Amendment SSA1-SB44

SB44-SSA1,818,21 149.146 (2) (a) Except as specified by the department, the terms of coverage under s. 149.14, including deductible reductions under s. 149.14 (5) (a) and prescription drug copayment reductions under s. 149.14 (5) (e), do not apply to the coverage offered under this section. Premium reductions under s. 149.165 do not apply to the coverage offered under this section.

SB44-SSA1, s. 2088 Section 2088. 149.16 (1) of the statutes is repealed.

SB44-SSA1, s. 2089 Section 2089. 149.16 (1m) of the statutes is created to read:

SB44-SSA1,818,25 149.16 (1m) The plan administrator may be selected by the department in a competitive bidding process.

SB44-SSA1, s. 2090 Section 2090. 149.16 (4) of the statutes is amended to read:

SB44-SSA1,819,4 149.16 (4) The If the plan administrator is the fiscal agent under s. 49.45 (2) (b) 2., the plan administrator shall account for costs related to the plan separately from costs related to medical assistance under subch. IV of ch. 49.

SB44-SSA1, s. 2091 Section 2091. 149.165 (4) of the statutes is amended to read:

SB44-SSA1,819,9 149.165 (4) The department shall reimburse the plan for premium reductions under sub. (2) and, deductible reductions under s. 149.14 (5) (a) with moneys transferred to the fund, and prescription drug copayment reductions under s. 149.14 (5) (e) from the appropriation account under s. 20.435 (4) (ah) (v).

SB44-SSA1, s. 2092 Section 2092. 150.963 (3) (e) of the statutes is amended to read:

SB44-SSA1,819,14 150.963 (3) (e) Accept on behalf of the state and deposit with the state treasurer secretary of administration any grant, gift, or contribution made to assist in meeting the cost of carrying out the purposes of this subchapter, and expend those funds for the purposes of this subchapter.

SB44-SSA1, s. 2092c Section 2092c. 153.01 (4j) of the statutes is created to read:

SB44-SSA1,819,19 153.01 (4j) "Entity" means a nonstock corporation organized under ch. 181 that is described in section 501 (c) (6) of the Internal Revenue Code and is exempt from federal income tax under section 501 (a) of the Internal Revenue Code, and that does all of the following:

SB44-SSA1,819,20 (a) Represents at least 70% of the hospitals in Wisconsin.

SB44-SSA1,819,22 (b) Receives oversight with respect to services performed by the entity under this chapter from a group that is composed of all of the following:

SB44-SSA1,819,24 1. The secretary of health and family services, who shall serve as chairperson and nonvoting member of the group.

SB44-SSA1,819,25 2. Two members designated by Wisconsin Manufacturers and Commerce, Inc.

SB44-SSA1,820,1 3. Two members designated by the Wisconsin Association of Health Plans, Inc.

SB44-SSA1,820,2 4. One member designated by the Wisconsin State AFL-CIO.

SB44-SSA1,820,3 5. Two members designated by the Wisconsin Hospital Association, Inc.

SB44-SSA1,820,4 6. One member designated by the speaker of the assembly.

SB44-SSA1,820,5 7. One member designated by the senate majority leader.

SB44-SSA1, s. 2092d Section 2092d. 153.05 (1) of the statutes is amended to read:

SB44-SSA1,820,10 153.05 (1) In order to provide to hospitals, health care providers, insurers, consumers, governmental agencies and others information concerning health care providers and uncompensated health care services, and in order to provide information to assist in peer review for the purpose of quality assurance, the:

SB44-SSA1,820,14 (a) The department shall collect from health care providers other than hospitals and ambulatory surgery centers, analyze, and disseminate health care information, as adjusted for case mix and severity, in language that is understandable to lay persons laypersons.

SB44-SSA1, s. 2092e Section 2092e. 153.05 (1) (b) of the statutes is created to read:

SB44-SSA1,820,24 153.05 (1) (b) The entity under contract under sub. (2m) (a) shall collect from hospitals and ambulatory surgery centers the health care information required of hospitals and ambulatory surgery centers by the department under ch. 153, 2001 stats., and the rules promulgated under ch. 153, 2001 stats., including, by the date that is 18 months after the date of the contract under sub. (2m) (a), all outpatient hospital-based services. The entity shall analyze and disseminate that health care information, as adjusted for case mix and severity, in the manner required under this chapter, under ch. 153, 2001 stats., and under the rules promulgated under ch. 153, 2001 stats., and in language that is understandable to laypersons.

SB44-SSA1, s. 2092f Section 2092f. 153.05 (2m) of the statutes is created to read:

SB44-SSA1,821,11 153.05 (2m) (a) Notwithstanding s. 16.75 (1), (2), and (3m), by the date that is the first day of the 2nd month after the effective date of this paragraph .... [revisor inserts date], the department of administration shall, from the appropriation under s. 20.505 (1) (im), contract with an entity to perform services under this chapter that are specified for the entity with respect to the collection, analysis, and dissemination of health care information of hospitals and ambulatory surgery centers. The department of administration may not, by this contract, require from the entity any collection, analysis, or dissemination of health care information of hospitals and ambulatory surgery centers that is in addition to that required under this chapter, and may include in the contract only terms standard to contracts with the department of administration under subch. IV of ch. 16.

SB44-SSA1,821,21 (b) Biennially, the group specified under s. 153.01 (4j) (b) shall review the entity's performance, including the timeliness and quality of the reports generated by the entity. If the group is dissatisfied with the entity's performance, the group may recommend to the department of administration that that department use a competitive request-for-proposal process to solicit offers from other organizations for performance of the services. If no organization responds to the request for proposal, the department of health and family services shall perform the services specified for the entity with respect to the collection, analysis, and dissemination of health care information of hospitals and ambulatory surgery centers under this chapter.

SB44-SSA1,822,2 (c) By April 1, 2004, and annually thereafter, the secretary of health and family services, as chairperson of the group specified under s. 153.01 (4j) (b), shall submit to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2), a report concerning the content and number of reports and currency of information and reports generated in the previous calendar year by the entity under contract under s. 153.05 (2m).

SB44-SSA1, s. 2092g Section 2092g. 153.05 (3) of the statutes is renumbered 153.05 (3) (a) and amended to read:

SB44-SSA1,822,8 153.05 (3) (a) Upon request of the department for health care information relating to health care providers other than hospitals and ambulatory surgery centers, state agencies shall provide that health care information to the department for use in preparing reports under this chapter.

SB44-SSA1, s. 2092h Section 2092h. 153.05 (3) (b) of the statutes is created to read:

SB44-SSA1,822,13 153.05 (3) (b) Upon request of the entity under contract under sub. (2m) (a) for health care information relating to hospitals and ambulatory surgery centers, state agencies shall provide that health care information to the entity for use in preparing reports under this chapter.

SB44-SSA1, s. 2092i Section 2092i. 153.05 (5) of the statutes is renumbered 153.05 (5) (a) and amended to read:

SB44-SSA1,822,20 153.05 (5) (a) Unless sub. (13) (a) applies, the department may require health care providers other than hospitals and ambulatory surgery centers to submit to the department information specified by rule under s. 153.75 (1) (n) for the preparation of reports, plans, and recommendations in the form specified by the department by rule.

SB44-SSA1, s. 2092j Section 2092j. 153.05 (5) (b) of the statutes is created to read:

SB44-SSA1,822,25 153.05 (5) (b) Unless sub. (13) (b) applies, the entity under contract under sub. (2m) (a) may require hospitals and ambulatory surgery centers to submit to the entity information for the preparation of reports, plans, and recommendations in the form specified by the entity.

SB44-SSA1, s. 2092k Section 2092k. 153.05 (6) of the statutes is amended to read:

SB44-SSA1,823,5 153.05 (6) The department may contract with a public or private entity organization 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) (a).

SB44-SSA1, s. 2092L Section 2092L. 153.05 (6r) of the statutes is amended to read:

SB44-SSA1,823,19 153.05 (6r) The department shall study and, based on the results of the study, may develop and implement a voluntary system of health care plan reporting that enables purchasers and consumers to assess the performance of health care plans and the health care providers, other than hospitals and ambulatory surgery centers, that are employed or reimbursed by the health care plans. The department shall undertake the study and any development and implementation in cooperation with private health care purchasers, the board, the department of employee trust funds, the office of the commissioner of insurance, the interagency coordinating council created under s. 15.107 (7), major associations of health care providers, health care plans and consumers. If implemented, the department shall operate the system in a manner so as to enable purchasers, consumers, the public, the governor and legislators to assess the performance of health care plans and health care providers other than hospitals and ambulatory surgery centers.

SB44-SSA1, s. 2093bg Section 2093bg. 153.05 (8) of the statutes is renumbered 153.05 (8) (a) and amended to read:

SB44-SSA1,824,9 153.05 (8) (a) Unless sub. (13) (a) applies, the department shall collect, analyze and disseminate, in language that is understandable to lay persons laypersons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, as determined by rules promulgated by the department, from health care providers, other than hospitals and ambulatory surgery centers, specified by rules promulgated by the department. Data from those health care providers may 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. If the department collects health care provider-specific data from health care plans data that is specific to health care providers other than hospitals and ambulatory surgery centers, the department shall attempt to avoid collecting the same data from those health care providers.

SB44-SSA1, s. 2093bh Section 2093bh. 153.05 (8) (b) of the statutes is created to read:

SB44-SSA1,824,18 153.05 (8) (b) Unless sub. (13) (b) applies, the entity under contract under sub. (2m) (a) shall collect, analyze, and disseminate, in language that is understandable to laypersons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, from hospitals and ambulatory surgery centers. Data from hospitals and ambulatory surgery centers may 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.

SB44-SSA1, s. 2093c Section 2093c. 153.05 (9) of the statutes is renumbered 153.05 (9) (a) and amended to read:

SB44-SSA1,824,24 153.05 (9) (a) The department shall provide orientation and training to health care providers, other than hospitals and ambulatory surgery centers, who submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release.

SB44-SSA1, s. 2093d Section 2093d. 153.05 (9) (b) of the statutes is created to read:

SB44-SSA1,825,4 153.05 (9) (b) The entity under contract under sub. (2m) (a) shall provide orientation and training to hospitals and ambulatory surgery centers that submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release.

SB44-SSA1, s. 2093e Section 2093e. 153.05 (12) of the statutes is renumbered 153.05 (12) (a).

SB44-SSA1, s. 2093f Section 2093f. 153.05 (12) (b) of the statutes is created to read:

SB44-SSA1,825,9 153.05 (12) (b) The entity under contract under sub. (2m) (a) shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the entity.

SB44-SSA1, s. 2094c Section 2094c. 153.05 (13) of the statutes is renumbered 153.05 (13) (a) and amended to read:

SB44-SSA1,825,18 153.05 (13) (a) The department may waive the requirement under sub. (1) (a), (5) (a), or (8) (a) for a health care provider, other than a hospital or ambulatory surgery center, who requests the waiver and presents evidence to the department that the requirement under sub. (1) (a), (5) (a), or (8) (a) is burdensome, under standards established by the department by rule. The department shall develop a form for use by a the health care provider in submitting a request under this subsection paragraph.

SB44-SSA1, s. 2094d Section 2094d. 153.05 (13) (b) of the statutes is created to read:

SB44-SSA1,825,25 153.05 (13) (b) The entity under contract under sub. (2m) (a) may waive the requirement under sub. (1) (b), (5) (b), or (8) (b) for a hospital or ambulatory surgery center that requests the waiver and presents evidence to the entity that the requirement under sub. (1) (b), (5) (b), or (8) (b) is burdensome. The entity shall develop a form for use by the hospital or ambulatory surgery center in submitting a request under this paragraph.

SB44-SSA1, s. 2094e Section 2094e. 153.07 (1) of the statutes is amended to read:

SB44-SSA1,826,4 153.07 (1) The board shall advise the department with regard to the collection, analysis and dissemination of health care information required of the department by this chapter.

SB44-SSA1, s. 2094f Section 2094f. 153.07 (4) (b) of the statutes is amended to read:

SB44-SSA1,826,8 153.07 (4) (b) Provide oversight on the standard reports required of the department under this chapter, including the reports report under ss. 153.20 and s. 153.21 (1).

SB44-SSA1, s. 2094g Section 2094g. 153.07 (4) (c) of the statutes is amended to read:

SB44-SSA1,826,11 153.07 (4) (c) Develop the overall strategy and direction for implementation of the department's duties and powers under this chapter.

SB44-SSA1, s. 2094h Section 2094h. 153.08 (5) of the statutes is created to read:

SB44-SSA1,826,14 153.08 (5) The entity under contract under s. 153.05 (2m) (a) shall annually publish a hospital rate increase report that contains all of the following information:

SB44-SSA1,826,15 (a) For each hospital that publishes a notice under sub. (4), all of the following:

SB44-SSA1,826,17 1. The name of the hospital and the city, village, or town in which the hospital is located.

SB44-SSA1,826,18 2. The date the rate increase is to take effect.

SB44-SSA1,826,19 3. The annualized percentage rate increase that will result.

SB44-SSA1,826,20 4. The geographic area of analysis in which the hospital is located.

SB44-SSA1,826,21 (b) A list of hospitals that have closed since 1993.

SB44-SSA1, s. 2094i Section 2094i. 153.10 of the statutes is renumbered 153.10 (1) and amended to read:

SB44-SSA1,827,3 153.10 (1) The department 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), standard reports concerning health care providers other than hospitals and ambulatory surgery centers that the department prepares and shall collect information necessary for preparation of those reports.

SB44-SSA1, s. 2094j Section 2094j. 153.10 (2) of the statutes is created to read:

SB44-SSA1,827,9 153.10 (2) The entity under contract under s. 153.05 (2m) (a) 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), standard reports concerning hospitals and ambulatory surgery centers that the entity prepares and shall collect information necessary for preparation of those reports.

SB44-SSA1, s. 2094k Section 2094k. 153.20 of the statutes is amended to read:

SB44-SSA1,827,18 153.20 Uncompensated health care services report. (1) The department entity under contract under s. 153.05 (2m) (a) 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 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).

SB44-SSA1,827,23 (2) Every hospital shall file with the department entity under contract under s. 153.05 (2m) (a) an annual 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.

SB44-SSA1, s. 2094L Section 2094L. 153.21 of the statutes is renumbered 153.21 (1) and amended to read:

SB44-SSA1,828,6 153.21 (1) 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 other than hospitals and ambulatory surgery centers and health care plans. The guide shall be written in language that is understandable to lay persons laypersons. The department shall widely publicize and distribute the guide to consumers.

SB44-SSA1, s. 2094m Section 2094m. 153.21 (2) of the statutes is created to read:

SB44-SSA1,828,15 153.21 (2) The entity under contract under s. 153.05 (2m) (a) 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 hospitals and ambulatory surgery centers. The guide shall be written in language that is understandable to laypersons and shall include data derived from the annual survey of hospitals conducted by the American Hospital Association and the annual hospital fiscal survey. The entity shall widely publicize and distribute the guide to consumers.

SB44-SSA1, s. 2094n Section 2094n. 153.22 of the statutes is created to read:

SB44-SSA1,828,22 153.22 Patient-level data utilization, charge, and quality report. (1) The entity under contract under s. 153.05 (2m) (a) 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 report that summarizes utilization, charge, and quality data on patients treated by hospitals and ambulatory surgery centers during the most recent calendar year.

SB44-SSA1, s. 2094q Section 2094q. 153.45 (title) of the statutes is amended to read:

SB44-SSA1,828,24 153.45 (title) Release of data by department.

SB44-SSA1, s. 2094r Section 2094r. 153.45 (1) (b) 1. of the statutes is renumbered 153.46 (1) (b) and amended to read:

SB44-SSA1,829,8 153.46 (1) (b) For information that is submitted by hospitals or ambulatory surgery centers, public use data files that do not permit the identification of specific patients, employers, or health care providers, as defined by rules promulgated by the department. The identification of patients, employers, or health care providers shall be protected by all necessary means, including the deletion of patient identifiers and the use of calculated variables and aggregated variables.

SB44-SSA1, s. 2094s Section 2094s. 153.45 (1) (b) 2. of the statutes is renumbered 153.45 (1) (b), and 153.45 (1) (b) (intro.), as renumbered, is amended to read: