153.50(5)(a)4.a.
a. The federal or state statutory requirement to obtain the patient-identifiable data.
153.50(5)(a)4.b.
b. Any federal or state statutory requirement to uphold the patient confidentiality provisions of this chapter or patient confidentiality provisions that are more restrictive than those of this chapter; or, if the latter evidence is inapplicable, an agreement, in writing, to uphold the patient confidentiality provisions of this chapter.
153.50(5)(b)
(b) Upon receipt of a request under
par. (a), the department, entity, or data organization, whichever is applicable, shall, as soon as practicable, comply with the request or notify the requester, in writing, of all of the following:
153.50(5)(b)1.
1. That the department, entity, or data organization, as applicable, is denying the request in whole or in part.
153.50(5m)
(5m) Employers not to request patient-identifiable data. Notwithstanding
subs. (4) and
(5) no employer may request the release of or access to patient-identifiable data of an employee of the employer.
153.50(6)(a)(a) The department or entity under contract under
s. 153.05 (2m) (a) may not require a health care provider submitting health care information under this chapter to include the patient's name, street address or social security number.
153.50(6)(b)
(b) The department may not require under this chapter a health care provider that is not a hospital or ambulatory surgery center to submit uniform patient billing forms.
153.50(6)(c)
(c) A health care provider that is not a hospital or ambulatory surgery center may not submit any of the following to the department under the requirements of this chapter:
153.50(6)(c)4.
4. Data regarding insureds other than the patient, other than the payer category code under
sub. (3m).
153.50(6)(d)
(d) If a health care provider that is not a hospital or ambulatory surgery center submits a data element that is specified in
par. (c) 1. to
10., the department shall immediately return this information to the health care provider or, if discovered later, shall remove and destroy the information.
153.50(6)(e)
(e) A health care provider may not submit information that uses any of the following as a patient account number:
153.50(6)(e)1.
1. The patient's social security number or any substantial portion of the patient's social security number.
153.50(6)(e)2.
2. A number that is related to another patient identifying number.
153.55
153.55
Protection of confidentiality. Data obtained under this chapter is not subject to inspection, copying or receipt under
s. 19.35 (1).
153.55 History
History: 1997 a. 231;
1999 a. 9.
153.60
153.60
Assessments to fund operations of department. Subject to
s. 153.455:
153.60(1)
(1) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures under this chapter for the department for that fiscal year for data collection, database development and maintenance, generation of data files and standard reports, orientation and training provided under
s. 153.05 (9) (a) and contracting with the data organization under
s. 153.05 (2r). The department shall assess the estimated total amount for that fiscal year, less the estimated total amount to be received for purposes of administration of this chapter under
s. 20.435 (1) (hi) during the fiscal year and the unencumbered balance of the amount received for purposes of administration of this chapter under
s. 20.435 (1) (hi) from the prior fiscal year, to health care providers, other than hospitals and ambulatory surgery centers, who are in a class of health care providers from whom the department collects data under this chapter in a manner specified by the department by rule. The department shall work together with the department of regulation and licensing to develop a mechanism for collecting assessments from health care providers other than hospitals and ambulatory surgery centers. No health care provider that is not a facility may be assessed under this subsection an amount that exceeds $75 per fiscal year. All payments of assessments shall be credited to the appropriation under
s. 20.435 (1) (hg).
153.60(3)
(3) The department shall, by the first October 1 after the commencement of each fiscal year, estimate the total amount of expenditures required for the collection, database development and maintenance and generation of public data files and standard reports for health care plans that voluntarily agree to supply health care data under
s. 153.05 (6r). The department shall assess the estimated total amount for that fiscal year to health care plans in a manner specified by the department by rule and may enter into an agreement with the office of the commissioner of insurance for collection of the assessments. Each health plan that voluntarily agrees to supply this information shall pay the assessments on or before December 1. All payments of assessments shall be deposited in the appropriation under
s. 20.435 (1) (hg) and may be used solely for the purposes of
s. 153.05 (6r).
153.60 Note
NOTE: Sub. (3) is repealed by
2005 Wis. Act 228 effective the date specified in s. 153.455 (1) of the statutes, as created by
2005 Wis. Act 228. Section 153.05 (6r) was repealed effective 7-1-06 by Act 228.
153.65
153.65
Provision of special information; user fees. 153.65(1)(1) Subject to
s. 153.455, the department may, but is not required to, provide, upon request from a person, a data compilation or a special report based on the information collected by the department. The department 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 subsection shall be credited to the appropriation under
s. 20.435 (1) (hi).
153.65(2)
(2) Beginning January 1, 2004, unless the entity under contract under
s. 153.05 (2m) (a) otherwise agrees and except as provided in
s. 153.46 (6), the entity has the exclusive right to use and to provide for a fee, upon request from a person, a data compilation or a special report based on the information concerning hospitals and ambulatory surgery centers that is collected by the entity or provided by the department to the entity. Subject to approval under
s. 153.01 (4j) (b), the entity shall establish reasonable and necessary user fees for the provision of a compilation or report, payable by the requester, which shall be sufficient to fund the cost of the compilation or report. The entity may retain all user fees paid under this subsection.
153.75(1)(1) The department shall promulgate the following rules:
153.75 Note
NOTE: Sub. (1) (intro.) is amended by
2005 Wis. Act 228 effective the date specified in s. 153.455 (1) of the statutes, as created by
2005 Wis. Act 228, to read:
Effective date text
(1) The department shall promulgate the following rules, of which pars. (a), (b), (f), (h), (m), (n), (o), (r), (t), and (u) shall apply only if the contract under s. 153.05 (2r) is terminated under s. 153.455 (3) and s. 153.455 (4) applies:
153.75(1)(a)
(a) Providing procedures, for information submitted by health care providers who are not hospitals or ambulatory surgery centers, to ensure the protection of patient confidentiality under
s. 153.50.
153.75(1)(b)
(b) Establishing procedures under which health care providers who are not hospitals or ambulatory surgery centers are permitted to review, verify and comment on information and include the comments with the information.
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)(m)
(m) Specifying the classes of health care providers, other than hospitals and ambulatory surgery centers, from whom claims data and other health care information will be collected.
153.75(1)(n)
(n) Specifying the uniform data set of health care information, as adjusted for case mix and severity, to be collected from health care providers other than hospitals and ambulatory surgery centers.
153.75(1)(o)
(o) Specifying the means by which the information in
par. (b) will be collected, including the procedures for submission of data by electronic means.
153.75(1)(p)
(p) Specifying the methods for using and disseminating health care data in order for health care providers other than hospitals and ambulatory surgery centers to provide health care that is effective and economically efficient and for consumers and purchasers to make informed decisions in selecting health care plans and health care providers.
153.75(1)(q)
(q) Specifying the information to be provided by the department in the consumer guide under
s. 153.21 (1).
153.75(1)(r)
(r) Specifying the standard reports that will be issued by the department in addition to those required in
s. 153.21 (1).
153.75(1)(u)
(u) Specifying the methods for adjusting health care information obtained from health care providers other than hospitals and ambulatory surgery centers for case mix and severity.
153.75(2)
(2) The department may promulgate all of the following rules:
153.75 Note
NOTE: Sub. (2) (intro.) is amended by
2005 Wis. Act 228 effective the date specified in s. 153.455 (1) of the statutes, as created by
2005 Wis. Act 228, to read:
Effective date text
(2) The department may promulgate all of the following rules, which shall apply only if the contract under s. 153.05 (2r) is terminated under s. 153.455 (3) and s. 153.455 (4) applies:
153.75(2)(a)
(a) Exempting certain classes of health care providers that are not hospitals or ambulatory surgery centers 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 department may require under this chapter.
153.75(2)(d)
(d) Specifying the information collected under any voluntary system of health care plan reporting under
s. 153.05 (6r) and the methods and criteria for assessing health care plans that submit data under that subsection.
153.75 Note
NOTE: Par. (d) is repealed by
2005 Wis. Act 228 effective the date specified in s. 153.455 (1) of the statutes, as created by
2005 Wis. Act 228. Section 153.05 (6r) was repealed effective 7-1-06 by Act 228.
153.75 Cross-reference
Cross Reference: See also ch.
DHS 120, Wis. adm. code.
153.85
153.85
Civil liability. Except as provided in
s. 153.86, 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;
1999 a. 9.
153.86
153.86
Immunity from liability. 153.86(1)
(1) A health care provider that submits information to the department under this chapter is immune from civil liability for all of the following:
153.86(1)(a)
(a) Any act or omission of an employee, official or agent of the health care provider that results in the release of a prohibited data element while submitting data to the department.
153.86(1)(b)
(b) Any act or omission of the department that results in the release of data.
153.86(2)
(2) The immunity provided under this section does not apply to intentional, willful or reckless acts or omissions by health care providers.
153.86 History
History: 1999 a. 9.
153.90(1)(1) Whoever intentionally violates
s. 153.45 (5) or
153.50 or rules promulgated under
s. 153.75 (1) (a) may be fined not more than $15,000 or imprisoned for not more than one year in the county jail or both.
153.90(2)
(2) Any person who violates this chapter or any rule promulgated under the authority of this chapter, except
ss. 153.45 (5),
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 department may directly assess forfeitures under
sub. (2). If the department determines that a forfeiture should be assessed for a particular violation or for failure to correct the violation, the department 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.
