Chapter DHS 120

DHS 120.23 Note Note: The bureau of quality assurance was renamed the division of quality assurance.

DHS 120.23(1)(c) (c) Databases of other state agencies, including the office of the commissioner of insurance for information related to health plan finances, market conduct, complaints and grievances, and quality indicators.

DHS 120.23(1)(d) (d) Other private sector information available through various websites.

DHS 120.23(1)(e) (e) Federal databases, including those of the health care financing administration.

DHS 120.23(2) (2) Contents. The consumer guide shall contain information on all of the following:

DHS 120.23(2)(a) (a) How to find and choose a doctor, hospital, health care plan, nursing home or other health care provider.

DHS 120.23(2)(b) (b) How to get health insurance or enroll in medicare, medical assistance, badgercare or family care and where to go with health care coverage or payment questions or problems.

DHS 120.23(2)(c) (c) Where to learn about specific conditions, illnesses or injuries.

DHS 120.23(2)(d) (d) Other websites and related information sources that provide information on health care questions.

DHS 120.23(3) (3) Report dissemination. The department shall make available from the department’s website an electronic version of the consumer guide at no charge. The department shall distribute a paper, summary version of the consumer guide at no charge to the governor, the legislature and a board-approved list of individuals and agencies. The department shall make the paper, summary version of the consumer guide available for purchase by others.

DHS 120.23(4) (4) Suggested use of the consumer guide. Some suggestions for using the report are as follows:

DHS 120.23(4)(a) (a) Health care plan. If available to the department, the following types of data for individual health care plans shall be contained in the consumer guide and may supplement consumers’ age, health status, mobility and financial resources as important factors consumers should consider when selecting a health care plan:

DHS 120.23(4)(a)1. 1. Health plan costs, such as premium per member.

DHS 120.23(4)(a)2. 2. Affiliations of specific physicians, clinics or hospitals.

DHS 120.23(4)(a)3. 3. Satisfaction of enrollees with access to providers.

DHS 120.23(4)(a)4. 4. Satisfaction of enrollees with service locations.

DHS 120.23(4)(a)5. 5. Measures of financial strength, such as profit margins and administrative versus medical costs.

DHS 120.23(4)(a)6. 6. Clinical process and outcome measures, such as those required for accreditation by the national committee for quality assurance or participation in the Wisconsin medical assistance program.

DHS 120.23(4)(a)7. 7. History and trend information on complaints and grievances.

DHS 120.23(4)(a)8. 8. Consumer satisfaction core measures from the consumer assessment of health plans or other satisfaction surveys.

DHS 120.23(4)(a)9. 9. Accreditation status.

DHS 120.23(4)(a)10. 10. Years of operating experience.

DHS 120.23(4)(a)11. 11. Location of plans, service area of plan by county.

DHS 120.23(4)(a)12. 12. Health plan product lines.

DHS 120.23(4)(b) (b) Health care provider.

DHS 120.23(4)(b)1. 1. If available to the department, the following information about a physician and a health care provider specified in s. DHS 120.15 (1) shall be contained in the consumer guide and may supplement other factors such as the consumer’s age, health status, mobility and financial resources as important factors consumers might consider when selecting a health care provider:

DHS 120.23(4)(b)1.a. a. Active status information.

DHS 120.23(4)(b)1.b. b. License or certification status, if applicable, including date of initial licensure or certification, credential suspensions or revocations.

DHS 120.23(4)(b)1.c. c. Medical education and training information.

DHS 120.23(4)(b)1.d. d. Specialty, board certification and recertification information.

DHS 120.23(4)(b)1.e. e. Practice information including name of practice, location, telephone number and hours spent at location.

DHS 120.23(4)(b)1.f. f. Whether the provider renders services to patients insured through medicare or medical assistance.

DHS 120.23(4)(b)1.g. g. Whether the provider accepts medicare assignment.

DHS 120.23(4)(b)1.h. h. The names and addresses of facilities at which the provider has been granted privileges, if applicable.

DHS 120.23(4)(b)1.i. i. Usual and customary charges for office visits, routine tests and diagnostic work-ups, preventive measures and frequently occurring procedures.

DHS 120.23(4)(b)1.j. j. Health plan affiliations, if applicable.

DHS 120.23(4)(b)1.k. k. Volume of surgical procedures for those specific procedures where the department has determined, based on existing scientific evidence, that surgical outcomes are related to volume of procedures performed, if applicable.

DHS 120.23(4)(b)1.L. L. Types of conditions treated.

DHS 120.23(4)(b)2. 2. The department shall provide consumers with information regarding how to assess the information specified in subd. 1. and what additional questions consumers may want to ask the health care provider.

DHS 120.23(4)(c) (c) Health care facility.

DHS 120.23(4)(c)1. 1. If available to the department, the following information about a health care facility shall be contained in the consumer guide and may supplement other factors such as the consumer’s age, health status, mobility and financial resources as important factors in selecting a hospital, nursing home, hospice or other health care facility:

DHS 120.23(4)(c)1.a. a. Facility type.

DHS 120.23(4)(c)1.b. b. Location.

DHS 120.23(4)(c)1.c. c. Ownership.

DHS 120.23(4)(c)1.d. d. Medicare and medical assistance participation.

DHS 120.23(4)(c)1.e. e. Number and type of medical professionals on staff.

DHS 120.23(4)(c)1.f. f. Number of staffed beds.

DHS 120.23(4)(c)1.g. g. Services provided.

DHS 120.23(4)(c)1.h. h. Accreditation status.

DHS 120.23(4)(c)1.i. i. Date of last inspection by the department.

DHS 120.23(4)(c)1.j. j. Degree of compliance with medicare and medical assistance regulations.

DHS 120.23(4)(c)1.k. k. Evaluation by consumers.

DHS 120.23(4)(c)1.L. L. Membership in professional organizations.

DHS 120.23(4)(c)1.m. m. If applicable, performance measures such as complication rates, volume of procedures, patient satisfaction and last report of facility surveys of care delivered.

DHS 120.23(4)(c)1.n. n. Years of operation.

DHS 120.23(4)(c)1.o. o. Costs.

DHS 120.23(4)(c)1.p. p. Satisfaction of clients.

DHS 120.23(4)(c)1.q. q. Measures of financial strength.

DHS 120.23(4)(c)1.r. r. Affiliations with specific physicians, clinics or hospitals.

DHS 120.23(4)(c)2. 2. The department shall provide consumers with information regarding how to assess the information specified in subd. 1. and what additional questions consumers may want to ask the health care facility.

DHS 120.23 History History: Cr. Register, December, 2000, No. 540, eff. 1-1-01.

DHS 120.24 DHS 120.24 Hospital rate increase report.

DHS 120.24(1) (1) Data sources. The hospital rate increase report shall be based on notarized copies of notices placed in newspapers and submitted to the department by hospitals.

DHS 120.24(2) (2) Contents.

DHS 120.24(2)(a) (a) The hospital rate increase report shall contain all of the following information:

DHS 120.24(2)(a)1. 1. For each hospital that publishes a notice as specified under s. DHS 120.09 (2), the report shall list all of the following:

DHS 120.24(2)(a)1.a. a. The name of the hospital and the city in which the hospital is located.

DHS 120.24(2)(a)1.b. b. The date the increase will be effective.

DHS 120.24(2)(a)1.c. c. The resulting annualized percentage increase.

DHS 120.24(2)(a)1.d. d. The geographic area of analysis in which the hospital is located.

DHS 120.24(2)(a)2. 2. A list of hospitals that have closed since 1993.

DHS 120.24(3) (3) Report dissemination. The department shall make the report available from the department’s website at no charge.

DHS 120.24(4) (4) Suggested use of report. Some suggestions for using the report are as follows:

DHS 120.24(4)(a) (a) To understand changes in hospital rates.

DHS 120.24(4)(b) (b) To compare rates across hospitals within and across state regions or statewide.

DHS 120.24(4)(c) (c) To project expected costs of hospitalizations.

DHS 120.24 History History: Cr. Register, December, 2000, No. 540, eff. 1-1-01.

DHS 120.25 DHS 120.25 Uncompensated health care services report.

DHS 120.25(1) (1) Data sources. The uncompensated health care services report shall be based on data derived from all of the following sources:

DHS 120.25(1)(a) (a) Annual hospital plans for the provision of uncompensated health care submitted to the department by hospitals.

DHS 120.25(1)(b) (b) Fiscal surveys of hospitals conducted by the department.

DHS 120.25(2) (2) Contents. The uncompensated health care services report shall contain all of the following information:

DHS 120.25(2)(a) (a) For each hospital, the report shall list all of the following:

DHS 120.25(2)(a)1. 1. The city in which the hospital is located.

DHS 120.25(2)(a)2. 2. The type of the hospital.

DHS 120.25(2)(a)3. 3. The dollar amount of charity care provided for the most recent fiscal year.

DHS 120.25(2)(a)4. 4. The proportion of total annual gross patient revenue that constitutes the charity care.

DHS 120.25(2)(a)5. 5. The annual amount of bad debt.

DHS 120.25(2)(a)6. 6. The proportion of total annual gross patient revenue that constitutes the bad debt.