146.89(3)
(3) Any volunteer health care provider and nonprofit agency whose joint application is approved under
sub. (2) shall meet the following applicable conditions:
146.89(3)(a)
(a) The volunteer health care provider shall provide services under
par. (b) without charge, except as provided in
sub. (3m), at the nonprofit agency, if the joint application of the volunteer health care provider and the nonprofit agency has received approval under
sub. (2) (a).
146.89(3)(b)
(b) Under this section, the nonprofit agency may provide the following health care services:
146.89(3)(b)8.
8. Dental services, including simple tooth extractions and any necessary suturing related to the extractions, performed by a dentist who is a volunteer health provider; and dental hygiene services, performed by a dental hygienist who is a volunteer health provider.
146.89(3)(b)9.
9. Any outpatient surgery that is permitted under the volunteer health care provider's license under
sub. (1) (r) 1. and for which the provider has the necessary training, experience, equipment, and facilities.
146.89(3)(c)
(c) Under this section, the nonprofit agency may not provide emergency medical services, hospitalization, or surgery, except as provided in
par. (b) 8.
146.89(3)(d)
(d) Under this section, the nonprofit agency shall provide health care services primarily to low-income persons who are uninsured and who are not recipients of any of the following:
146.89(3m)
(3m) A volunteer health care provider who is a dentist may provide dental services or a volunteer health care provider who is a dental hygienist may provide dental hygiene services, to persons who are recipients of Medical Assistance, if all of the following apply:
146.89(3m)(a)
(a) The nonprofit agency's fees for these services apply to the recipients and to persons who are not recipients of Medical Assistance.
146.89(3m)(b)
(b) The agency accepts discounted payments, based on ability to pay, from the persons who are not Medical Assistance recipients.
146.89(3r)
(3r) All of the following apply to a volunteer health care provider whose joint application with a school board or relevant governing body is approved under
sub. (2):
146.89(3r)(a)
(a) Before first providing health care services in a school, the volunteer health care provider shall provide to the school board or relevant governing body proof of satisfactory completion of any competency requirements that are relevant to the volunteer health care provider, as specified by the department of public instruction by rule, and shall consult with the school nurse, if any, of the school.
146.89(3r)(b)
(b) Under this subsection, the volunteer health care provider may provide only to students from 4-year-old kindergarten to grade 6 the following health care services:
146.89(3r)(b)5.
5. Any other health care services designated by the department of public instruction by rule.
146.89(3r)(c)
(c) Under this subsection, the volunteer health care provider may not provide any of the following:
146.89(3r)(d)
(d) Any health care services provided under
par. (b) shall be provided without charge at the school and shall be available to all students from 4-year-old kindergarten to grade 6 regardless of income.
146.89(3r)(e)
(e) Under this subsection, a volunteer health care provider may not provide instruction in human growth and development under
s. 118.019.
146.89(4)
(4) Volunteer health care providers who provide services under this section are, for the provision of these services, state agents of the department of health services for purposes of
ss. 165.25 (6),
893.82 (3) and
895.46. This state agency status applies regardless of whether the volunteer health care provider has coverage under a policy of health care liability insurance that would extend to services provided by the volunteer health care provider under this section; and the limitations under
s. 895.46 (1) (a) on the payment by the state of damages and costs in excess of any insurance coverage applicable to the agent and on the duty of a governmental unit to provide or pay for legal representation do not apply. Any policy of health care liability insurance providing coverage for services of a health care provider may exclude coverage for services provided by the health care provider under this section.
146.903
146.903
Disclosures required of health care providers and hospitals. 146.903(1)(b)
(b) "Clinic" means a place, other than a residence or a hospital, that is used primarily for the provision of nursing, medical, podiatric, dental, chiropractic, or optometric care and treatment.
146.903(1)(br)
(br) "Health care information organization" means an organization that gathers data from health care providers or hospitals regarding utilization and quality of health care services and that produces reports on the comparative quality of health care services provided by health care providers or hospitals.
146.903(1)(c)
(c) "Health care provider" has the meaning given in
s. 146.81 (1) (a) to
(L) and includes a clinic and an ambulatory surgical center but does not include a nursing home, as defined in
s. 50.01 (3).
146.903(1)(e)
(e) "Median billed charge" means one of the following:
146.903(1)(e)1.
1. For a health care provider, the amount the health care provider charged, before any discount or contractual rate applicable to certain patients or payers was applied, during the first 2 calendar quarters of the most recently completed calendar year, as calculated by arranging the charges in that reporting period from highest to lowest and selecting the middle charge in the sequence or, for an even number of charges, selecting the 2 middle charges in the sequence and calculating the average of the 2.
146.903(1)(e)2.
2. For a hospital, the amount the hospital charged, before any discount or contractual rate applicable to certain patients or payers was applied, during the 4 calendar quarters for which the hospital most recently reported data under
ch. 153, as calculated by arranging the charges in the reporting period from highest to lowest and selecting the middle charge in the sequence or, for an even number of charges, selecting the 2 middle charges in the sequence and calculating the average of the 2.
146.903(1)(g)
(g) "Public information" means information that any person may access from a health care information organization, regardless of whether the organization charges a fee for the information.
146.903(2)(a)2.
2. For each type of health care provider, annually identify the 25 presenting conditions for which that type of health care provider most frequently provides health care services.
146.903(2)(a)3.
3. Prescribe the methods by which health care providers shall calculate and present median billed charges and Medicare and private 3rd-party payer payments under
sub. (3) (b).
146.903(2)(b)
(b) In performing the duties under
par. (a), the department shall consult with organizations in this state that do all of the following:
146.903(2)(b)1.
1. Develop performance measures for assessing the quality of health care services.
146.903(2)(b)2.
2. Guide the collection, validation, and analysis of data related to measures described under
subd. 1.
146.903(2)(b)3.
3. Report results of assessments of the quality of health care services.
146.903(2)(b)4.
4. Share best practices of organizations that provide health care services.
146.903(3)
(3) Health care provider disclosure of charges. 146.903(3)(a)(a) Except as provided in
par. (g), a health care provider or the health care provider's designee shall, upon request by and at no cost to a health care consumer, disclose to the consumer within a reasonable period of time after the request, the median billed charge, assuming no medical complications, for a health care service, diagnostic test, or procedure that is specified by the consumer and that is provided by the health care provider.
146.903(3)(am)
(am) A health care provider that submits data to a health care information organization shall, when it makes a disclosure to a consumer under
par. (a), make available to the consumer any public information reported by the health care information organization regarding the quality of health care services provided by the health care provider compared to the quality of health care services provided by other health care providers that is relevant to the health care service, diagnostic test, or procedure specified by the consumer under
par. (a). A health care provider may make the information available to the consumer by providing the consumer a paper copy of the information or by providing the consumer the address of an Internet site where the information is posted. If the health care provider submits data to more than one health care information organization and more than one of the health care information organizations reports to the health care provider public information on comparative quality that is relevant to the health care service, diagnostic test, or procedure, the health care provider is required under this paragraph to make available to the consumer public information reported by only one of the health care information organizations.
146.903(3)(b)
(b) Except as provided in
par. (g), a health care provider shall prepare a single document that lists the following charge information, assuming no medical complications, for diagnosing and treating each of the 25 presenting conditions identified for the health care provider's provider type under
sub. (2):
146.903(3)(b)2.
2. If the health care provider is certified as a provider of Medicare, the Medicare payment to the provider.
146.903(3)(b)3.
3. The average allowable payment from private, 3rd-party payers.
146.903(3)(bm)
(bm) A health care provider that submits data to a health care information organization shall make available with the document required under
par. (b) any public information reported by the health care information organization regarding the quality of health care services provided by the health care provider compared to the quality of health care services provided by other health care providers that is relevant to a presenting condition for which the provider is required to list charge information under
par. (b). A health care provider may make the information available by attaching it to the document or by including the address of an Internet site where the information is posted with the document. If the health care provider submits data to more than one health care information organization and more than one of the health care information organizations reports to the health care provider public information on comparative quality that is relevant to a presenting condition, the health care provider is required under this paragraph to make available public information reported by only one of the health care information organizations for the presenting condition.
146.903(3)(c)
(c) Except as provided in
par. (g), a health care provider or the health care provider's designee shall, upon request by and at no cost to a health care consumer, provide the consumer a copy of the document prepared under
par. (b) and the information described under
par. (bm).
146.903(3)(d)
(d) Except as provided in
par. (g), a health care provider shall annually update the document under
par. (b).
