Amendment SA1-SSA1-SB45

SB45-SSA1-SA1, s. 2262r Section 2262r. 149.143 (1) (b) 1. a. of the statutes is renumbered 149.143 (1) (b) and amended to read:

SB45-SSA1-SA1,291,6 149.143 (1) (b) First, Next from premiums from eligible persons with coverage under s. 149.14 set, except as reduced under sub. (2m), at 150% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan, including amounts received for premium and deductible subsidies under s. 149.144 and under the transfer to the fund from the appropriation account under ss. s. 20.435 (5) (4) (ah) and 149.144, and from premiums collected from eligible persons with coverage under s. 149.146 set in accordance with s. 149.146 (2) (b).

SB45-SSA1-SA1, s. 2263b Section 2263b. 149.143 (1) (b) 1. b. of the statutes is repealed.

SB45-SSA1-SA1, s. 2263e Section 2263e. 149.143 (1) (b) 1. c. of the statutes is repealed.

SB45-SSA1-SA1, s. 2263m Section 2263m. 149.143 (1) (b) 1. d. of the statutes is repealed.

SB45-SSA1-SA1, s. 2263r Section 2263r. 149.143 (1) (b) 2. of the statutes is renumbered 149.143 (1) (c) and 149.143 (1) (c) (intro.) and 2., as renumbered, are amended to read:

SB45-SSA1-SA1,291,12 149.143 (1) (c) (intro.) A total of 40% The remainder as follows:

SB45-SSA1-SA1,291,14 2. Fifty percent from adjustments to provider payment rates, excluding adjustments to those rates under ss. s. 149.144 and 149.15 (3) (e).

SB45-SSA1-SA1, s. 2264b Section 2264b. 149.143 (2) (a) 1. of the statutes is repealed.

SB45-SSA1-SA1, s. 2264e Section 2264e. 149.143 (2) (a) 2. of the statutes is amended to read:

SB45-SSA1-SA1,291,22 149.143 (2) (a) 2. After making the determinations under subd. 1., by By rule set premium rates for the new plan year, including the rates under s. 149.146 (2) (b), in the manner specified in sub. (1) (b) 1. a. and c. and such that a rate for coverage under s. 149.14 is not less than 150% nor more than 200% of the rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as are provided under the plan.

SB45-SSA1-SA1, s. 2264m Section 2264m. 149.143 (2) (a) 3. of the statutes is amended to read:

SB45-SSA1-SA1,292,2 149.143 (2) (a) 3. By rule set the total insurer assessments under s. 149.13 for the new plan year by estimating and setting the assessments at the amount necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. a. (c) 1. and notify the commissioner of the amount.

SB45-SSA1-SA1, s. 2264r Section 2264r. 149.143 (2) (a) 4. of the statutes is amended to read:

SB45-SSA1-SA1,292,7 149.143 (2) (a) 4. By the same rule as under subd. 3. adjust the provider payment rate for the new plan year by estimating and setting the rate at the level necessary to equal the amounts specified in sub. (1) (b) 1. d. and 2. b. (c) 2. and as provided in s. 149.145.

SB45-SSA1-SA1, s. 2265b Section 2265b. 149.143 (2) (b) of the statutes is amended to read:

SB45-SSA1-SA1,292,15 149.143 (2) (b) In setting the premium rates under par. (a) 2., the insurer assessment amount under par. (a) 3. and the provider payment rate under par. (a) 4. for the new plan year, the department shall include any increase or decrease necessary to reflect the amount, if any, by which the rates and amount and rate set under par. (a) for the current plan year differed from the rates and amount and rate which would have equaled the amounts specified in sub. (1) (b) (c) in the current plan year.".

SB45-SSA1-SA1,292,16 950. Page 1165, line 15: delete "60% of".

SB45-SSA1-SA1,292,17 951. Page 1165, line 20: delete "(1) (b) 1." and substitute "(1) (b).".

SB45-SSA1-SA1,292,18 952. Page 1165, line 21: delete lines 21 to 24.

SB45-SSA1-SA1,292,19 953. Page 1166, line 1: delete lines 1 to 8 and substitute:

SB45-SSA1-SA1,292,21 " Section 2267c. 149.143 (3) (a) of the statutes is renumbered 149.143 (3) and amended to read:

SB45-SSA1-SA1,293,7 149.143 (3) If, during a plan year, the department determines that the amounts estimated to be received as a result of the rates and amount set under sub. (2) (a) 2. to 4. and any adjustments in insurer assessments and the provider payment rate under s. 149.144 will not be sufficient to cover plan costs, the department may by rule increase the premium rates set under sub. (2) (a) 2. for the remainder of the plan year, subject to s. 149.146 (2) (b) and the maximum specified in sub. (2) (a) 2., by rule increase the assessments set under sub. (2) (a) 3. for the remainder of the plan year, subject to sub. (1) (b) 2. a. (c) 1., and by the same rule under which assessments are increased adjust the provider payment rate set under sub. (2) (a) 4. for the remainder of the plan year, subject to sub. (1) (b) 2. b (c) 2.

SB45-SSA1-SA1, s. 2267g Section 2267g. 149.143 (3) (b) of the statutes is repealed.".

SB45-SSA1-SA1,293,9 954. Page 1166, line 15: delete "sub." and substitute "subs.".

SB45-SSA1-SA1,293,10 955. Page 1166, line 16: after "(b)" insert "and (2m) (b) 1".

SB45-SSA1-SA1,293,11 956. Page 1167, line 19: delete "(a) and (b)" and substitute "(a) and (b)".

SB45-SSA1-SA1,293,12 957. Page 1170, line 11: after that line insert:

SB45-SSA1-SA1,293,13 " Section 2279m. 153.05 (4n) of the statutes is created to read:

SB45-SSA1-SA1,293,17 153.05 (4n) The office shall provide the public service commission with information necessary for performance of duties of the public service commission under subch. II of ch. 196 and as requested of the office by the public service commission.".

SB45-SSA1-SA1,293,18 958. Page 1170, line 18: after that line insert:

SB45-SSA1-SA1,293,20 " Section 2280b. 153.45 (1) (b) of the statutes is renumbered 153.45 (1) (b) 1. and amended to read:

SB45-SSA1-SA1,294,3 153.45 (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.

SB45-SSA1-SA1, s. 2280c Section 2280c. 153.45 (1) (b) 2. of the statutes is created to read:

SB45-SSA1-SA1,294,16 153.45 (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:

SB45-SSA1-SA1,294,17 a. The patient's county of residence.

SB45-SSA1-SA1,294,18 b. The payment source, by type.

SB45-SSA1-SA1,294,20 c. The patient's age category, by 5-year intervals up to age 80 and a category of 80 years or older.

SB45-SSA1-SA1,294,21 d. The patient's procedure code.

SB45-SSA1-SA1,294,22 e. The patient's diagnosis code.

SB45-SSA1-SA1,294,23 f. Charges assessed with respect to the procedure code.

SB45-SSA1-SA1,294,25 g. The name and address of the facility in which the patient's services were rendered.

SB45-SSA1-SA1,295,1 h. The patient's sex.

SB45-SSA1-SA1,295,6 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.

SB45-SSA1-SA1,295,9 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.

SB45-SSA1-SA1,295,11 k. Information other than patient-identifiable data, as defined in s. 153.50 (1) (b), as approved by the independent review board.

SB45-SSA1-SA1, s. 2280e Section 2280e. 153.45 (1) (c) of the statutes is renumbered 153.45 (1) (c) (intro.) and amended to read:

SB45-SSA1-SA1,295,25 153.45 (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:

SB45-SSA1-SA1, s. 2280f Section 2280f. 153.45 (1) (c) 1. to 4. of the statutes are created to read:

SB45-SSA1-SA1,296,2 153.45 (1) (c) 1. Other potentially identifying data elements are not released.

SB45-SSA1-SA1,296,3 2. Population density is sufficient to mask patient identity.

SB45-SSA1-SA1,296,5 3. Other potentially identifying data elements are grouped to provide population density sufficient to protect identity.

SB45-SSA1-SA1,296,6 4. Multiple years of data elements are added to protect identity.

