SB315: Bill Text

Prefatory note: This bill was prepared for the joint legislative council's special committee on health care information.

Current law creates an office of health care information (OHCI) in the office of the commissioner of insurance. OHCI is given specific powers and duties relating to the collection, analysis and dissemination of health care information under ch. 153 of the statutes. In addition, current law creates a board on health care information, which advises the director of OHCI and approves all rules that the commissioner of insurance promulgates with respect to OHCI and ch. 153. Current law also creates an interagency coordinating council with members representing several state agencies that are involved in collection, analysis and dissemination of health care information.

This bill eliminates OHCI and transfers many of its powers and duties to the department of health and family services (DHFS). These functions would be undertaken by a bureau of health care information in the division with primary responsibility for health issues in DHFS. The bill requires the bureau to coordinate its activities with persons in that division with responsibility for medical assistance administration and collection and analysis of health statistics.

The bill also transfers the board on health care information to DHFS and adds a requirement that appointees to the board are subject to confirmation by the senate. To reflect the transfer of functions, the membership of the interagency coordinating council is changed to add a representative from DHFS. In addition, the bill requires the interagency coordinating council to establish methods and criteria for analyzing and comparing complaints filed against health care plans and grievances filed with health maintenance organizations.

The bill deletes from the statutes the specific sources of health care information collected for purposes of ch. 153 and the specific reports OHCI is required to prepare periodically, except the annual report on uncompensated health care services provided by hospitals. These provisions are replaced by provisions requiring DHFS to specify by rule the standard reports that it will issue and the uniform data set of health care information to be collected and other details relating to collecting, using and disseminating data. As with other rules under ch. 153, these rules would have to be approved by the board on health care information.

In addition to the report on uncompensated health care services, which is retained from current law, the bill requires DHFS to prepare an annual consumer guide to assist consumers in selecting health care providers and health care plans. The bill also requires DHFS to prepare a report on the feasibility of requiring annual reports and plans on uncompensated health care services (i.e., charity care and bad debt services) from major health care providers other than hospitals, which are already required to prepare these reports and plans.

The bill also requires DHFS to study a voluntary system of health plan reporting and allows DHFS, based on the results of the study, to develop and implement such a system.

The bill modifies the current law on assessments on hospitals and ambulatory surgery centers to fund activities under ch. 153 by instead allowing assessments on health care providers who are in a class of health providers from whom DHFS collects claims data and other health care data under ch. 153. The classes of health care providers from whom claims data and other health care data is collected and the methods and criteria for assessing those health care providers would be specified by DHFS by rule.

The bill repeals the required approval of the board on health care information for contracts under ch. 153. In addition, the bill requires the board and DHFS to jointly: (1) develop rules under ch. 153; (2) provide oversight on standard reports; (3) develop the overall strategy and direction for implementation of ch. 153; and (4) provide information on their activities to the interagency coordinating council.

In preparing this bill in final form, the legislative reference bureau deleted a statement of legislative purpose and incorporated it, in large part, into a provision that cross-references the statement. The statement adopted by the special committee was as follows:

153.03 Legislative purpose. The availability of health care information is critical in a competitive health care market. Consumers and purchasers need information to make informed decisions in selecting health care plans and health care providers. Health care providers need information to provide health care that is both effective and economically efficient. The purpose of this chapter is to grant the department the authority and responsibility of collecting and disseminating health care information in a manner to meet those needs.

Current law requires that before a hospital increases its rates by more than the increase in the consumer price index, it must publish a notice and hold a public hearing. The bill eliminates the requirement that a public hearing be held. In addition, the bill requires that the notice be published in the area where the hospital is located and eliminates the alternative of publishing the notice in the official state newspaper.

The bill prohibits DHFS from releasing any health care information that is subject to the department's rules on review and verification until those rules have been complied with. Whoever intentionally violates this prohibition may be fined not more than $10,000, imprisoned for not more than 9 months, or both.

The bill creates a new crime in the criminal extortion statute, relating to using or threatening to use patient health care records for purposes of extortion or to compel a person to do an act against his or her will. A violator is subject to a Class D felony, punishable by a fine not to exceed $10,000, imprisonment not to exceed 5 years, or both.

