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Quality Measurement and Reporting in Wisconsin

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        Wisconsin requires hospitals to submit a quality indicators report that shows differences in care.  The report does not identify individual hospitals, but promotes improvement in quality care.1  Hospitals and ambulatory surgical centers are also required to report quality data on patients treated.2  Wisconsin law also requires health insurance plans to submit data on quality indicators to state agencies.  The state agencies are to then send the data to the Department of Health Services to be publicly reported.3

        Wisconsin requires various entities, including Resource Centers, Nursing Facilities, the Department of Health Services, Defined Network Plans, and Preferred Provider Plans to implement quality improvement and quality assurance procedures and/or committees.4

 

Footnotes

  • 1. Wis. Admin. Code DHS §120.26
  • 2. W.S.A. 153.22
  • 3. Wis. Admin. Code §DHS 120.16
  • 4. W.S.A. § 46.283; W.S.A. § 49.498; W.S.A. § 256.08; W.S.A. § 609.32

 

Quality Measurement and Reporting in Wisconsin

Subtopic Statute/Regulation Description
Quality reporting requirements – providers and health plans Collection and dissemination of health care and related information – Wis. Stat. Ann. § 153.05 Collection and Dissemination of health care and related information The purpose of this section is to give providers, consumers, insurers, and...
Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 The Wisconsin Department of Health Services must identify ways for providers to calculate median billed charges.  In conducting its duties, the...
Disclosures required of health care providers and hospitals – Wis. Stat. Ann. § 146.903 The Department of Health Services must do the following: Categorize health care providers by type; For each type of provider, annually...
Hospital Quality Indicators Report – Wis. Admin. Code DHS §120-26 The hospital quality indicators report should be based on hospital inpatient data that has been collected.  The purpose of the report is to show...
Patient-level data utilization, charge, and quality report – Wis. Stat. Ann. § 153.22 The contracted entity must prepare an annual report that outlines utilization, charge, and quality data on patients treated by hospitals and...
Wis. Admin. Code DHS §120-16 – Data to be submitted by health care plans Health plans may voluntarily submit data directly to the Department of Health Services or must submit data to state agencies that forward the...
Quality assurance programs for hospitals or public programs Quality assessment and performance improvement – Wis. Admin. Code DHS §131-22 Quality Assessment and Performance Improvement at Hospices This law puts forth requirements for quality assessment and performance improvement...
State emergency medical services activities – Wis. Stat. Ann. § 256.08 State Emergency Medical Services Activities This law requires that the Department of Health Services (DHS) prepare a state emergency medical services...
Performance measurement for health care providers or insurance plans Quality assurance – Wis. Stat. Ann. § 609.32 Defined network plans must create quality assurance standards in order to identify and resolve issues relating care quality, access, and continuity....
Quality assessment for health plans Requirements for skilled nursing facilities – Wis. Stat. Ann. § 49.498 Requirements for Skilled Nursing Facilities This law sets forth a number of administrative requirements for skilled nursing facilities.  First,...
Reporting, Use and/or Confidentiality of quality data (Cross reference Privacy & Confidentiality) Resource centers for Provision of Social Services – Wis. Stat. Ann. § 46.283 Resource Centers for Provision of Social Services Resource centers are created through contracts with the DHS and counties, long-term care districts...
Quality Measurement and Reporting Wis. Admin. Code DHS §124-10 - Quality Assurance This law governs quality assurance at hospitals.  The law makes the governing body responsible for ensuring that the hospital has a quality...
Wis. Admin. Code DHS §34-25 - Client Rights - Emergency Mental Health Service Programs This law requires that all emergency mental health service programs comply with Wis. Stat. Ann. § 51.61 with respect to patient rights. ...
Wis. Admin. Code DHS §40-16 - Program Evaluation - Mental Health Day Treatment Services for Children Every program providing mental health day treatment services for children must annually evaluate its services on their effectiveness.  This law...
Wis. Admin. Code DHS §61-12 - Grievance Procedure - Community Mental Health and Developmental Disabilities Services Programs that provide community mental health and developmental disabilities must comply with the grievance procedures mandated under Wis. Stat. Ann...
Click on the individual state law in the table above to see our summary of the individual law.


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