Wisconsin Legislature: DHS 120.16(2)(a)

1. Name of the provider and address or addresses of main practice or employment.

2. Date of birth.

3. License or certification status, if applicable, including date of initial licensure or certification, credential suspensions or revocations.

4. Specialty, board certification and recertification information, if applicable.

5. Post-secondary education and training.

6. Whether the provider renders services to medicare and medical assistance patients and, if applicable, whether the provider has signed a medicare participation agreement indicating that she or he accepts assignment on all medicare patients.

7. Whether the provider participates in a voluntary partnercare program specified under s. 71.55 (10), Stats., under which assignment is accepted for low-income elderly.

Note: Section 71.55 (10), Stats., was repealed by 2003 Wis. Act 33.

8. Current names and addresses of facilities at which the provider has been granted privileges, if applicable.

9. The usual and customary charges for office visits, routine tests and preventive measures and frequently occurring procedures, as specified by the department.

10. Participation in health maintenance organizations, preferred provider organizations and independent practice arrangements.

11. Practice name, location, phone number and hours spent at location.

12. Type of degree or certification.

13. Date degree or certification granted.

14. Date, state and county of most recent residency.

(c) If the data specified in par. (b) is not available from the department of safety and professional services, or is not available for the desired time interval or in the required format, the department shall require the health care provider to submit that information directly to the department or its designee in a format prescribed by the department.

(d) The department shall consult with each applicable health care provider group specified in sub. (1), through a technical advisory committee or trade association, before the department collects data directly from members of that health care provider group.

(3) Data submission procedures.

(a) The department shall require that information specified in sub. (2) be submitted to the department at least once every 3 years according to a schedule developed by the department. The department may require that the requested information be submitted on an annual or biennial basis according to a schedule developed by the department.

(b) The department may grant an extension of a deadline specified in par. (a) for submission of health care provider information only when the health care provider adequately justifies to the department the health care provider’s need for additional time. In this paragraph, “adequate justification” means a delay due to a labor strike, fire, natural disaster or catastrophic computer failure. A health care provider desiring an extension shall submit a request for an extension in writing to the department at least 10 calendar days prior to the date that the data are due. The department may grant an extension for up to 30 calendar days. Health care providers who have been granted an extension by the department shall submit their data directly to the department.

Note: Health care providers who are required to send their information directly to the department should use the following address: Bureau of Health Information and Policy, P. O. Box 2659, Madison, Wisconsin 53701-2659, or deliver the communications to Room 372, 1 W. Wilson Street, Madison, Wisconsin.

(4) Data verification, review and comment procedures. Health care providers specified in sub. (1) shall verify or correct information contained on their survey. The department shall verify questionable data by contacting the applicable health care provider.

(5) Data adjustment methods. There shall be no adjustment methods for data submitted under this section.

(6) Waiver from data submission requirements. There shall be no waivers from the data submission requirements under this section.

Note: With the exception of s. DHS 120.15, under s. 153.78 (2), Stats., and s. DHS 120.10 (3) (b), the department may assess fines on health care providers that do not submit the data specified in this subchapter on a timely basis. Health care providers may be subject to a fine of $100 per day per type of data that has not been submitted to the Department under this subchapter.

History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; correction in (2) (c) made under s. 13.92 (4) (b) 6., Stats., Register February 2012 No. 674.

DHS 120.16 Data to be submitted by health care plans.

(1) Applicability. This section applies to health care plans that either voluntarily submit health care plan data directly to the department or submit it to the department through the data collection of other state agencies.

(2) Data to be collected. The department shall collect all of the following types of data from each participating health care plan or through a designated state agency:

(a) Financial data. Information regarding the financial status of the health care plan secured under the authority of the commissioner of insurance.

(b) Market conduct. Information regarding the conduct of the health care plan in the marketplace secured under the authority of the commissioner of insurance.

(c) Quality indicators. Measures of quality of care provided by the health care plan from the office of the commissioner of insurance.

Note: Quality indicators include Health Plan Employer Data and Information (HEDIS) measures and Consumer Assessment of Health Plans (CAHPS) patient satisfaction measures.

