No. 38564 (Repeal and Reenact): Rule R428-10. Health Data Authority Hospital Inpatient Reporting Rule

(Repeal and Reenact)

DAR File No.: 38564
Filed: 06/02/2014 09:50:28 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

This filing is in response to a review of Title R428 that identified inconsistencies in the writing of the rule.

Summary of the rule or change:

Items from the repealed rule, no longer in the reenacted rule: subsections on definitions, exemptions, extensions, and waivers, and penalties. Items in the reenacted rule, that are not in the old rule: none. Other changes: removes definitions of terms, exemption, and extension procedures; and penalties from Rule R428-10 that are contained in Rule R428-2. Makes technical and conforming amendments. (DAR NOTE: the proposed repeal and reenactment of Rule R428-2 is under DAR No. 38562 in this issue, June 15, 2014, of the Bulletin.)

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 33a

Anticipated cost or savings to:

the state budget:

This amendment makes technical changes that improve consistency and clarity of Rule R428-10. The Utah Department of Health (UDOH) determines that these changes will not create any cost or savings impact to the state budget or UDOH's budget, since the changes will not increase workload and can be carried out with existing budget.

local governments:

This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule; nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.

small businesses:

None--Small businesses will not be impacted by this rule change--as a result, the rule will have no effect on small business budgets for costs or savings.

persons other than small businesses, businesses, or local governmental entities:

Minor technical changes in Rule R428-10 will not create any cost or savings to businesses, individuals, local governments or persons that are not small businesses.

Compliance costs for affected persons:

There are no compliance costs for persons affected by these changes to Rule R428-10. Although there are several modifications within this filing, they will not impact affected persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

No effect on business because it does not materially modify current operations.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at [e-mail]
• Rex Olsen at the above address, by phone at 801-538-9498, by FAX at 801-536-0940, or by Internet E-mail at [e-mail]
• Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/15/2014

This rule may become effective on:

07/22/2014

Authorized by:

David Patton, Executive Director

RULE TEXT

R428. Health, Center for Health Data, Health Care Statistics.

R428-10. Health Data Authority Hospital Inpatient Reporting Rule.

[R428-10-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a, and in accordance with the Health Data Plan.

 

R428-10-2. Purpose.

This rule establishes the reporting standards for inpatient discharge data by licensed hospitals. Inpatient discharge data are needed to develop and maintain a statewide hospital inpatient discharge data base.

 

R428-10-3. Definitions.

These definitions apply to rule R428-10.

(1) "Office" as defined in R428-2-3(A).

(2) "Discharge data" means the consolidation of complete billing, medical, and personal information describing a patient, the services received, and charges billed for a single inpatient hospital stay into a discharge data record.

(3) "Hospital" means a facility that is licensed under R432-100.

(4) "Level 1 data element" means a required reportable data element.

(5) "Level 2 data element" means a data element that is reported when the information is available from the patient's hospital record.

(6) "Patient Social Security number" is the social security number of the patient receiving inpatient care.

(7) "Record linkage number" is an irreversible, unique, encrypted number that will replace patient social security number. The Office assigns the number to serve as a control number for data analysis.

(8) "Uniform billing form" means the uniform billing form recommended for use by the National Uniform Billing Committee.

 

R428-10-4. Source of Inpatient Hospital Discharge Data Reporting.

The reporting source for hospital inpatient discharge data is Utah licensed hospitals.

(1) A hospital facility, either general acute care, critical access, children's, long term, psychiatric or rehabilitation hospital, shall report discharge data records for each inpatient discharged from its facility.

(2) A hospital may designate an intermediary, such as the Utah Hospital Association, or may submit discharge data directly to the committee.

(3) Each hospital is responsible for compliance with these rules. Use of a designated intermediary does not relieve the hospital of its reporting responsibility.

(4) Each hospital shall designate a department within the hospital and a person responsible for submitting the discharge data records. This person shall also be responsible for communicating with the Office.

 

R428-10-5. Data Submittal Schedule.

