Part 5. Health Data of California Health And Safety Code >> Division 107. >> Part 5.
This chapter shall be known as the Health Data and Advisory
Council Consolidation Act.
The Legislature hereby finds and declares that:
(a) Significant changes have taken place in recent years in the
health care marketplace and in the manner of reimbursement to health
facilities by government and private third-party payers for the
services they provide.
(b) These changes have permitted the state to reevaluate the need
for, and the manner of data collection from health facilities by the
various state agencies and commissions.
(c) It is the intent of the Legislature that as a result of this
reevaluation that the data collection function be consolidated in a
single state agency. It is the further intent of the Legislature that
the single state agency only collect that data from health
facilities that are essential. The data should be collected, to the
extent practical on consolidated, multipurpose report forms for use
by all state agencies.
(d) It is the further intent of the Legislature to eliminate the
California Health Facilities Commission, the State Advisory Health
Council, and the California Health Policy and Data Advisory
Commission, and to consolidate data collection and planning functions
within the office.
(e) It is the Legislature's further intent that the review of the
data that the state collects be an ongoing function. The office shall
annually review this data for need and shall revise, add, or delete
items as necessary. The office shall consult with affected state
agencies and the affected industry when adding or eliminating data
items. However, the office shall neither add nor delete data items to
the Hospital Discharge Abstract Data Record or the quarterly reports
without prior authorizing legislation, unless specifically required
by federal law or judicial decision.
(f) The Legislature recognizes that the authority for the
California Health Facilities Commission is scheduled to expire
January 1, 1986. It is the intent of the Legislature, by the
enactment of this chapter, to continue the uniform system of
accounting and reporting established by the commission and required
for use by health facilities. It is also the intent of the
Legislature to continue an appropriate, cost-disclosure program.
The office shall conduct, under contract with a qualified
consulting firm, a comprehensive review of the financial and
utilization reports that hospitals are required to file with the
office and similar reports required by other departments of state
government, as appropriate. The contracting consulting firm shall
have a strong commitment to public health and health care issues, and
shall demonstrate fiscal management and analytical expertise. The
purpose of the review is to identify opportunities to eliminate the
collection of data that no longer serve any significant purpose, to
reduce the redundant reporting of similar data to different
departments, and to consolidate reports wherever practical. The
contracting consulting firm shall evaluate specific reporting
requirements, exceptions to and exemptions from the requirements, and
areas of duplication or overlap within the requirements. The
contracting consulting firm shall consult with a broad range of data
users, including, but not limited to, consumers, payers, purchasers,
providers, employers, employees, and the organizations that represent
the data users. It is expected that the review will result in
greater efficiency in collecting and disseminating needed hospital
information to the public and will reduce hospital costs and
administrative burdens associated with reporting the information.
Intermediate care facilities/developmentally
disabled-habilitative, as defined in subdivision (e) of Section 1250,
are not subject to this chapter.
Intermediate care facilities/developmentally
disabled--nursing, as defined in subdivision (h) of Section 1250, are
not subject to this chapter.
As used in this chapter, the following terms mean:
(a) "Ambulatory surgery procedures" mean those procedures
performed on an outpatient basis in the general operating rooms,
ambulatory surgery rooms, endoscopy units, or cardiac catheterization
laboratories of a hospital or a freestanding ambulatory surgery
clinic.
(b) "Emergency department" means, in a hospital licensed to
provide emergency medical services, the location in which those
services are provided.
(c) "Encounter" means a face-to-face contact between a patient and
the provider who has primary responsibility for assessing and
treating the condition of the patient at a given contact and
exercises independent judgment in the care of the patient.
(d) "Freestanding ambulatory surgery clinic" means a surgical
clinic that is licensed by the state under paragraph (1) of
subdivision (b) of Section 1204.
(e) "Health facility" or "health facilities" means all health
facilities required to be licensed pursuant to Chapter 2 (commencing
with Section 1250) of Division 2.
