2005 WISCONSIN ACT 228
An Act to repeal 15.07 (2) (b), 15.07 (3) (bm) 1., 15.107 (7), 15.195 (6), 15.195 (9), 16.03, 153.01 (2), 153.05 (6r), 153.07, 153.45 (6), 153.60 (3), 153.67, 153.75 (2) (d) and 153.76;
to renumber 153.01 (1) and 153.22 (1); to amend 20.435 (1) (hg), 20.435 (1) (hg), 20.435 (1) (hi), 20.515 (1) (ut), 20.515 (1) (ut), 153.01 (5m), 153.05 (1) (a), 153.05 (2r) (intro.), 153.05 (3) (a), 153.05 (5) (a), 153.05 (8) (a), 153.05 (9) (a), 153.05 (12) (a), 153.10 (1), 153.45 (1) (b) 9., 153.45 (1) (b) 11., 153.45 (1) (c) (intro.), 153.50 (1) (b) 2. (intro.), 153.50 (3) (intro.), 153.50 (3) (a), 153.50 (3) (b) (intro.), 153.50 (3) (d), 153.50 (3m), 153.50 (4) (a) (intro.), 153.50 (4) (a) 1. a., 153.50 (4) (a) 1. b., 153.50 (4) (a) 2., 153.50 (4) (a) 3., 153.50 (5) (a) (intro.), 153.50 (5) (b) (intro.), 153.50 (5) (b) 1., 153.60 (title), 153.60 (1), 153.60 (1), 153.65 (1), 153.75 (1) (intro.), 153.75 (1) (intro.), 153.75 (2) (intro.) and 153.75 (2) (intro.); and to create 153.01 (1d), 153.01 (2g), 153.01 (3g), 153.01 (8m), 153.05 (1) (c), 153.05 (2r), 153.05 (2s), 153.05 (3) (c), 153.05 (5) (c), 153.05 (8) (c), 153.05 (9) (c), 153.05 (12) (c), 153.45 (intro.), 153.455, 153.50 (intro.), 153.50 (1) (b) 1m., 153.50 (4) (a) 1. c., 153.50 (4) (c) and 153.60 (intro.) of the statutes; relating to: requiring a contract with a data organization for the collection, analysis, and dissemination of health care claims information; eliminating the Board on Health Care Information, the Interagency Coordinating Council, and the Independent Review Board; and making appropriations.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
228,1
Section
1. 15.07 (2) (b) of the statutes is repealed.
228,2
Section
2. 15.07 (3) (bm) 1. of the statutes is repealed.
228,3
Section
3. 15.107 (7) of the statutes is repealed.
228,4
Section
4. 15.195 (6) of the statutes is repealed.
228,5
Section
5. 15.195 (9) of the statutes is repealed.
228,6
Section
6. 16.03 of the statutes is repealed.
20.435 (1) (hg) General program operations; health care information. The amounts in the schedule to fund the activities of the department of health and family services and the board on health care information under ch. 153 and to contract with the data organization under s. 153.05 (2r). The contract fees paid under s. 153.05 (6m) and assessments paid under s. 153.60 shall be credited to this appropriation account.
228,8
Section
8
. 20.435 (1) (hg) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
20.435 (1) (hg) General program operations; health care information. The amounts in the schedule to fund the activities of the department of health and family services and the board on health care information under ch. 153 and to contract with the data organization under s. 153.05 (2r). The contract fees paid under s. 153.05 (6m) and assessments paid under s. 153.60 shall be credited to this appropriation account.
20.435 (1) (hi) Compilations and special reports; health care information. All moneys received from user fees imposed under s. 153.65 (1) for the purpose of financing the costs of the department of health and family services of producing special data compilations or special reports under s. 153.65 and to contract with the data organization under s. 153.05 (2r).
228,10m
Section 10m. 20.515 (1) (ut) of the statutes is amended to read:
20.515 (1) (ut) Health insurance data collection and analysis contracts. From the public employee trust fund, the amounts in the schedule for the costs of contracting for insurance data collection and analysis services under s. ss. 40.03 (6) (j) and 153.05 (2r).
228,10n
Section 10n. 20.515 (1) (ut) of the statutes, as affected by 2005 Wisconsin Act .... (this act), is amended to read:
20.515 (1) (ut) Health insurance data collection and analysis contracts. From the public employee trust fund, the amounts in the schedule for the costs of contracting for insurance data collection and analysis services under ss. s. 40.03 (6) (j) and 153.05 (2r).
228,11
Section
11. 153.01 (1) of the statutes is renumbered 153.01 (1g).
228,12
Section
12. 153.01 (1d) of the statutes is created to read:
153.01 (1d) "Administrator" has the meaning given in s. 633.01 (1).
228,13
Section
13. 153.01 (2) of the statutes is repealed.
228,14
Section
14. 153.01 (2g) of the statutes is created to read:
153.01 (2g) "Calculated variable" means a data element that is computed or derived from an original data item or derived using another data source.
228,15
Section
15. 153.01 (3g) of the statutes is created to read:
153.01
(3g) "Data organization" means a nonstock corporation organized under ch. 181 that is described in section
501 (c) (3) of the Internal Revenue Code, is exempt from federal income tax under section
501 (a) of the Internal Revenue Code, and, in its capacity as a public health authority, does all of the following:
(a) Represents health care consumers, insurers, administrators, and health care providers.
(b) Is formed specifically to do all of the following:
1. Create a centralized claims repository for this state with credible and useful data elements for the purposes of quality improvement, health care provider performance comparisons, ready understandability, and consumer decision making.
2. Use the information it collects to develop and disseminate unified public reports on health care quality, safety, and efficiency.
228,16
Section
16. 153.01 (5m) of the statutes is amended to read:
153.01 (5m) "Insurer" has the meaning given under s. 600.03 (27) 632.745 (15).
228,17
Section
17. 153.01 (8m) of the statutes is created to read:
153.01 (8m) "Public health authority" means the department or a person acting under this chapter under a grant of authority from or contract with the department.
228,18
Section
18. 153.05 (1) (a) of the statutes is amended to read:
153.05 (1) (a) The Subject to s. 153.455, the department shall collect from health care providers other than hospitals and ambulatory surgery centers, analyze, and disseminate health care information, as adjusted for case mix and severity, in language that is understandable to laypersons.
228,19
Section
19. 153.05 (1) (c) of the statutes is created to read:
153.05 (1) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request health care claims information from insurers and administrators. The data organization shall analyze and publicly report the health care claims information with respect to the cost, quality, and effectiveness of health care, in language that is understandable by lay persons, and shall develop and maintain a centralized data repository. The data organization shall provide to the department, without charge, health care claims information collected by and reports produced by the data organization that the department requests. If s. 153.455 (4) applies, the department may request health care claims information, which may be voluntarily provided by insurers and administrators, and may perform or contract for the performance of the other duties specified for the data organization under this paragraph.
228,20
Section
20. 153.05 (2r) of the statutes is created to read:
153.05 (2r) Notwithstanding s. 16.75 (1), (2), and (3m), from the appropriation account under s. 20.515 (1) (ut) the department of employee trust funds may expend up to $150,000, and from the appropriation accounts under s. 20.435 (1) (hg) and (hi) the department of health and family services, in its capacity as a public health authority, may expend moneys, to contract jointly with a data organization to perform services under this chapter that are specified for the data organization under sub. (1) (c) or, if s. 153.455 (4) applies, for the department of health and family services to perform or contract for the performance of these services. As condition of the contract under this subsection, all of the following apply:
(a) At least during the period of the contract, the data organization shall include as voting members of the board of directors of the data organization the secretary of health and family services and the secretary of employee trust funds, or their designees.
(b) The data organization shall provide matching funds, which may include in-kind contributions, as specified in the contract.
(c) Termination of funding and of services of the data organization under the contract or modification of the contract is subject to a determination made under s. 153.455 (3).
228,20m
Section 20m. 153.05 (2r) (intro.) of the statutes, as created by 2005 Wisconsin Act .... (this act), is amended to read:
153.05 (2r) (intro.) Notwithstanding s. 16.75 (1), (2), and (3m), from the appropriation account under s. 20.515 (1) (ut) the department of employee trust funds may expend up to $150,000, and from the appropriation accounts under s. 20.435 (1) (hg) and (hi) the department of health and family services, in its capacity as a public health authority, may expend moneys, to contract jointly with a data organization to perform services under this chapter that are specified for the data organization under sub. (1) (c) or, if s. 153.455 (4) applies, for the department of health and family services to perform or contract for the performance of these services. As condition of the contract under this subsection, all of the following apply:
228,20p
Section 20p. 153.05 (2s) of the statutes is created to read:
153.05 (2s) Annually, the department of health and family services and the department of employee trust funds shall jointly prepare and submit under s. 13.172 (3) to standing committees of the legislature with jurisdiction over health issues a report on the activities of the data organization under this chapter.
228,21
Section
21. 153.05 (3) (a) of the statutes is amended to read:
153.05 (3) (a) Upon request of the department for health care information relating to health care providers other than hospitals and ambulatory surgery centers and, if s. 153.455 (4) applies, for health care claims information as specified in sub. (1) (c), state agencies shall provide that health care information to the department for use in preparing reports under this chapter.