Each hospital shall submit to the Office a single discharge data record for each patient discharged according to the schedule shown in Table 1, Hospital Discharge Data Submittal Schedule, or a schedule mutually agreed upon by the Office and hospital. For a patient with multiple discharges, each hospital shall submit a single discharge data record for each discharge. For a patient with multiple billing claims each hospital shall consolidate the multiple billings into a single discharge data record for submission after the patient's discharge.

 

TABLE 1
HOSPITAL DISCHARGE DATA SUBMITTAL SCHEDULE

   PATIENT'S DATE OF DISCHARGE                 DISCHARGE DATA RECORD   IS BETWEEN                                  IS DUE BY   January 1 through March 31                  May 15   April 1 through June 30                     August 15   July 1 through September 30                 November 15   October 1 through December 31               February 15 

 

R428-10-6. Data Element Reporting.

Tables 2 and 3 display the reportable data elements by defined level. A hospital shall, as a minimum, report the required level 1 data elements shown in Table 2. Each hospital shall report level 2 data elements shown in Table 3 whenever the information is a part of the hospital's patient record. Beginning January 1, 1995, each hospital shall collect patient social security number as a level 1 (required) data element on the hospital discharge record, and report the patient social security number with the complete discharge record according to the submittal schedule. The Department shall adopt an encryption method to mask patient identity and replace patient social security number with a record linkage number as the control number. The Department may not retain the original record containing patient social security number and shall destroy the original record containing patient social security number after the Department assures the validity of the patient record. The Department of Health may conduct on-site audits to verify the accuracy of all submittals.

Each hospital shall submit the reported data elements on compact disc, DVD, or send electronically through the Utah Health Information Network or another compatible electronic data interchange network or other secure upload or secure email method. The Office shall accept data that complies with data standards established in R590-164, Uniform Health Billing Rule. The Office shall provide to each hospital, a Hospital Inpatient Discharge Data Submittal Technical Manual which outlines the specifications, format, and types of data to report. The revised Submittal Technical Manual is effective for discharges occurring on or after January 1, 2012.

 

TABLE 2
REQUIRED LEVEL 1
HOSPITAL INPATIENT DISCHARGE DATA ELEMENTS

         CATEGORY            NAME        Provider           1.             Provider identifier (hospital name)        Patient        2.             Patient control number        3.             Patient's medical record number        4.             Patient Social Security Number        5.             Patient name        6.             Patient's address, city, state, zip        7.             Patient's date of birth        8.             Patient's gender        Service        9.             Admission date        10.            Type of admission/visit        11.            Point of origin for admission or visit        12.            Patient's discharge status        13.            Statement covers period        14.            Condition codes (do not resuscitate,                            homeless, others)        Charge        15.            Service line        16.            Revenue codes        17.            HCPCS Procedure codes including modifiers        18.            Unit or basis for measurement code        19.            Service units/days        20.            Total charges by revenue code        Payer        21.            Payer's identification        22.            Patient's relationship to insured        Diagnosis and Treatment        23.            Diagnosis version qualifier        24.            Principal diagnosis with present on                            admission        25.            Other diagnosis codes with present on                            admission        26.            Admitting diagnosis code        27.            Patient's reason for visit codes        28.            External cause of injury codes (E-code)                            with present on admission        29.            Principal ICD procedure code        30.            Other ICD procedure codes        31.            Date of principal procedure        Physician        32.            Attending provider primary ID        33.            Operating physician primary ID        34.            Other operating physician primary ID        35.            Rendering physician primary ID        36.            Referring provider primary ID        Other        37.            Type of bill 

 

 

TABLE 3
WHEN DATA ELEMENT IS AVAILABLE FROM THE
HOSPITAL'S PATIENT RECORD
LEVEL 2
HOSPITAL INPATIENT DISCHARGE DATA ELEMENTS

         CATEGORY            NAME        Patient        1.             Patient marital status        2.             Patient race and ethnicity        Employer        3.             Employer name        Charge        4.             Prior payments        5.             Estimated amount due        Payer         6.            Insured names        7.             Certificate/Social Security Number/Health                            Insurance Claim/Identification Number        8.             Insured group names        Physician        9.             Attending provider secondary ID        10.            Attending provider specialty information        11.            Operating physician secondary ID        12.            Operating physician specialty information        13.            Other operating physician secondary ID        14.            Other operating physic. specialty                            information        15.            Rendering physician secondary ID        16.            Rendering physician specialty information        17.            Referring provider secondary ID        18.            Referring provider specialty information        19.            Resident ID        20.            Resident ID Type 

 

R428-10-7. Exemptions, Extensions, and Waivers.