(f) "Hospital" means all health facilities except skilled nursing,
intermediate care, and congregate living health facilities.
(g) "Office" means the Office of Statewide Health Planning and
Development.
(h) "Risk-adjusted outcomes" means the clinical outcomes of
patients grouped by diagnoses or procedures that have been adjusted
for demographic and clinical factors.
On and after January 1, 1986, any reference in this code to
the Advisory Health Council or the California Health Policy and Data
Advisory Commission shall be deemed a reference to the office.
(a) Effective January 1, 1986, the office shall be the
single state agency designated to collect the following health
facility or clinic data for use by all state agencies:
(1) That data required by the office pursuant to Section 127285.
(2) That data required in the Medi-Cal cost reports pursuant to
Section 14170 of the Welfare and Institutions Code.
(3) Those data items formerly required by the California Health
Facilities Commission that are listed in Sections 128735 and 128740.
Information collected pursuant to subdivision (g) of Section 128735
and Sections 128736 and 128737 shall be made available to the State
Department of Health Care Services and the State Department of Public
Health. The departments shall ensure that the patient's rights to
confidentiality shall not be violated in any manner. The departments
shall comply with all applicable policies and requirements involving
review and oversight by the State Committee for the Protection of
Human Subjects.
(b) The office shall consolidate any and all of the reports listed
under this section or Sections 128735 and 128740, to the extent
feasible, to minimize the reporting burdens on hospitals, provided,
however, that the office shall neither add nor delete data items from
the Hospital Discharge Abstract Data Record or the quarterly reports
without prior authorizing legislation, unless specifically required
by federal law or regulation or judicial decision.
An organization that operates, conducts, owns, or maintains
a health facility, and the officers thereof, shall make and file
with the office, at the times as the office shall require, all of the
following reports on forms specified by the office that shall be in
accord, if applicable, with the systems of accounting and uniform
reporting required by this part, except that the reports required
pursuant to subdivision (g) shall be limited to hospitals:
(a) A balance sheet detailing the assets, liabilities, and net
worth of the health facility at the end of its fiscal year.
(b) A statement of income, expenses, and operating surplus or
deficit for the annual fiscal period, and a statement of ancillary
utilization and patient census.
(c) A statement detailing patient revenue by payer, including, but
not limited to, Medicare, Medi-Cal, and other payers, and revenue
center, except that hospitals authorized to report as a group
pursuant to subdivision (d) of Section 128760 are not required to
report revenue by revenue center.
(d) A statement of cashflows, including, but not limited to,
ongoing and new capital expenditures and depreciation.
(e) A statement reporting the information required in subdivisions
(a), (b), (c), and (d) for each separately licensed health facility
operated, conducted, or maintained by the reporting organization,
except those hospitals authorized to report as a group pursuant to
subdivision (d) of Section 128760.
(f) Data reporting requirements established by the office shall be
consistent with national standards, as applicable.
(g) A Hospital Discharge Abstract Data Record that includes all of
the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) ZIP Code.
(5) Preferred language spoken.
(6) Patient social security number, if it is contained in the
patient's medical record.
(7) Prehospital care and resuscitation, if any, including all of
the following:
(A) "Do not resuscitate" (DNR) order on admission.
(B) "Do not resuscitate" (DNR) order after admission.
(8) Admission date.
(9) Source of admission.
(10) Type of admission.
(11) Discharge date.
(12) Principal diagnosis and whether the condition was present on
admission.
(13) Other diagnoses and whether the conditions were present on
admission.
(14) External causes of morbidity and whether present on
admission.
(15) Principal procedure and date.
(16) Other procedures and dates.
(17) Total charges.
(18) Disposition of patient.
(19) Expected source of payment.
(20) Elements added pursuant to Section 128738.
