Amendment SSA2-SB315

LRBs0488/1

DAK/PJK/KSH:kmg&kaf:hmh

1997 - 1998 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 2, TO 1997 SENATE BILL 315

February 12, 1998 - Offered by Joint committee on Finance.

SB315-SSA2,2,7 An Act to repeal 153.01 (3) and (9), 153.05 (1) (a) to (e), 153.05 (2), 153.05 (4), 153.05 (5) (a) and (bm), 153.05 (7), 153.05 (11), 153.07 (2), 153.08 (2) (b), 153.10 (1) (a) and (b), 153.10 (2), 153.15, 153.25, 153.30, 153.35, 153.40, 153.60 (2), 153.75 (1) (c), (d), (e), (i) and (j) and 153.75 (2) (b); to renumber and amend 153.05 (1) (intro.) and 153.10 (1) (intro.); to consolidate, renumber and amend 153.05 (5) (intro.) and (b) and 153.08 (2) (intro.) and (a); to amend 15.195 (6), 16.03 (1), 20.435 (1) (hg), 51.30 (4) (a), 146.82 (2) (b), 153.05 (3), 153.05 (6), 153.05 (6m), 153.05 (8), 153.05 (9), 153.07 (1), 153.20, 153.45 (1) (intro.), 153.45 (1) (a), 153.45 (1) (b), 153.45 (1) (c), 153.45 (3), 153.50, 153.60 (1), 153.65, 153.75 (1) (b), 153.75 (1) (f), (k) and (L), 153.75 (2) (intro.) and 153.90 (1) and (2); and to create 15.07 (1) (b) 21., 15.107 (7) (g), 15.194, 153.01 (4d), (4h), (4p) and (4t), 153.05 (6r), 153.05 (13), 153.07 (4), 153.21, 153.45 (4), 153.45 (5), 153.60 (3), 153.75 (1) (m), (n), (o), (p), (q), (r), (s) and (t), 153.75 (2) (d), 610.70, 895.505 and 943.30 (5) of the statutes; relating to: collection, analysis and dissemination of health care information by the department of health and family services, confidentiality of patient health care records, membership of the board on health care information, authorizing disclosure of personal medical information to an insurer, disclosure by an insurer of personal medical information, granting rule-making authority, providing a penalty and making an appropriation.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB315-SSA2, s. 1 Section 1. 15.07 (1) (b) 21. of the statutes is created to read:

SB315-SSA2,2,9 15.07 (1) (b) 21. Board on health care information.

SB315-SSA2, s. 2 Section 2. 15.107 (7) (g) of the statutes is created to read:

SB315-SSA2,2,11 15.107 (7) (g) A representative of the office of the commissioner of insurance.

SB315-SSA2, s. 3 Section 3. 15.194 of the statutes is created to read:

SB315-SSA2,2,15 15.194 Same; specified bureaus. (1) Bureau of health care information. There is created in the division within the department of health and family services that has primary responsibility for health issues a bureau of health care information.

SB315-SSA2, s. 4 Section 4. 15.195 (6) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,3,2 15.195 (6) Board on health care information. There is created a board on health care information which is attached to the department of health and family services under s. 15.03. The board shall consist of 9 10 members, a majority of whom may neither be nor 5 of whom shall be or represent health care providers, including at least one, but not more than 2, physicians, as defined in s. 448.01 (5). The State Medical Society of Wisconsin may recommend board membership for up to 5 physicians, one of whom the governor shall appoint. The members shall be appointed for 4-year terms.

SB315-SSA2, s. 5 Section 5. 16.03 (1) of the statutes is amended to read:

SB315-SSA2,3,18 16.03 (1) General functions. The interagency coordinating council shall serve as a means of increasing the efficiency and utility and facilitating the effective functioning of state agencies in activities related to health care data collection. The interagency coordinating council shall advise and assist state agencies in the coordination of health care data collection programs and the exchange of information related to health care data collection and dissemination, including agency budgets for health care data collection programs, health care data monitoring and management, public information and education, health care data analysis and facilities, research activities and the appropriation and allocation of state funds for health care data collection. The interagency coordinating council shall establish methods and criteria for analyzing and comparing complaints filed against health care plans, as defined under s. 628.36 (2) (a) 1., and grievances filed with health maintenance organizations, as defined under s. 609.01 (2), without requiring the collection of information in addition to the information already collected by state agencies.

SB315-SSA2, s. 6 Section 6. 20.435 (1) (hg) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,3,25 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. The contract fees paid under s. 153.05 (6m) and assessments paid under s. 153.60 shall be credited to this appropriation account.

SB315-SSA2, s. 7 Section 7. 51.30 (4) (a) of the statutes is amended to read:

SB315-SSA2,4,9 51.30 (4) (a) Confidentiality of records. Except as otherwise provided in this chapter and ss. 610.70 (3) and (5), 905.03 and 905.04, all treatment records shall remain confidential and are privileged to the subject individual. Such records may be released only to the persons designated in this chapter or ss. 610.70 (3) and (5), 905.03 and 905.04, or to other designated persons with the informed written consent of the subject individual as provided in this section. This restriction applies to elected officials and to members of boards appointed under s. 51.42 (4) (a) or 51.437 (7) (a).

SB315-SSA2, s. 8 Section 8. 146.82 (2) (b) of the statutes is amended to read:

SB315-SSA2,4,14 146.82 (2) (b) Unless Except as provided in s. 610.70 (3) and (5), unless authorized by a court of record, the recipient of any information under par. (a) shall keep the information confidential and may not disclose identifying information about the patient whose patient health care records are released.

SB315-SSA2, s. 9 Section 9. 153.01 (3) and (9) of the statutes are repealed.

SB315-SSA2, s. 10 Section 10. 153.01 (4d), (4h), (4p) and (4t) of the statutes are created to read:

SB315-SSA2,4,17 153.01 (4d) "Department" means the department of health and family services.

SB315-SSA2,4,19 (4h) "Employer coalition" means an organization of employers formed for the purpose of purchasing health care coverage or services as a group.

SB315-SSA2,4,21 (4p) "Health care plan" means an insured or self-insured plan providing coverage of health care expenses or an employer coalition.

SB315-SSA2,4,23 (4t) "Health care provider" has the meaning given in s. 146.81 (1) and includes an ambulatory surgery center.

SB315-SSA2, s. 11 Section 11. 153.05 (1) (intro.) of the statutes is renumbered 153.05 (1) and amended to read:

SB315-SSA2,5,11 153.05 (1) In order to provide to hospitals, health care providers, insurers, consumers, governmental agencies and others information concerning hospital service utilization, charges, revenues, expenditures, mortality and morbidity rates health care providers and uncompensated health care services, and in order to provide information to assist in peer review for the purpose of quality assurance, the office department shall collect, analyze and disseminate health care information, in language that is understandable to lay persons, health care information obtained from the following data sources:. This chapter shall be administered by a bureau of health care information. The bureau of health care information shall coordinate its activities with persons with responsibility for medical assistance administration and collection and analysis of health statistics.

SB315-SSA2, s. 12 Section 12. 153.05 (1) (a) to (e) of the statutes, as affected by 1997 Wisconsin Act 27, are repealed.

SB315-SSA2, s. 13 Section 13. 153.05 (2) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 14 Section 14. 153.05 (3) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,5,20 153.05 (3) Upon request of the department, state agencies shall provide health care information to the department for use in preparing reports under ss. 153.10 to 153.35 this chapter.

SB315-SSA2, s. 15 Section 15. 153.05 (4) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 16 Section 16. 153.05 (5) (intro.) and (b) of the statutes, as affected by 1997 Wisconsin Act 27, are consolidated, renumbered 153.05 (5) and amended to read:

SB315-SSA2,6,6 153.05 (5) The Unless sub. (13) applies, the department: (b) May may require hospitals health care providers to submit to the department information from sources identified under sub. (1) (a) to (e) that the department deems necessary for the preparation of reports, plans and recommendations under ss. 153.10 to 153.35 and any other reports required of the department in the form specified by the department by rule.

SB315-SSA2, s. 17 Section 17. 153.05 (5) (a) and (bm) of the statutes, as affected by 1997 Wisconsin Act 27, are repealed.

SB315-SSA2, s. 18 Section 18. 153.05 (6) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,6,15 153.05 (6) If the requirements of s. 153.07 (2) are first met, the The department may contract with a public or private entity that is not a major purchaser, payer or provider of health care services in this state for the provision of data processing services for the collection, analysis and dissemination of health care information under sub. (1) or the department shall provide the services under s. 153.07 (2).

SB315-SSA2, s. 19 Section 19. 153.05 (6m) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,6,24 153.05 (6m) If the requirements of s. 153.07 (2) are first met, the 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 or the department shall provide the services under s. 153.07 (2). 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) (kx) (hg).

SB315-SSA2, s. 20 Section 20. 153.05 (6r) of the statutes is created to read:

SB315-SSA2,7,12 153.05 (6r) The department shall study and, based on the results of the study, may develop and implement a voluntary system of health care plan reporting that enables purchasers and consumers to assess the performance of health care plans and the health care providers that are employed or reimbursed by the health care plans. The department shall undertake the study and any development and implementation in cooperation with private health care purchasers, the board, the department of employe trust funds, the office of the commissioner of insurance, the interagency coordinating council created under s. 15.107 (7), major associations of health care providers, health care plans and consumers. If implemented, the department shall operate the system in a manner so as to enable purchasers, consumers, the public, the governor and legislators to assess the performance of health care plans and health care providers.

SB315-SSA2, s. 21 Section 21. 153.05 (7) of the statutes, as affected by 1997 Wisconsin Act, is repealed.

SB315-SSA2, s. 22 Section 22. 153.05 (8) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,8,3 153.05 (8) Beginning April 1, 1992, the Unless sub. (13) applies, the department shall collect, analyze and disseminate, in language that is understandable to lay persons, health care claims information and other health care information under the provisions of this chapter, as determined by rules promulgated by the department, from health care providers, as defined specified by rules promulgated by the department, other than hospitals and ambulatory surgery centers. Data from physicians shall 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 health care provider-specific data from health care plans, the department shall attempt to avoid collecting the same data from health care providers.

SB315-SSA2, s. 23 Section 23. 153.05 (9) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,8,9 153.05 (9) The department shall provide orientation and training to physicians, hospital personnel and other health care providers who submit data under this chapter to explain the process of data collection and analysis and the procedures for data verification, interpretation and release.

SB315-SSA2, s. 24 Section 24. 153.05 (11) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 25 Section 25. 153.05 (13) of the statutes is created to read:

SB315-SSA2,8,17 153.05 (13) The department may waive the requirement under sub. (1), (5) or (8) for a health care provider, who requests the waiver and presents evidence to the department that the requirement under sub. (1), (5) or (8) is burdensome, under standards established by the department by rule. The department shall develop a form for use by a health care provider in submitting a request under this subsection.

SB315-SSA2, s. 26 Section 26. 153.07 (1) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,8,22 153.07 (1) The board shall advise the director of the department with regard to the collection, analysis and dissemination of health care information required by this chapter.

SB315-SSA2, s. 27 Section 27. 153.07 (2) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 28 Section 28. 153.07 (4) of the statutes is created to read:

SB315-SSA2,9,1 153.07 (4) The board and the department shall jointly do all of the following:

SB315-SSA2,9,2 (a) Develop the rules that are required or authorized under this chapter.

SB315-SSA2,9,4 (b) Provide oversight on the standard reports under this chapter, including the reports under ss. 153.20 and 153.21.

SB315-SSA2,9,6 (c) Develop the overall strategy and direction for implementation of this chapter.

SB315-SSA2,9,8 (d) Provide information on their activities to the interagency coordinating council created under s. 15.107 (7).

SB315-SSA2, s. 29 Section 29. 153.08 (2) (intro.) and (a) of the statutes are consolidated, renumbered 153.08 (2) and amended to read:

SB315-SSA2,9,18 153.08 (2) No hospital may increase its rates or charge any payer an amount exceeding its rates that are in effect on May 12, 1992, unless the hospital first does all of the following: (a) Causes causes to be published a class 1 notice under ch. 985 in the official newspaper designated under s. 985.04 or 985.05 or in a newspaper likely to give notice in the area where the hospital is located, no sooner than 45 days and no later than 30 days before the proposed rate change is to take effect. The notice shall describe the proposed rate change and the time and place for the public hearing required under sub. (2).

SB315-SSA2, s. 30 Section 30. 153.08 (2) (b) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 31 Section 31. 153.10 (1) (intro.) of the statutes, as affected by 1997 Wisconsin Act 27, is renumbered 153.10 and amended to read:

SB315-SSA2,9,25 153.10 Health care data reports. Beginning in 1990 and quarterly thereafter, the 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), in a manner that permits comparisons among hospitals, a report setting forth all of the following for every hospital for the preceding quarter: standard reports that the department prepares and shall collect information necessary for preparation of those reports.

SB315-SSA2, s. 32 Section 32. 153.10 (1) (a) and (b) of the statutes, as affected by 1997 Wisconsin Act 27, are repealed.

SB315-SSA2, s. 33 Section 33. 153.10 (2) of the statutes is repealed.

SB315-SSA2, s. 34 Section 34. 153.15 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB315-SSA2, s. 35 Section 35. 153.20 of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB315-SSA2,10,20 153.20 Uncompensated health care services report. (1) Beginning in 1990 and annually thereafter, the The department shall prepare, and submit to the governor and to the chief clerk of each house of the legislature for distribution to the legislature under s. 13.172 (2) a, an annual report setting forth the number of patients to whom uncompensated health care services were provided by each hospital and the total charges for the uncompensated health care services provided to the patients for the preceding year, together with the number of patients and the total charges that were projected by the hospital for that year in the plan filed under sub. (2).

SB315-SSA2,10,25 (2) Beginning in 1990 and annually thereafter, every Every hospital shall file with the department a an annual plan setting forth the projected number of patients to whom uncompensated health care services will be provided by the hospital and the projected total charges for the uncompensated health care services to be provided to the patients for the ensuing year.

SB315-SSA2, s. 36 Section 36. 153.21 of the statutes is created to read: