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

 

(1)   Definitions. In this section:

(a) "Net expenditure" means the excess of revenues over expenses.

(b) "State fiscal year" means the 12-month period beginning July 1 and ending the following June 30.

(2)   Estimate of expenditures. By October 1 of each year, the department shall estimate the total expenditures for the ch. 153 , Stats. , operations of the department and the board for the current state fiscal year from which it shall deduct all of the following:

(a) The estimated total amount of monies related to this chapter the department will receive from user fees, gifts, grants, bequests, devises and federal funds for that state fiscal year.

(b) The unencumbered remaining balances of the total amount of monies received through assessments, user fees, gifts, grants, bequests, devises and federal funds from the prior state fiscal year related to this chapter.

(c) The estimated total amount to be received for purposes of administration of this chapter under s. 20.435 (1) (hi) , Stats., during the fiscal year and the unencumbered remaining balance of the amount received for purposes of administration of this chapter under s. 20.435 (1) (hg) , Stats., for the fiscal year.

(3)   Calculation of assessments.

(a) Health care providers .

1. The department shall annually assess health care providers a fee in order to fund the operations of the department and the board as authorized in s. 153.60 , Stats. The department shall calculate net expenditures and resulting assessments separately for hospitals, as a group, freestanding ambulatory surgery centers, as a group, and each type of health care provider, as a group, based on the collection, analysis and dissemination of information related to each group.

2. The assessment for an individual hospital shall be based on the hospital's proportion of the reported gross private-pay patient revenue for all hospitals for its most recently concluded fiscal year, which is that year ending at least 120 days prior to July 1.

2m. The assessment for a hospital emergency department shall be based on the hospital's proportion of the reported total number of emergency visits for general medical surgical and critical access hospitals. The assessment period shall cover the hospital's most recently concluded fiscal year, which is that year ending at least 120 days prior to July 1.

3. The assessment for an individual freestanding ambulatory surgery center shall be based on the freestanding ambulatory surgery center's proportion of the number of reported surgical procedures for all freestanding ambulatory surgery centers for the most recently concluded calendar year.

4. The board shall approve assessment amounts for health care provider classes other than hospitals and freestanding ambulatory surgery centers prior to assessment. The amounts shall equal the quotient of the total amount to be paid by the provider group divided by the number of providers licensed by and practicing in Wisconsin.

5. No health care provider that is not a facility may be assessed under this section an amount exceeding $75 per year.

(b) Health care plans.

1. The department shall, by October 1 of each year, estimate the total amount of expenditures related to the collection, database development and maintenance and generation of public data files and standard reports for health care plans that voluntarily agree to supply data to the department.

2. The department shall divide the expenditure estimate derived in subd. 1. by the total number of enrollees in health care plans that have, by October 1 of each year, notified the department that the health care plan is going to voluntarily supply data to the department under s. DHS 120.15 .

3. The department shall annually assess each health care plan that has voluntarily agreed to supply data to the department a fee proportionate to the amount estimated in subd. 1. equivalent to the health care plan's contribution to the total number of enrollees determined under subd. 2.

(4)   Payment of assessments.

(a) Definitions. In this subsection:

1. "Evidence of being fully retired" means a completed department survey on which the physician certifies that he or she is fully retired and is signed by the physician.

2. "Additional evidence" means a letter from the entity through which medical care was provided by the physician.

(b) Hospitals and freestanding ambulatory surgery centers. Each hospital and freestanding ambulatory surgical center shall pay the amount it has been assessed on or before December 1 of each year by check or money order payable as specified in the assessment notice. Payment of the assessment is timely if the assessment is mailed to the address specified in the assessment notice, is postmarked before midnight of December 1 of the year in which the assessment is due, with postage prepaid, and is received not more than 5 days after the prescribed date for making the payment. A payment that fails to satisfy these requirements solely because of a delay or administrative error of the U.S. postal service shall be considered to be timely.

(c) Individual health care provider classes.

1. `All individual health care provider classes.' Each health care provider class other than hospitals and freestanding ambulatory surgical centers shall pay the annual or biennial amount assessed.

2. `Physicians.'

a. A physician providing evidence of being fully retired shall be exempt from paying the assessment of the collection of claims data specified in subd. 1. The department shall consider physicians providing all medical care free of charge during retirement to be fully retired. The department shall consider physicians who are retired under the patient compensation fund to be fully retired.

b. The department may audit its inpatient and ambulatory surgery databases to corroborate the evidence submitted by physicians. If the department audit indicates that a physician who has submitted evidence of being fully retired is actively practicing in the previous calendar quarter, the physician shall submit the claims data assessment, unless the physician can provide additional evidence that the physician's care was provided at no charge. If the physician claims to be providing medical care at no charge, the physician shall submit additional evidence.

(d) Health care plans . Each health care plan voluntarily submitting health care plan data shall pay the amount it has been assessed on or before December 1 of each year by check or money order payable as specified in the assessment notice. Payment of the assessment is timely if the assessment is mailed to the address specified in the assessment notice, is postmarked before midnight of December 1 of the year in which due, with postage prepaid, and is received not more than 5 days after the prescribed date for making the payment. A payment that fails to satisfy these requirements solely because of a delay or administrative error of the U.S. postal service shall be considered to be timely.

History: Cr. Register, December, 2000, No. 540 , eff. 1-1-01; CR 01-051 : am. (2) (intro.), cr. (3) (a) 2m., Register September 2001 No. 549 eff. 10-1-01; correction in (2) (c) made under s. 13.93 (2m) (b) 7., Stats., Register December 2003 No. 576 ; corrections in (2) (c) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637 .