(h) It is the intent of the Legislature that the patient's rights
of confidentiality shall not be violated in any manner. Patient
social security numbers and other data elements that the office
believes could be used to determine the identity of an individual
patient shall be exempt from the disclosure requirements of the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code).
(i) A person reporting data pursuant to this section shall not be
liable for damages in an action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(g).
(j) A hospital shall use coding from the International
Classification of Diseases in reporting diagnoses and procedures.
(a) Each hospital shall file an Emergency Care Data Record
for each patient encounter in a hospital emergency department. The
Emergency Care Data Record shall include all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) Ethnicity.
(5) Preferred language spoken.
(6) ZIP Code.
(7) Patient social security number, if it is contained in the
patient's medical record.
(8) Service date.
(9) Principal diagnosis.
(10) Other diagnoses.
(11) External causes of morbidity.
(12) Principal procedure.
(13) Other procedures.
(14) Disposition of patient.
(15) Expected source of payment.
(16) Elements added pursuant to Section 128738.
(b) It is the expressed intent of the Legislature that the patient'
s rights of confidentiality shall not be violated in any manner.
Patient social security numbers and any other data elements that the
office believes could be used to determine the identity of an
individual patient shall be exempt from the disclosure requirements
of the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(c) No person reporting data pursuant to this section shall be
liable for damages in any action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(a).
(d) Data reporting requirements established by the office shall be
consistent with national standards as applicable.
(e) This section shall become operative on January 1, 2004.
(a) Each general acute care hospital and freestanding
ambulatory surgery clinic shall file an Ambulatory Surgery Data
Record for each patient encounter during which at least one
ambulatory surgery procedure is performed. The Ambulatory Surgery
Data Record shall include all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) Ethnicity.
(5) Preferred language spoken.
(6) ZIP Code.
(7) Patient social security number, if it is contained in the
patient's medical record.
(8) Service date.
(9) Principal diagnosis.
(10) Other diagnoses.
(11) Principal procedure.
(12) Other procedures.
(13) External causes of morbidity.
(14) Disposition of patient.
(15) Expected source of payment.
(16) Elements added pursuant to Section 128738.
(b) It is the expressed intent of the Legislature that the patient'
s rights of confidentiality shall not be violated in any manner.
Patient social security numbers and any other data elements that the
office believes could be used to determine the identity of an
individual patient shall be exempt from the disclosure requirements
of the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(c) No person reporting data pursuant to this section shall be
liable for damages in any action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(a).
(d) Data reporting requirements established by the office shall be
consistent with national standards as applicable.
(e) This section shall become operative on January 1, 2004.
(a) The office shall allow and provide for, in accordance
with appropriate regulations, additions or deletions to the patient
level data elements listed in subdivision (g) of Section 128735,
Section 128736, and Section 128737, to meet the purposes of this
chapter.
(b) Prior to any additions or deletions, all of the following
shall be considered:
(1) Utilization of sampling to the maximum extent possible.
(2) Feasibility of collecting data elements.
(3) Costs and benefits of collection and submission of data.
(4) Exchange of data elements as opposed to addition of data
elements.
(c) The office shall add no more than a net of 15 elements to each
data set over any five-year period. Elements contained in the
uniform claims transaction set or uniform billing form required by
the Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. Sec. 300gg) shall be exempt from the 15-element limit.
(d) The office, in order to minimize costs and administrative
burdens, shall consider the total number of data elements required
from hospitals and freestanding ambulatory surgery clinics, and
optimize the use of common data elements.
(a) Commencing with the first calendar quarter of 1992, the
following summary financial and utilization data shall be reported
to the office by each hospital within 45 days of the end of every
calendar quarter. Adjusted reports reflecting changes as a result of
audited financial statements may be filed within four months of the
close of the hospital's fiscal or calendar year. The quarterly
summary financial and utilization data shall conform to the uniform
description of accounts as contained in the Accounting and Reporting
Manual for California Hospitals and shall include all of the
following:
(1) Number of licensed beds.