SB45-SSA1-SA1, s. 2280g Section 2280g. 153.45 (6) of the statutes is created to read:

SB45-SSA1-SA1,296,11 153.45 (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.

SB45-SSA1-SA1, s. 2280ge Section 2280ge. 153.50 (1) (a) of the statutes is renumbered 153.01 (2m).

SB45-SSA1-SA1, s. 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:

SB45-SSA1-SA1,296,17 153.50 (1) (b) 1. (intro.) "Patient-identifiable data", for information submitted by hospitals and ambulatory surgery centers, means all of the following data elements:

SB45-SSA1-SA1, s. 2280gm Section 2280gm. 153.50 (1) (b) 2. of the statutes is created to read:

SB45-SSA1-SA1,296,21 153.50 (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:

SB45-SSA1-SA1,296,22 a. Data elements specified in subd. 1. a. to g., L. and m.

SB45-SSA1-SA1,296,24 b. Whether the patient's condition is related to employment, and occurrence and place of an auto accident or other accident.

SB45-SSA1-SA1,297,2 c. Date of first symptom of current illness, of current injury or of current pregnancy.

SB45-SSA1-SA1,297,3 d. First date of patient's same or similar illness, if any.

SB45-SSA1-SA1,297,5 e. Dates that the patient has been unable to work in his or her current occupation.

SB45-SSA1-SA1,297,6 f. Dates of receipt by patient of medical service.

SB45-SSA1-SA1,297,7 g. The patient's city, town or village.

SB45-SSA1-SA1, s. 2280h Section 2280h. 153.50 (2) of the statutes is repealed.

SB45-SSA1-SA1, s. 2280i Section 2280i. 153.50 (3) (b) 7. of the statutes is created to read:

SB45-SSA1-SA1,297,11 153.50 (3) (b) 7. The patient's account number, after use only as verification of data by the department.

SB45-SSA1-SA1, s. 2280j Section 2280j. 153.50 (3) (c) of the statutes is created to read:

SB45-SSA1-SA1,297,16 153.50 (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.

SB45-SSA1-SA1, s. 2280k Section 2280k. 153.50 (3) (d) of the statutes is created to read:

SB45-SSA1-SA1,297,19 153.50 (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).

SB45-SSA1-SA1, s. 2280km Section 2280km. 153.50 (3m) of the statutes is created to read:

SB45-SSA1-SA1,297,25 153.50 (3m) Healthcare 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.

SB45-SSA1-SA1, s. 2280kp Section 2280kp. 153.50 (4) (intro.) of the statutes is renumbered 153.50 (4) (a) (intro.) and amended to read:

SB45-SSA1-SA1,298,5 153.50 (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:

SB45-SSA1-SA1, s. 2280kq Section 2280kq. 153.50 (4) (a) of the statutes is repealed.

SB45-SSA1-SA1, s. 2280kr Section 2280kr. 153.50 (4) (b) to (e) of the statutes are renumbered 153.50 (4) (a) 1. to 4.

SB45-SSA1-SA1, s. 2280ks Section 2280ks. 153.50 (4) (b) of the statutes is created to read:

SB45-SSA1-SA1,298,13 153.50 (4) (b) Of information submitted by health care providers that are not hospitals or ambulatory surgery centers, patient-identifiable data that contains a patient's date of birth may be released under par. (a) only under circumstances as specified by rule by the department.

SB45-SSA1-SA1, s. 2280ku Section 2280ku. 153.50 (5) (a) (intro.) of the statutes is amended to read:

SB45-SSA1-SA1,298,18 153.50 (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:

SB45-SSA1-SA1, s. 2280kv Section 2280kv. 153.50 (5) (a) 3. of the statutes is amended to read:

SB45-SSA1-SA1,298,22 153.50 (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.

SB45-SSA1-SA1, s. 2280kw Section 2280kw. 153.50 (5) (a) 4. (intro.) of the statutes is amended to read:

SB45-SSA1-SA1,299,3 153.50 (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:

SB45-SSA1-SA1, s. 2280kx Section 2280kx. 153.50 (5) (b) 3. of the statutes is amended to read: