H 3660 Session 110 (1993-1994)
H 3660 General Bill, By Wilkins, Alexander, Allison, Bailey, H. Brown, Carnell,
Cato, C.D. Chamblee, Davenport, L.L. Elliott, J.G. Felder, R.C. Fulmer, Gamble,
J.L. Harris, Harrison, M.F. Jaskwhich, Keegan, Kennedy, Koon, Lanford, Law,
Littlejohn, J.G. McAbee, Meacham, Quinn, Richardson, Riser, Robinson, Sharpe,
J.S. Shissias, Simrill, R. Smith, C.H. Stone, Stuart, Townsend, Vaughn,
C.Y. Waites, D.C. Waldrop, Walker, C.C. Wells, Wilder, J.B. Wilder, Witherspoon,
S.S. Wofford, D.A. Wright, Young-Brickell and R.M. Young
Similar(S 507)
A Bill to amend the Code of Laws of South Carolina, 1976, by adding Section
44-6-185 so as to require the Division of Research and Statistical Services to
collect, analyze, and make available certain nonidentifying health care
information.
03/08/93 House Introduced and read first time HJ-30
03/08/93 House Referred to Committee on Medical, Military,
Public and Municipal Affairs HJ-30
05/06/93 House Committee report: Favorable with amendment
Medical, Military, Public and Municipal Affairs HJ-3
05/20/93 House Amended HJ-34
05/20/93 House Read second time HJ-44
05/20/93 House Unanimous consent for third reading on next
legislative day HJ-44
05/21/93 House Read third time and sent to Senate HJ-24
05/26/93 Senate Introduced, read first time, placed on calendar
without reference SJ-21
06/01/93 Senate Read second time SJ-63
06/01/93 Senate Ordered to third reading with notice of
amendments SJ-63
01/13/94 Senate Continued SJ-20
Indicates Matter Stricken
Indicates New Matter
INTRODUCED
May 26, 1993
H. 3660
Introduced by REPS. Wilkins, Waldrop, T.C. Alexander, Simrill, Felder,
Wright, Riser, Harrison, G. Bailey, Cato, Davenport, Chamblee, Fulmer,
Sharpe, Jaskwhich, Carnell, Kennedy, Lanford, Littlejohn, R. Smith,
Townsend, Vaughn, Wells, Wofford, A. Young, R. Young, J. Wilder,
Stuart, Gamble, D. Wilder, Witherspoon, Richardson, Waites, Law,
Keegan, Shissias, Quinn, Allison, Walker, H. Brown, Robinson, Elliott,
Koon, McAbee, Stone, J. Harris and Meacham
S. Printed 5/26/93--S.
Read the first time May 26, 1993.
A BILL
TO AMEND THE CODE OF LAWS OF SOUTH CAROLINA, 1976,
BY ADDING SECTION 44-6-185 SO AS TO REQUIRE THE
DIVISION OF RESEARCH AND STATISTICAL SERVICES TO
COLLECT, ANALYZE, AND MAKE AVAILABLE CERTAIN
NONIDENTIFYING HEALTH CARE INFORMATION.
Be it enacted by the General Assembly of the State of South Carolina
SECTION 1. Section 44-6-150 of the 1976 Code, as last amended by
Act 189 of 1989, is further amended to read:
"Section 44-6-150. (A) There is created the South Carolina
Medically Indigent Assistance Program, administered by the
commission. The program is authorized to sponsor up to fifteen
million dollars of inpatient hospital care, for which hospitals
shall receive no reimbursement except as provided in Section
44-6-155(D). Any A general hospital equipped to
provide the necessary treatment must shall:
(1) admit a patient sponsored by the program; and
(2) accept the transfer of a patient sponsored by the program from
a hospital which is not equipped to provide the necessary treatment.
In addition to or in lieu of any an action taken
affecting the license of the hospital, when it is established that
any an officer, employee, or member of the hospital
medical staff has violated the provisions of this section, the
South Carolina Department of Health and Environmental Control shall
require the hospital to pay a civil penalty of up to ten thousand dollars.