SB315, s. 1 Section 1. 15.01 (6) of the statutes is amended to read:

SB315,4,5 15.01 (6) "Division," "bureau," "section" and "unit" means mean the subunits of a department or an independent agency, whether specifically created by law or created by the head of the department or the independent agency for the more economic and efficient administration and operation of the programs assigned to the department or independent agency. The office of justice assistance in the department of administration and the office of credit unions in the department of financial institutions have the meaning of "division" under this subsection. The office of health care information in the office of the commissioner of insurance, the office of the long-term care ombudsman under the board on aging and long-term care and the office of educational accountability in the department of education have the meaning of "bureau" under this subsection.

SB315, s. 2 Section 2. 15.02 (3) (c) 2. of the statutes is amended to read:

SB315,4,12 15.02 (3) (c) 2. The principal subunit of the division is the "bureau". Each bureau shall be headed by a "director". The office of health care information in the office of the commissioner of insurance, the office of the long-term care ombudsman under the board on aging and long-term care and the office of educational accountability in the department of education have the meaning of "bureau" under this subdivision.

SB315, s. 3 Section 3. 15.07 (1) (b) 21. of the statutes is created to read:

SB315,4,14 15.07 (1) (b) 21. Board on health care information.

SB315, s. 4 Section 4. 15.107 (7) (b) to (d) of the statutes are amended to read:

SB315,4,17 15.107 (7) (b) A representative of the unit in the department of health and social family services that deals with health statistics.

SB315,4,19 (c) A representative of the unit in the department of health and social family services that deals with the medical assistance program.

SB315,4,21 (d) A representative of the unit in the office of the commissioner of insurance that deals with health care information.

SB315, s. 5 Section 5. 15.107 (7) (g) of the statutes is created to read:

SB315,4,24 15.107 (7) (g) A representative of the bureau of health care information in the department of health and family services.

SB315, s. 6 Section 6. 15.194 of the statutes is created to read:

SB315,5,3 15.194 Same; specified bureaus. (1) 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, s. 7 Section 7. 15.735 (2) of the statutes is renumbered 15.195 (6) and amended to read:

SB315,5,10 15.195 (6) Board on health care information. There is created a board on health care information which is attached to the office of the commissioner of insurance department of health and family services under s. 15.03. The board shall consist of 9 members, a majority of whom may neither be nor represent health care providers, appointed for 4-year terms.

SB315, s. 8 Section 8. 15.737 of the statutes is repealed.

SB315, s. 9 Section 9. 16.03 (1) of the statutes is amended to read:

SB315,6,2 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, s. 10 Section 10. 16.03 (3) of the statutes is amended to read:

SB315,6,7 16.03 (3) Report. The interagency coordinating council shall report at least twice annually to the board on health care information in the office of the commissioner of insurance department of health and family services, concerning the council's activities under this section.

SB315, s. 11 Section 11. 20.145 (1) (g) of the statutes is amended to read:

SB315,6,13 20.145 (1) (g) General program operations. The amounts in the schedule for general program operations and for funding the activities of the office of health care information under s. 153.05 (8) the commissioner of insurance. Ninety percent of all moneys received under ss. 601.31, 601.32, 601.45 and 601.47 shall be credited to this appropriation.

SB315, s. 12 Section 12. 20.145 (8) (title) of the statutes is repealed.

SB315, s. 13 Section 13. 20.145 (8) (hg) of the statutes is renumbered 20.435 (1) (hg) and amended to read:

SB315,6,21 20.435 (1) (hg) (title) General program operations; office of health care information. The amounts in the schedule to fund the activities of the office of health care information 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, s. 14 Section 14. 20.145 (8) (hi) of the statutes is renumbered 20.435 (1) (hi), and 20.435 (1) (hi) (title), as renumbered, is amended to read:

SB315,6,25 20.435 (1) (hi) (title) Compilations and special reports; office of health care information.

SB315, s. 15 Section 15. 20.145 (8) (hj), (kx) and (mr) of the statutes are repealed.

SB315, s. 16 Section 16. 40.03 (6) (j) of the statutes is amended to read:

SB315,7,7 40.03 (6) (j) May contract with the office of health care information in the office of the commissioner of insurance department of health and family services and may contract with other public or private entities for data collection and analysis services related to health maintenance organizations and insurance companies that provide health insurance to state employes.

SB315, s. 17 Section 17. 153.01 (3), (4m), (6) and (9) of the statutes are repealed.

SB315, s. 18 Section 18. 153.01 (4d), (4h), (4p) and (4t) of the statutes are created to read:

SB315,7,10 153.01 (4d) "Department" means the department of health and family services.

