153.05(5)(c)
(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.
153.05(6)
(6) The department may contract with a public or private 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).
153.05(6m)
(6m) The department may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employees. The department shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under
s. 20.435 (1) (hg).
153.05(8)(a)(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.
153.05(8)(b)
(b) Unless
sub. (13) 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.
153.05(8)(c)
(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.
153.05(9)(a)(a) 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.
153.05(9)(b)
(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.
153.05(9)(c)
(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.
153.05(12)(a)(a) 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.
153.05(12)(b)
(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.
153.05(12)(c)
(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.
153.05(13)
(13) The department may waive the requirement under
sub. (1),
(5) or
(8) for a health care provider, who requests the waiver and presents evidence to the department that the requirement under
sub. (1),
(5) or
(8) is burdensome, under standards established by the department by rule. The department shall develop a form for use by a health care provider in submitting a request under this subsection.
153.05 Cross-reference
Cross Reference: See also ch.
DHS 120, Wis. adm. code.
153.08
153.08
Hospital rate increases or charges in excess of rates. 153.08(1)(b)
(b) Notwithstanding
s. 153.01 (5), "hospital" has the meaning given in
s. 50.33 (2), except that "hospital" does not include a center for the developmentally disabled as defined in
s. 51.01 (3).
153.08(1)(c)
(c) "Rates" means individual charges of a hospital for the services that it provides.
153.08(2)
(2) No hospital may increase its rates or charge any payer an amount exceeding its rates that are in effect on May 12, 1992, unless the hospital first causes to be published a class 1 notice under
ch. 985 in a newspaper likely to give notice in the area where the hospital is located, no sooner than 45 days and no later than 30 days before the proposed rate change is to take effect. The notice shall describe the proposed rate change.
153.08(3)
(3) This section does not apply to a hospital that proposes to increase its rates during the course of the hospital's fiscal year by any amount or amounts that, in the aggregate, do not exceed the percentage amount that is the percentage difference between the consumer price index reported for the 12-month period ending on December 31 of the preceding year and the consumer price index reported for the 12-month period ending on December 31 of the year prior to the preceding year.
153.08(4)
(4) A hospital shall publish a class 1 notice under
ch. 985 at least 10 days prior to the institution by the hospital of a rate increase.
153.08(5)
(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:
153.08(5)(a)
(a) For each hospital that publishes a notice under
sub. (4), all of the following:
153.08(5)(a)1.
1. The name of the hospital and the city, village, or town in which the hospital is located.
153.08(5)(a)3.
3. The annualized percentage rate increase that will result.
153.08(5)(a)4.
4. The geographic area of analysis in which the hospital is located.
153.08(5)(b)
(b) A list of hospitals that have closed since 1993.
153.10
153.10
Health care data reports. 153.10(1)
(1) 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.
153.10(2)
(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.
153.20
153.20
Uncompensated health care services report. 153.20(1)(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 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).
153.20(2)
(2) Every hospital shall file with the 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.
153.21(1)(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 and health care plans. The guide shall be written in language that is understandable to laypersons. The department shall widely publicize and distribute the guide to consumers.
153.21(2)
(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.
153.21 History
History: 1997 a. 231;
2003 a. 33.
153.22
153.22
Patient-level data utilization, charge, and quality report. 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.
153.22 History
History: 2003 a. 33;
2005 a. 228.
153.45
153.45
Release of data by department. Subject to
s. 153.455:
153.45(1)
(1) After completion of data verification, comment and review procedures specified by the department by rule, the department shall release data, together with comments, if any, in the following forms:
153.45(1)(b)
(b) For information that is submitted by health care providers other than 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; the use of calculated variables and aggregated variables; the specification of counties as to residence, rather than zip codes; the use of 5-year categories for age, rather than exact age; not releasing information concerning a patient's race, ethnicity, or dates of admission, discharge, procedures, or visits; and masking sensitive diagnoses and procedures by use of larger diagnostic and procedure categories. Public use data files under this paragraph may include only the following:
153.45(1)(b)6.
6. Charges assessed with respect to the procedure code.
153.45(1)(b)7.
7. The name and address of the facility in which the patient's services were rendered.
153.45(1)(b)9.
9. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center, if the department first reviews and approves the release.
153.45(1)(b)10.
10. Calendar quarters of service, except if the department specifies by rule that the number of data elements included in the public use data file is too small to enable protection of patient confidentiality.
153.45(1)(c)
(c) Custom-designed reports containing portions of the data under
par. (b). 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 department first reviews and approves the release. Reports under this paragraph may include the patient's zip code only if at least one of the following applies:
153.45(1)(c)1.
1. Other potentially identifying data elements are not released.
153.45(1)(c)2.
2. Population density is sufficient to mask patient identity.
153.45(1)(c)3.
3. Other potentially identifying data elements are grouped to provide population density sufficient to protect identity.
153.45(1)(c)4.
4. Multiple years of data elements are added to protect identity.
153.45(1m)
(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.
153.45(2)
(2) The department shall provide to other agencies or to organizations the data necessary to fulfill their statutory mandates for epidemiological purposes or to minimize the duplicate collection of similar data elements.
153.45(3)
(3) The department may, but is not required to, release health care provider-specific and employer-specific data that relates to health care providers other than hospitals and ambulatory surgery centers, except in public use data files as specified under
sub. (1) (b), in a manner that is specified in rules promulgated by the department.
153.45(4)
(4) The department shall prohibit purchasers of data from rereleasing individual data elements of health care data files.
153.45(5)
(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 information to a health care provider that is not a hospital or ambulatory surgery center, to whom the information is specific.
153.455
153.455
Data organization; contract contingency. 153.455(1)(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 April 13, 2006.
153.455(3)
(3) Beginning on the date, if any, that the secretary of health 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.
153.455(4)
(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 April 13, 2006, 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.
153.46
153.46
Release of data by entity. 153.46(1)
(1) After completion of data verification, comment, and review procedures, the entity under contract under
s. 153.05 (2m) (a) shall release data, together with comments, if any, in the following forms:
153.46(1)(b)
(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. 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.
153.46(1)(c)
(c) Custom-designed reports containing portions of the data under
par. (b). Reports under this paragraph may include the patient's zip code only if at least one of the following applies:
153.46(1)(c)1.
1. Other potentially identifying data elements are not released.
153.46(1)(c)2.
2. Population density is sufficient to mask patient identity.
153.46(1)(c)3.
3. Other potentially identifying data elements are grouped to provide population density sufficient to protect identity.
153.46(1)(c)4.
4. Multiple years of data elements are added to protect identity.