(d) Grievances and complaints data. Measures of grievances and complaints filed by enrollees of the health care plan from the office of the commissioner of insurance and the department of employee trust funds.

(3) Data submission procedures. State agencies specified in sub. (2) shall forward to the department information specified in sub. (2) in electronic files on an annual basis. The information shall be in a format that has been agreed upon by the department and the state agencies.

(4) Data verification, review and comment procedures. Each of the state agencies specified in sub. (2) shall verify that the information provided to the department has been reviewed and meets the agency’s standards for release to the public.

(5) Data adjustment methods. The department shall include caveats regarding the information the department releases to the public, when needed, to assist consumers in understanding the differences in populations served by the health care plans. Caveats may include references to large populations, such as commercial, medical assistance or medicare populations.

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

Subchapter IV — Standard Reports

DHS 120.20 General provisions.

(1) Standard reports. The department shall prepare the paper reports listed in this subsection and shall make these paper reports available to the public at a charge that meets the department’s cost of printing, copying and mailing a report to the requester. The department shall make electronic copies of the reports available from the department’s website at no charge.

(a) Hospital rate increase report.

(b) Patient-level data utilization, charge and quality report.

(d) Uncompensated health care services report.

(e) Consumer guide.

(f) Hospital quality indicators.

Note: The Department’s web address is: http://www.dhs.wisconsin.gov

(2) Prohibition on early release of reports. If the department releases drafts of any of the standard reports to health care providers for comment, health care providers or subsequent holders of the drafts may not release these reports or data elements from the reports.

(3) Open records applicability.

(a) Except as prohibited under par. (b), the data used to compile the reports under this chapter are not subject to inspection, copying or receipt as specified in the open records provisions under s. 19.35 (1), Stats. When the department completes the reports and distributes them to the governor and legislature the reports shall be publicly available.

(b) Data collected under ss. DHS 120.11 to 120.16 shall not be subject to inspection, copying or receipt as specified in the open record provisions under s. 19.35 (1), Stats.

History: Cr. Register, December, 2000, No. 540, eff. 1-1-01; CR 03-033: am. (3) (b) Register December 2003 No. 576, eff. 1-1-04.

DHS 120.21 Guide to Wisconsin hospitals.

(1) Data sources. The guide to Wisconsin hospitals shall be based on data derived from all of the following sources:

(a) The annual hospital fiscal year survey.

(b) The annual survey of hospitals.

(2) Contents.

(a) General. The guide to Wisconsin hospitals shall present descriptive financial, utilization and staffing information about individual Wisconsin hospitals, as well as summary and trend information for selected aggregate data.

(b) Hospital information. The guide shall present and interpret all of the following information for all Wisconsin hospitals individually and in the aggregate:

1. Income statement data.

2. Payer source.

3. Hospital type.

4. Average inpatient stay.

5. Number of outpatient visits.

6. Balance sheet data.

7. Occupancy rate.

8. Number and type of beds set up and staffed.

9. Number of discharges.

10. Number of inpatient days.

11. Average census.

12. Number of full-time equivalent staff by occupational category.

13. Type of inpatient service.

14. Type of ancillary or other hospital service.

15. Hospital analysis area.

16. Hospital volume group.

(c) Explanatory information. In addition to the information specified under par. (a), the guide shall present all of the following information:

1. A glossary of terms used in the guide.

2. Caveats, data limitations and technical notes associated with the guide.

3. A copy of the department’s annual survey of hospitals.

4. A copy of the department’s hospital fiscal survey.

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

(4) Suggested uses of report. The guide may be used in a variety of ways. Examples of how to use the guide include all of the following:

(a) As a tool to evaluate the fiscal health and operating efficiency of hospitals in Wisconsin.

(b) In conjunction with other department data on hospital inpatient discharges and ambulatory surgeries, to evaluate levels of reimbursement or coverage provisions.

(c) In conjunction with other information, to determine patterns of hospital service availability statewide. Service availability patterns, in turn, can help policy-makers and others identify mechanisms that may enhance service accessibility and availability, such as targeting reimbursement incentives or establishing new or additional health service programs.

(d) As a resource document for persons wishing to conduct research or collect information on hospital utilization, services and finances.

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

DHS 120.22 Utilization, charge and quality reports.