H 4048 Session 110 (1993-1994)
H 4048 General Bill, By W.S. Houck, R.S. Corning, M. McLeod, J.B. Wilder and
D.A. Wright
A Bill to amend Section 44-6-170, as amended, Code of Laws of South Carolina,
1976, relating to hospital data reporting requirements, so as to require
certain health care providers to report and to further require what data must
be reported, to establish the Health Data Access Committee to advise and make
recommendations relative to the release of information, to authorize the
Division of Research and Statistical Services to link data collected pursuant
to this Section with other agency data bases and to prohibit the release of
patient's name or patient-identifiable records; and to amend Section 44-6-180,
as amended, relating to confidentiality of information reported, so as to
provide that data reported by health care providers is also confidential.
04/14/93 House Introduced and read first time HJ-45
04/14/93 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-45
A BILL
TO AMEND SECTION 44-6-170, AS AMENDED, CODE OF LAWS
OF SOUTH CAROLINA, 1976, RELATING TO HOSPITAL DATA
REPORTING REQUIREMENTS, SO AS TO REQUIRE CERTAIN
HEALTH CARE PROVIDERS TO REPORT AND TO FURTHER
REQUIRE WHAT DATA MUST BE REPORTED, TO ESTABLISH
THE HEALTH DATA ACCESS COMMITTEE TO ADVISE AND
MAKE RECOMMENDATIONS RELATIVE TO THE RELEASE OF
INFORMATION, TO AUTHORIZE THE DIVISION OF RESEARCH
AND STATISTICAL SERVICES TO LINK DATA COLLECTED
PURSUANT TO THIS SECTION WITH OTHER AGENCY DATA
BASES AND TO PROHIBIT THE RELEASE OF A PATIENT'S
NAME OR PATIENT-IDENTIFIABLE RECORDS; AND TO AMEND
SECTION 44-6-180, AS AMENDED, RELATING TO
CONFIDENTIALITY OF INFORMATION REPORTED, SO AS TO
PROVIDE THAT DATA REPORTED BY HEALTH CARE
PROVIDERS IS ALSO CONFIDENTIAL.
Whereas, the General Assembly recognizes and desires that provider
identifiable data be made available for public use including, but not
limited to, information on charges, utilization, and patient origin and
outcomes; and
Whereas, in order to collect, analyze, and properly disseminate this
information observing the strictest limits of confidentiality, it is
necessary to broaden the data base currently being collected and to
provide a more representative advisory body to assist in this process and
procedures.
Now therefore be it enacted by the General Assembly of the State of
South Carolina:
SECTION 1. Section 44-6-170 of the 1976 Code, as last amended by
Act 105 of 1991, is further amended to read:
"Section 44-6-170. (A) In order to develop a timely and
meaningful data base and to assist the commission in its efforts to
properly carry out its functions as provided by the South Carolina
Medically Indigent Assistance Act, the Division of Research and
Statistical Services of the State Budget and Control Board shall require
the standardized reporting by hospitals of the following hospital-specific
information for the twelve-month period from October first through
September thirtieth for each federal fiscal year, and the commission shall
reimburse the division for the cost of collecting and preparing this
information. The information must be submitted by February first of the
following year:
(1) total gross revenue, including:
(a) gross inpatient revenue;
(b) Medicare gross revenue;
(c) Medicaid gross revenue;
(d) South Carolina Medically Indigent Assistance Fund gross
revenue;
(2) total deductions from gross revenue, including:
(a) Medicare contractual allowances;
(b) Medicaid contractual allowances;
(c) other contractual allowances; and
(d) bad debts;
(3) total direct costs and medical education
(a) reimbursed; and
(b) unreimbursed;
(4) total indirect costs of medical education
(a) reimbursed; and
(b) unreimbursed;
(5) total costs of care for medically indigent
(a) reimbursed; and
(b) unreimbursed;
(6) total admissions, including:
(a) Medicare admissions;
(b) Medicaid admissions;
(c) South Carolina Medically Indigent Assistance Program
admissions; and
(d) other admissions;
(7) total patient days;
(8) average length of stay;
(9) total outpatient visits;
(10) extracts of the following medical record information:
(a) patient date of birth;
(b) patient number;
(c) patient sex;
(d) patient county of residence;
(e) patient zip code;
(f) patient race;
(g) date of admission;
(h) source of admission;
(i) type of admission;
(j) discharge date;
(k) principal and up to four other diagnoses;
(l) principal procedure and date;
(m) patient status at discharge;
(n) up to four other procedures;
(o) hospital identification number;
(p) principal source of payments; and
(q) total charges and components of those charges, including
associated room and board units;
(r) patient medical record or chart number; and
(s) attending physician and primary surgeon.;
(t) patient name and social security number;
(u) patient address;
(v) external cause of injury code (E-code);
(w) for cancer patients, date of first
diagnosis.
In addition, the division shall collect data as recommended by the
Health Care Planning and Oversight Committee Health Data
Access Committee established pursuant to subsection (C) of this
section (D) and other data relative to the medically indigent
population, including: demographic characteristics, economic status,
utilization of health care services, and fluctuations in the population over
time. These requirements are must be promulgated
by in regulations in accordance with the Administrative
Procedures Act.
(B) It is the intent of the South Carolina Medically Indigent
Assistance Act and of regulations promulgated pursuant thereto
under this act to protect the confidentiality of individual patient
information, physician provider identifiers, and the
proprietary information of hospitals providers. Only the
data collected pursuant to the Health Care Planning and Oversight
Committee recommendations of the Health Data Access
Committee as provided for in this section, may be
collected, analyzed, and released to
nongovernmental entities and individuals as directed by that
committee. All other patient, physician, and hospital specific
and provider-specific information collected pursuant to
subsection (A) of this section is confidential and must not be
released to any nongovernmental entity or individual unless
release is made of statistical information so that no individual
patient, physician, or hospital or provider can be
identified, except that release must be made, no less than semi-annually,
of the patient medical record information listed in Section
44-6-170(A)(10)(a)-(sw) to submitting hospitals
provider, and the information listed in Section
44-6-170(A)(10)(a)-(r), (v) and (w) to the hospitals'
providers' designee. The information provided to any
governmental agency as provided in this section must not be released
pursuant to the Freedom of Information Act in the form in which it was
provided to any other party. For purposes of this section,
governmental agency does not include a governmental hospital.
(C) Because accurate, comparable data on the costs and usage of
health care services is not currently available in South Carolina, it is
extremely difficult to make careful policy choices for future health care
cost management strategies. Neither the public sector nor the private
sector purchasers of health care have available sufficient data to enable
them to make informed choices among health care providers in the
market place. The lack of a uniform system for the collection and
analysis of data, and the lack of full data participation by providers,
purchasers, and payors has led to inadequate and unusable data. In order
to remedy this problem, it is necessary to create a uniform system for the
collection, analysis, and distribution of health care cost data. The
purposes of this data system are to insure ensure that
data is available to make valid comparisons of prices among providers
of services and to support ongoing analysis of the health care delivery
system. Accordingly, after receiving comments and
recommendations from health care providers, consumers, and
governmental agencies, the Health Care Planning and Oversight
Committee shall recommend to the Division:
(1) the data elements to be collected and analyzed. These
elements may include, but are not limited to, those already listed in
subsection (A) of this section;
(2) the format in which the data may be released to the public;
and
(3) the frequency with which the data should be collected and
released on a routine basis in addition to the hospital reporting
requirements in subsection (A) the data required by subsection
(A)(1O)must be reported to the division by:
(1) specialized hospitals including, but not limited to,
psychiatric hospitals, alcohol and substance abuse hospitals, and
rehabilitation hospitals;
(2) hospital outpatient surgery facilities and hospital outpatient
facilities using high technology medical equipment which is subject to
the certificate of need process;
(3) ambulatory surgical facilities subject to the
certificate of need process and nonhospital based facilities using high
technology medical equipment which is subject to the certificate of need
process.
Other provider charge information must be collected from
existing data sources and the Health Data Access Committee shall
recommend the method and type of data to be collected.
Patient-level data including, but not limited to, patient identifiers, as
provided for in subsection (A)(l0)(t) and (u), must be collected from
existing government data sources for nursing homes and home health
agencies. The Health Data Access Committee shall review this data
collection process and make recommendations for revisions to the
process if necessary to carry out the purposes of this section.
(D) There is established the Health Care Data Access Committee to
be composed of:
(l) the following members to be appointed by the Governor with
the advice and consent of the Senate:
(a) two hospital administrators from recommendations
submitted by the South Carolina Hospital Association;
(b) two physicians from recommendations submitted by the
South Carolina Medical Association;
(c) two representatives of major third party health care
payors, one of whom must be the administrator of the state's health
insurance plan;
(d) one representative of the managed health care industry;
(e) one nursing home administrator from recommendations
submitted by the South Carolina Health Care Asscoaition;
(f) one representative of home health agencies from
recommendations of the South Carolina Home Care Association;
(g) two representatives of non-health care related businesses,
from recommendations submitted by the South Carolina Chamber of
Commerce;
(h) one health care consumer from the public at large; and
(2) these ex officio members or their designees:
(a) the chairman of the health planning committee created
pursuant to Section 44-7-l80;
(b) the Commissioner of the S.C. Department of Health and
Environmental Control;
(c) the Commissioner of the South Carolina Department of
Mental Health;
(d) the Director of the South Carolina Commission on Alcohol
and Drug Abuse;
(e) the Executive Director of the South Carolina Health and
Human Services Finance Commission;
(f) the Executive Assistant of the Health and Human Services
Division of the Governor's Office;
(g) the Commissioner of the State Department of Mental
Retardation.
The appointed members shall serve for terms of three years and until
their successors are appointed and qualify. The members shall elect a
chairman from among the committee members. The Division of
Research and Statistical Services shall provide staff assistance to the
committee.
(E) The committee may review all data collected pursuant to their
section and at the end of three years, and thereafter as needed, the
Committee shall report and make recommendations to the General
Assembly and the Governor concerning:
(l) what provider-identifiable data should be released for public
use;
(2) what data should be released for research purposes including
linked data bases;
(3) changes needed, if any, to carry out the purposes of this
section;
(4) whether this committee should continue or whether its
functions should be assigned to another entity or organizational
structure.
The committee upon consultation with the Health Data Analysis Task
Force created in subsection (F) shall advise the Division of Research and
Statistical Services on types of data analysis to be released and shall
establish procedures for agencies receiving patient identifiable data to
use in conducting follow back studies for collecting additional patient
level data.
(F) The Division of Research and Statistical Services shall convene
a Health Data Analysis Task Force composed of technical
representatives of private and public agencies and universities to make
recommendations to the Health Data Access Committee concerning
types of analysis needed to carry out the purposes of this section.
(D) (G) In addition to hospitals licensed by the
Department of Health and Environmental Control, effective July 1,
1991, the provisions of this section apply
applies to a hospital licensed in another state if the hospital
does business in South Carolina. Information required by subsection
(A)(1) through (9) of this section must be submitted for all
patients. Information required by subsection (A)(7) of this
section also must identify total patient days attributed to South
Carolina residents. Information required by subsection (A)(10) of
this section must be submitted only for residents of South Carolina.
A hospital is considered to be doing business in this State if the hospital,
or the firm, corporation, association, or partnership which owns or
operates the hospital, either directly or through a subsidiary corporation,
establishes a physical presence in this State by owning, leasing,
subleasing, or by any other means arranges to provide space to engage
in or transact activity for financial profit or gain.
(H) The Division of Research and Statistical Services
shall promulgate regulations to implement this section including, but not
limited to, reporting format and frequency and may establish in
regulation civil fines for failure to comply with this section or
regulations promulgated under this section."
SECTION 2. Section 44-6-180 of the 1976 Code, as last amended by
Act 189 of 1989, is further amended to read:
"Section 44-6-180. (A) Patient records, received by
counties, the commission, or other entities involved in the administration
of the program created pursuant to Section 44-6-150 are confidential.
Patient records and physician and hospital provider
identifiers gathered pursuant to Section 44-6-170 are also confidential.
This information collected pursuant to Section
44-6-170(A)(10)(a)-(s) must not be released to
nongovernmental entities or individuals unless release is made
of aggregate statistical information so that no individual patient,
physician, or hospital provider can be identified,
except as provided in Section 44-6-170 (C) or otherwise as
provided by law for the collection of patient identifiable data for disease
surveillance or disease or injury registries or provider identifiable data
required by certificate of need. The Division shall use
patient-identifiable data collected pursuant to Section 44-6-l70 for the
purpose of linking various data bases to carry out the purposes of
Section 44-6-l70. Linked data files must be made available to those
agencies providing data files for linkage. No agency receiving
patient-identifiable data collected pursuant to Section 44-6-170 may
release this data in a manner such that an individual patient or provider
may be identified. Nothing in this subsection may be construed as
limiting access to hospital identifiable information needed by
any governmental agency as provided in Section 44-6-l70(B) or
by the submitting hospitals or their designee as provided in Section
44-6-l70(B) for in regulation or pursuant to agreements
authorizing the release of this information. A hospital designee
receiving this information is subject to the confidentiality provisions of
this section.
(B) Any A person violating the provisions of
this section is guilty of a misdemeanor, and upon conviction, must
be fined not more than five thousand dollars or imprisoned not more
than one year, or both."
SECTION 3. This act takes effect upon approval by the Governor.
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