SB315,7,12 (4h) "Employer coalition" means an organization of employers formed for the purpose of purchasing health care coverage or services as a group.

SB315,7,14 (4p) "Health care plan" means an insured or self-insured plan providing coverage of health care expenses or an employer coalition.

SB315,7,16 (4t) "Health care provider" has the meaning given in s. 146.81 (1) and includes an ambulatory surgery center.

SB315, s. 19 Section 19. 153.05 (1) (intro.) of the statutes is renumbered 153.05 (1) and amended to read:

SB315,8,4 153.05 (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, s. 20 Section 20. 153.05 (1) (a) to (e) of the statutes are repealed.

SB315, s. 21 Section 21. 153.05 (2) of the statutes is repealed.

SB315, s. 22 Section 22. 153.05 (3) of the statutes is amended to read:

SB315,8,10 153.05 (3) Upon request of the office department, state agencies shall provide health care information to the office department for use in preparing reports under ss. 153.10 to 153.35 this chapter.

SB315, s. 23 Section 23. 153.05 (4) of the statutes is repealed.

SB315, s. 24 Section 24. 153.05 (5) (intro.) and (b) of the statutes are consolidated, renumbered 153.05 (5) and amended to read:

SB315,8,19 153.05 (5)  The office: (b) May department may require hospitals health care providers to submit to the office department information from sources identified under sub. (1) (a) to (e) that the office 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 office in the form specified by the office department by rule.

SB315, s. 25 Section 25. 153.05 (5) (a) and (bm) of the statutes are repealed.

SB315, s. 26 Section 26. 153.05 (6) of the statutes is amended to read:

SB315,9,2 153.05 (6) If the requirements of s. 153.07 (2) are first met, the office 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 of health and family services shall provide the services under s. 153.07 (2).

SB315, s. 27 Section 27. 153.05 (6m) of the statutes is amended to read:

SB315,9,11 153.05 (6m) If the requirements of s. 153.07 (2) are first met, the office 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 commissioner shall provide the services under s. 153.07 (2). The office 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. 20.145 (8) (kx) 20.435 (1) (hg).

SB315, s. 28 Section 28. 153.05 (6r) of the statutes is created to read:

SB315,9,24 153.05 (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, s. 29 Section 29. 153.05 (7) of the statutes is repealed.

SB315, s. 30 Section 30. 153.05 (8) of the statutes is amended to read:

SB315,10,13 153.05 (8) Beginning April 1, 1992, the office 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 commissioner department, from health care providers, as defined specified by rules promulgated by the commissioner, other than hospitals and ambulatory surgery centers department. 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, s. 31 Section 31. 153.05 (9) of the statutes is amended to read:

SB315,10,18 153.05 (9) The office 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, s. 32 Section 32. 153.05 (11) of the statutes is repealed.

SB315, s. 33 Section 33. 153.05 (12) of the statutes is amended to read:

SB315,10,23 153.05 (12) The office department shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the office department.

SB315, s. 34 Section 34. 153.07 (1) of the statutes is amended to read:

SB315,11,3 153.07 (1) The board shall advise the director of the office department with regard to the collection, analysis and dissemination of health care information required by this chapter.

SB315, s. 35 Section 35. 153.07 (2) of the statutes is repealed.

SB315, s. 36 Section 36. 153.07 (3) of the statutes is amended to read:

SB315,11,7 153.07 (3) The board shall approve all rules which are proposed by the commissioner department for promulgation to implement this chapter.

SB315, s. 37 Section 37. 153.07 (4) of the statutes is created to read:

SB315,11,9 153.07 (4) The board and the department shall jointly do all of the following:

SB315,11,10 (a) Develop the rules that are required or authorized under this chapter.

SB315,11,12 (b) Provide oversight on the standard reports under this chapter, including the reports under ss. 153.20 and 153.21.

SB315,11,14 (c) Develop the overall strategy and direction for implementation of this chapter.

SB315,11,16 (d) Provide information on their activities to the interagency coordinating council created under s. 15.107 (7).

SB315, s. 38 Section 38. 153.08 (2) (intro.) and (a) of the statutes are consolidated, renumbered 153.08 (2) and amended to read:

SB315,12,2 153.08 (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, s. 39 Section 39. 153.08 (2) (b) of the statutes is repealed.