Wisconsin Legislature: 228,20m

228,10m Section 10m. 20.515 (1) (ut) of the statutes is amended to read:

20.515 (1) (ut) Health insurance data collection and analysis contracts. From the public employee trust fund, the amounts in the schedule for the costs of contracting for insurance data collection and analysis services under s. ss. 40.03 (6) (j) and 153.05 (2r).

228,10n Section 10n. 20.515 (1) (ut) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:

228,11 Section 11. 153.01 (1) of the statutes is renumbered 153.01 (1g).

228,12 Section 12. 153.01 (1d) of the statutes is created to read:

153.01 (1d) "Administrator" has the meaning given in s. 633.01 (1).

228,13 Section 13. 153.01 (2) of the statutes is repealed.

228,14 Section 14. 153.01 (2g) of the statutes is created to read:

153.01 (2g) "Calculated variable" means a data element that is computed or derived from an original data item or derived using another data source.

228,15 Section 15. 153.01 (3g) of the statutes is created to read:

153.01 (3g) "Data organization" means a nonstock corporation organized under ch. 181 that is described in section 501 (c) (3) of the Internal Revenue Code, is exempt from federal income tax under section 501 (a) of the Internal Revenue Code, and, in its capacity as a public health authority, does all of the following:

(a) Represents health care consumers, insurers, administrators, and health care providers.

(b) Is formed specifically to do all of the following:

1. Create a centralized claims repository for this state with credible and useful data elements for the purposes of quality improvement, health care provider performance comparisons, ready understandability, and consumer decision making.

2. Use the information it collects to develop and disseminate unified public reports on health care quality, safety, and efficiency.

228,16 Section 16. 153.01 (5m) of the statutes is amended to read:

153.01 (5m) "Insurer" has the meaning given under s. 600.03 (27) 632.745 (15).

228,17 Section 17. 153.01 (8m) of the statutes is created to read:

153.01 (8m) "Public health authority" means the department or a person acting under this chapter under a grant of authority from or contract with the department.

228,18 Section 18. 153.05 (1) (a) of the statutes is amended to read:

153.05 (1) (a) The Subject to s. 153.455, 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 laypersons.

228,19 Section 19. 153.05 (1) (c) of the statutes is created to read:

153.05 (1) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request health care claims information from insurers and administrators. The data organization shall analyze and publicly report the health care claims information with respect to the cost, quality, and effectiveness of health care, in language that is understandable by lay persons, and shall develop and maintain a centralized data repository. The data organization shall provide to the department, without charge, health care claims information collected by and reports produced by the data organization that the department requests. If s. 153.455 (4) applies, the department may request health care claims information, which may be voluntarily provided by insurers and administrators, and may perform or contract for the performance of the other duties specified for the data organization under this paragraph.

228,20 Section 20. 153.05 (2r) of the statutes is created to read:

153.05 (2r) Notwithstanding s. 16.75 (1), (2), and (3m), from the appropriation account under s. 20.515 (1) (ut) the department of employee trust funds may expend up to $150,000, and from the appropriation accounts under s. 20.435 (1) (hg) and (hi) the department of health and family services, in its capacity as a public health authority, may expend moneys, to contract jointly with a data organization to perform services under this chapter that are specified for the data organization under sub. (1) (c) or, if s. 153.455 (4) applies, for the department of health and family services to perform or contract for the performance of these services. As condition of the contract under this subsection, all of the following apply:

(a) At least during the period of the contract, the data organization shall include as voting members of the board of directors of the data organization the secretary of health and family services and the secretary of employee trust funds, or their designees.

(b) The data organization shall provide matching funds, which may include in-kind contributions, as specified in the contract.

(c) Termination of funding and of services of the data organization under the contract or modification of the contract is subject to a determination made under s. 153.455 (3).

228,20m Section 20m. 153.05 (2r) (intro.) of the statutes, as created by 2005 Wisconsin Act .... (this act), is amended to read:

153.05 (2r) (intro.) Notwithstanding s. 16.75 (1), (2), and (3m), from the appropriation account under s. 20.515 (1) (ut) the department of employee trust funds may expend up to $150,000, and from the appropriation accounts under s. 20.435 (1) (hg) and (hi) the department of health and family services, in its capacity as a public health authority, may expend moneys, to contract jointly with a data organization to perform services under this chapter that are specified for the data organization under sub. (1) (c) or, if s. 153.455 (4) applies, for the department of health and family services to perform or contract for the performance of these services. As condition of the contract under this subsection, all of the following apply:

228,20p Section 20p. 153.05 (2s) of the statutes is created to read:

153.05 (2s) Annually, the department of health and family services and the department of employee trust funds shall jointly prepare and submit under s. 13.172 (3) to standing committees of the legislature with jurisdiction over health issues a report on the activities of the data organization under this chapter.

