considered a
21final action.
AB925,32,2522 (b) Notwithstanding par. (a), the department may extend the review period of
23all projects being reviewed concurrently for 60 days if the department finds that
24completing the review within the 75-day time period under par. (a) is not practical
25due to the number of applications under review.
AB925,33,7
1(3) (a) If an applicant's application is rejected, the applicant may request a
2public hearing to review the department's initial finding if the applicant submits a
3request for the hearing in writing no later than 10 days after the department issues
4the initial finding or the applicant may initiate a hearing under s. 227.42. The
5department shall commence the hearing no later than 30 days after the date on
6which a timely request for the hearing is received unless all parties consent to an
7extension of the period.
AB925,33,108 (b) Except as provided in s. 227.42, ss. 227.43 to 227.50 do not apply to hearings
9under this subsection. The department shall promulgate rules specifying all of the
10following:
AB925,33,1111 1. Procedures for scheduling hearings under this subsection.
AB925,33,1412 2. Procedures for conducting hearings under this subsection, including
13methods of presenting arguments, cross-examination of witnesses, and submission
14of exhibits.
AB925,33,1615 3. Procedures following the completion of a hearing under this subsection,
16including the establishment of time limits for issuance of a decision.
AB925,33,1817 4. Standards relating to ex parte communication in hearings under this
18subsection.
AB925,33,1919 5. Procedures for reconsideration and rehearing.
AB925,33,2020 (c) The department shall issue all decisions in writing.
AB925,33,2321 (d) Each applicant has the burden of proving, by clear and convincing evidence,
22that the department's initial finding was arbitrary and capricious, contrary to law,
23or contrary to the weight of the evidence on the record when considered as a whole.
AB925,34,2 24150.725 Judicial review. An applicant adversely affected by a decision of the
25department under s. 150.723 (3) may petition for judicial review of the decision under

1s. 227.52. The scope of judicial review shall be as provided in s. 227.57, and the record
2before the reviewing court shall consist of all of the following:
AB925,34,4 3(1) The application and all supporting material received prior to the
4department's initial finding issued under s. 150.723 (2)
AB925,34,5 5(2) The record of the public meeting held under s. 150.723 (1).
AB925,34,7 6(3) The department's analysis of the activity and the activity's compliance with
7the criteria specified in s. 150.72 (1).
AB925,34,8 8(4) The record of the hearing held under s. 150.723 (3).
AB925,34,9 9(5) The department's decisions and analysis issued under s. 150.723 (2) or (3).
AB925,34,12 10150.727 Validity and contents of an approval. (1) An approval is valid for
11one year from the date of issuance. The department may grant one extension of up
12to 6 months for each approval.
AB925,34,14 13(2) Each approval shall specify the maximum capital expenditure that may be
14obligated for an activity.
AB925,34,19 15(3) Each approval shall include the proposed timetable for implementing and
16completing the project and, for the 3-year period following completion of the activity,
17the activity's depreciation and interest schedule, any required staff, the proposed per
18diem rate needed to pay capital costs, and the proposed per diem rate needed to pay
19operating costs.
AB925,34,25 20150.73 Capital budget reporting. Beginning January 1, 2003, each hospital
21shall annually, by January 1, submit to the department a proposed capital budget for
22the 5-year period that begins on July 1 of the year in which the proposed budget is
23submitted. The budget shall specify all anticipated capital expenditures for
24activities specified in s. 150.71 (1) (a) to (c) and (e) and all anticipated application
25dates.
AB925,35,6
1150.733 State medical facilities plan. (1) The department shall adopt a
2state medical facilities plan at least once every 3 years that includes a description
3of the state hospital system and identifies any needed or surplus hospital beds. Each
4plan, except the initial plan adopted under this subsection, shall also include a
5description of needed and surplus health services and any other comments the
6department determines are useful.
AB925,35,11 7(2) The department may not approve an application for any activity that
8requires the addition of hospital beds that would exceed the number of beds
9authorized by the state medical facilities plan for the acute care service area where
10the project would be located. The department shall promulgate rules to define an
11acute care service.
AB925, s. 10 12Section 10. 153.08 of the statutes is repealed.
AB925, s. 11 13Section 11. 153.75 (1) (g) of the statutes is repealed.
AB925, s. 12 14Section 12. 165.40 of the statutes is repealed.
AB925, s. 13 15Section 13. 230.08 (2) (mp) of the statutes is created to read:
AB925,35,1716 230.08 (2) (mp) One staff director of the hospital rate-setting commission,
17created under s. 15.105 (27).
AB925, s. 14 18Section 14. 632.75 (5) of the statutes is amended to read:
AB925,35,2219 632.75 (5) Payments for hospital services. No insurer may reimburse a
20hospital for patient health care costs at a rate exceeding the rate established under
21ch. 54, 1985 stats., or s. 146.60, 1983 stats., for care provided prior to July 1, 1987
22ss. 150.61 to 150.67.
AB925, s. 15 23Section 15. Nonstatutory provisions.
AB925,36,224 (1) Initial appointment of members of the hospital rate-setting commission.
25Notwithstanding the length of terms specified for the members of the hospital

1rate-setting commission under section 15.105 (27) of the statutes, as created by this
2act, the initial members shall be appointed for the following terms:
AB925,36,33 (a) One member for a term expiring on March 1, 2005.
AB925,36,44 (b) One member for a term expiring on March 1, 2007.
AB925,36,55 (c) One member for a term expiring on March 1, 2009.
AB925,36,96 (2) Initial appointment of members of the hospital rate-setting council.
7Notwithstanding the length of terms specified for the members of the hospital
8rate-setting council under section 15.107 (18) of the statutes, as created by this act,
9the initial members shall be appointed for the following terms:
AB925,36,1110 (a) The members specified under section 15.107 (18) (a) of the statutes, as
11created by this act, for terms expiring on July 1, 2003.
AB925,36,1412 (b) The members specified under section 15.107 (18) (b) and (d) of the statutes,
13as created by this act, and the members not specified in section 15.107 (18) (a) to (e)
14of the statutes, as created by this act, for terms expiring on July 1, 2005.
AB925,36,1615 (c) The members specified under section 15.107 (18) (c) and (e) of the statutes,
16as created by this act, for terms expiring on July 1, 2007.
AB925,36,2217 (3) Request to supplement appropriation. By April 1, 2002, the hospital
18rate-setting commission shall submit to the secretary of administration a request to
19supplement the appropriation under section 20.438 (1) (g) of the statutes, as created
20by this act, as specified under section 16.515 of the statutes. The request shall
21include a proposed budget for activities of the hospital rate-setting commission
22under subchapter III of chapter 150 of the statutes, as created by this act.
AB925,36,2323 (4) Hospital rate-setting commission rules.
AB925,37,224 (a) The hospital rate-setting commission shall submit proposed rules required
25under section 150.615 of the statutes, as created by this act, to the legislative council

1staff for review under section 227.15 (1) of the statutes no later than May 1, 2002.
2These rules may not take effect before July 1, 2002.
Loading...
Loading...