153.10 History
History: 1987 a. 399.
153.15
153.15
Small area analysis reports. Beginning in 1990 and annually thereafter, the office 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) reports identifying health care services or procedures provided by one or more hospitals in specific areas of the state for which the rate of utilization of the service or procedure is significantly different than the state or area average.
153.15 History
History: 1987 a. 399.
153.20
153.20
Uncompensated health care services report. 153.20(1)(1) Beginning in 1990 and annually thereafter, the office 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 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).
153.20(2)
(2) Beginning in 1990 and annually thereafter, every hospital shall file with the office a 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.
153.20 History
History: 1987 a. 399;
1989 a. 18.
153.25
153.25
Mortality and morbidity report. Beginning in 1990 and annually thereafter, the office 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) reports setting forth mortality and morbidity rates for every hospital. Before the release of a report under this section, the office shall provide the physicians, hospitals or other health care providers identified in the report with the opportunity to review and comment under
s. 153.40 (6).
153.25 History
History: 1987 a. 399.
153.30
153.30
Health care insurance report. Beginning in 1990 and annually thereafter, the office may prepare and submit to the governor, and to the legislature under
s. 13.172 (2), a report specifying, to the extent possible, on a regional basis, the number, nature of coverage and costs of health care coverage plans covering residents of this state during the preceding year.
153.30 History
History: 1987 a. 399;
1993 a. 16.
153.35
153.35
Report by the office. The office shall annually, by October 1, under rules promulgated by the commissioner, submit under
s. 13.172 (3) a report to the legislature for distribution to standing committees with jurisdiction over health matters, that shall include all of the following:
153.35(1)
(1) The range, median and mean of charges and increases or decreases in specific charges by hospitals for up to 100 charge elements, as selected by the office, as reported to the office under
s. 153.05 (1) (c) 1.
153.35(2)
(2) Comparisons, among hospitals, of increases or decreases in gross revenues, net revenues, revenues and expenditures, as reported under
s. 153.05 (1) (c) 2. and
3. and
(e).
153.35 History
History: 1987 a. 399;
1993 a. 16.
153.40
153.40
Procedures for data verification and review. 153.40(1)(1) Prior to data submission, hospitals, ambulatory surgery centers or other health care providers shall review discharge data for accuracy and shall obtain verification by the physician of the principal and secondary diagnoses and primary and secondary procedures. The verification shall occur within the time specified by rules promulgated by the commissioner for data submission to the office. If the verification is not made on a timely basis, the hospital or other health care provider shall submit the data noting the lack of verification.
153.40(2)
(2) The office shall be responsible for assuring that appropriate editing is conducted for all submitted data to identify systematic errors, missing data, values beyond an allowed range, illegal codes within a range, illogical sequence of dates, diagnoses and procedures inconsistent with age and sex, other data failing internal consistency checks and other patterns inconsistent with what would be expected. The office shall notify hospitals, ambulatory surgery centers or, beginning April 1, 1992, other health care providers of missing or incorrect information under this subsection.
153.40(3)
(3) Hospitals, ambulatory surgery centers or, beginning April 1, 1992, other health care providers shall be responsible for resolving the errors found by the editing under
sub. (2) and shall resubmit corrected data within 10 working days after receiving written notification from the office of the errors.
153.40(4)
(4) The office shall send edited and corrected data to hospitals, ambulatory surgery centers or, beginning April 1, 1992, other health care providers for a 10-working-day review period before the data are released.
153.40(5)
(5) The office may, by rules promulgated by the commissioner, require that other forms of data verification, including reabstracting studies and comparisons with information collected from other data systems, be conducted prior to the release of physician-specific data.
153.40(6)
(6) At least 30 calendar days prior to the release of a report under
s. 153.25, the office shall notify a physician, hospital or other health care provider identified in the report of the office's intent to release the report. The notification shall include a copy of the draft report and a statement that those identified may submit comments on the report to the office. If the office receives comments prior to the release of the report, the office shall append the comments to the report. If the office receives comments after the report is released, the office shall make the comments available to anyone requesting the comments.
153.45
153.45
Release of data. 153.45(1)(1) After completion of data verification and review procedures under
s. 153.40, the office shall release data in the following forms:
153.45(1)(b)
(b) Public use tapes which do not permit the identification of specific patients, physicians, employers or other health care providers, as defined by rules promulgated by the commissioner. 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.
153.45(1)(c)
(c) Custom-designed subfile tapes, other electronic media, special data compilations or reports containing portions of the public use tape data under
par. (b).
