153.55 Protection of confidentiality.
153.60 Assessments to fund operations of department and board.
153.65 Provision of special information; user fees.
153.67 Independent review board.
153.76 Rule-making by the independent review board.
153.86 Immunity from liability.
153.01
153.01
Definitions. In this chapter:
153.01(2)
(2) "Board" means the board on health care information.
153.01(2m)
(2m) "Data element" means an item of information from a uniform patient billing form.
153.01(4)
(4) "Department" means the department of health and family services.
153.01(4h)
(4h) "Employer coalition" means an organization of employers formed for the purpose of purchasing health care coverage or services as a group.
153.01(4p)
(4p) "Health care plan" means an insured or self-insured plan providing coverage of health care expenses or an employer coalition.
153.01(4t)
(4t) "Health care provider" has the meaning given in
s. 146.81 (1) and includes an ambulatory surgery center.
153.01(7)
(7) "Patient" means a person who receives health care services from a health care provider.
153.01(8)
(8) "Payer" means a 3rd party payer, including an insurer, federal, state or local government or another who is responsible for payment of a hospital charge.
153.05
153.05
Collection and dissemination of health care and related information. 153.05(1)
(1) In order to provide to hospitals, health care providers, insurers, consumers, governmental agencies and others information concerning 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 department shall collect, analyze and disseminate health care information, as adjusted for case mix and severity, in language that is understandable to lay persons.
153.05(3)
(3) Upon request of the department, state agencies shall provide health care information to the department for use in preparing reports under this chapter.
153.05(5)
(5) Unless
sub. (13) applies, the department may require health care providers to submit to the department information specified by rule under
s. 153.75 (1) (n) for the preparation of reports, plans and recommendations in the form specified by the department by rule.
153.05(6)
(6) 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).
153.05(6m)
(6m) 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 employees. 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 (4) (hg).
153.05(6r)
(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 employee 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.
153.05(8)
(8) Unless
sub. (13) applies, the department shall collect, analyze and disseminate, in language that is understandable to lay persons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, as determined by rules promulgated by the department, from health care providers specified by rules promulgated by the department. Data from 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.
153.05(9)
(9) The department shall provide orientation and training to health care providers who submit data under this chapter to explain the process of data collection and analysis and the procedures for data verification, comment, interpretation and release.
153.05(12)
(12) The department shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the department.
153.05(13)
(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.
153.07
153.07
Board powers and duties. 153.07(1)
(1) The board shall advise the department with regard to the collection, analysis and dissemination of health care information required by this chapter.
153.07(3)
(3) The board shall approve all rules which are proposed by the department for promulgation to implement this chapter.
153.07(4)
(4) The board and the department shall jointly do all of the following:
153.07(4)(b)
(b) Provide oversight on the standard reports under this chapter, including the reports under
ss. 153.20 and
153.21.
153.07(4)(c)
(c) Develop the overall strategy and direction for implementation of this chapter.
153.07(4)(d)
(d) Provide information on their activities to the interagency coordinating council created under
s. 15.107 (7).
153.08
153.08
Hospital rate increases or charges in excess of rates. 153.08(1)(b)
(b) Notwithstanding
s. 153.01 (5), "hospital" has the meaning given in
s. 50.33 (2), except that "hospital" does not include a center for the developmentally disabled as defined in
s. 51.01 (3).
153.08(1)(c)
(c) "Rates" means individual charges of a hospital for the services that it provides.
153.08(2)
(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 causes to be published a class 1 notice under
ch. 985 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.
153.08(3)
(3) This section does not apply to a hospital that proposes to increase its rates during the course of the hospital's fiscal year by any amount or amounts that, in the aggregate, do not exceed the percentage amount that is the percentage difference between the consumer price index reported for the 12-month period ending on December 31 of the preceding year and the consumer price index reported for the 12-month period ending on December 31 of the year prior to the preceding year.
153.08(4)
(4) A hospital shall publish a class 1 notice under
ch. 985 at least 10 days prior to the institution by the hospital of a rate increase.
153.10
153.10
Health care data reports. 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), standard reports that the department prepares and shall collect information necessary for preparation of those reports.
153.10 History
History: 1987 a. 399;
1997 a. 27,
231.
153.20
153.20
Uncompensated health care services report. 153.20(1)(1) 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), 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).
153.20(2)
(2) Every hospital shall file with the department 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.
153.21
153.21
Consumer guide. 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) an annual guide to assist consumers in selecting health care providers and health care plans. The guide shall be written in language that is understandable to lay persons. The department shall widely publicize and distribute the guide to consumers.
153.21 History
History: 1997 a. 231.
153.45
153.45
Release of data. 153.45(1)(1) After completion of data verification, comment and review procedures specified by the department by rule, the department shall release data, together with comments, if any, in the following forms:
153.45(1)(b)1.1. For information that is submitted by 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 and the use of calculated variables and aggregated variables.
153.45(1)(b)2.
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:
153.45(1)(b)2.g.
g. The name and address of the facility in which the patient's services were rendered.
153.45(1)(b)2.i.
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.
153.45(1)(b)2.j.
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.
153.45(1)(c)
(c) 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:
153.45(1)(c)1.
1. Other potentially identifying data elements are not released.
153.45(1)(c)2.
2. Population density is sufficient to mask patient identity.
153.45(1)(c)3.
3. Other potentially identifying data elements are grouped to provide population density sufficient to protect identity.
153.45(1)(c)4.
4. Multiple years of data elements are added to protect identity.
153.45(1m)
(1m) After completion of data verification and review procedures specified by the department by rule, the department may, but is not required to, release special data compilations.
153.45(2)
(2) The department 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 department may, but is not required to, release health care provider-specific and employer-specific data, except in public use data files as specified under
sub. (1) (b), in a manner that is specified in rules promulgated by the department.
153.45(4)
(4) The department shall prohibit purchasers of data from rereleasing individual data elements of health care data files.
153.45(5)
(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, comment 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.
153.45(6)
(6) The department may not sell or distribute databases 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.