146.903(3)(e)
(e) Information provided upon request under
par. (a) or included on the document under
par. (b) does not constitute a legally binding estimate of the charge for a specific patient or the amount that a 3rd-party payer will pay on behalf of the patient.
146.903(3)(f)
(f) Except as provided in
par. (g), a health care provider shall prominently display, in the area of the health care provider's practice or facility that is most commonly frequented by health care consumers, a statement informing the consumers that they have the right to receive charge information as provided in
pars. (a) and
(b) and, if applicable, the information described under
par. (bm), from the health care provider and, if the requirements, if any, under
s. 632.798 (2) (d) are met, a good faith estimate, from their insurers or self-insured health plans, of the insured's total out-of-pocket cost according to the insured's benefit terms for the specified health care service in the geographic region in which the health care service will be provided.
146.903(3)(g)
(g) The requirements under
pars. (a) to
(f) do not apply to any of the following:
146.903(3)(g)1.
1. A health care provider that practices individually or in association with not more than 2 other individual health care providers.
146.903(3)(g)2.
2. A health care provider that is an association of 3 or fewer individual health care providers.
146.903(4)(a)(a) Each hospital shall prepare a single document that lists the following charge information, assuming no medical complications, for inpatient care for each of the 75 diagnosis related groups identified under
s. 153.21 (3) and the following charge information for each of the 75 outpatient surgical procedures identified under
s. 153.21 (3):
146.903(4)(a)3.
3. The average allowable payment from private, 3rd-party payers.
146.903(4)(am)
(am) A hospital that submits data to a health care information organization shall make available with the document required under
par. (a) any public information reported by the health care information organization regarding the quality of health care services provided by the hospital compared to the quality of health care services provided by other hospitals that is relevant to a diagnosis related group or outpatient surgical procedure for which the hospital is required to list charge information under
par. (a). A hospital may make the information available by attaching it to the document or by including the address of an Internet site where the information is posted with the document. If a hospital submits data to more than one health care information organization and more than one of the health care information organizations reports to the hospital public information on comparative quality that is relevant to a diagnosis related group or outpatient surgical procedure, the hospital is required under this paragraph to make available public information reported by only one of the health care information organizations for the diagnosis related group or outpatient surgical procedure.
146.903(4)(b)
(b) A hospital shall, upon request by and at no cost to a health care consumer, provide the consumer a copy of the document prepared under
par. (a) and the information described under
par. (am).
146.903(4)(c)
(c) A hospital shall update the document under
par. (a) every calendar quarter.
146.903(4)(d)
(d) Information included on the document under
par. (a) does not constitute a legally binding estimate of the charge for a specific patient or the amount that a 3rd-party payer will pay on behalf of the patient.
146.903(4)(e)
(e) Each hospital shall prominently display, in the area of the hospital that is most commonly frequented by health care consumers, a statement informing the consumers that they have the right to receive a copy of the document under
par. (a) and, if applicable, the information described under
par. (am), from the hospital and, if the requirements, if any, under
s. 632.798 (2) (d) are met, a good faith estimate, from their insurers or self-insured health plans, of the insured's total out-of-pocket cost according to the insured's benefit terms for the specified health care service in the geographic region in which the health care service will be provided.
146.903(5)(a)(a) Whoever violates
sub. (3) or
(4) may be required to forfeit not more than $250 for each violation.
146.903(5)(b)
(b) The department may directly assess forfeitures provided for under
par. (a). If the department determines that a forfeiture should be assessed for a particular violation, the department shall send a notice of assessment to the alleged violator. The notice shall specify the amount of the forfeiture assessed, the violation, and the statute or rule alleged to have been violated, and shall inform the alleged violator of the right to a hearing under
par. (c).
146.903(5)(c)
(c) An alleged violator may contest an assessment of a forfeiture by sending, within 10 days after receipt of notice under
par. (b), a written request for a hearing under
s. 227.44 to the division of hearings and appeals created under
s. 15.103 (1). The administrator of the division may designate a hearing examiner to preside over the case and recommend a decision to the administrator under
s. 227.46. The decision of the administrator of the division shall be the final administrative decision. The division shall commence the hearing within 30 days after receipt of the request for a hearing and shall issue a final decision within 15 days after the close of the hearing. Proceedings before the division are governed by
ch. 227. In any petition for judicial review of a decision by the division, the party, other than the petitioner, who was in the proceeding before the division shall be the named respondent.
