9,2277t
Section 2277t. 149.165 (3m) of the statutes is created to read:
149.165 (3m)
Upon request of the board, the joint committee on finance may approve or disapprove adjustment
, by the board or the department, of the household income dollar amounts listed in sub. (2) (a) to (e), except for the first dollar amount listed in sub. (2) (a), to reflect changes in the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.
With any request for approval of adjustment under this subsection, the board shall submit to the joint committee on finance the proposed adjusted amounts.
9,2278b
Section 2278b. 149.165 (4) of the statutes is amended to read:
149.165 (4) The department shall reimburse the plan for premium reductions under sub. (2) and deductible reductions under s. 149.14 (5) (a) with moneys transferred to the fund from the appropriation account under s. 20.435 (5) (4) (ah).
9,2278c
Section 2278c. 149.17 (2) of the statutes is amended to read:
149.17 (2) A schedule of premiums, deductibles, copayments and coinsurance payments which that complies with all requirements of this chapter.
9,2278g
Section 2278g. 149.17 (4) of the statutes is amended to read:
149.17 (4) Cost containment provisions established by the department by rule, including managed care requirements. The department shall obtain the approval
of the board before promulgating a rule that establishes a cost containment provision that would have an effect on an eligible person's access to health care services, such as the creation of new prior authorization requirements.
9,2278r
Section 2278r. 150.46 (3) of the statutes is created to read:
150.46 (3) This subchapter does not apply to the nursing care facility operated by the department of veterans affairs under s. 45.385.
9,2278rm
Section 2278rm. 150.84 (2) of the statutes is amended to read:
150.84 (2) "Health care facility" 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 or other place licensed or approved by the department under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.35, 51.08, or 51.09
, 58.06, 252.073 or 252.076 or a facility under s. 45.365, 51.05, 51.06, 233.40, 233.41, 233.42 or 252.10.
9,2280
Section
2280. 153.05 (6m) of the statutes is amended to read:
153.05 (6m) The department may contract with the group insurance board for the provision of data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance for state employes. The department shall establish contract fees for the provision of the services. All moneys collected under this subsection shall be credited to the appropriation under s. 20.435 (1) (4) (hg).
9,2280b
Section 2280b. 153.45 (1) (b) of the statutes is renumbered 153.45 (1) (b) 1. and amended to read:
153.45 (1) (b) 1. Public For information that is submitted by hospitals or ambulatory surgery centers, public use data files which that do not permit the identification of specific patients, employers or health care providers, as defined by rules promulgated by the department. The identification of these groups patients, employers or health care providers shall be protected by all necessary means, including the deletion of patient identifiers and the use of calculated variables and aggregated variables.
9,2280c
Section 2280c. 153.45 (1) (b) 2. of the statutes is created to read:
153.45 (1) (b) 2. For information that is submitted by health care providers other than hospitals or ambulatory surgery centers, public use data files that do not permit the identification of specific patients, employers or health care providers, as defined by rules promulgated by the department. The identification of patients, employers or health care providers shall be protected by all necessary means, including the deletion of patient identifiers; the use of calculated variables and aggregated variables; the specification of counties as to residence, rather than zip codes; the use of 5-year categories for age, rather than exact age; not releasing information concerning a patient's race or ethnicity or dates of admission, discharge, procedures or visits; and masking sensitive diagnoses and procedures by use of larger diagnostic and procedure categories. Public use data files under this subdivision may include only the following:
a. The patient's county of residence.
b. The payment source, by type.
c. The patient's age category, by 5-year intervals
up to age 80 and a category of 80 years or older.
d. The patient's procedure code.
e. The patient's diagnosis code.
f. Charges assessed with respect to the procedure code.
g. The name and address of the facility in which the patient's services were rendered.
h. The patient's sex.
i. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center, if the independent review board first reviews and approves the release or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release.
j. Calendar quarters of service, except if the department specifies by rule that the number of data elements included in the public use data file is too small to enable protection of patient confidentiality.
k. Information other than patient-identifiable data, as defined in s. 153.50 (1) (b), as approved by the independent review board.
9,2280e
Section 2280e. 153.45 (1) (c) of the statutes is renumbered 153.45 (1) (c) (intro.) and amended to read:
153.45 (1) (c) (intro.) Custom-designed reports containing portions of the data under par. (b). Of information submitted by health care providers that are not hospitals or ambulatory surgery centers, requests under this paragraph for data elements other than those available for public use data files under par. (b) 2., including the patient's month and year of birth, require review and approval by the independent review board before the data elements may be released. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center may be released only if the independent review board first reviews and approves the release or if the department promulgates rules that specify circumstances under which the independent review board need not review and approve the release. Reports under this paragraph may include the patient's zip code only if at least one of the following applies:
9,2280f
Section 2280f. 153.45 (1) (c) 1. to 4. of the statutes are created to read:
153.45 (1) (c) 1. Other potentially identifying data elements are not released.
2. Population density is sufficient to mask patient identity.
3. Other potentially identifying data elements are grouped to provide population density sufficient to protect identity.
4. Multiple years of data elements are added to protect identity.
9,2280g
Section 2280g. 153.45 (6) of the statutes is created to read:
153.45 (6) The department may not sell or distribute data bases of information, from health care providers who are not hospitals or ambulatory surgery centers, that are able to be linked with public use data files, unless first approved by the independent review board.
9,2280ge
Section 2280ge. 153.50 (1) (a) of the statutes is renumbered 153.01 (2m).
9,2280gg
Section 2280gg. 153.50 (1) (b) of the statutes is renumbered 153.50 (1) (b) 1., and 153.50 (1) (b) 1. (intro.), as renumbered, is amended to read:
153.50 (1) (b) 1. (intro.) "Patient-identifiable data", for information submitted by hospitals and ambulatory surgery centers, means all of the following data elements:
9,2280gm
Section 2280gm. 153.50 (1) (b) 2. of the statutes is created to read:
153.50 (1) (b) 2. "Patient-identifiable data", for information submitted by health care providers who are not hospitals or ambulatory surgery centers, means all of the following data elements:
a. Data elements specified in subd. 1. a. to g., L. and m.
b. Whether the patient's condition is related to employment, and occurrence and place of an auto accident or other accident.
c. Date of first symptom of current illness, of current injury or of current pregnancy.
d. First date of patient's same or similar illness, if any.
e. Dates that the patient has been unable to work in his or her current occupation.
f. Dates of receipt by patient of medical service.
g. The patient's city, town or village.
9,2280h
Section 2280h. 153.50 (2) of the statutes is repealed.
9,2280i
Section 2280i. 153.50 (3) (b) 7. of the statutes is created to read:
153.50 (3) (b) 7. The patient's account number, after use only as verification of data by the department.
9,2280j
Section 2280j. 153.50 (3) (c) of the statutes is created to read:
153.50 (3) (c) Develop, for use by purchasers of data under this chapter, a data use agreement that specifies data use restrictions, appropriate uses of data and penalties for misuse of data, and notify prospective and current purchasers of data of the appropriate uses.
9,2280k
Section 2280k. 153.50 (3) (d) of the statutes is created to read:
153.50 (3) (d) Require that a purchaser of data under this chapter sign and have notarized the data use agreement of the department specified in par. (c).
9,2280km
Section 2280km. 153.50 (3m) of the statutes is created to read:
153.50 (3m) Health care provider measures to ensure patient identity protection. A health care provider that is not a hospital or ambulatory surgery center shall, before submitting information required by the department under this chapter, convert to a payer category code as specified by the department any names of an insured's payer or other insured's payer.
9,2280kp
Section 2280kp. 153.50 (4) (intro.) of the statutes is renumbered 153.50 (4) (a) (intro.) and amended to read:
153.50 (4) (a) (intro.) Under Except as specified in par. (b), under the procedures specified in sub. (5), release of patient-identifiable data may be made only to any of the following:
9,2280kq
Section 2280kq. 153.50 (4) (a) of the statutes is repealed.
9,2280kr
Section 2280kr. 153.50 (4) (b) to (e) of the statutes are renumbered 153.50 (4) (a) 1. to 4.
9,2280ks
Section 2280ks. 153.50 (4) (b) of the statutes is created to read:
153.50 (4) (b) Of information submitted by health care providers that are not hospitals or ambulatory surgery centers, patient-identifiable data that contain a patient's date of birth may be released under par. (a) only under circumstances as specified by rule by the department.
9,2280ku
Section 2280ku. 153.50 (5) (a) (intro.) of the statutes is amended to read:
153.50 (5) (a) (intro.) 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:
9,2280kv
Section 2280kv. 153.50 (5) (a) 3. of the statutes is amended to read:
153.50 (5) (a) 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.
9,2280kw
Section 2280kw. 153.50 (5) (a) 4. (intro.) of the statutes is amended to read:
153.50 (5) (a) 4. (intro.) For an entity that is authorized under sub. (4) (e) (a) 4. to receive or have access to patient-identifiable data, evidence, in writing, of all of the following:
9,2280kx
Section 2280kx. 153.50 (5) (b) 3. of the statutes is amended to read:
153.50 (5) (b) 3. For a person who believes that he or she is authorized under sub. (4) (a), the action provided under s. 19.37.
9,2280n
Section 2280n. 153.50 (5m) of the statutes is created to read:
153.50 (5m) Employers not to request patient-identifiable data. Notwithstanding subs. (4) and (5) no employer may request the release of or access to patient-identifiable data of an employe of the employer.
9,2280p
Section 2280p. 153.50 (6) of the statutes is renumbered 153.50 (6) (a).
9,2280q
Section 2280q. 153.50 (6) (b), (c), (d) and (e) of the statutes are created to read:
153.50 (6) (b) The department may not require under this chapter a health care provider that is not a hospital or ambulatory surgery center to submit uniform patient billing forms.
(c) A health care provider that is not a hospital or ambulatory surgery center may not submit any of the following to the department under the requirements of this chapter:
1. The data elements specified under sub. (3) (b).
2. The patient's telephone number.
3. The insured's employer's name or school name.
4. Data regarding insureds other than the patient, other than the payer category code under sub. (3m).
5. The patient's employer's name or school name.
6. The patient's relationship to the insured.
7. The insured's identification number.
8. The insured's policy or group number.
9. The insured's date of birth or sex.
10. The patient's marital, employment or student status.
