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(4j)
(4j) "Entity" means a nonstock corporation organized under
ch. 181 that is described in section
501 (c) (6) of the Internal Revenue Code and is exempt from federal income tax under section
501 (a) of the Internal Revenue Code, and that does all of the following:
153.01(4j)(a)
(a) Represents at least 70% of the hospitals in Wisconsin.
153.01(4j)(b)
(b) Receives oversight with respect to services performed by the entity under this chapter from the secretary of health and family services.
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 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:
153.05(1)(a)
(a) The department shall collect from health care providers other than hospitals and ambulatory surgery centers, analyze, and disseminate health care information, as adjusted for case mix and severity, in language that is understandable to laypersons.
153.05(1)(b)
(b) The entity under contract under
sub. (2m) (a) shall collect from hospitals and ambulatory surgery centers the health care information required of hospitals and ambulatory surgery centers by the department under ch.
153, 2001 stats., and the rules promulgated under ch.
153, 2001 stats., including, by the date that is 18 months after the date of the contract under
sub. (2m) (a), outpatient hospital-based services. The entity shall analyze and disseminate that health care information, as adjusted for case mix and severity, in the manner required under this chapter, under ch.
153, 2001 stats., and under the rules promulgated under ch.
153, 2001 stats., and in language that is understandable to laypersons.
153.05(2m)(a)(a) Notwithstanding
s. 16.75 (1),
(2), and
(3m), by the 2nd month after July 26, 2003, the department of administration shall, from the appropriation under
s. 20.505 (1) (im), contract with an entity to perform services under this chapter that are specified for the entity with respect to the collection, analysis, and dissemination of health care information of hospitals and ambulatory surgery centers. The department of administration may not, by this contract, require from the entity any collection, analysis, or dissemination of health care information of hospitals and ambulatory surgery centers that is in addition to that required under this chapter.
153.05(2m)(b)
(b) Biennially, the group specified under
s. 153.01 (4j) (b) shall review the entity's performance, including the timeliness and quality of the reports generated by the entity. If the group is dissatisfied with the entity's performance, the group may recommend to the department of administration that that department use a competitive request-for-proposal process to solicit offers from other organizations for performance of the services. If no organization responds to the request for proposal, the department of health and family services shall perform the services specified for the entity with respect to the collection, analysis, and dissemination of health care information of hospitals and ambulatory surgery centers under this chapter.
153.05(2m)(c)
(c) By April 1, annually, the secretary of health and family services shall submit to the chief clerk of each house of the legislature for distribution to the legislature under
s. 13.172 (2), a report concerning the content and number of reports and currency of information and reports generated in the previous calendar year by the entity under contract under
s. 153.05 (2m).
153.05(3)(a)(a) Upon request of the department for health care information relating to health care providers other than hospitals and ambulatory surgery centers, state agencies shall provide that health care information to the department for use in preparing reports under this chapter.
153.05(3)(b)
(b) Upon request of the entity under contract under
sub. (2m) (a) for health care information relating to hospitals and ambulatory surgery centers, state agencies shall provide that health care information to the entity for use in preparing reports under this chapter.
153.05(5)(a)(a) Unless
sub. (13) applies, the department may require health care providers other than hospitals and ambulatory surgery centers 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(5)(b)
(b) Unless
sub. (13) applies, the entity under contract under
sub. (2m) (a) may require hospitals and ambulatory surgery centers to submit to the entity information for the preparation of reports, plans, and recommendations in the form specified by the entity.
153.05(6)
(6) The department may contract with a public or private organization 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) (a).
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, other than hospitals and ambulatory surgery centers, 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 other than hospitals and ambulatory surgery centers.
153.05(8)(a)(a) Unless
sub. (13) applies, the department shall collect, analyze and disseminate, in language that is understandable to laypersons, 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, other than hospitals and ambulatory surgery centers, specified by rules promulgated by the department. Data from those 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 from health care plans data that is specific to health care providers other than hospitals and ambulatory surgery centers, the department shall attempt to avoid collecting the same data from those health care providers.
153.05(8)(b)
(b) Unless
sub. (13) applies, the entity under contract under
sub. (2m) (a) shall collect, analyze, and disseminate, in language that is understandable to laypersons, claims information and other health care information, as adjusted for case mix and severity, under the provisions of this chapter, from hospitals and ambulatory surgery centers. Data from hospitals and ambulatory surgery centers 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.
153.05(9)(a)(a) The department shall provide orientation and training to health care providers, other than hospitals and ambulatory surgery centers, 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(9)(b)
(b) The entity under contract under
sub. (2m) (a) shall provide orientation and training to hospitals and ambulatory surgery centers that 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)(a)(a) 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(12)(b)
(b) The entity under contract under
sub. (2m) (a) shall, to the extent possible and upon request, assist members of the public in interpreting data in health care information disseminated by the entity.
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.
153.05 Cross-reference
Cross Reference: See also ch.
HFS 120, Wis. adm. code.
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.
153.08(5)
(5) The entity under contract under
s. 153.05 (2m) (a) shall annually publish a hospital rate increase report that contains all of the following information:
153.08(5)(a)
(a) For each hospital that publishes a notice under
sub. (4), all of the following:
153.08(5)(a)1.
1. The name of the hospital and the city, village, or town in which the hospital is located.
153.08(5)(a)3.
3. The annualized percentage rate increase that will result.
153.08(5)(a)4.
4. The geographic area of analysis in which the hospital is located.
153.08(5)(b)
(b) A list of hospitals that have closed since 1993.
153.10
153.10
Health care data reports. 153.10(1)
(1) 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 concerning health care providers other than hospitals and ambulatory surgery centers that the department prepares and shall collect information necessary for preparation of those reports.
153.10(2)
(2) The entity under contract under
s. 153.05 (2m) (a) 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 concerning hospitals and ambulatory surgery centers that the entity prepares and shall collect information necessary for preparation of those reports.
153.20
153.20
Uncompensated health care services report. 153.20(1)(1) The entity under contract under
s. 153.05 (2m) (a) 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 entity under contract under
s. 153.05 (2m) (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.
153.21(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 guide to assist consumers in selecting health care providers and health care plans. The guide shall be written in language that is understandable to laypersons. The department shall widely publicize and distribute the guide to consumers.
153.21(2)
(2) The entity under contract under
s. 153.05 (2m) (a) 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 hospitals and ambulatory surgery centers. The guide shall be written in language that is understandable to laypersons and shall include data derived from the annual survey of hospitals conducted by the American Hospital Association and the annual hospital fiscal survey. The entity shall widely publicize and distribute the guide to consumers.
153.21 History
History: 1997 a. 231;
2003 a. 33.
153.22
153.22
Patient-level data utilization, charge, and quality report.
