SB45-SSA1-SA1,366,6 Subchapter II Hospital rate price caps

SB45-SSA1-SA1,366,7 196.991 Definitions. In this subchapter:

SB45-SSA1-SA1,366,8 (1) "Commission" means the public service commission.

SB45-SSA1-SA1,366,9 (2) "Consumer price index" has the meaning given in s. 16.004 (8) (e) 1.

SB45-SSA1-SA1,366,11 (3) "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).

SB45-SSA1-SA1,366,14 (3m) "Price cap" means the maximum rate that may be charged for a service and includes any allowable increases in the maximum rate that are based on increases in the consumer price index.

SB45-SSA1-SA1,366,17 (4) "Rates" means individual charges of a hospital for the services that it provides or, if authorized under s. 196.993, the aggregate charges based on case mix measurements.

SB45-SSA1-SA1,366,20 196.992 Hospital rate price caps. (1) The commission shall promulgate rules that establish price caps for hospital rates. The commission shall consider each of the following in promulgating rules under this subsection:

SB45-SSA1-SA1,366,22 (a) The need to reduce the rate of hospital cost increases while preserving the quality of health care in all parts of the state.

SB45-SSA1-SA1,366,24 (b) A variety of cost-related trend factors based on nationally or regionally recognized economic models.

SB45-SSA1-SA1,367,1 (c) The past budget and rate experiences of hospitals in this state.

SB45-SSA1-SA1,367,8 (2) Rules promulgated under sub. (1) shall include requirements and procedures for hospitals to provide the commission with information that the commission determines is necessary to carry out its duties under this subchapter and for hospitals to notify the commission and patients of rates charged and any proposed increases or decreases in rates. The rules shall also include requirements and procedures for the commission to regularly review and, if necessary, revise the price caps established in the rules promulgated under sub. (1).

SB45-SSA1-SA1,367,10 (3) Rules promulgated under sub. (1) may include requirements and procedures for each of the following:

SB45-SSA1-SA1,367,13 (a) Exceptions from price caps for rural or teaching hospitals if the commission determines that such hospitals are subject to special circumstances that warrant an exception.

SB45-SSA1-SA1,367,16 (b) A uniform system for hospitals to make reports to the commission if the commission determines that such a system is necessary for the commission to carry out its duties under this subchapter.

SB45-SSA1-SA1,367,23 196.993 Case mix measurements. The commission may promulgate rules establishing a system that defines rates as aggregate charges based on case mix measurements if the commission submits its proposed system to the joint committee on finance under s. 13.10, receives that committee's approval and holds a public hearing prior to promulgating its rules. Such a system may not take effect prior to January 1, 2001, shall be consistent with the standard under s. 196.992 (1) (a) and shall ensure quality of care at a reasonable cost to patients.

SB45-SSA1-SA1,367,25 196.994 Commission prohibitions. In carrying out its duties under this subchapter, the commission may not do any of the following:

SB45-SSA1-SA1,368,2 (a) Interfere directly in the personal or decision-making relationships between a patient and the patient's physician.

SB45-SSA1-SA1,368,6 (b) Restrict the freedom of patients to receive care at a hospital consistent with their religious preferences or request a hospital that is affiliated with a religious group to act in a manner contrary to the mission and philosophy of the religious group.

SB45-SSA1-SA1,368,9 (c) Restrict directly the freedom of hospitals to exercise management decisions in complying with the price caps established in rules promulgated under s. 196.992 (1).

SB45-SSA1-SA1,368,11 (d) Require the submission of unrelated financial data from religious groups affiliated with a hospital.

SB45-SSA1-SA1,368,17 196.995 Enforcement. (1) The commission may seek a judicial remedy to enforce compliance with any requirement of this subchapter or with any rule or order of the commission under this subchapter if it first notifies the hospital and provides the hospital a reasonable time to correct a violation. The commission shall commence any action under this subsection in the circuit court for the county in which the hospital is located.

SB45-SSA1-SA1,368,21 (2) Any court that finds an intentional failure to comply with a price cap established in rules promulgated under s. 196.992 (1) may impose a forfeiture of up to $5,000. Each week that a hospital continues its intentional failure to comply with the price cap constitutes a separate violation.

SB45-SSA1-SA1,368,24 (3) Any court with jurisdiction over an action brought under this section may adopt remedies that it finds necessary to enforce compliance. Remedies under this section apply notwithstanding the existence or pursuit of any other remedy.

SB45-SSA1-SA1,368,25 196.996 Assessments. (1) In this section:

SB45-SSA1-SA1,369,3 (a) "Commercial insurance" includes a group or individual disability insurance policy, as defined in s. 632.895 (1) (a), an employer's self-insured health care plan and worker's compensation.

SB45-SSA1-SA1,369,6 (b) "Deduction" means the portion of a charge that was incurred by a patient but was not received from 3rd-party payers or governmental or private payment. "Deduction" includes charity care but does not include bad debt.

SB45-SSA1-SA1,369,8 (c) "Expense" means the cost of operation, including bad debt, that is charged to a hospital during the hospital's fiscal year.

SB45-SSA1-SA1,369,12 (d) "Gross patient revenue" means the total charges to medicare, as defined in s. 49.498 (1) (f), the medical assistance program, other public programs, commercial insurance and other self-payers or nonpublic payers, that are generated by a hospital from inpatient and outpatient services.