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§ 449.6. Data submission and collection

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 35 P.S. Health and SafetyEffective: July 1, 2010

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 35 P.S. Health and Safety (Refs & Annos)
Chapter 1D. Health Care Cost Containment Act (Refs & Annos)
Effective: July 1, 2010
35 P.S. § 449.6
§ 449.6. Data submission and collection
(a) (1) Submission of data.--The council is hereby authorized to collect and data sources are hereby 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, such schedules to avoid, to the extent possible, submission of identical data from more than one data source, established and promulgated by the council in regulations pursuant to its authority under section 5(b).1 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 sources to contract with any specific vendor for submission of any specific data elements to the council.
(1.1) Any data source shall comply with data submission guidelines established in the report submitted under section 17.2.2 The council shall maintain a vendor list of at least two vendors that may be chosen by any data source for submission of any specific data elements.
(2) Except as provided in this section, the council may adopt any nationally recognized methodology to adjust data submitted under subsection (c) for severity of illness. Every three years after the effective date of this paragraph, the council shall solicit bids from third-party vendors to adjust the data. The solicitation shall be in accordance with 62 Pa.C.S. (relating to procurement). 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 diseases, procedures and medical conditions, not to exceed 35, for which data under subsections (c)(21) and (d) shall be required. The chosen 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)(21) 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 pursuant to 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 starting on the effective date of this paragraph. 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 said claims and billing form format to all data sources, and said claims and billing form shall be utilized and maintained by all data sources for all services covered by this act. 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).
(c) Data elements.--For each covered service performed in Pennsylvania, the council shall be required to collect the following data elements:
(1) uniform patient identifier, continuous across multiple episodes and providers;
(2) patient date of birth;
(3) patient sex;
(3.1) patient race, consistent with the method of collection of race/ethnicity data by the United States Bureau of the Census and the United States Standard Certificates of Live Birth and Death;
(4) patient ZIP Code number;
(5) date of admission;
(6) date of discharge;
(7) principal and secondary diagnoses by standard code, including external cause of injury, complication, infection and childbirth;
(8) principal procedure by council-specified standard code and date;
(9) up to three secondary procedures by council-specified standard codes and dates;
(10) uniform health care facility identifier, continuous across episodes, patients and providers;
(11) uniform identifier of admitting physician, by unique physician identification number established by the council, continuous across episodes, patients and providers;
(12) uniform identifier of consulting physicians, by unique physician identification number established by the council, continuous across episodes, patients and providers;
(13) total charges of health care facility, segregated into major categories, including, but not limited to, room and board, radiology, laboratory, operating room, drugs, medical supplies and other goods and services according to guidelines specified by the council;
(14) actual payments to health care facility, segregated, if available, according to the categories specified in paragraph (13);
(15) charges of each physician or professional rendering service relating to an incident of hospitalization or treatment in an ambulatory service facility;
(16) actual payments to each physician or professional rendering service pursuant to paragraph (15);
(17) uniform identifier of primary payor;
(18) ZIP Code number of facility where health care service is rendered;
(19) uniform identifier for payor group contract number;
(20) patient discharge status; and
(21) provider service effectiveness and provider quality pursuant to section 5(d)(4) and subsection (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 section 5(d)(4) and subsection (c)(21), 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 5(d)(4). 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 or to 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 or to 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 the promulgation of regulations under section 5(b). The public comment period shall be no less than 30 days from the release of these elements.
(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 section 5(d)(3) and (4) and subsections (c) and (d), 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:
(1) The council shall obtain a cost-benefit analysis of the proposed addition or deletion which shall include the cost to data sources of any proposed additions.
(2) The council shall publish notice of the proposed addition or deletion, along with a copy or summary of the cost-benefit analysis, in the Pennsylvania Bulletin, and such notice shall include provision for a 60-day comment period.
(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 such hearings or other reports in making a final determination on the proposed addition or deletion.
(f) Other data required to be submitted.--Providers are hereby required to submit and the council is hereby authorized to collect, in accordance with submission dates and schedules established by the council, the following additional data, provided such data is not available to the council from public records:
(1) Audited annual financial reports of all hospitals and ambulatory service facilities providing covered services as defined in section 3.3
(2) The Medicare cost report for Medical Assistance or successor forms, including the settled Medicare cost report.
(3) Additional data, including, but not limited to, data which can be used in reports about:
(i) the incidence of medical and surgical procedures in the population for individual providers;
(ii) physicians who provide covered services and accept medical assistance patients;
(iii) physicians who provide covered services and accept Medicare assignment as full payment;
(iv) Deleted by 1993, June 28, P.L. 146, No. 34, § 1, imd. effective.
(v) mortality rates for specified diagnoses and treatments, grouped by severity, for individual providers;
(vi) rates of infection for specified diagnoses and treatments, grouped by severity, for individual providers;
(vii) morbidity rates for specified diagnoses and treatments, grouped by severity, for individual providers;
(viii) readmission rates for specified diagnoses and treatments, grouped by severity, for individual providers;
(ix) rate of incidence of postdischarge professional care for selected diagnoses and procedures, grouped by severity, for individual providers; and
(x) data from other public sources.
(4) Any other data the council requires to carry out its responsibilities pursuant to section 5(d).
(f.1) Review and correction of data.--The council shall provide a reasonable period for data sources to review and correct the data submitted under section 64 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 11.5 When corrections are provided, the council shall correct the appropriate data in its data files and subsequent reports.
(g) 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 such 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.
(g.1) Allowance for correction.--The council shall verify the patient safety indicator data submitted by hospitals pursuant to subsection (c)(7) 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.
(h) Availability of data.--Nothing in this act shall prohibit a purchaser from obtaining from its health care insurer, nor relieve said health care insurer from the obligation of providing said purchaser, on terms consistent with past practices, data previously provided or additional data not currently provided to said purchaser by said health care insurer pursuant to any existing or future arrangement, agreement or understanding.

Credits

1986, July 8, P.L. 408, No. 89, § 6, imd. effective. Reenacted and amended 1993, June 28, P.L. 146, No. 34, § 1, imd. effective; 2003, July 17, P.L. 31, No. 14, § 2, imd. effective. Reenacted 2009, June 10, P.L. 10, No. 3, § 2, retroactive effective June 29, 2008. Amended 2009, June 10, P.L. 10, No. 3, § 2, effective July 1, 2010.
EXPIRATION
<See 35 P.S. § 449.19 for expiration of this act.>
HISTORICAL AND STATUTORY NOTES
Act 1993-34 legislation
The 1993 amendment in subsec. (a) added the provision relating to obtaining of payor data from primary payor sources, inserted subd. (c)(3.1), in subd. (c)(7) substituted “five” for “four” and added “, including external cause code”, and deleted par. (f)(3)(iv).
Act 2003-14 legislation
Act 2003-14, § 2, designated former subsec. (a) as (a)(1); added subsecs. (a)(2) and (a.1); rewrote subsec. (c)(7), which prior thereto read:
“(7) principal and up to five secondary diagnoses by standard code, including external cause code;”
; in subsec. (d), added the fourth through sixth sentences; and added subsecs. (f.1) and (g.1).
Section 10 of 2003, July 17, P.L. 31, No. 14, imd. effective, provides that “[t]his act shall apply retroactively to June 29, 2003.”
Act 2009-3 legislation
Act 2009-3, § 2, in subsec. (a)(1), inserted “The council shall not require any data sources to contract with any specific vendor for submission of any specific data elements to the council.”; added subsec. (a)(1.1); rewrote subsec. (a)(2), which prior thereto read:
“(2) Except as provided in this section, the council may adopt any nationally recognized methodology to adjust data submitted under subsection (c) for severity of illness. Every three years after the effective date of this paragraph, the council shall solicit bids from third-party vendors to adjust the data. The solicitation shall be in accordance with 62 Pa.C.S. (relating to procurement). Except as provided in subparagraph (i), 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 following apply:
“(i) Within 60 days of the effective date of this paragraph, the council shall publish in the Pennsylvania Bulletin a list of diseases, procedures and medical conditions, not to exceed 35, for which data under subsections (c)(21) and (d) shall be required. The chosen 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)(21) 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 pursuant to 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 starting on the effective date of this subparagraph. The adjusted list of diseases, procedures and medical conditions shall at no time be more than 50% of total hospital discharges.
“(ii) If the current data vendor is unable to achieve, on a per-chart basis, savings of at least 40% in the cost of hospital compliance with the data abstracting and submission requirements of this act by June 30, 2004, as compared to June 30, 2003, then the council shall disqualify the current vendor and reopen the bidding process. The independent auditor shall determine the extent and validity of the savings. In determining any demonstrated cost savings, surveys of all hospitals in this Commonwealth shall be conducted and consideration shall be given at a minimum to:
“(A) new costs, in terms of making the methodology operational, associated with laboratory, pharmacy and other information systems a hospital is required to purchase in order to reduce hospital compliance costs, including the cost of electronic transfer of required data; and
“(B) the audited direct personnel and related costs of data abstracting and submission required.
“(iii) Review by the independent auditor shall commence by March 1, 2004, and shall conclude with a report of findings by July 31, 2004. The report shall be delivered to the council, the Governor, the Health and Human Services Committee of the House of Representatives and the Public Health and Welfare Committee of the Senate.”
; deleted subsec. (a.1), which read:
“(a.1) Abstraction and technology work group.--
“(1) The council shall establish a data abstraction and technology work group to produce recommendations for improving and refining the data required by the council and reducing, through innovative direct data collection techniques, the cost of collecting required data. The work group shall consist of the following members appointed by the council:
“(i) one member representing the Office of Health Care Reform;
“(ii) one member representing the business community;
“(iii) one member representing labor;
“(iv) one member representing consumers;
“(v) two members representing physicians;
“(vi) two members representing nurses;
“(vii) two members representing hospitals;
“(viii) one member representing health underwriters; and
“(ix) one member representing commercial insurance carriers.
“(2) The work group, with approval of the council, may hire an independent auditor to determine the value of various data sets. The work group shall have no more than one year to study current data requirements and methods of collecting and transferring data and to make recommendations for changes to produce a 50% overall reduction in the cost of collecting and reporting required data to the council while maintaining the scientific credibility of the council's analysis and reporting. The work group recommendations shall be presented to the council for a vote.”
; in subsec. (b), substituted “maintain” for “adopt, within 180 days of the commencement of its operations pursuant to section 4(i),” and deleted “UB-82/HCFA-1450, and the HCFA-1500, or their successors” following “Uniform Hospital Billing Form”; rewrote subsec. (d), which prior thereto read:
“(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 section 5(d)(4) and subsection (c)(21), 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 5(d)(4). The council may adopt a nationally recognized methodology of quantifying and collecting data on provider quality and provider service effectiveness until such time as the council has the capability of developing its own methodology and standard data elements. The council shall include in the Pennsylvania Uniform Claims and Billing Form a field consisting of the data elements required pursuant to subsection (c)(21) to provide information on each provision of covered services sufficient to permit analysis of provider quality and provider service effectiveness within 180 days of commencement of its operations pursuant to section 4. In carrying out its responsibilities, 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 or to 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 or to the Insurance Department. The council may adopt the quality findings as reported to nationally recognized accrediting organizations.”
; rewrote subsec. (f)(2), which prior thereto read:
“(2) The Medicare cost report (OMB Form 2552 or equivalent Federal form), or the AG-12 form for Medical Assistance or successor forms, whether completed or partially completed, and including the settled Medicare cost report and the certified AG-12 form.”
; in subsec. (f)(3), in the introductory paragraph, substituted “in reports about” for “to provide at least the following information”; and added subsec. (f)(3)(x).
Sections 11 and 12 of 2009, June 10, P.L. 10, No. 3, provide:
Ҥ 11. This act shall apply as follows:
“(1) Except as set forth in paragraph (2), this act shall apply retroactively to June 29, 2008.
“(2) The reenactment of section 6 of the act [35 P.S. § 449.6] shall apply retroactively under paragraph (1), but the amendment of section 6 of the act shall apply from the effective date of the amendment under section 12(1) of this act.
Ҥ 12. This act shall take effect as follows:
“(1) The amendment of section 6 of the act [35 P.S. § 449.6] shall take effect July 1, 2010.
“(2) The remainder of this act shall take effect immediately.”

Footnotes

35 P.S. § 449.5.
35 P.S. § 449.17b.
35 P.S. § 449.3.
35 P.S. § 449.6.
35 P.S. § 449.11.
35 P.S. § 449.6, PA ST 35 P.S. § 449.6
Current through 2018 Regular Session Act 11
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