Chapter DHS 120

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.

DHS 120.25(2)(a)7. 7. The total annual dollar amount of charity care and bad debt.

DHS 120.25(2)(a)8. 8. The proportion of total annual gross patient revenue that constitutes both charity care and bad debt.

DHS 120.25(2)(a)9. 9. The proportion of total nongovernmental patient revenue that constitutes the charity care.

DHS 120.25(2)(a)10. 10. The proportion of total nongovernmental patient revenue that constitutes the bad debt.

DHS 120.25(2)(a)11. 11. The proportion of total annual nongovernmental patient revenue that constitutes both charity care and bad debt.

DHS 120.25(2)(a)12. 12. The number of patients that received charity care during the most recent fiscal year.

DHS 120.25(2)(a)13. 13. The number of patients projected to receive charity care during the subsequent fiscal year.

DHS 120.25(2)(a)14. 14. The number of bad debt patient accounts during the most recent fiscal year.

DHS 120.25(2)(a)15. 15. The number of bad debt patient accounts projected for the subsequent fiscal year.

DHS 120.25(2)(a)16. 16. The total number of charity care and bad debt cases during the most recent fiscal year.

DHS 120.25(2)(a)17. 17. The total number of charity care and bad debt cases projected for the subsequent fiscal year.

DHS 120.25(2)(a)18. 18. Whether and to what extent the hospital has outstanding obligations on state loan funds, excluding fund proceeds from the Wisconsin health and educational facilities authority, during the most recent fiscal year.

DHS 120.25(2)(b) (b) For each hospital with county general relief revenues greater than $500,000 or 1% of total gross patient revenue for the most recent fiscal year, the report shall list all of the following:

DHS 120.25(2)(b)1. 1. The county in which the hospital is located.

DHS 120.25(2)(b)2. 2. The amount of general relief revenues the hospital received.

DHS 120.25(2)(b)3. 3. The proportion of total gross revenue that the general relief revenue represents.

DHS 120.25(2)(b)4. 4. The proportion of charges for general relief cases that were reimbursed by counties.

DHS 120.25(2)(c) (c) A copy of the department’s hospital uncompensated health care plan survey.

DHS 120.25(2)(d) (d) A copy of the department’s hospital fiscal survey.

DHS 120.25(2)(e) (e) A glossary of terms used in the report.

DHS 120.25(2)(f) (f) Brief discussions of all of the following:

DHS 120.25(2)(f)1. 1. The definition of uncompensated health care services.

DHS 120.25(2)(f)2. 2. Problems associated with measuring hospitals’ charitable contributions to their communities.