DAR File No. 38564
This rule was published in the June 15, 2014, issue (Vol. 2014, No. 12) of the Utah State Bulletin.
Health, Center for Health Data, Health Care Statistics
Rule R428-10
Health Data Authority Hospital Inpatient Reporting Rule
Notice of Proposed 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Items from the repealed rule, no longer in the reenacted rule: subsections on definitions, exemptions, extensions, and waivers, and penalties.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:
HealthCenter 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 mikemartin@utah.gov
- Rex Olsen at the above address, by phone at 801-538-9498, by FAX at 801-536-0940, or by Internet E-mail at rolsen@utah.gov
- Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at nthurston@utah.gov
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
Additional Information
More information about a Notice of Proposed Rule is available online.
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For questions regarding the content or application of this rule, please contact Mike Martin at the above address, by phone at 801-538-9205, by FAX at 801-538-9916, or by Internet E-mail at mikemartin@utah.gov; Rex Olsen at the above address, by phone at 801-538-9498, by FAX at 801-536-0940, or by Internet E-mail at rolsen@utah.gov; Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at nthurston@utah.gov. For questions about the rulemaking process, please contact the Division of Administrative Rules.