§ 3305. Data submission and collection
Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 35 Pa.C.S.A. Health and SafetyEffective: April 20, 2020
Effective: April 20, 2020
35 Pa.C.S.A. § 3305
Formerly cited as PA ST 35 P.S. § 449.6
§ 3305. Data submission and collection
(1) The council is authorized to collect and data sources are required to submit, upon request of the council, all data required in this section, according to uniform submission formats, coding systems and other technical specifications necessary to render the incoming data substantially valid, consistent, compatible and manageable using electronic data processing according to data submission schedules. The schedules shall avoid, to the extent possible, submission of identical data from more than one data source. The uniform submission formats, coding systems and other technical specifications may be established by the council pursuant to its authority under section 3304(b) (relating to powers and duties of council). If payor data is requested by the council, it shall, to the extent possible, be obtained from primary payor sources. The council shall not require any data source to contract with any specific vendor for submission of any specific data elements to the council.
(2) In carrying out its responsibilities, the council shall not require health care facilities to report data elements which are not included in the manual developed by the National Uniform Billing Committee. The council shall publish in the Pennsylvania Bulletin a list of no more than 35 diseases, procedures and medical conditions for which data under subsections (c)(22) and (d) shall be required. The list shall not represent more than 50% of total hospital discharges, based upon the previous year's hospital discharge data. Subsequent to the publication of the list, any data submission requirements under subsections (c)(22) and (d) previously in effect shall be null and void for diseases, procedures and medical conditions not found on the list. All other data elements under subsection (c) shall continue to be required from data sources. The council shall review the list and may add no more than a net of three diseases, procedures or medical conditions per year over a five-year period. The adjusted list of diseases, procedures and medical conditions shall at no time be more than 50% of total hospital discharges.
(b) Pennsylvania Uniform Claims and Billing Form.--The council shall maintain a Pennsylvania Uniform Claims and Billing Form format. The council shall furnish the claims and billing form format to all data sources, and the claims and billing form shall be utilized and maintained by all data sources for all services covered by this chapter. The Pennsylvania Uniform Claims and Billing Form shall consist of the Uniform Hospital Billing Form, as developed by the National Uniform Billing Committee, with additional fields as necessary to provide all of the data set forth in subsections (c) and (d).
(d) Provider quality and provider service effectiveness data elements.--In carrying out its duty to collect data on provider quality and provider service effectiveness under subsection (c)(22) and section 3304(d)(5), the council shall define a methodology to measure provider service effectiveness, which may include additional data elements to be specified by the council sufficient to carry out its responsibilities under section 3304(d)(5). The council shall not require health care insurers to report on data elements that are not reported to nationally recognized accrediting organizations, to the Department of Health, the Department of Human Services or the Insurance Department, in quarterly or annual reports. The council shall not require reporting by health care insurers in different formats than are required for reporting to nationally recognized accrediting organizations or on quarterly or annual reports submitted to the Department of Health, the Department of Human Services or the Insurance Department. The council may adopt the quality findings as reported to nationally recognized accrediting organizations. Additional quality data elements must be defined and released for public comment prior to use.
(e) Reserve field utilization and addition or deletion of data elements.--The council shall include in the Pennsylvania Uniform Claims and Billing Form a reserve field. The council may utilize the reserve field by adding other data elements beyond those required to carry out its responsibilities under subsections (c) and (d) and section 3304(d)(4) and (5), or the council may delete data elements from the Pennsylvania Uniform Claims and Billing Form only by a majority vote of the council and only pursuant to the following procedure:
(3) The council may hold additional hearings or request such other reports as it deems necessary and shall consider the comments received during the 60-day comment period and any additional information gained through the hearings or other reports in making a final determination on the proposed addition or deletion.
(f) Other data required to be submitted.--Each provider is required to submit, and the council is authorized to collect, in accordance with submission dates and schedules established by the council, the following additional data in its possession, provided the data is not available to the council from public records:
(g) Review and correction of data.--The council shall provide a reasonable period for data sources to review and correct the data submitted under this section which the council intends to prepare and issue in reports to the General Assembly, to the general public or in special studies and reports under section 3309 (relating to special studies and reports). When corrections are provided, the council shall correct the appropriate data in its data files and subsequent reports.
(h) Allowance for clarification or dissents.--The council shall maintain a file of written statements submitted by data sources who wish to provide an explanation of data that they feel might be misleading or misinterpreted. The council shall provide access to the file to any person and shall, where practical, in its reports and data files indicate the availability of such statements. When the council agrees with such statements, it shall correct the appropriate data and comments in its data files and subsequent reports.
(i) Allowance for correction.--The council shall verify the patient safety indicator data submitted by hospitals under subsection (c)(8) within 60 days of receipt. The council may allow hospitals to make changes to the data submitted during the verification period. After the verification period, but within 45 days of receipt of the adjusted hospital data, the council shall risk adjust the information and provide reports to the patient safety committee of the relevant hospital.
(j) Availability of data.--Nothing in this chapter shall prohibit a purchaser from obtaining from its health care insurer, nor relieve the health care insurer from the obligation of providing the purchaser, on terms consistent with past practices, data previously provided or additional data not currently provided to the purchaser by the health care insurer pursuant to any existing or future arrangement, agreement or understanding.
Credits
2020, April 20, P.L. 82, No. 15, § 1, imd. effective.
35 Pa.C.S.A. § 3305, PA ST 35 Pa.C.S.A. § 3305
Current through Act 10 of the 2024 Regular Session. Some statute sections may be more current, see credits for details.
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