228,22
Section
22. 153.05 (3) (c) of the statutes is created to read:
153.05 (3) (c) Upon request of the data organization under contract under sub. (2r) for health care claims information, insurers and administrators may provide the health care claims information to the data organization for use in preparing reports and developing and maintaining a central data repository under this chapter, and, if s. 153.455 (4) applies, insurers and administrators may provide the health care claims information as requested by the department.
228,23
Section
23. 153.05 (5) (a) of the statutes is amended to read:
153.05 (5) (a) Unless sub. (13) applies, subject to s. 153.455, the department may require health care providers other than hospitals and ambulatory surgery centers to submit to the department health care information specified by rule under s. 153.75 (1) (n) for the preparation of reports, plans, and recommendations in the form specified by the department by rule.
228,24
Section
24. 153.05 (5) (c) of the statutes is created to read:
153.05 (5) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request insurers and administrators to submit to the data organization health care claims information for the preparation of reports, plans, and recommendations in the form specified by the data organization, including in standard electronic format. If s. 153.455 (4) applies, the department may request submission of the health care claims information from insurers and administrators in the form specified by the department, including in standard electronic format.
228,25
Section
25. 153.05 (6r) of the statutes is repealed.
228,26
Section
26. 153.05 (8) (a) of the statutes is amended to read:
153.05 (8) (a) Unless sub. (13) applies, subject to s. 153.455, the department shall collect, analyze and disseminate, in language that is understandable to laypersons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, as determined by rules promulgated by the department, from health care providers, other than hospitals and ambulatory surgery centers, specified by rules promulgated by the department. Data from those health care providers may be obtained through sampling techniques in lieu of collection of data on all patient encounters and data collection procedures shall minimize unnecessary duplication and administrative burdens. If the department collects from health care plans data that is specific to health care providers other than hospitals and ambulatory surgery centers, the department shall attempt to avoid collecting the same data from those health care providers.
228,27
Section
27. 153.05 (8) (c) of the statutes is created to read:
153.05 (8) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) may request, analyze, and publicly report, in language that is understandable to laypersons, health care claims information, as adjusted for case mix and severity, from insurers and administrators. Data from these sources may be obtained through sampling techniques in lieu of collection of data on all insureds, and data collection procedures shall minimize unnecessary duplication and administrative burdens. If s. 153.455 (4) applies, the department may request health care claims information, which may be voluntarily provided by insurers and administrators, and may perform or contract for the performance of the other duties specified for the data organization under this paragraph.
228,28
Section
28. 153.05 (9) (a) of the statutes is amended to read:
153.05 (9) (a) The Subject to s. 153.455, the department shall provide orientation and training to health care providers, other than hospitals and ambulatory surgery centers, who submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release.
228,29
Section
29. 153.05 (9) (c) of the statutes is created to read:
153.05 (9) (c) Subject to s. 153.455 (1) to (3), the data organization under contract under sub. (2r) shall provide orientation and training to insurers and administrators that submit data under this chapter, to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation, and release. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.
228,30
Section
30. 153.05 (12) (a) of the statutes is amended to read:
153.05 (12) (a) The Subject to s. 153.455, the department shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the department.
228,31
Section
31. 153.05 (12) (c) of the statutes is created to read:
153.05 (12) (c) The data organization under contract under sub. (2r) shall, subject to s. 153.455 (1) to (3), to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the data organization. If s. 153.455 (4) applies, the department may perform or contract for the performance of the duties specified for the data organization under this paragraph.
228,32
Section
32. 153.07 of the statutes is repealed.
228,33
Section
33. 153.10 (1) of the statutes is amended to read:
153.10 (1) The Subject to s. 153.455, the department shall prepare, and submit to the governor and the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2), standard reports concerning health care providers other than hospitals and ambulatory surgery centers that the department prepares and shall collect information necessary for preparation of those reports. If s. 153.455 (4) applies, the department shall include in the reports under this subsection reports concerning any health care claims information the department collects or contracts to collect under s. 153.05.
228,34
Section
34. 153.22 (1) of the statutes is renumbered 153.22.
228,35
Section
35. 153.45 (intro.) of the statutes is created to read:
153.45 (intro.) Subject to s. 153.455:
228,36
Section
36
. 153.45 (1) (b) 9. of the statutes is amended to read:
153.45 (1) (b) 9. Information that contains the name of a health care provider that is not a hospital or ambulatory surgery center, if the independent review board department 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.
228,37
Section
37. 153.45 (1) (b) 11. of the statutes is amended to read:
153.45 (1) (b) 11. Information other than patient-identifiable data, as defined in s. 153.50 (1) (b), as approved by the independent review board department.
228,38
Section
38. 153.45 (1) (c) (intro.) of the statutes is 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), 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 department 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:
228,39
Section
39. 153.45 (6) of the statutes is repealed.
228,40
Section
40. 153.455 of the statutes is created to read:
