Section 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.

(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.

Note

Quality indicators include Health Plan Employer Data and Information (HEDIS) measures and Consumer Assessment of Health Plans (CAHPS) patient satisfaction measures. Microsoft Windows NT 6.1.7601 Service Pack 1