(2) Average number of available beds.
(3) Average number of staffed beds.
(4) Number of discharges.
(5) Number of inpatient days.
(6) Number of outpatient visits.
(7) Total operating expenses.
(8) Total inpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(9) Total outpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(10) Deductions from revenue in total and by component, including
the following: Medicare contractual adjustments, Medi-Cal contractual
adjustments, and county indigent program contractual adjustments,
other contractual adjustments, bad debts, charity care, restricted
donations and subsidies for indigents, support for clinical teaching,
teaching allowances, and other deductions.
(11) Total capital expenditures.
(12) Total net fixed assets.
(13) Total number of inpatient days, outpatient visits, and
discharges by payer, including Medicare, Medi-Cal, county indigent
programs, other third parties, self-pay, charity, and other payers.
(14) Total net patient revenues by payer including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(15) Other operating revenue.
(16) Nonoperating revenue net of nonoperating expenses.
(b) Hospitals reporting pursuant to subdivision (d) of Section
128760 may provide the items in paragraphs (7), (8), (9), (10), (14),
(15), and (16) of subdivision (a) on a group basis, as described in
subdivision (d) of Section 128760.
(c) The office shall make available at cost, to any person, a hard
copy of any hospital report made pursuant to this section and in
addition to hard copies, shall make available at cost, a computer
tape of all reports made pursuant to this section within 105 days of
the end of every calendar quarter.
(d) The office shall adopt by regulation guidelines for the
identification, assessment, and reporting of charity care services.
In establishing the guidelines, the office shall consider the
principles and practices recommended by professional health care
industry accounting associations for differentiating between charity
services and bad debts. The office shall further conduct the onsite
validations of health facility accounting and reporting procedures
and records as are necessary to assure that reported data are
consistent with regulatory guidelines.
This section shall become operative January 1, 1992.
(a) Commencing July 1993, and annually thereafter, the
office shall publish risk-adjusted outcome reports in accordance with
the following schedule:
Procedures and
Publication Period Conditions
Date Covered Covered
July 1993 1988-90 3
July 1994 1989-91 6
July 1995 1990-92 9
Reports for subsequent years shall include conditions and
procedures and cover periods as appropriate.
(b) The procedures and conditions required to be reported under
this chapter shall be divided among medical, surgical, and obstetric
conditions or procedures and shall be selected by the office. The
office shall publish the risk-adjusted outcome reports for surgical
procedures by individual hospital and individual surgeon unless the
office in consultation with medical specialists in the relevant area
of practice determines that it is not appropriate to report by
individual surgeon. The office, in consultation with the clinical
panel established by Section 128748 and medical specialists in the
relevant area of practice, may decide to report nonsurgical
procedures and conditions by individual physician when it is
appropriate. The selections shall be in accordance with all of the
following criteria:
(1) The patient discharge abstract contains sufficient data to
undertake a valid risk adjustment. The risk adjustment report shall
ensure that public hospitals and other hospitals serving primarily
low-income patients are not unfairly discriminated against.
(2) The relative importance of the procedure and condition in
terms of the cost of cases and the number of cases and the
seriousness of the health consequences of the procedure or condition.
(3) Ability to measure outcome and the likelihood that care
influences outcome.
(4) Reliability of the diagnostic and procedure data.
(c) (1) In addition to any other established and pending reports,
on or before July 1, 2002, the office shall publish a risk-adjusted
outcome report for coronary artery bypass graft surgery by hospital
for all hospitals opting to participate in the report. This report
shall be updated on or before July 1, 2003.
(2) In addition to any other established and pending reports,
commencing July 1, 2004, and every year thereafter, the office shall
publish risk-adjusted outcome reports for coronary artery bypass
graft surgery for all coronary artery bypass graft surgeries
performed in the state. In each year, the reports shall compare
risk-adjusted outcomes by hospital, and in every other year, by
hospital and cardiac surgeon. Upon the recommendation of the clinical
panel established by Section 128748 based on statistical and
technical considerations, information on individual hospitals and
surgeons may be excluded from the reports.
(3) Unless otherwise recommended by the clinical panel established
by Section 128748, the office shall collect the same data used for
the most recent risk-adjusted model developed for the California
Coronary Artery Bypass Graft Mortality Reporting Program. Upon
recommendation of the clinical panel, the office may add any clinical
data elements included in the Society of Thoracic Surgeons'
database. Prior to any additions from the Society of Thoracic
Surgeons' database, the following factors shall be considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Exchange of data elements as opposed to addition of data
elements.
(4) Upon recommendation of the clinical panel, the office may add,
delete, or revise clinical data elements, but shall add no more than
a net of six elements not included in the Society of Thoracic
Surgeons' database, to the data set over any five-year period. Prior
to any additions or deletions, all of the following factors shall be
considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Feasibility of collecting data elements.
(C) Costs and benefits of collection and submission of data.
(D) Exchange of data elements as opposed to addition of data
elements.
(5) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model for the
coronary artery bypass graft report.
(6) Patient medical record numbers and any other data elements
that the office believes could be used to determine the identity of
an individual patient shall be exempt from the disclosure
requirements of the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).
(d) The annual reports shall compare the risk-adjusted outcomes
experienced by all patients treated for the selected conditions and
procedures in each California hospital during the period covered by
each report, to the outcomes expected. Outcomes shall be reported in
the five following groupings for each hospital:
(1) "Much higher than average outcomes," for hospitals with
risk-adjusted outcomes much higher than the norm.
(2) "Higher than average outcomes," for hospitals with
risk-adjusted outcomes higher than the norm.
(3) "Average outcomes," for hospitals with average risk-adjusted
outcomes.
(4) "Lower than average outcomes," for hospitals with
risk-adjusted outcomes lower than the norm.
(5) "Much lower than average outcomes," for hospitals with
risk-adjusted outcomes much lower than the norm.
(e) For coronary artery bypass graft surgery reports and any other
outcome reports for which auditing is appropriate, the office shall
conduct periodic auditing of data at hospitals.
(f) The office shall publish in the annual reports required under
this section the risk-adjusted mortality rate for each hospital and
for those reports that include physician reporting, for each
physician.
(g) The office shall either include in the annual reports required
under this section, or make separately available at cost to any
person requesting it, risk-adjusted outcomes data assessing the
statistical significance of hospital or physician data at each of the
following three levels: 99-percent confidence level (0.01 p-value),
95-percent confidence level (0.05 p-value), and 90-percent confidence
level (0.10 p-value). The office shall include any other analysis or
comparisons of the data in the annual reports required under this
section that the office deems appropriate to further the purposes of
this chapter.
Commencing July 1, 2002, and biennially thereafter, the
office shall evaluate the impact of the office's published
risk-adjusted outcome reports required by Sections 128745 and 128746
on mortality rates in California and on any other measure of quality
the office deems appropriate. The office shall also coordinate with
other state agencies in promoting prevention and educational
initiatives on those reported procedures and conditions.
(a) This section shall apply to any risk-adjusted outcome
report that includes reporting of data by an individual physician.
(b) (1) The office shall obtain data necessary to complete a
risk-adjusted outcome report from hospitals. If necessary data for an
outcome report is available only from the office of a physician and
not the hospital where the patient received treatment, then the
hospital shall make a reasonable effort to obtain the data from the
physician's office and provide the data to the office. In the event
that the office finds any errors, omissions, discrepancies, or other
problems with submitted data, the office shall contact either the
hospital or physician's office that maintains the data to resolve the
problems.
(2) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model. Except for
data collected for purposes of testing or validating a risk-adjusted
model, the office shall not collect data for an outcome report nor
issue an outcome report until the clinical panel established pursuant
to this section has approved the risk-adjusted model.
