Governor Doyle has signed new legislation mandating health care providers to disclose to consumers, upon request, the median charge billed for health care services, diagnostic tests and procedures. This new legislation, originally introduced as 2009 Assembly Bill 164, also requires a health care provider to provide a summary of charges for the provider’s most common services.
Under this bill, the Department of Health Services will be required to identify, on an annual basis, the 25 presenting conditions for which each provider most frequently provides health care services. DHS will prepare these lists in consultation with the Wisconsin Collaborative for Healthcare Quality and using various other claims data. Health care providers will be required to create a single document listing the following charge information for diagnosing and treating each of those 25 presenting conditions: (1) median billed charges; (2) reimbursement amount under Medical Assistance (for participating providers); (3) reimbursement amount under Medicare (again, for participating providers); and (4) the average allowable payment from private third-party payers. The provider must make that list available to consumers upon request, although the list will not constitute a legally binding estimate of the cost to any individual consumer.
The term “health care providers” has the meaning given in Chapter 146 of the Wisconsin Statutes, including hospitals, ambulatory surgery centers, and nursing homes, but does not include providers who practice individually or in an association of less than four individual practitioners.
The bill also contains various disclosure requirements applicable to certain self-insured health plans and insurers, requiring good faith estimates of the median reimbursement that the insurer or self-insured health plan would expect to pay for a specified health care service in the geographic region and of the insured’s total out-of-pocket costs for the specified health care service.
Finally, health care providers must post prominent notices advising consumers of their right to receive charge information from the providers and from their insurers.
This new law will go into effect in early 2011.