Chapter DHS 120

Register January 2011 No. 661

Chapter DHS 120

HEALTH CARE INFORMATION

Subchapter I — General Provisions

DHS 120.01   Authority and purpose.

DHS 120.02   Applicability.

DHS 120.03   Definitions.

Subchapter II — Administration

DHS 120.04   Assessments to fund the ch. 153, Stats., operations of the department and the board.

DHS 120.05   Communications addressed to the department.

DHS 120.06   Selection of a contractor.

DHS 120.07   Training.

DHS 120.08   Reporting status changes required.

DHS 120.09   Notice of hospital rate increases or charges in excess of rates.

DHS 120.10   Liabilities; penalties.

Subchapter III — Data Collection and Submission

DHS 120.11   Common data verification, review and comment procedures.

DHS 120.12   Data to be submitted by hospitals.

DHS 120.13   Data to be submitted by freestanding ambulatory surgery centers.

DHS 120.14   Data to be submitted by physician class of provider.

DHS 120.15   Data to be submitted by other classes of health care providers.

DHS 120.16   Data to be submitted by health care plans.

Subchapter IV — Standard Reports

DHS 120.20   General provisions.

DHS 120.21   Guide to Wisconsin hospitals.

DHS 120.22   Utilization, charge and quality reports.

DHS 120.23   Consumer guide.

DHS 120.24   Hospital rate increase report.

DHS 120.25   Uncompensated health care services report.

DHS 120.26   Hospital quality indicators report.

Subchapter V — Data Dissemination

DHS 120.29   Public use files.

DHS 120.30   Patient data elements considered patient-identifiable.

DHS 120.31   Data dissemination.

Ch. DHS 120 Note Note: Chapter HSS 120 was renumbered ch. Ins 120, Register, February, 1995, No. 470, eff. 3-1-95. Corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, June, 1997, No. 498. Chapter Ins 120 was renumbered Chapter HFS 120 under s. 13.93 (2m) (b) 1., Stats., and corrections made under s. 13.93 (2m) (b) 6. and 7., Stats., Register, January, 1998, No. 505. Chapter HFS 120 was repealed and recreated, Register, December, 2000, No. 540, eff. 1-1-01. Chapter HFS 120 was renumbered to chapter DHS 120 under s. 13.92 (4) (b) 1., Stats., and corrections made under s. 13.92 (4) (b) 7, Stats., Register January 2009 No. 637.

subch. I of ch. DHS 120 Subchapter I — General Provisions

DHS 120.01 DHS 120.01 Authority and purpose. This chapter is promulgated under the authority of s. 153.75, Stats., to implement ch. 153, Stats. Its purpose is to provide to health care providers, insurers, consumers, governmental agencies and others information concerning health care providers and uncompensated health care services, and provide information to assist in peer review for the purpose of quality assurance.

DHS 120.01 History History: Cr. Register, December, 2000, No. 540, eff. 1-1-01.

DHS 120.02 DHS 120.02 Applicability. This chapter applies to the department, the board on health care information, the independent review board, qualified vendors, health care plans, health care providers licensed in this state and persons requesting data from the department.

DHS 120.02 History History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 03-033: am. Register December 2003 No. 576, eff. 1-1-04.

DHS 120.03 DHS 120.03 Definitions. Unless otherwise indicated, in this chapter:

DHS 120.03(1) (1) “Affirmation statement” means a department document that when signed by a health care provider or an authorized representative of a health care provider submitting data to the department affirms, to the best of the signer’s knowledge, all of the following:

DHS 120.03(1)(a) (a) Any necessary corrections to data submitted to the department have been made.

DHS 120.03(1)(b) (b) The data submitted are complete and accurate.

DHS 120.03(2) (2) “Bad debts” means claims arising from rendering patient care services that the hospital, using a sound credit and collection policy, determines are uncollectible, but does not include charity care.

DHS 120.03(3) (3) “Board” means the board on health care information established under s. 15.195 (6), Stats.

DHS 120.03 Note Note: Section 15.195 (6), Stats., was repealed by 2005 Wis. Act 228.

DHS 120.03(4) (4) “Charity care” means health care a hospital provides to a patient who, after an investigation of the circumstances surrounding the patient’s ability to pay, including nonqualification for a public program, is determined by the hospital to be unable to pay all or a portion of the hospital’s normal billed charges. “Charity care” does not include any of the following:

DHS 120.03(4)(a) (a) Care provided to patients for which a public program or public or private grant funds pay for any of the charges for the care.

DHS 120.03(4)(b) (b) Contractual adjustments in the provision of health care services below normal billed charges.

DHS 120.03(4)(c) (c) Differences between a hospital’s charges and payments received for health care services provided to the hospital’s employees, to public employees or to prisoners.

DHS 120.03(4)(d) (d) Hospital charges associated with health care services for which a hospital reduces normal billed charges as a courtesy.

DHS 120.03(4)(e) (e) Bad debts.

DHS 120.03(5) (5) “Contractual adjustment” means the difference between a hospital’s full amount billed for medical services for patient services and the discounted charge or payment received by the hospital from the payer.

DHS 120.03(6) (6) “Data profile” means a summary of all submitted data and a summary of the number of records received by the department from a health care provider.

DHS 120.03(7) (7) “Data submission manual” means the department’s document specifying the procedures for submitting data, including data formats, coding specifications and instructions for editing incorrect data.

DHS 120.03(8) (8) “Data summary” means a report summarizing what the health care provider submitted, including number of records, and a listing of all questionable data records.