DHS 120.15(2)(b)10.
10. Participation in health maintenance organizations, preferred provider organizations and independent practice arrangements.
DHS 120.15(2)(c)
(c) If the data specified in
par. (b) is not available from the department of safety and professional services, or is not available for the desired time interval or in the required format, the department shall require the health care provider to submit that information directly to the department or its designee in a format prescribed by the department.
DHS 120.15(2)(d)
(d) The department shall consult with each applicable health care provider group specified in
sub. (1), through a technical advisory committee or trade association, before the department collects data directly from members of that health care provider group.
DHS 120.15(3)(a)(a) The department shall require that information specified in
sub. (2) be submitted to the department at least once every 3 years according to a schedule developed by the department. The department may require that the requested information be submitted on an annual or biennial basis according to a schedule developed by the department.
DHS 120.15(3)(b)
(b) The department may grant an extension of a deadline specified in
par. (a) for submission of health care provider information only when the health care provider adequately justifies to the department the health care provider's need for additional time. In this paragraph, “adequate justification" means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A health care provider desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days. Health care providers who have been granted an extension by the department shall submit their data directly to the department.
DHS 120.15 Note
Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.
DHS 120.15(4)
(4) Data verification, review and comment procedures. Health care providers specified in
sub. (1) shall verify or correct information contained on their survey. The department shall verify questionable data by contacting the applicable health care provider.
DHS 120.15(5)
(5) Data adjustment methods. There shall be no adjustment methods for data submitted under this section.
DHS 120.15(6)
(6) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.
DHS 120.15 Note
Note: With the exception of s.
DHS 120.15, under s.
153.78 (2), Stats., and s.
DHS 120.10 (3) (b), the department may assess fines on health care providers that do not submit the data specified in this subchapter on a timely basis. Health care providers may be subject to a fine of $100 per day per type of data that has not been submitted to the Department under this subchapter.
DHS 120.15 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01;
correction in (2) (c) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674. DHS 120.16
DHS 120.16 Data to be submitted by health care plans. DHS 120.16(1)(1)
Applicability. This section applies to health care plans that either voluntarily submit health care plan data directly to the department or submit it to the department through the data collection of other state agencies.
DHS 120.16(2)
(2) Data to be collected. The department shall collect all of the following types of data from each participating health care plan or through a designated state agency:
DHS 120.16(2)(a)
(a)
Financial data. Information regarding the financial status of the health care plan secured under the authority of the commissioner of insurance.
DHS 120.16(2)(b)
(b)
Market conduct. Information regarding the conduct of the health care plan in the marketplace secured under the authority of the commissioner of insurance.
DHS 120.16(2)(c)
(c)
Quality indicators. Measures of quality of care provided by the health care plan from the office of the commissioner of insurance.
DHS 120.16 Note
Note: Quality indicators include Health Plan Employer Data and Information (HEDIS) measures and Consumer Assessment of Health Plans (CAHPS) patient satisfaction measures.
DHS 120.16(2)(d)
(d)
Grievances and complaints data. Measures of grievances and complaints filed by enrollees of the health care plan from the office of the commissioner of insurance and the department of employee trust funds.
DHS 120.16(3)
(3) Data submission procedures. State agencies specified in
sub. (2) shall forward to the department information specified in
sub. (2) in electronic files on an annual basis. The information shall be in a format that has been agreed upon by the department and the state agencies.
DHS 120.16(4)
(4) Data verification, review and comment procedures. Each of the state agencies specified in
sub. (2) shall verify that the information provided to the department has been reviewed and meets the agency's standards for release to the public.
DHS 120.16(5)
(5) Data adjustment methods. The department shall include caveats regarding the information the department releases to the public, when needed, to assist consumers in understanding the differences in populations served by the health care plans. Caveats may include references to large populations, such as commercial, medical assistance or medicare populations.
DHS 120.16 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01.
DHS 120.20(1)
(1)
Standard reports. The department shall prepare the paper reports listed in this subsection and shall make these paper reports available to the public at a charge that meets the department's cost of printing, copying and mailing a report to the requester. The department shall make electronic copies of the reports available from the department's website at no charge.
DHS 120.20(2)
(2) Prohibition on early release of reports. If the department releases drafts of any of the standard reports to health care providers for comment, health care providers or subsequent holders of the drafts may not release these reports or data elements from the reports.
DHS 120.20(3)(a)(a) Except as prohibited under
par. (b), the data used to compile the reports under this chapter are not subject to inspection, copying or receipt as specified in the open records provisions under s.
19.35 (1), Stats. When the department completes the reports and distributes them to the governor and legislature the reports shall be publicly available.
DHS 120.20 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01;
CR 03-033: am. (3) (b)
Register December 2003 No. 576, eff. 1-1-04.
DHS 120.21
DHS 120.21 Guide to Wisconsin hospitals. DHS 120.21(1)
(1)
Data sources. The guide to Wisconsin hospitals shall be based on data derived from all of the following sources:
DHS 120.21(2)(a)(a)
General. The guide to Wisconsin hospitals shall present descriptive financial, utilization and staffing information about individual Wisconsin hospitals, as well as summary and trend information for selected aggregate data.
DHS 120.21(2)(b)
(b)
Hospital information. The guide shall present and interpret all of the following information for all Wisconsin hospitals individually and in the aggregate:
DHS 120.21(2)(c)
(c) Explanatory information. In addition to the information specified under
par. (a), the guide shall present all of the following information:
DHS 120.21(2)(c)2.
2. Caveats, data limitations and technical notes associated with the guide.
DHS 120.21(3)
(3) Report dissemination. The department shall distribute the paper version of the report at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper version of the report available for purchase by others. The department shall make available from the department's website an electronic version of the report at no charge.
DHS 120.21(4)
(4) Suggested uses of report. The guide may be used in a variety of ways. Examples of how to use the guide include all of the following:
DHS 120.21(4)(a)
(a) As a tool to evaluate the fiscal health and operating efficiency of hospitals in Wisconsin.
DHS 120.21(4)(b)
(b) In conjunction with other department data on hospital inpatient discharges and ambulatory surgeries, to evaluate levels of reimbursement or coverage provisions.
DHS 120.21(4)(c)
(c) In conjunction with other information, to determine patterns of hospital service availability statewide. Service availability patterns, in turn, can help policy-makers and others identify mechanisms that may enhance service accessibility and availability, such as targeting reimbursement incentives or establishing new or additional health service programs.
DHS 120.21(4)(d)
(d) As a resource document for persons wishing to conduct research or collect information on hospital utilization, services and finances.
DHS 120.21 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01;
CR 03-033: am. (1) (a)
Register December 2003 No. 576, eff. 1-1-04.
DHS 120.22
DHS 120.22 Utilization, charge and quality reports. DHS 120.22(1)(1)
Data sources. The utilization, charge and quality reports shall be based on four broad types of data:
DHS 120.22(1)(a)
(a) Facility-level data derived from all of the following sources:
DHS 120.22(1)(c)
(c) Patient information derived from billing forms submitted by health care providers. Patient information may include any data element contained in billing forms except those that might allow a patient to be identified. Data elements include patient age, gender, county, diagnoses, procedures, charges and expected payer. Hospital data elements also include source and type of admission and discharge status.
DHS 120.22(1)(d)
(d) Information collected from the department of safety and professional services regarding practices, specialties, education and licensing, certification and credential revocation and suspension information of individual health care providers licensed to practice in Wisconsin.
DHS 120.22(2)
(2) Contents. The utilization, charge and quality reports summarize utilization, charge and quality data on patients treated by health care providers in Wisconsin during the most recent calendar year. The report contains information on services provided to hospital inpatients, the primary reasons for hospitalization, length of stay, expected pay source, discharge status, volume of procedures, charges for services received, and the most common diagnostic conditions. The report also contains selected utilization, charge and quality indicators for individual hospitals and makes comparisons to previous year data, thereby assisting readers in understanding where changes are occurring. The report devoted to outpatient data contains utilization and charge data for patients undergoing selected surgical procedures at hospitals, freestanding ambulatory surgery centers and physician's offices. The section of the report devoted to emergency department data contains utilization and charge data for patients in emergency departments at hospitals. Some of the specific contents of the reports include the following topics:
DHS 120.22(2)(a)
(a) A summary of patient-related data and how that data compares to similar data from the previous year.
DHS 120.22(2)(b)
(b) A reader's guide to the report's data containing an explanation of data sources, terms, concepts and data limitations.
