DAR File No. 39766

Health, Center for Health Data, Health Care Statistics

Rule R428-1

Health Data Plan and Incorporated Documents

Notice of Proposed Rule

(Amendment)

DAR File No.: 39766
Filed: 09/25/2015 11:20:56 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to update versions of documents incorporated by reference within Rule R428-1; specifically, Utah All-Payer Claims Database (APCD) Data Submission Guide Version 2.0 should be replaced by Utah All-Payer Claims Database Submission Guide Version 2.1, effective for all APCD claims submitted 04/01/2015 to 02/29/2016; and Utah All-Payer Claims Database Submission Guide Version 2.2 should be added, effective for all APCD claims submitted as of 03/01/2016. Clarify data elements and related requirements where needed to make uniform with existing practice.

Summary of the rule or change:

Update material incorporated by reference to reflect technical requirements expected for compliance with APCD submissions through February 2016 and thereafter. The amendment also makes minor technical edits.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 33a

This rule or change incorporates by reference the following material:

• Adds Utah All-Payer Claims Database Data Submittal Guide, published by Utah Department of Health, 12/15/2015
• Removes Utah All-Payer Claims Database Data Submission Guide, published by Utah Department of Health, 11/18/2013

Anticipated cost or savings to:

the state budget:

This rule amendment updates version numbering of technical documents for submissions to Utah's All-Payer Claims Database. The Utah Department of Health determines enactment of the amended version will not create any cost or savings impact to the state budget or UDOH's budget, since the change 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 are not impacted by this rule change, with all potentially impacted having more than 50 employees. 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:

Technical changes will not create any cost or savings to businesses, individuals, local governments or persons that are not small businesses.

Compliance costs for affected persons:

The most significant change in Version 2.2 is a clarification that submissions from dental stand-alone carriers can now be accepted. Dental stand-alone carriers (DSOs) have always been required to submit data to the APCD, however, the Office has been granting blanket exemptions since our new vendor has not had the capacity to accept these submissions. In the spring of 2015, the Office notified DSOs that the blanket exemption would be eliminated effective 01/01/2016 and began the process of moving DSOs into submission testing, with the goal of completing testing by the end of October 2015. Since this particular rule change is merely a clarification of the existing rule and policy (DSOs are already required to submit data, it does not represent additional compliance costs to the DSOs). Other substantive changes have been identified as relatively minor and necessary to ensure usefulness of the data for required reporting. The agency anticipates that some carriers will need to make programming changes to implement the additional flexibility and clarifications. The estimated cost of those programming changes should be negligible as they are part of normal data quality efforts.

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

The proposed amendment impacts business because dental stand-alone carriers will no longer have a blanket exemption from APCD submission requirements while OCHS's vendor developed capacity to accept submissions from these types of carriers. The vendor now has capacity to accept the submissions.

Joseph Miner, MD, 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:

• 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:

11/16/2015

This rule may become effective on:

11/23/2015

Authorized by:

Joseph Miner, Executive Director

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

R428-1. Health Data Plan and Incorporated Documents.

R428-1-1. Legal Authority.

This rule is promulgated in accordance with Title 26, Chapter 33a.

 

R428-1-2. Purpose.

This rule adopts and incorporates documents related to the collection, analysis, and dissemination of data covered in this title.

 

R428-1-3. Health Data Plan Adoption.

As required by Section 26-33a-104, the Health Data Committee adopts by rule the health data plan dated October 3, 1991.

 

R428-1-4. Incorporation by Reference.

The following documents are adopted and incorporated by reference:

(1) Utah Hospital Inpatient Discharge Data Submittal Manual, Data Element Descriptions and Definitions, Version VI, February 2014

(2) Utah Ambulatory Surgery Data Submission Manual, Version IV, March 2015

(3) HEDIS 2014, Volume 3: Specifications for Survey Measures, published by NCQA

(4) HEDIS 2014, Volume 5: HEDIS Compliance Audit: Standards, Policies, and Procedures, published by NCQA

(5) Utah All-Payer Claims Database Data Submission Guide Version [2.0]2.1

(6) Utah All-Payer Claims Database Data Submission Guide Version [2.1]2.2

 

KEY: health, health policy, health planning

Date of Enactment or Last Substantive Amendment: [ October 1, ]2015

Notice of Continuation: November 21, 2011

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