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

 

(1)   Definitions. In this section:

(a) "Annualized percentage" means an estimate of the percentage increase in a hospital's gross revenue due to a price increase in charges for patient services for the 12-month period beginning with the effective date of the price increase.

(b) "Change in the consumer price index" means the percentage difference between the consumer price index, as defined in s. 16.004 (8) (e) 1. , Stats., for the 12-month period ending on December 31 of the preceding year and the consumer price index for the 12-month period ending on December 31 of the year prior to the preceding year.

(c) "Charge element" means any service, supply or combination of services or supplies that is specified in the categories for payment under the charge revenue code of the uniform patient billing form.

(d) "Class 1 notice" means, in accordance with s. 985.07 (1) , Stats., the publication of a notice at least once in a newspaper likely to give notice to interested persons in the area where the hospital is located.

(e) "Room and board" means the charges associated with all services provided to the patient in a private or semi-private room.

(2)   Notice required. No sooner than 45 calendar days and no later than 30 calendar days before a hospital implements a reportable price increase, it shall publish a class 1 notice of the proposed price increase as provided in this section.

(3)   Contents of notice.

(a) Required format . Each notice under sub. (2) shall include a boldface heading printed in capital letters of at least 18-point type. The text of the notice shall be printed in at least 10-point type. Any numbers printed in the notice shall be expressed as numerals.

(b) Notice of price increase . A notice under sub. (2) shall include, at a minimum, all of the following in the following order:

1. A heading entitled, "NOTICE OF PROPOSED HOSPITAL PRICE INCREASE FOR (name of hospital)."

2. The address of the hospital.

3. The beginning and ending dates of the hospital's fiscal year.

4. The total anticipated amount of the price increase, expressed as an annualized percentage.

5. The date the price increase will take effect.

6. The effective date of the hospital's last reportable price increase and the amount of that increase, expressed as an annualized percentage.

6m. The effective date of any other reported price increases within one year prior to the increase in subd. 6. and the amount of each increase, expressed as an annualized percentage.

7. The name of each charge element listed in table DHS 120.09 for which the hospital proposes to increase the price. A hospital may, but need not, include any charge element for which no price increase is proposed. For each charge element listed, the hospital shall include all of the following information, formatted as follows:

a. Current per unit price.

b. Proposed per unit price.

c. Amount of the price change between subd. 7. a. and b.

d. Percentage of the price change between subd. 7. a. and b.

8. An explanation of the reason for the proposed price increase.

Table DHS 120.09

HOSPITAL CHARGE ELEMENTS

ROOM AND BOARD – PRIVATE

  General classification

  Medical/surgical/gynecology

  Obstetric

  Pediatric

  Psychiatric

  Hospice

  Detoxification

  Oncology

  Other

ROOM AND BOARD – SEMIPRIVATE TWO BED

  General classification

  Medical/surgical/gynecology

  Obstetric

  Pediatric

  Psychiatric

  Hospice

  Detoxification

  Oncology

  Other

NURSERY

  General classification

  Newborn

  Premature

  Neonatal intensive care unit

  Other

INTENSIVE CARE

  General classification

  Surgical

  Medical

  Pediatric

  Psychiatric

  Post-intensive care unit

  Burn care

  Trauma

  Other

CORONARY CARE

  General classification

  Myocardial infarction

INCREMENTAL NURSING CHARGE RATE

  General classification

  Nursery

  Intensive care

  Coronary care

OTHER IMAGING SERVICES

Mammography, excluding physician fees

EMERGENCY ROOM

General classification – based on highest volume, excluding physician fees

LABOR ROOM/DELIVERY

  General classification

  Labor

  Delivery

  Circumcision

  Birthing center

  Other

PSYCHIATRIC/PSYCHOLOGICAL TREATMENTS

  General classification

  Electroshock treatment

  Milieu therapy

  Play therapy

  Other

PSYCHIATRIC/PSYCHOLOGICAL SERVICES

  General classification

  Rehabilitation

  Day care

  Night care

  Individual therapy

  Group therapy

  Family therapy

  Biofeedback

  Testing

  Other

(4)   Affidavit of publication. A hospital that publishes any notice under sub. (3) shall require the newspaper in which the notice is published to furnish the hospital with an affidavit of publication attached to a copy of the notice clipped from the paper. The affidavit shall state the name of the newspaper and the date of publication and shall be signed by the editor, publisher, owner or designee of the editor, publisher or owner. Within 14 calendar days after the hospital receives the affidavit of publication, the hospital shall transmit to the department the affidavit and the notice clipped from the newspaper attached.

History: Cr. Register, December, 2000, No. 540 , eff. 1-1-01; CR 01-051 : cr. (3) (a) 6m., Register September 2001 No. 549 eff. 10-1-01.

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. Microsoft Windows NT 6.1.7601 Service Pack 1