153.45(2)
(2) The office shall provide to other entities the data necessary to fulfill their statutory mandates for epidemiological purposes or to minimize the duplicate collection of similar data elements.
153.45(3)
(3) The office shall release physician-specific and employer-specific data, except in public use tapes as specified under
sub. (1) (b), in a manner that is specified in rules promulgated by the commissioner.
153.50
153.50
Protection of patient confidentiality. Patient-identifiable data obtained under this chapter and contained in the discharge data base of the office is not subject to inspection, copying or receipt under
s. 19.35 (1) and may not be released by the office, except to the patient or to a person granted permission for release by the patient and except that a hospital, a physician, the agent of a hospital or physician or the commissioner may have access to patient-identifiable data to ensure the accuracy of the information in the discharge data base. The department of health and family services may have access to the discharge data base for the purposes of completing epidemiological reports and eliminating the need to maintain a data base that duplicates that of the office, if the department of health and family services does not release or otherwise provide access to the patient-identifiable data.
153.60
153.60
Assessments to fund operations of office and board. 153.60(1)(1) The office shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures for the office and the board for that fiscal year. The office shall assess the estimated total amount for that fiscal year less the estimated total amount to be received under
s. 20.145 (8) (hi),
(hj),
(kx) and
(mr) during the fiscal year and the unencumbered balances of the amounts received under
s. 20.145 (8) (hi),
(hj) and
(mr) 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. Each hospital shall pay the assessment on or before December 1. All payments of assessments shall be deposited in the appropriation under
s. 20.145 (8) (hg).
153.60(2)
(2) The office may assess ambulatory surgery centers under this section, using as the basis for individual ambulatory surgery center assessments the methods and criteria promulgated by rule by the commissioner under
s. 153.75 (1) (k).
153.65
153.65
Provision of special information; user fees. The office may provide, upon request from a person, a data compilation or a special report based on the information collected by the office under
s. 153.05 (1),
(3),
(4) (b),
(5),
(7) or
(8) or
153.08. The office 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. 20.145 (8) (hi).
153.65 History
History: 1987 a. 399;
1993 a. 16,
104.
153.75(1)(1) Following approval by the board, the commissioner shall promulgate the following rules:
153.75(1)(a)
(a) Providing procedures to ensure the protection of patient confidentiality under
s. 153.50.
153.75(1)(b)
(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 office.
153.75(1)(c)
(c) Regarding the scope of health care information required under
s. 153.05 (8) from health care providers other than hospitals and ambulatory surgery centers, defining the term "health care provider" for this purpose and for purposes of
s. 153.45 (1) (b) and specifying forms to be used to collect the information.
153.75(1)(d)
(d) Determining the diagnostic-related groups or up to 100 charge elements, based on those most frequently used by hospitals in the aggregate, for purposes of the reports under
ss. 153.05 (1) (c) and
153.10 (1) (a).
153.75(1)(e)
(e) Implementing requirements for use of uniform patient billing forms and other information under
s. 153.05 (4).
153.75(1)(g)
(g) Establishing criteria for the publication and contents of notices under
s. 153.08.
153.75(1)(h)
(h) Defining the term "major purchaser, payer or provider of health care services" for the purposes of
s. 153.05 (6).
153.75(1)(i)
(i) Regarding the scope and implementation of the reporting requirements under
s. 153.35.
153.75(1)(k)
(k) Establishing methods and criteria for assessing hospitals and ambulatory surgery centers under
s. 153.60.
153.75(2)
(2) With the approval of the board, the commissioner may promulgate all of the following rules:
153.75(2)(a)
(a) Exempting certain classes of health care providers from providing all or portions of the data required under this chapter.
153.75(2)(c)
(c) Providing for the efficient collection, analysis and dissemination of health care information which the office may require under this chapter.
153.85
153.85
Civil liability. Any person violating
s. 153.50 or rules promulgated under
s. 153.75 (1) (a) is liable to the patient for actual damages and costs, plus exemplary damages of up to $1,000 for a negligent violation and up to $5,000 for an intentional violation.
153.85 History
History: 1987 s. 399.
153.90(1)(1) Whoever intentionally violates
s. 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.
153.90(2)
(2) Any person who violates this chapter or any rule promulgated under the authority of this chapter, except
ss. 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.
153.90(3)
(3) The commissioner may directly assess forfeitures under
sub. (2). If the commissioner determines that a forfeiture should be assessed for a particular violation or for failure to correct the violation, the commissioner shall send a notice of assessment to the alleged violator. The notice shall specify the alleged violation of the statute or rule and the amount of the forfeiture assessed and shall inform the alleged violator of the right to contest the assessment under
s. 227.44.
