Any act or omission of an employee, official or agent of the health care provider that results in the release of a prohibited data element while submitting data to the department.
Any act or omission of the department that results in the release of data.
The immunity provided under this subsection does not apply to intentional, willful or reckless acts or omissions by health care providers.
(4) Criminal penalties.
In accordance with s. 153.78 (1)
, Stats., whoever intentionally violates s. 153.45 (5)
, Stats., or rules related thereto under subchs. III
of this chapter may be fined not more than $15,000 or imprisoned for not more than one year in the county jail or both.
In accordance with s. 153.78 (2)
, Stats., whoever violates ch. 153, Stats.
, or this chapter, except as provided in par. (c)
, shall forfeit not more than $100 for each violation. Except as stated in s. 153.78 (2)
, Stats., each day of a violation for each individual type of data the department requires to be submitted constitutes a separate offense.
DHS 120.10(5)(b)1.1. `Forfeiture commencement and duration.'
The forfeiture begins on the date the health care provider was in violation, as determined by the department, and is computed for the number of days the health care provider is in violation until the date the health care provider achieves compliance, except that no day in the period between the date on which a request for a hearing is filed under s. 227.44
, Stats., and the date of the conclusion of all administrative and judicial proceedings arising out of a decision under this subsection constitutes a violation.
2. `Collection of forfeiture.'
The department may directly assess forfeitures. If the department determines that a forfeiture should be assessed for a particular violation or for failure to correct the violation, the department shall send a notice of assessment to the alleged violator containing all of the following information:
The total amount due or, if the violation is continuing at the time the notice is sent, a statement specifying how the alleged violator shall calculate the total amount due.
3. `Due date for payment of forfeitures.'
All forfeitures shall be paid to the department within 10 calendar days of receipt of notice of assessment or, if the forfeiture is contested under par. (c)
, within 10 calendar days of receipt of the final decision under administrative review, unless the final administrative decision is appealed and the order stayed by court order under s. 227.52
, Stats. Receipt of notice is presumed within 5 days of the date the notice was mailed. The department shall remit all forfeitures paid to the state treasurer for deposit in the school fund.
Appeals of forfeitures.
A health care provider may contest the department's assessment of a forfeiture by filing, within 10 calendar days after receipt of the department's notification of forfeiture assessment, a written request for hearing under s. 227.44
, Stats., with the department of administration's division of hearings and appeals created under s. 15.103 (1)
, Stats. A request is considered filed when the request is received by the division of hearings and appeals. The division of hearings and appeals shall hold the hearing and issue a decision, in proposed form, no later than 30 calendar days after receiving the request for hearing, unless both parties agree to a later date, and shall provide at least 10 calendar days prior notification of the date, time and place for the hearing. Both parties may file comments on the proposed decision with the division of hearings and appeals within 30 calendar days from the date of issuance of the proposed decision. At the close of the comment period, the division shall forward the proposed decision and comments to the secretary of the department for issuance of a final decision, and the secretary of the department shall issue the final decision within 30 calendar days thereafter.
DHS 120.10 Note
Note: A hearing request should be addressed to the Division of Hearings and Appeals, P.O. Box 7875, Madison, WI 53707, 608-266-3096. Hearing requests may be delivered in person to that office at 5005 University Ave., Room 201, Madison, WI.
Forfeitures for nonpayment of assessments.
A hospital or freestanding ambulatory surgery center that does not comply with s. DHS 120.04 (4) (b)
or health plan that does not comply with s. DHS 120.04 (4) (d)
is subject to a forfeiture of $25 for each day after December 31 that the assessment is not paid, subject to a maximum forfeiture equal to the amount of the assessment due or $500, whichever is greater. A forfeiture under this subdivision does not relieve the hospital, association or health care plan from the responsibility of paying the corresponding assessment.
DHS 120.10 History
Cr. Register, December, 2000, No. 540
, eff. 1-1-01; CR 01-051
: am. (1), Register, September 2001 No. 549
eff. 10-1-01; corrections in (2), (3) (a) (intro.), (4), (5) (a) made under s. 13.92 (4) (b) 7.
, Stats., Register January 2011 No. 661
DHS 120.11 Common data verification, review and comment procedures. DHS 120.11(2)
In this section, “facility" means hospitals and freestanding ambulatory surgery centers.
(3) Facility data verification, review and comment procedures. DHS 120.11(3)(a)(a)
Each facility shall review its collected data for accuracy and completeness before submitting the data to the department.
The department shall check the accuracy and completeness of all submitted data and record all questionable data based on standard edits or the electronic editing features of the department's data submission system.
If the department determines data submitted by the facility to be questionable, and the department has determined that the data cannot be verified or corrected by telephone or electronic means, the department may return the questionable data to the facility or the facility's qualified vendor with information for revision and resubmission.
Supply the department with the affirmation statement that was included with the data profile. The affirmation statement shall be signed by the chief executive officer or designee indicating that the facility's data are accurate and complete. Facilities submitting affirmation statements to the department electronically shall use the digital signature approved by the department and returned by the facility during the timeframes for data submission specified by the department. A signature on the electronic data affirmation statement represents the signatory's acknowledgement that the data is accurate to the best of his or her knowledge and that the data submitter may no longer submit revised data.
Failure to comply with subd. 1.
shall result in the facility being non-compliant with this subsection and the facility may be subject to forfeitures under this chapter.
After the department has made any revisions under par. (d)
in the data for a particular facility, the department shall send the facility all of the following:
If the department discovers data errors after the department's release of the data or if a facility representative notifies the department of data errors after the department's release of the data, the department shall note the data errors as caveats to the completed datasets.
(4) Physician verification, review and comment on facility-submitted data. DHS 120.11(4)(a)(a)
During the facility-submitted data verification, review and comment procedures described in sub. (3)
, the department shall give a physician the opportunity to concurrently review the facility-submitted data associated with the physician's license number.
The department shall notify each physician with a Wisconsin license number appearing in the facility-submitted data of the physician's opportunity to review that data.
The department shall notify each identified physician using the physician's last known address on file with the department of safety and professional services or information provided by the facility that may be more current.
An indication that the physician has 10 working days from the date the notice was sent to notify the department that the physician intends to review the requested data before the data is released.
A statement informing the physician that the department will not provide further notice of the physician's right to review if the physician chooses not to review the data at that time.
If a physician files a timely request to review data before release, the department shall make the data available to the physician as it is submitted to the department. The department's report shall contain a “permission to change" authorization form that may be duplicated in the event of multiple problems.
If the physician wants to dispute the data, the physician shall attest to the problem associated with the data on the authorization form, and an authorized representative of the facility shall indicate on the form if the facility agrees to the change.
The physician shall return the form to the department within 20 working days after the date on which the data were made available to the physician.
When the department receives the signed “permission to change" form, the department shall change the data within the facility dataset before its release.
If the facility does not agree to the physician's change, the physician may submit his or her written comments on the data to the department within the same 20 working days after the date of the department transmittal. The facility shall also submit its reason for concluding that the submitted data are correct within the same 20 working days. The department may not change the data submitted by the facility, but shall include both sets of comments with the data released to data requesters.
A physician desiring to comment on data he or she submits shall submit his or her comments in a standard electronic word processing format. Comments shall be limited to a maximum of 1000 words. All comments shall be submitted no later than the 20th
working day following the department's transmittal.
If the department receives comments from a physician after the release of data, the department shall retain the comments and provide them as part of the documentation released to future data requesters. The department shall note as caveats to the completed data the subsequent discovery of data errors by either the department or the data submitter after the release of data.
DHS 120.11 History
Cr. Register, December, 2000, No. 540
, eff. 1-1-01; CR 01-051
: am. (1) and (3) (d) 1., Register September 2001 No. 549
eff. 10-1-01; CR 03-033
: am. (3)
(c), (d) 1. (intro.), (4) (e) 1. and 2., r. (3) (f) Register December 2003 No. 576
, eff. 1-1-04; correction in (4) (c) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674.
DHS 120.12 Data to be submitted by hospitals. DHS 120.12(1)(a)(a)
Data to be collected.
Hospitals shall provide all of the following data:
A set of definitions describing terms used by the hospital throughout the uncompensated health care plan.
The procedures the hospital uses to determine a patient's ability to pay for health care services received and to verify financial information from the patient.
The hospital's means of informing the public about charity care available at that hospital and a description of the procedure for obtaining the care.
The amount of any state loan funds, excluding fund proceeds from the Wisconsin health and educational facilities authority, outstanding with a continuing obligation during the previous year.
Every hospital shall annually file with the department within 120 calendar days following the close of the hospital's fiscal year the plan required under par. (a)
DHS 120.12 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.
The department may grant an extension of a deadline specified under subd. 1.
only when the hospital adequately justifies to the department the hospital's need for additional time. In this subdivision, “adequate justification" means a delay due to a strike, fire, natural disaster or delay due to catastrophic computer failure. A hospital desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days before the date the data are due. The department may grant an extension for up to 30 calendar days.
Each hospital shall review the plan for accuracy and completeness prior to submitting the plan to the department.
The department shall notify a hospital if the plan or any elements of the plan appear to contain questionable data.
The hospital shall either verify the accuracy of the plan or send a corrected plan to the department within 10 working days from the date the department notified the hospital of the questionable data.
Within the same 10-working day period under subd. 3.
, the chief executive officer or designee of each hospital shall submit to the department a signed affirmation statement.
Hospitals submitting affirmation statements to the department electronically shall use a digital signature approved by the department and returned by the hospital during the timeframes for data submission specified by the department. A signature on the electronic data affirmation statement represents the signatory's acknowledgment that the data is accurate and the data submitter may no longer submit revised data.
If the department discovers data errors after the department's release of the data or if a hospital representative notifies the department of data errors after the department's release of the data, the department shall note the data errors as caveats to the completed datasets.
Data adjustment methods.
There shall be no adjustment methods for uncompensated health care services report data submitted by hospitals.
Waiver from data submission requirements.
There shall be no waivers from the data submission requirements under this subsection.
DHS 120.12(2)(b)1.1. `General hospital data.'
Hospitals shall report all of the following financial data to the department in the format specified by the department, in accordance with this subsection and department instructions that are based on guidelines from the 2003 update of the Health Care Organizations — AICPA Audit and Accounting Guide,
published by the American institute of certified public accountants, generally accepted accounting principles and the national annual survey of hospitals conducted by the American hospital association.
Gross revenue the hospital derives from services it provides to patients and the sources of that revenue.
Deductions from gross revenue the hospital derives from services it provides to patients and the sources of that revenue, including contractual adjustments, charity care and other noncontractual deductions.