228,21 Section 21. 153.05 (3) (a) of the statutes is amended to read:

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 and, if s. 153.455 (4) applies, for health care claims information as specified in sub. (1) (c), state agencies shall provide that health care information to the department for use in preparing reports under this chapter.

228,22 Section 22. 153.05 (3) (c) of the statutes is created to read:

153.05 (3) (c) Upon request of the data organization under contract under sub. (2r) for health care claims information, insurers and administrators may provide the health care claims information to the data organization for use in preparing reports and developing and maintaining a central data repository under this chapter, and, if s. 153.455 (4) applies, insurers and administrators may provide the health care claims information as requested by the department.

228,23 Section 23. 153.05 (5) (a) of the statutes is amended to read:

153.05 (5) (a) Unless sub. (13) applies, subject to s. 153.455, the department may require health care providers other than hospitals and ambulatory surgery centers to submit to the department health care 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.

228,24 Section 24. 153.05 (5) (c) of the statutes is created to read:

153.05 (5) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request insurers and administrators to submit to the data organization health care claims information for the preparation of reports, plans, and recommendations in the form specified by the data organization, including in standard electronic format. If s. 153.455 (4) applies, the department may request submission of the health care claims information from insurers and administrators in the form specified by the department, including in standard electronic format.

228,25 Section 25. 153.05 (6r) of the statutes is repealed.

228,26 Section 26. 153.05 (8) (a) of the statutes is amended to read:

153.05 (8) (a) Unless sub. (13) applies, subject to s. 153.455, the department 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, 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 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.

228,27 Section 27. 153.05 (8) (c) of the statutes is created to read:

153.05 (8) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request, analyze, and publicly report, in language that is understandable to laypersons, health care claims information, as adjusted for case mix and severity, from insurers and administrators. Data from these sources may be obtained through sampling techniques in lieu of collection of data on all insureds, and data collection procedures shall minimize unnecessary duplication and administrative burdens. If s. 153.455 (4) applies, the department may request health care claims information, which may be voluntarily provided by insurers and administrators, and may perform or contract for the performance of the other duties specified for the data organization under this paragraph.

228,28 Section 28. 153.05 (9) (a) of the statutes is amended to read:

153.05 (9) (a) The Subject to s. 153.455, 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.

228,29 Section 29. 153.05 (9) (c) of the statutes is created to read:

153.05 (9) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) shall provide orientation and training to insurers and administrators 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. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.

228,30 Section 30. 153.05 (12) (a) of the statutes is amended to read:

153.05 (12) (a) The Subject to s. 153.455, the department shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the department.

228,31 Section 31. 153.05 (12) (c) of the statutes is created to read:

153.05 (12) (c) The data organization under contract under sub. (2r) shall, subject to s. 153.455 (1) to (3), to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the data organization. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.

228,32 Section 32. 153.07 of the statutes is repealed.

228,33 Section 33. 153.10 (1) of the statutes is amended to read:

153.10 (1) The Subject to s. 153.455, 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. If s. 153.455 (4) applies, the department shall include in the reports under this subsection reports concerning any health care claims information the department collects or contracts to collect under s. 153.05.

228,34 Section 34. 153.22 (1) of the statutes is renumbered 153.22.

228,35 Section 35. 153.45 (intro.) of the statutes is created to read:

153.45 (intro.) Subject to s. 153.455:

228,36 Section 36 . 153.45 (1) (b) 9. of the statutes is amended to read:

153.45 (1) (b) 9. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center, if the independent review board department first reviews and approves the release or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release.

228,37 Section 37. 153.45 (1) (b) 11. of the statutes is amended to read:

153.45 (1) (b) 11. Information other than patient-identifiable data, as defined in s. 153.50 (1) (b), as approved by the independent review board department.

228,38 Section 38. 153.45 (1) (c) (intro.) of the statutes is amended to read:

153.45 (1) (c) (intro.) Custom-designed reports containing portions of the data under par. (b). Of information submitted by health care providers that are not hospitals or ambulatory surgery centers, requests under this paragraph for data elements other than those available for public use data files under par. (b), including the patient's month and year of birth, require review and approval by the independent review board before the data elements may be released. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center may be released only if the independent review board department first reviews and approves the release or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release. Reports under this paragraph may include the patient's zip code only if at least one of the following applies:

228,39 Section 39. 153.45 (6) of the statutes is repealed.

228,40 Section 40. 153.455 of the statutes is created to read:

153.455 Data organization; contract contingency. (1) Except as provided in subs. (2), (3), and (4), beginning on the date, if any, that is 60 days after the contract under s. 153.05 (2r) takes effect, the department shall cease collecting, for calendar quarters that occur after that date, health care information as specified under s. HFS 120.14 (1), 2005 Wis. Adm. Code, in effect on the effective date of this subsection .... [revisor inserts date].

(2) Subsection (1) does not apply to ss. 153.21 (1) and 153.60 (1).

(3) Beginning on the date, if any, that the secretary of health and family services and the secretary of employee trust funds determine that the data organization is not in compliance with the contract under s. 153.05 (2r) with respect to the performance of the collection and public reporting of information regarding the cost, quality, and effectiveness of health care, including the development and maintenance of a centralized data repository, or determine that there is insufficient statewide participation under the requirements of the contract, the secretaries may modify or terminate the contract. If the secretaries terminate the contract, they shall 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 required of the data organization under the terminated contract. If no organization responds to the request for proposals or if a successor contract cannot be achieved, sub. (4) applies.

(4) If the contract with the data organization is terminated under sub. (3) and no organization responds to the request for proposals or a successor contract cannot be achieved, the department, in its capacity as a public health authority, shall collect health care information, including as specified under s. HFS 120.14 (1), Wis. Adm. Code, in effect on the effective date of this subsection .... [revisors inserts date], and may request health care claims information, which may be voluntarily provided by insurers or administrators, under this chapter; shall analyze and disseminate, or contract for the performance of analysis and dissemination of, the health care information; and may analyze and disseminate, or may contract for the performance of analysis and dissemination of, the health care claims information.

228,41 Section 41. 153.50 (intro.) of the statutes is created to read:

153.50 (intro.) Subject to s. 153.455:

228,42 Section 42. 153.50 (1) (b) 1m. of the statutes is created to read:

153.50 (1) (b) 1m. "Patient-identifiable data" does not include calculated variables that are derived from patient-identifiable data and the dissemination of which does not permit patient identification.

228,43 Section 43. 153.50 (1) (b) 2. (intro.) of the statutes is amended to read:

153.50 (1) (b) 2. (intro.) "Patient-identifiable data", for information submitted by health care providers who are not hospitals or ambulatory surgery centers and by insurers and administrators, means all of the following data elements:

228,44 Section 44. 153.50 (3) (intro.) of the statutes is amended to read:

153.50 (3) Measures to ensure protection of patient identity. (intro.) To ensure that the identity of patients is protected when information obtained by the department or, by the entity under contract under s. 153.05 (2m) (a), or by the data organization under contract under s. 153.05 (2r) is disseminated, the department and, the entity, and the data organization shall do all of the following:

228,45 Section 45. 153.50 (3) (a) of the statutes is amended to read:

153.50 (3) (a) Aggregate any data element category containing small numbers. The department, in so doing, shall use procedures that are developed by the department and approved by the board and that follow commonly accepted statistical methodology.

228,46 Section 46. 153.50 (3) (b) (intro.) of the statutes is amended to read:

153.50 (3) (b) (intro.) Remove and destroy all of the following data elements on the uniform patient billing forms that are received by the department or by, the entity, or the data organization under the requirements of this chapter:

228,47 Section 47. 153.50 (3) (d) of the statutes is amended to read:

153.50 (3) (d) Require that a purchaser of data under this chapter sign and have notarized the data use agreement of the department or of, the entity specified in par. (c), or the data organization, as applicable.

228,48 Section 48. 153.50 (3m) of the statutes is amended to read:

153.50 (3m) Health care provider Provider, administrator, or insurer measures to ensure patient identity protection. A health care provider that is not a hospital or ambulatory surgery center or an insurer or an administrator shall, before submitting information required by the department, or by the data organization under contract under s. 153.05 (2r), under this chapter, convert to a payer category code as specified by the department or the data organization, as applicable, any names of an insured's payer or other insured's payer.

228,49 Section 49. 153.50 (4) (a) (intro.) of the statutes is amended to read: