DHS 120.09(3)(b)4.
4. The total anticipated amount of the price increase, expressed as an annualized percentage.
DHS 120.09(3)(b)6.
6. The effective date of the hospital's last reportable price increase and the amount of that increase, expressed as an annualized percentage.
DHS 120.09(3)(b)6m.
6m. The effective date of any other reported price increases within one year prior to the increase in
subd. 6. and the amount of each increase, expressed as an annualized percentage.
DHS 120.09(3)(b)7.
7. The name of each charge element listed in table DHS 120.09 for which the hospital proposes to increase the price. A hospital may, but need not, include any charge element for which no price increase is proposed. For each charge element listed, the hospital shall include all of the following information, formatted as follows:
Table DHS 120.09
HOSPITAL CHARGE ELEMENTS
ROOM AND BOARD – PRIVATE
General classification
Medical/surgical/gynecology
Obstetric
Pediatric
Psychiatric
Hospice
Detoxification
Oncology
Other
ROOM AND BOARD – SEMIPRIVATE TWO BED
General classification
Medical/surgical/gynecology
Obstetric
Pediatric
Psychiatric
Hospice
Detoxification
Oncology
Other
NURSERY
General classification
Newborn
Premature
Neonatal intensive care unit
Other
INTENSIVE CARE
General classification
Surgical
Medical
Pediatric
Psychiatric
Post-intensive care unit
Burn care
Trauma
Other
CORONARY CARE
General classification
Myocardial infarction
INCREMENTAL NURSING CHARGE RATE
General classification
Nursery
Intensive care
Coronary care
OTHER IMAGING SERVICES
Mammography, excluding physician fees
EMERGENCY ROOM
General classification – based on highest volume, excluding physician fees
LABOR ROOM/DELIVERY
General classification
Labor
Delivery
Circumcision
Birthing center
Other
PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS
General classification
Electroshock treatment
Milieu therapy
Play therapy
Other
PSYCHIATRIC/PSYCHOLOGICAL SERVICES
General classification
Rehabilitation
Day care
Night care
Individual therapy
Group therapy
Family therapy
Biofeedback
Testing
Other
DHS 120.09(4)
(4) Affidavit of publication. A hospital that publishes any notice under
sub. (3) shall require the newspaper in which the notice is published to furnish the hospital with an affidavit of publication attached to a copy of the notice clipped from the paper. The affidavit shall state the name of the newspaper and the date of publication and shall be signed by the editor, publisher, owner or designee of the editor, publisher or owner. Within 14 calendar days after the hospital receives the affidavit of publication, the hospital shall transmit to the department the affidavit and the notice clipped from the newspaper attached.
DHS 120.09 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 120.09 History
History: Cr.
Register, December, 2000, No. 540, eff. 1-1-01;
CR 01-051: cr. (3) (a) 6m.,
Register September 2001 No. 549 eff. 10-1-01.
