Amendment SSA2-SB315

SB315-SSA2, s. 37 Section 37. 153.25 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 38 Section 38. 153.30 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 39 Section 39. 153.35 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 40 Section 40. 153.40 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 41 Section 41. 153.45 (1) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,11,20 153.45 (1) (intro.) After completion of data verification and review procedures under s. 153.40 specified by the department by rule, the department shall release data in the following forms:

SB315-SSA2, s. 42 Section 42. 153.45 (1) (a) of the statutes is amended to read:

SB315-SSA2,11,22 153.45 (1) (a) Standard reports in accordance with ss. 153.10 to 153.35.

SB315-SSA2, s. 43 Section 43. 153.45 (1) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,12,5 153.45 (1) (b) Public use tapes data files which do not permit the identification of specific patients, physicians, employers or other health care providers, as defined by rules promulgated by the department. The identification of these groups shall be protected by all necessary means, including the deletion of patient identifiers and the use of calculated variables and aggregated variables.

SB315-SSA2, s. 44 Section 44. 153.45 (1) (c) of the statutes is amended to read:

SB315-SSA2,12,9 153.45 (1) (c) Custom-designed subfile tapes, other electronic media, special data compilations or reports containing portions of the public use tape data under par. (b).

SB315-SSA2, s. 45 Section 45. 153.45 (3) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,12,15 153.45 (3) The department shall release physician-specific health care provider-specific and employer-specific data, except in public use tapes data files as specified under sub. (1) (b), in a manner that is specified in rules promulgated by the department.

SB315-SSA2, s. 46 Section 46. 153.45 (4) of the statutes is created to read:

SB315-SSA2,12,18 153.45 (4) The department shall prohibit purchasers of data from rereleasing individual data elements of health care data files.

SB315-SSA2, s. 47 Section 47. 153.45 (5) of the statutes is created to read:

SB315-SSA2,12,24 153.45 (5) The department may not release any health care information that is subject to rules promulgated under s. 153.75 (1) (b) until the verification and review procedures required under those rules have been complied with. Nothing in this subsection prohibits release of health care provider-specific information to the health care provider to whom the information relates.

SB315-SSA2, s. 48 Section 48. 153.50 of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,13,10 153.50 Protection of patient confidentiality. Patient-identifiable data obtained under this chapter and contained in the discharge data base of the department is not subject to inspection, copying or receipt under s. 19.35 (1) and may not be released by the department, except to the patient or to a person granted permission for release by the patient and except that a hospital, a physician health care provider or the agent of a hospital or physician health care provider may have access to patient-identifiable data to ensure the accuracy of the information in the discharge data base.

SB315-SSA2, s. 49 Section 49. 153.60 (1) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,14,5 153.60 (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. 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).

SB315-SSA2, s. 50 Section 50. 153.60 (2) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 51 Section 51. 153.60 (3) of the statutes is created to read:

SB315-SSA2,14,19 153.60 (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).

SB315-SSA2, s. 52 Section 52. 153.65 of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,15,3 153.65 Provision of special information; user fees. The department may 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).

SB315-SSA2, s. 53 Section 53. 153.75 (1) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,15,8 153.75 (1) (b) Establishing procedures under which hospitals and health care providers are permitted to review and verify patient-related information prior to its submission to the department.

SB315-SSA2, s. 54 Section 54. 153.75 (1) (c), (d), (e), (i) and (j) of the statutes are repealed.

SB315-SSA2, s. 55 Section 55. 153.75 (1) (f), (k) and (L) of the statutes are amended to read:

SB315-SSA2,15,12 153.75 (1) (f) Governing the release of physician-specific health care provider-specific and employer-specific data under s. 153.45 (3).

SB315-SSA2,15,14 (k) Establishing methods and criteria for assessing hospitals and ambulatory surgery centers health care providers under s. 153.60 (1).

SB315-SSA2,15,16 (L) Defining the term "uncompensated health care services" for the purposes of ss. 153.05 (1) (d) and s. 153.20.