(B) Hospital charges for patients sponsored by the Medically
Indigent Assistance Program must be adjusted by the most recent
audited cost to charge ratio when used to calculate:
(1) claims against the Medically Indigent Assistance Program by
county residents as required by Section 44-6-146(B);
(2) the fifteen million dollar limit on hospital care sponsored by
the Medically Indigent Assistance Program; and
(3) hospital reimbursements authorized by Section
44-6-155(D). reported to the Division of Research and
Statistical Services pursuant to Section 44-6-170.
(C) In administering the Medically Indigent Assistance Program, the
commission shall determine:
(1) the method of administration, including the specific
procedures and materials to be used statewide in determining eligibility
for the program;
(a) In a nonemergency cases, the patient shall
submit the necessary documentation to his the patient's
county of residence or its designee to determine eligibility before
admission to the hospital.
(b) In case of an emergency, the hospital shall admit the
patient pursuant to Section 44-7-260. If a hospital holds the patient
financially responsible for all or a portion of the inpatient hospital bill,
and if the hospital determines that the patient could be eligible for
the program, it shall forward the necessary documentation along with the
patient's bill and other supporting information to the patient's county of
residence or its designee for processing. A county may request that all
claims hospital bills incurred by its residents
sponsored by the program be submitted to the county or its
designee for review before being forwarded to the commission for
processing. If a county exercises its option to review claims, the reviews
must be completed within fifteen days.
(2) the population to be served including eligibility criteria based
on family income and resources. Eligibility is determined on an episodic
basis for a given spell of illness. Eligibility criteria must be uniform
statewide and may include only those persons who meet the
program's definition of medically indigent;
(3) the health care services covered;
(4) a system to reimburse hospitals if funds are available as
provided in Section 44-6-155(D);
(5) requirements for hospitals to report information needed to
administer the program. This includes, but is not limited to, each
sponsored patient's name, program authorization number, county of
residence, primary diagnosis, and hospital charges;
(6) (4) a process by which any claim or
an eligibility determination can be contested and appealed; and
(7) (5) a method for processing claims.
the program may not sponsor a patient until all other means of paying
for or providing services have been exhausted. This includes Medicaid,
Medicare, health insurance, employee benefit plans, or other persons or
agencies required by law to provide medical care for the person.
Hospitals may require eligible patients whose gross family income is
between one hundred percent and two hundred percent of the federal
poverty guidelines, to make a copayment based on a sliding payment
scale developed by the commission based on income and family size.
(D) Nothing in this section may be construed as relieving hospitals
of their Hill-Burton obligation to provide unreimbursed medical care to
indigent persons."
SECTION 2. Section 44-6-155 of the 1976 Code, as last amended by
Act 105 of 1991, is further amended to read:
"Section 44-6-155. (A) There is created the Medicaid
Expansion Fund into which must be deposited funds:
(1) funds collected pursuant to Section 44-6-146;
(2) funds collected pursuant to Section 12-23-810; and
(3) funds appropriated pursuant to subsection (B) of
this section.
This fund must be separate and distinct from the general fund. These
funds are supplementary and may not be used to replace general funds
appropriated by the General Assembly or other funds used to support
Medicaid. These funds and the programs specified in subsection (C) are
exempt from any budgetary cuts, reductions, or eliminations caused by
the lack of general fund revenues. Earnings on investments from this
fund must remain part of the separate fund and must not be deposited in
the general fund.
(B) The commission shall estimate the amount of federal matching
funds which will be spent in the State during the next fiscal year due to
the changes in Medicaid authorized by subsection (C) of this
section. Based on this estimate, the General Assembly shall
appropriate to the Medicaid Expansion Fund state funds equal to the
additional state revenue generated by the expenditure of these federal
funds.
(C) Monies in the fund must be used for the following
purposes to:
(1) to provide Medicaid coverage to pregnant women and
infants with family incomes above one hundred percent but below one
hundred eighty-five percent of the federal poverty guidelines;
(2) to provide Medicaid coverage to children aged one
through six with family income below federal poverty guidelines;
(3) to provide Medicaid coverage to aged and disabled
persons with family income below federal poverty guidelines;
(4) to provide Medicaid coverage through a medically
needy program to eligible persons in families with medical expenses
which reduce the net family income below state and federal standards;
(5) to provide Medicaid reimbursement for hospital
patients in need of subacute care, including patients in swing beds;
(6) to provide a pool of at least forty-four million dollars
for the sole purpose of adjusting Medicaid reimbursement for hospitals
as provided in Section 44-6-140(A)(1). Funds in the pool not
immediately used for this purpose must be carried forward for eventual
use for this purpose;
(7) to provide up to two hundred forty thousand dollars to
reimburse the Division of Research and Statistical Services and hospitals
for the cost of collecting and reporting data pursuant to Section
44-6-170; and
(8) to supplement state funds needed to administer items
(3) and (4), not to exceed $700,000.
(D) All funds not expended for the purposes specified above must
be used at the end of the fiscal year to reimburse hospitals for care given
to patients sponsored by the Medically Indigent Assistance Program
during the same fiscal year.
(E) (D) Any funds not expended for the purposes
specified in subsections subsection (C) and (D)
above during a given year are carried forward to the succeeding year
for the same purposes."
SECTION 3. 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.
(A) As used in this section:
(1) `Division' means the Division of Research and Statistical
Services of the Budget and Control Board.
(2) `Council' means the Data Oversight Council.
(3) `Committee' means the Data Oversight Committee.
(B) There is established the Data Oversight Council comprised of:
(1) one hospital administrator;
(2) the chief executive officer or designee of the South
Carolina Hospital Association;
(3) one physician;
(4) the chief executive officer or designee of the South
Carolina Medical Association;
(5) one representative of major third party health care
payers;
(6) one representative of the managed health care industry;
(7) one nursing home administrator;
(8) three representatives of nonhealth care related businesses;
(9) one representative of a nonhealth care related business
of less than one hundred employees;
(10) the executive vice president or designee of the South
Carolina Chamber of Commerce;
(11) a member of the Governor's office staff;
(12) a representative from the Human Services Coordinating
Council;
(13) the commissioner or his designee of the South Carolina
Department of Health and Environmental Control;
(14) the executive director or his designee of the State Health and
Human Services Finance Commission;
(15) the chairman or his designee of the Health Planning
Committee created pursuant to Section 44-7-180.
The members enumerated in items (1) through (10) must be
appointed by the Governor for three-year terms and until their successors
are appointed and qualify; the remaining members serve ex officio. The
Governor shall appoint one of the members to serve as chairman. The
division shall provide staff assistance to the council.
(C) There is created the Data Oversight Committee comprised of six
members, three of whom must be members of the Senate to be appointed
by the President of the Senate and three of whom must be members of
the House of Representatives to be appointed by the Speaker of the
House of Representatives. The members are appointed for two year
terms. At its first meeting the committee shall organize by selecting
from its membership a chairman and a vice chairman with the officers
alternating between the House of Representatives and the Senate each
term. The members of the committee shall receive the usual per diem,
mileage, and subsistence as provided by law for members of boards,
commissions, and committees.
(D) The division with the approval of the council shall promulgate
regulations to implement this section in accordance with the
Administrative Procedures Act. No data may be released by the division
except in a format recommended by the council and approved by the
committee. Patient identifiers gathered pursuant to this section are
confidential. The information collected may not be released to entities
or individuals unless release is made of aggregate statistical information
so that no individual patient may be identified. The committee upon
recommendations of the council shall determine what
provider-identifiable data should be released for public use and what
data should be released for research purposes. Any such release must be
preceded by notice to the identified provider who must be provided
sufficient time to review the information and whose written response
must be considered before a release and must be included, if requested,
in the release. Nothing in this section may be construed to change or
interfere with the mode of collection and format of release of existing
inpatient hospital data by the division by general acute care hospitals,
until recommendations are adopted by the council and approved by the
committee. The council shall make periodic recommendations to the
committee and the General Assembly concerning the collection and
release of health care related data by the State. The council shall
forward to the committee, before December 2, 1993, recommendations
for the collection of additional health care information and data
including, but not limited to, all outpatient data, information concerning
health care manpower needs for the State, information to assist in the
development and evaluation of health outcomes, and other information
the council may consider necessary to assist in the formation of health
care policy in the State. Recommendations by the council mandating the
collection of this data apply to every provider or insurer affected by the
recommendation, regardless of how the data is collected by the provider
or insurer. Every effort must be made to utilize existing data sources.
(E) Information may be required to be produced only with respect to
admissions of and treatment to patients after the effective date of the
regulations implementing this section, except that data with respect to
the medical history of the patient reasonably necessary to evaluation of
the admission of and treatment to the patient may be required.
(F) The division shall convene a Health Data Analysis Task Force
composed of technical representatives of universities and of the private
sector and public agencies including, but not limited to, health care
providers and insurers to make recommendations to the council
concerning types of analysis needed to carry out this section.
(G) All general acute care hospitals and specialized hospitals
including, but not limited to, psychiatric hospitals, alcohol and substance
abuse hospitals, and rehabilitation hospitals shall provide the following
information to the division: hospital-specific information for the
twelve-month period from October first through September thirtieth for
each federal fiscal year. This information must be
submitted reported by February March
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
Program gross revenue;
(2) total deductions for contractual allowances from
gross revenue, including:
(a) Medicare contractual allowances;
(b) Medicaid contractual allowances; and
(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 bad debt
and charity care:
(a) reimbursed; and South Carolina Medically
Indigent Assistance Program;
(b) unreimbursed other charity care;
and
(c) bad debt;
(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 eight other
diagnoses;
(l) principal procedure and date;
(m) patient status at discharge;
(n) up to four five other procedures;
(o) hospital identification number;
(p) principal source of payment; 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, patient social security number, and patient
address; and
(u) external cause of injury code (E-code), as set forth in
regulation.
Release must be made no less than semi-annually of the patient
medical record information listed in this subsection to the submitting
hospital and the information listed in items (10)(a) through (r) and (u) to
the hospital's designee.
(H) A person violating 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.
In addition, the division shall collect data as recommended by the
Health Care Planning and Oversight Committee pursuant to subsection
(C) of this section 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 promulgated by 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 to
protect the confidentiality of individual patient information, physician
identifiers, and the proprietary information of hospitals. Only the data
collected pursuant to the Health Care Planning and Oversight Committee
recommendations, as provided 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 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 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)-(s) to
submitting hospitals, and the information listed in Section
44-6-170(A)(10)(a)-(r) to the hospitals' 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 participation by providers,
purchasers, and payors has led to inadequate and unuseable 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 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.
(D) In addition to hospitals licensed by the Department of Health and
Environmental Control, effective July 1, 1991, the provisions of this
section apply 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."
SECTION 4. 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 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 can be identified, except as provided in Section
44-6-170(C). Nothing in this subsection may be construed as limiting
access to information needed by any governmental agency as provided
in Section 44-6-170(B) or by the submitting hospitals or their designee
as provided in Section 44-6-170(B). The division shall use
patient-identifiable data collected pursuant to Section 44-6-170 for the
purpose of linking various data bases to carry out the purposes of
Section 44-6-170. 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 except as provided in Section 44-6-170. Nothing in
this section may be construed to limit access by a submitting provider or
its designee to that provider's information.
(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 5. Section 44-6-200 of the 1976 Code, as last amended by
Act 189 of 1989, is further amended to read:
"Section 44-6-200. (A) Any A person who
commits a material falsification of information required to determine
eligibility for the Medically Indigent Assistance Program is guilty of a
misdemeanor and, upon conviction, must be fined not more than five
hundred dollars or imprisoned for not more than one year, or both.
(B) Any general hospital which materially falsifies information to
seek reimbursement from the Medically Indigent Assistance Program
must be fined not more than five thousand dollars.
(C) (B) Unless otherwise specified in this chapter,
any an individual or facility violating any of the
provisions of this chapter or a regulation under this chapter is guilty
of a misdemeanor and, upon conviction, must be fined not more than one
hundred dollars for the first offense and not more than five thousand
dollars for a subsequent offense."
SECTION 6. This act takes effect upon approval by the Governor;
except, the reporting requirement in Section 44-6-170(G)(10)(u) takes
effect for hospitals with more than one hundred fifty beds ninety days
after approval by the Governor and for hospitals with one hundred fifty
beds or fewer on October 1, 1994.
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