(1) Hospitals may submit requests for exemptions or waivers to the committee within 60 calendar days of the due date as listed in the hospital discharge data submittal schedule in R428-10-5, Table 1. Exemptions or waivers to the requirements of this rule may be granted for a maximum of one calendar year. A hospital wishing an exemption or waiver for more than one year must submit a request annually.

(2) Requests for extensions must be submitted to the Office at least ten working days prior to the due date as listed in the hospital discharge data submittal schedule. Extensions to the submittal schedule may be granted for a maximum of 30 calendar days. The hospital must separately request each additional 30 calendar day extension.

(3) The committee may grant exemptions or waivers when the hospital demonstrates that compliance imposes an unreasonable cost to the hospital. The Office may grant extensions when the hospital documents that technical or unforeseen difficulties prevent compliance. A petitioner requesting an exemption, extension, or waiver shall make the request in writing. A request for exemption, extension, or waiver must contain the following information:

(a) the petitioner's name, mailing address, telephone number, and contact person;

(b) the date the exemption, extension, or waiver is to start and end;

(c) a description of the relief sought, including reference to the specific sections of the rule;

(d) a statement of facts, reasons, or legal authority in support of the request; and

(e) a proposed alternative to the requirement.

(4) A form for exemption, extension, or waiver can be found in the technical manual available from the Office. Exemptions, extensions, or waivers may be granted for the following:

(a) Hospital exemption: All hospitals are subject to the reporting requirements. Reasons justifying an exemption might be a circumstance where the hospital makes no effort to charge any patient for service.

(b) Discharge data consolidation exemption: This exemption allows variation in the data consolidation requirement, such as allowing the hospital to submit multiple records containing the reportable data elements rather than a single consolidated discharge data record.

(c) Reportable data element exemption: Each request for a data element exemption must be made separately.

(d) Submission media exemption: This exemption allows variation in the submission media, such as uploading using secure sftp.

(e) Submittal schedule extension: The request must specifically document the technical or unforeseen difficulties that prevent compliance.

(f) Submission format waiver: This waiver allows variation in the submission format. Each request must state an alternative transfer electronic media, its format, and the record layout for the discharge data records. Granting of this waiver is dependent on the Office's ability to process the submittal media and format with available computer resources.

 

R428-10-8. Penalties.

Pursuant to Section 26-23-6, any person that violates any provision of this rule may be assessed an administrative civil money penalty not to exceed $3,000 upon an administrative finding of a first violation and up to $5,000 for a subsequent similar violation within two years. A person may also be subject to penalties imposed by a civil or criminal court, which may not exceed $5,000 or a class B misdemeanor for the first violation and a class A misdemeanor for any subsequent similar violation within two years.]

R428-10-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a, and in accordance with the Health Data Plan.

 

R428-10-2. Purpose.

This rule establishes the reporting standards for inpatient discharge data by licensed hospitals. The data will be used to develop and maintain a statewide hospital discharge data base.

 

R428-10-3. Source of Inpatient Hospital Discharge Data.

(1) The source for hospital inpatient discharge data shall be Utah licensed hospitals.

(2) Each hospital shall report discharge data records for each inpatient discharged from its facility.

(3) For a patient with multiple discharges, each hospital shall submit a single discharge data record for each discharge. For a patient with multiple billing claims each hospital shall consolidate the multiple billings into a single discharge data record for submission after the patient's discharge.

(4) A hospital may designate an intermediary or may submit discharge data directly to the committee.

(5) Each hospital is responsible for compliance with these rules. Use of a designated intermediary does not relieve the hospital of its reporting responsibility.

(6) Each hospital shall designate a department or other appropriate entity within the hospital and a person responsible for submitting the discharge data records. This person shall also be responsible for communicating with the Office.

(7) The Department of Health may conduct on-site audits to verify the accuracy of all submittals.

 

R428-10-4. Data Submittal Schedule.

Each hospital shall submit to the Office discharge data according to the schedule shown in Table 1. The Director of the Office may approve an alternate schedule that meets the needs of the committee.

 

TABLE

    (1) HOSPITAL DISCHARGE DATA SUBMITTAL SCHEDULE      PATIENT'S DATE OF DISCHARGE                 DISCHARGE DATA RECORD   IS BETWEEN                                  IS DUE BY   January 1 through March 31                  May 15   April 1 through June 30                     August 15   July 1 through September 30                 November 15   October 1 through December 31               February 15 

 

R428-10-5. Data Element Reporting.

(1) Tables 2 and 3 list the required data elements. Each hospital shall collect and report all data elements shown in Table 2. Each hospital shall report data elements shown in Table 3 whenever the information is a part of the hospital's patient record. Hospitals shall base data submissions on the specifications in the Submittal Manual for Inpatient Data.

(2) Each hospital shall collect patient social security number as a required data element on the hospital discharge record and report the patient social security number with the complete discharge record according to the submittal schedule.

(3) The Office shall adopt an encryption method for the patient social security number by creating a record linkage number as the control number.

(4) Each hospital shall submit the reported data elements on encrypted electronic media acceptable to the Office or send electronically through the Utah Health Information Network or another compatible electronic data interchange network or other secure upload or secure email method.

(5) The Office shall accept data that complies with data standards established in Rule R590-164, Uniform Health Billing Rule.

 

TABLE

   (2) LEVEL 1 DATA ELEMENTS           CATEGORY            NAME        Provider           1.             Provider identifier (hospital name)        Patient        2.             Patient control number        3.             Patient's medical record number        4.             Patient Social Security Number        5.             Patient name        6.             Patient's address, city, state, zip        7.             Patient's date of birth        8.             Patient's gender        Service        9.             Admission date        10.            Type of admission/visit        11.            Point of origin for admission or visit        12.            Patient's discharge status        13.            Statement covers period        14.            Condition codes (do not resuscitate,                            homeless, others)        Charge        15.            Service line        16.            Revenue codes        17.            HCPCS Procedure codes including modifiers        18.            Unit or basis for measurement code        19.            Service units/days        20.            Total charges by revenue code        Payer        21.            Payer's identification        22.            Patient's relationship to insured        Diagnosis and Treatment        23.            Diagnosis version qualifier        24.            Principal diagnosis with present on                            admission        25.            Other diagnosis codes with present on                            admission        26.            Admitting diagnosis code        27.            Patient's reason for visit codes        28.            External cause of injury codes (E-code)                            with present on admission        29.            Principal ICD procedure code        30.            Other ICD procedure codes        31.            Date of principal procedure        Physician        32.            Attending provider primary ID        33.            Operating physician primary ID        34.            Other operating physician primary ID        35.            Rendering physician primary ID        36.            Referring provider primary ID        Other        37.            Type of bill 

 

 

TABLE

   (3) LEVEL 2 DATA ELEMENTS           CATEGORY            NAME        Patient        1.             Patient marital status        2.             Patient race and ethnicity        Employer        3.             Employer name        Charge        4.             Prior payments        5.             Estimated amount due        Payer         6.            Insured names        7.             Certificate/Social Security Number/Health                            Insurance Claim/Identification Number        8.             Insured group names        Physician        9.             Attending provider secondary ID        10.            Attending provider specialty information        11.            Operating physician secondary ID        12.            Operating physician specialty information        13.            Other operating physician secondary ID        14.            Other operating physic. specialty                            information        15.            Rendering physician secondary ID        16.            Rendering physician specialty information        17.            Referring provider secondary ID        18.            Referring provider specialty information        19.            Resident ID        20.            Resident ID Type 

 

KEY: health, hospital policy, health planning

Date of Enactment or Last Substantive Amendment: [May 31, 2012]2014

Notice of Continuation: November 30, 2011

Authorizing, and Implemented or Interpreted Law: 26-33a-104; 26-33a-108

 

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