Current Status Introducing Body:House Bill Number:4048 Primary Sponsor:Houck Committee Number:27 Type of Legislation:GB Subject:Hospital data reporting Residing Body:House Current Committee:Medical, Military, Public and Municipal Affairs Computer Document Number:JMG/1059AC.93 Introduced Date:19930414 Last History Body:House Last History Date:19930414 Last History Type:Introduced, read first time, referred to Committee Scope of Legislation:Statewide All Sponsors:Houck McLeod J. Wilder Wright Corning Type of Legislation:General Bill
Bill Body Date Action Description CMN Leg Involved
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4048 House 19930414 Introduced, read first time, 27
referred to Committee
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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.