SB315-SSA2, s. 56 Section 56. 153.75 (1) (m), (n), (o), (p), (q), (r), (s) and (t) of the statutes are created to read:

SB315-SSA2,15,20 153.75 (1) (m) Specifying the classes of health care providers from whom claims data and other health care information will be collected.

SB315-SSA2,15,21 (n) Specifying the uniform data set of health care information to be collected.

SB315-SSA2,15,23 (o) Specifying the means by which the information in par. (b) will be collected, including the procedures for submission of data by electronic means.

SB315-SSA2,16,2 (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.

SB315-SSA2,16,4 (q) Specifying the information to be provided in the consumer guide under s. 153.21.

SB315-SSA2,16,6 (r) Specifying the standard reports that will be issued by the department in addition to those required in ss. 153.20 and 153.21.

SB315-SSA2,16,7 (s) Defining "individual data elements" for purposes of s. 153.45 (4).

SB315-SSA2,16,9 (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.

SB315-SSA2, s. 57 Section 57. 153.75 (2) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,16,13 153.75 (2) (intro.) With the Following approval of by the board, the department may promulgate all of the following rules:

SB315-SSA2, s. 58 Section 58. 153.75 (2) (b) of the statutes is repealed.

SB315-SSA2, s. 59 Section 59. 153.75 (2) (d) of the statutes is created to read:

SB315-SSA2,16,18 153.75 (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.

SB315-SSA2, s. 60 Section 60. 153.90 (1) and (2) of the statutes are amended to read:

SB315-SSA2,16,22 153.90 (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.

SB315-SSA2,17,4 (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.

SB315-SSA2, s. 61 Section 61. 610.70 of the statutes is created to read:

SB315-SSA2,17,7 610.70 Disclosure of personal medical information. (1) Definitions. In this section:

SB315-SSA2,17,11 (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.

SB315-SSA2,17,15 (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.

SB315-SSA2,17,23 (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.

SB315-SSA2,17,25 2. Notwithstanding subd. 1., "insurance support organization" does not include insurance agents, government institutions, insurers or health care providers.

SB315-SSA2,18,2 (d) "Insurance transaction" means any of the following involving insurance that is primarily for personal, family or household needs:

SB315-SSA2,18,4 1. The determination of an individual's eligibility for an insurance coverage, benefit or payment.

SB315-SSA2,18,5 2. The servicing of an insurance application, policy, contract or certificate.

SB315-SSA2,18,14 (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.

SB315-SSA2,18,16 (f) 1. "Personal medical information" means information concerning an individual that satisfies all of the following:

SB315-SSA2,18,18 a. Relates to the individual's physical or mental health, medical history or medical treatment.

SB315-SSA2,18,20 b. Is obtained from a health care provider, a medical care institution, the individual or the individual's spouse, parent or legal guardian.

SB315-SSA2,18,24 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.

SB315-SSA2,19,3 (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:

SB315-SSA2,19,5 1. All instructions and other information contained in the form are presented in plain language.

SB315-SSA2,19,6 2. The form is dated.

SB315-SSA2,19,8 3. The form specifies the types of persons that are authorized to disclose information about the individual.

SB315-SSA2,19,10 4. The form specifies the nature of the information that is authorized to be disclosed.

SB315-SSA2,19,12 5. The form names the insurer, and identifies by generic reference representatives of the insurer, to whom the information is authorized to be disclosed.

SB315-SSA2,19,13 6. The form specifies the purposes for which the information is being obtained.

SB315-SSA2,19,15 7. Subject to par. (b), the form specifies the length of time for which the authorization remains valid.

SB315-SSA2,19,17 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.

SB315-SSA2,19,22 (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.

SB315-SSA2,20,2 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.

SB315-SSA2,20,8 (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:

SB315-SSA2,20,11 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.

SB315-SSA2,20,18 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.

SB315-SSA2,20,24 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.

SB315-SSA2,21,4 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.

SB315-SSA2,21,13 (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.

SB315-SSA2,21,17 (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.

SB315-SSA2,21,23 (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.

SB315-SSA2,22,3 (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.

SB315-SSA2,22,6 (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).

SB315-SSA2,22,9 (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.

SB315-SSA2,22,13 (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.

SB315-SSA2,22,17 (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: