(b) Remove and destroy all of the following data elements on the uniform patient billing forms that are received by the department under the requirements of this chapter:
1. The patient's name and street address.
2. The insured's name, address and telephone number.
3. Any other insured's name, employer name and date of birth.
4. The signature of the patient or other authorized signature.
5. The signature of the insured or other authorized signature.
6. The signature of the physician.
(4) Release of patient-identifiable data. Under the procedures specified in sub. (5), release of patient-identifiable data may be made to any of the following:
(a) The patient or a person granted permission in writing by the patient for release of the patient's patient-identifiable data.
(b) An agent of the department who is responsible for the patient-identifiable data in the department, in order to store the data and ensure the accuracy of the information in the data base of the department.
(c) A health care provider or the agent of a health care provider, to ensure the accuracy of the information in the data base of the department.
(d) The department, for purposes of epidemiological investigation or to eliminate the need for duplicative data bases.
(e) An entity that is required by federal or state statute to obtain patient-identifiable data for purposes of epidemiological investigation or to eliminate the need for duplicative data bases.
(5) Procedures for release of patient-identifiable data. (a) The department may not release or provide access to patient-identifiable data to a person authorized under sub. (4) (a), (c), (d) or (e) unless the authorized person requests the department, in writing, to release the patient-identifiable data. The request shall include all of the following:
1. The requester's name and address.
2. The reason for the request.
3. For a person who is authorized under sub. (4) (a), (c) or (d) to receive or have access to patient-identifiable data, evidence, in writing, that indicates that authorization.
4. For an entity that is authorized under sub. (4) (e) to receive or have access to patient-identifiable data, evidence, in writing, of all of the following:
a. The federal or state statutory requirement to obtain the patient-identifiable data.
b. Any federal or state statutory requirement to uphold the patient confidentiality provisions of this chapter or patient confidentiality provisions that are more restrictive than those of this chapter; or, if the latter evidence is inapplicable, an agreement, in writing, to uphold the patient confidentiality provisions of this chapter.
(b) Upon receipt of a request under par. (a), the department shall, as soon as practicable, comply with the request or notify the requester, in writing, of all of the following:
1. That the department is denying the request in whole or in part.
2. The reason for the denial.
3. For a person who believes that he or she is authorized under sub. (4), the action provided under s. 19.37.
(6) Information submitted. The department may not require a health care provider submitting health care information under this chapter to include the patient's name, street address or social security number.
231,48r
Section 48r. 153.55 of the statutes is created to read:
153.55 Protection of health care provider confidentiality. Health care provider-identifiable data obtained under this chapter is not subject to inspection, copying or receipt under s. 19.35 (1).
231,49
Section 49
. 153.60 (1) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.60 (1) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures under this chapter for the department and the board for that fiscal year for data collection, data base development and maintenance, generation of data files and standard reports, orientation and training provided under s. 153.05 (9) and maintaining the board. The department shall assess the estimated total amount for that fiscal year less the estimated total amount to be received for purposes of administration of this chapter under s. 20.435 (1) (hi) during the fiscal year and the unencumbered balance of the amount received for purposes of administration of this chapter under s. 20.435 (1) (hi) from the prior fiscal year, to hospitals in proportion to each hospital's respective gross private-pay patient revenues during the hospital's most recently concluded entire fiscal year health care providers who are in a class of health care providers from whom the department collects data under this chapter in a manner specified by the department by rule. The department shall obtain approval from the board for the amounts of assessments for health care providers other than hospitals and ambulatory surgery centers. The department shall work together with the department of regulation and licensing to develop a mechanism for collecting assessments from health care providers other than hospitals and ambulatory surgery centers. No health care provider that is not a facility may be assessed under this subsection an amount that exceeds $75 per fiscal year. Each
hospital health care provider shall pay the assessment on or before December 1. All payments of assessments shall be deposited in the appropriation under s. 20.435 (1) (hg).
231,50
Section 50
. 153.60 (2) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.
231,51
Section 51
. 153.60 (3) of the statutes is created to read:
153.60 (3) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures required for the collection, database development and maintenance and generation of public data files and standard reports for health care plans that voluntarily agree to supply health care data under s. 153.05 (6r). The department shall assess the estimated total amount for that fiscal year to health care plans in a manner specified by the department by rule and may enter into an agreement with the office of the commissioner of insurance for collection of the assessments. Each health plan that voluntarily agrees to supply this information shall pay the assessments on or before December 1. All payments of assessments shall be deposited in the appropriation under s. 20.435 (1) (hg) and may be used solely for the purposes of s. 153.05 (6r).
231,52
Section 52
. 153.65 of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.65 Provision of special information; user fees. The department may, but is not required to, provide, upon request from a person, a data compilation or a special report based on the information collected by the department under s. 153.05 (1), (3), (4) (b), (5), (7) or (8) or 153.08. The department shall establish user fees for the provision of these compilations or reports, payable by the requester, which shall be sufficient to fund the actual necessary and direct cost of the compilation or report. All moneys collected under this section shall be credited to the appropriation under s. 20.435 (1) (hi).
231,53
Section 53
. 153.75 (1) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.75 (1) (b) Establishing procedures under which hospitals and health care providers are permitted to review and, verify patient-related and comment on information prior to its submission to the department
and include the comments with the information.
231,54
Section 54
. 153.75 (1) (c), (d), (e), (i) and (j) of the statutes are repealed.
231,55
Section 55
. 153.75 (1) (f), (k) and (L) of the statutes are amended to read:
153.75 (1) (f) Governing the release of physician-specific health care provider-specific and employer-specific data under s. 153.45 (1m) and (3).
(k) Establishing methods and criteria for assessing hospitals and ambulatory surgery centers health care providers under s. 153.60 (1).
(L) Defining the term “uncompensated health care services" for the purposes of ss. 153.05 (1) (d) and
s. 153.20.
231,56
Section 56
. 153.75 (1) (m), (n), (o), (p), (q), (r), (s), (t) and (u) of the statutes are created to read:
153.75 (1) (m) Specifying the classes of health care providers from whom claims data and other health care information will be collected.
(n) Specifying the uniform data set of health care information, as adjusted for case mix and severity, to be collected.
(o) Specifying the means by which the information in par. (b) will be collected, including the procedures for submission of data by electronic means.
(p) Specifying the methods for using and disseminating health care data in order for health care providers to provide health care that is effective and economically efficient and for consumers and purchasers to make informed decisions in selecting health care plans and health care providers.
(q) Specifying the information to be provided in the consumer guide under s. 153.21.
(r) Specifying the standard reports that will be issued by the department in addition to those required in ss. 153.20 and 153.21.
(s) Defining “individual data elements" for purposes of s. 153.45 (4).
(t) Establishing standards for determining under s. 153.05 (13) if a requirement under s. 153.05 (1), (5) or (8) is burdensome for a health care provider.
(u) Specifying the methods for adjusting health care information for case mix and severity.
231,57
Section 57
. 153.75 (2) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:
153.75 (2) (intro.) With the
Following approval of by the board, the department may promulgate all of the following rules:
231,58
Section 58
. 153.75 (2) (b) of the statutes is repealed.
231,59
Section 59
. 153.75 (2) (d) of the statutes is created to read:
153.75 (2) (d) Specifying the information collected under any voluntary system of health care plan reporting under s. 153.05 (6r) and the methods and criteria for assessing health care plans that submit data under that subsection.
231,60
Section 60
. 153.90 (1) and (2) of the statutes are amended to read:
153.90 (1) Whoever intentionally violates s.
153.45 (5) or 153.50 or rules promulgated under s. 153.75 (1) (a) may be fined not more than $10,000 or imprisoned for not more than 9 months or both.
(2) Any person who violates this chapter or any rule promulgated under the authority of this chapter, except ss. 153.45 (5), 153.50 and 153.75 (1) (a), as provided in s. 153.85 and sub. (1), shall forfeit not more than $100 for each violation. Each day of violation constitutes a separate offense, except that no day in the period between the date on which a request for a hearing is filed under s. 227.44 and the date of the conclusion of all administrative and judicial proceedings arising out of a decision under this section constitutes a violation.
231,60g
Section 60g. 227.01 (13) (yt) of the statutes is created to read:
227.01 (13) (yt) Relates to the amounts of assessments that are made under s. 153.60 (1) for health care providers.
231,60r
Section 60r. 440.03 (11m) of the statutes is created to read:
440.03 (11m) The department shall work together with the department of health and family services to develop a mechanism for collecting assessments under s. 153.60 (1) from health care providers other than hospitals and ambulatory surgery centers.
231,61
Section 61
. 610.70 of the statutes is created to read:
610.70 Disclosure of personal medical information. (1) Definitions. In this section:
(a) “Health care provider" means any person licensed, registered, permitted or certified by the department of health and family services or the department of regulation and licensing to provide health care services, items or supplies in this state.
(b) “Individual" means a natural person who is a resident of this state. For purposes of this paragraph, a person is a state resident if his or her last-known mailing address, according to the records of an insurer or insurance support organization, was in this state.
(c) 1. “Insurance support organization" means any person that regularly engages in assembling or collecting personal medical information about natural persons for the primary purpose of providing the personal medical information to insurers for insurance transactions, including the collection of personal medical information from insurers and other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity.
2. Notwithstanding subd. 1., “insurance support organization" does not include insurance agents, government institutions, insurers or health care providers.
(d) “Insurance transaction" means any of the following involving insurance that is primarily for personal, family or household needs:
1. The determination of an individual's eligibility for an insurance coverage, benefit or payment.
2. The servicing of an insurance application, policy, contract or certificate.
(e) “Medical care institution" means a facility, as defined in s. 647.01 (4), or any hospital, nursing home, community-based residential facility, county home, county infirmary, county hospital, county mental health center, tuberculosis sanatorium, adult family home, assisted living facility, rural medical center, hospice or other place licensed, certified or approved by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.90, 51.04, 51.08, 51.09, 58.06, 252.073 or 252.076 or a facility under s. 45.365, 51.05, 51.06 or 252.10 or under ch. 233 or licensed or certified by a county department under s. 50.032 or 50.033.
(f) 1. “Personal medical information" means information concerning an individual that satisfies all of the following:
a. Relates to the individual's physical or mental health, medical history or medical treatment.
b. Is obtained from a health care provider, a medical care institution, the individual or the individual's spouse, parent or legal guardian.
2. “Personal medical information" does not include information that is obtained from the public records of a governmental authority and that is maintained by an insurer or its representatives for the purpose of insuring title to real property located in this state.
(2) Disclosure authorization. (a) Any form that is used in connection with an insurance transaction and that authorizes the disclosure of personal medical information about an individual to an insurer shall comply with all of the following:
1. All instructions and other information contained in the form are presented in plain language.
2. The form is dated.
3. The form specifies the types of persons that are authorized to disclose information about the individual.
4. The form specifies the nature of the information that is authorized to be disclosed.
5. The form names the insurer, and identifies by generic reference representatives of the insurer, to whom the information is authorized to be disclosed.
6. The form specifies the purposes for which the information is being obtained.
7. Subject to par. (b), the form specifies the length of time for which the authorization remains valid.
8. The form advises that the individual, or an authorized representative of the individual, is entitled to receive a copy of the completed authorization form.
(b) 1. For an authorization under this subsection that will be used for the purpose of obtaining information in connection with an insurance policy application, an insurance policy reinstatement or a request for a change in policy benefits, the length of time specified in par. (a) 7. may not exceed 30 months from the date on which the authorization is signed.
2. For an authorization under this subsection that will be used for the purpose of obtaining information in connection with a claim for benefits under an insurance policy, the length of time specified in par. (a) 7. may not exceed the policy term or the pendency of a claim for benefits under the policy, whichever is longer.
(3) Access to recorded personal medical information. (a) If, after proper identification, an individual or an authorized representative of an individual submits a written request to an insurer for access to recorded personal medical information that concerns the individual and that is in the insurer's possession, within 30 business days after receiving the request the insurer shall do all of the following:
