Current Status Introducing Body:
HouseBill Number: 3660Primary Sponsor: WilkinsType of Legislation: GBSubject: Nonidentifying health care informationResiding Body: SenateCompanion Bill Number: 507Computer Document Number: 436/11031AC.93Introduced Date: 19930308Date of Last Amendment: 19930520Last History Body: SenateLast History Date: 19940113Last History Type: ContinuedScope of Legislation: StatewideAll Sponsors: 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 MeachamType of Legislation: General Bill
Bill Body Date Action Description CMN Leg Involved ---- ------ ------------ ------------------------------ --- ------------ 3660 Senate 19940113 Continued 3660 Senate 19930601 Read second time, notice of general amendments 3660 Senate 19930526 Introduced, read first time, placed on Calendar without reference 3660 House 19930521 Read third time, sent to Senate 3660 House 19930520 Amended, read second time, unanimous consent for third reading on Friday, May 21, 1993 3660 House 19930506 Committee Report: Favorable 27 with amendment 3660 House 19930308 Introduced, read first time, 27 referred to CommitteeView additional legislative information at the LPITS web site.
Indicates Matter Stricken
Indicates New Matter
May 26, 1993
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.
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
(4) total indirect costs of medical education:
(a) reimbursed; and
(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.