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. 153.75 (1) (c), (d), (e), (i) and (j) of the statutes are repealed.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:
1. Inform the individual or authorized representative of the nature and substance of the recorded personal medical information in writing, by telephone or by any other means of communication at the discretion of the insurer.
2. At the option of the individual or authorized representative, permit the individual or authorized representative to inspect and copy the recorded personal medical information, in person and during the insurer's normal business hours, or provide by mail to the individual or authorized representative a copy of the recorded personal medical information. If the recorded personal medical information is in coded form, the insurer shall provide to the individual or authorized representative an accurate written translation in plain language.
3. Disclose to the individual or authorized representative the identities, if recorded, of any persons to whom the insurer has disclosed the recorded personal medical information within 2 years prior to the request. If the identities are not recorded, the insurer shall disclose to the individual or authorized representative the names of any insurance agents, insurance support organizations or other entities to whom such information is normally disclosed.
4. Provide to the individual or authorized representative a summary of the procedures by which the individual or authorized representative may request the correction, amendment or deletion of any recorded personal medical information in the possession of the insurer.
(b) Notwithstanding par. (a), an insurer may, in the insurer's discretion, provide a copy of any recorded personal medical information requested by an individual or authorized representative under par. (a) to a health care provider who is designated by the individual or authorized representative and who is licensed, registered, permitted or certified to provide health care services with respect to the condition to which the information relates. If the insurer chooses to provide the information to the designated health care provider under this paragraph, the insurer shall notify the individual or authorized representative, at the time of disclosure, that the information has been provided to the health care provider.
(c) An insurer is required to comply with par. (a) or (b) only if the individual or authorized representative provides a reasonable description of the information that is the subject of the request and if the information is reasonably easy to locate and retrieve by the insurer.
(d) If an insurer receives personal medical information from a health care provider or a medical care institution with instructions restricting disclosure of the information under s. 51.30 (4) (d) 1. to the individual to whom the information relates, the insurer may not disclose the personal medical information to the individual under this subsection, but shall disclose to the individual the identity of the health care provider or a medical care institution that provided the information.
(e) Any copy of recorded personal medical information provided under par. (a) or (b) shall include the identity of the source of the information if the source is a health care provider or a medical care institution.
(f) An insurer may charge the individual a reasonable fee to cover the costs incurred in providing a copy of recorded personal medical information under par. (a) or (b).
(g) The requirements for an insurer under this subsection may be satisfied by another insurer, an insurance agent, an insurance support organization or any other entity authorized by the insurer to act on its behalf.
(h) The requirements under this subsection do not apply to information concerning an individual that relates to, and that is collected in connection with or in reasonable anticipation of, a claim or civil or criminal proceeding involving the individual.
(4) Correction, amendment or deletion of recorded personal medical information. (a) Within 30 business days after receiving a written request from an individual to correct, amend or delete any recorded personal medical information that is in the insurer's possession, an insurer shall do either of the following:
1. Comply with the request.
2. Notify the individual of all of the following:
a. That the insurer refuses to comply with the request.
b. The reasons for the refusal.
c. That the individual has a right to file a statement as provided in par. (c).
(b) An insurer that complies with a request under par. (a) shall notify the individual of that compliance in writing and furnish the correction, amendment or fact of deletion to all of the following:
1. Any person who may have received, within the preceding 2 years, the recorded personal medical information concerning the individual and who is specifically designated by the individual.
2. Any insurance support organization for which insurers are the primary source of personal medical information and to which the insurer, within the preceding 7 years, has systematically provided recorded personal medical information. This subdivision does not apply to an insurance support organization that does not maintain recorded personal medical information concerning the individual.
3. Any insurance support organization that furnished to the insurer the personal medical information that has been corrected, amended or deleted.
(c) If an insurer refuses to comply with a request under par. (a) 1., the individual making the request may file with the insurer, an insurance agent or an insurance support organization any of the following:
1. A concise statement setting forth the information that the individual believes to be correct, relevant or fair.
2. A concise statement setting forth the reasons why the individual disagrees with the insurer's refusal to correct, amend or delete the recorded personal medical information.
(d) If the individual files a statement under par. (c), the insurer shall do all of the following:
1. File any statement filed by the individual under par. (c) with the recorded personal medical information that is the subject of the request under par. (a) in such a manner that any person reviewing the recorded personal medical information will be aware of and have access to the statement.
2. In any subsequent disclosure by the insurer of the recorded personal medical information, clearly identify any matter in dispute and provide any statement filed by the individual under par. (c) that relates to the recorded personal medical information along with the information.
3. Furnish any statement filed by the individual under par. (c) to any person to whom the insurer would have been required to furnish a correction, amendment or fact of deletion under par. (b).
(e) The requirements under this subsection do not apply to information concerning an individual that relates to, and that is collected in connection with or in reasonable anticipation of, a claim or civil or criminal proceeding involving the individual.
(5) Disclosure of personal medical information by insurers. Any disclosure by an insurer of personal medical information concerning an individual shall be consistent with the individual's signed disclosure authorization form, unless the disclosure satisfies any of the following:
(a) Is otherwise authorized by the individual, or by a person who is authorized to consent on behalf of an individual who lacks the capacity to consent.
(b) Is reasonably related to the protection of the insurer's interests in the assessment of causation, fault or liability or in the detection or prevention of criminal activity, fraud, material misrepresentation or material nondisclosure.