(c) For each risk-adjusted outcome report on a medical, surgical,
or obstetric condition or procedure that includes reporting of data
by an individual physician, the office director shall appoint a
clinical panel, which shall have nine members. Three members shall be
appointed from a list of three or more names submitted by the
physician specialty society that most represents physicians
performing the medical, surgical, and obstetric procedure for which
data is collected. Three members shall be appointed from a list of
three or more names submitted by the California Medical Association.
Three members shall be appointed from lists of names submitted by
consumer organizations. At least one-half of the appointees from the
lists submitted by the physician specialty society and the California
Medical Association, and at least one appointee from the lists
submitted by consumer organizations, shall be experts in collecting
and reporting outcome measurements for physicians or hospitals. The
panel may include physicians from another state. The panel shall
review and approve the development of the risk-adjustment model to be
used in preparation of the outcome report.
(d) For the clinical panel authorized by subdivision (c) for
coronary artery bypass graft surgery, three members shall be
appointed from a list of three or more names submitted by the
California Chapter of the American College of Cardiology. Three
members shall be appointed from list of three or more names submitted
by the California Medical Association. Three members shall be
appointed from lists of names submitted by consumer organizations. At
least one-half of the appointees from the lists submitted by the
California Chapter of the American College of Cardiology, and the
California Medical Association, and at least one appointee from the
lists submitted by consumer organizations, shall be experts in
collecting and reporting outcome measurements for physicians and
surgeons or hospitals. The panel may include physicians from another
state. The panel shall review and approve the development of the
risk-adjustment model to be used in preparation of the outcome
report.
(e) Any report that includes reporting by an individual physician
shall include, at a minimum, the risk-adjusted outcome data for each
physician. The office may also include in the report, after
consultation with the clinical panel, any explanatory material,
comparisons, groupings, and other information to facilitate consumer
comprehension of the data.
(f) Members of a clinical panel shall serve without compensation,
but shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of the clinical
panel.
(a) Prior to the public release of the annual outcome
reports, the office shall furnish a preliminary report to each
hospital that is included in the report. The office shall allow the
hospital and chief of staff 60 days to review the outcome scores and
compare the scores to other California hospitals. A hospital or its
chief of staff that believes that the risk-adjusted outcomes do not
accurately reflect the quality of care provided by the hospital may
submit a statement to the office, within the 60 days, explaining why
the outcomes do not accurately reflect the quality of care provided
by the hospital. The statement shall be included in an appendix to
the public report, and a notation that the hospital or its chief of
staff has submitted a statement shall be displayed wherever the
report presents outcome scores for the hospital.
(b) (1) Prior to the public release of any outcome report that
includes data by a physician, the office shall furnish a preliminary
report to each physician that is included in the report. The office
shall allow the physician 30 days from the date the office sends the
report to the physician to review the outcome scores and compare the
scores to other California physicians. A physician who believes that
the risk-adjusted outcome does not accurately reflect the quality of
care provided by the physician may submit a statement to the office
within the 30 days, explaining why the outcomes do not accurately
reflect the quality of care provided by the physician.
(2) The office shall promptly review the physician's statement and
shall respond to the physician with one of the following
conclusions:
(A) The physician's statement reveals a flaw in the accuracy of
the reported data relating to the physician that materially
diminishes the validity of the report. If this finding is made, the
data for that physician shall not be included in the report until the
flaw in the physician's data is corrected.
(B) The physician's statement reveals a flaw in the
risk-adjustment model that materially diminishes the value of the
report for all physicians. If this finding is made, the report using
that risk-adjustment model shall not be issued until the flaw is
corrected.
(C) The physician's statement does not reveal a flaw in either the
accuracy of the reported data relating to the physician or the
risk-adjustment model in which case the report shall be used, unless
the physician chooses to use the procedure set forth in paragraph
(3).
(3) If a physician is not satisfied with the conclusion reached by
the office, the physician shall notify the office of that fact. Upon
receipt of the notice, the office shall forward the physician's
statement to the appropriate clinical panel appointed pursuant to
Section 128748. The office shall forward the physician's statement
with any information identifying the physician or the physician's
hospital redacted, or shall adopt other means to ensure the physician'
s identity is not revealed to the panel. The clinical panel shall
promptly review the physician statement and the conclusion of the
office and shall respond by either upholding the conclusion or
reaching one of the other conclusions set forth in this subdivision.
The panel decision shall be the final determination regarding the
physician's statement. The process set forth in this subdivision
shall be completed within 60 days from the date the office sends the
report to each physician included in the report. If a decision by
either the office or the clinical panel cannot be reached within the
60-day period, then the outcome report may be issued but shall not
include data for the physician submitting the statement.
(c) The office shall, in addition to public reports, provide
hospitals and the chiefs of staff of the medical staffs with a report
containing additional detailed information derived from data
summarized in the public outcome reports as an aid to internal
quality assurance.
(d) If, pursuant to the recommendations of the office, the
Legislature subsequently amends Section 128735 to authorize the
collection of additional discharge data elements, then the outcome
reports for conditions and procedures for which sufficient data is
not available from the current abstract record will be produced
following the collection and analysis of the additional data
elements.
(e) The recommendations of the office for the addition of data
elements to the discharge abstract should take into consideration the
technical feasibility of developing reliable risk-adjustment factors
for additional procedures and conditions as determined by the office
with the advice of the research community, physicians and surgeons,
hospitals, consumer or patient advocacy groups, and medical records
personnel.
(f) The office at a minimum shall identify a limited set of core
clinical data elements to be collected for all of the added
procedures and conditions and unique clinical variables necessary for
risk adjustment of specific conditions and procedures selected for
the outcomes report program. In addition, the committee should give
careful consideration to the costs associated with the additional
data collection and the value of the specific information to be
collected.
(g) The office shall also engage in a continuing process of data
development and refinement applicable to both current and prospective
outcome studies.
(a) (1) Hospitals shall file the reports required by
subdivisions (a), (b), (c), and (d) of Section 128735 with the office
within four months after the close of the hospital's fiscal year
except as provided in paragraph (2).
(2) If a licensee relinquishes the facility license or puts the
facility license in suspense, the last day of active licensure shall
be deemed a fiscal year end.
(3) The office shall make the reports filed pursuant to this
subdivision available no later than three months after they were
filed.
(b) (1) Skilled nursing facilities, intermediate care facilities,
intermediate care facilities/developmentally disabled, hospice
facilities, and congregate living facilities, including nursing
facilities certified by the department to participate in the Medi-Cal
program, shall file the reports required by subdivisions (a), (b),
(c), and (d) of Section 128735 with the office within four months
after the close of the facility's fiscal year, except as provided in
paragraph (2).
(2) (A) If a licensee relinquishes the facility license or puts
the facility licensure in suspense, the last day of active licensure
shall be deemed a fiscal year end.
(B) If a fiscal year end is created because the facility license
is relinquished or put in suspense, the facility shall file the
reports required by subdivisions (a), (b), (c), and (d) of Section
128735 within two months after the last day of active licensure.
(3) The office shall make the reports filed pursuant to paragraph
(1) available not later than three months after they are filed.
(4) (A) Effective for fiscal years ending on or after December 31,
1991, the reports required by subdivisions (a), (b), (c), and (d) of
Section 128735 shall be filed with the office by electronic media,
as determined by the office.
(B) Congregate living health facilities are exempt from the
electronic media reporting requirements of subparagraph (A).
(c) A hospital shall file the reports required by subdivision (g)
of Section 128735 as follows:
(1) For patient discharges on or after January 1, 1999, through
December 31, 1999, the reports shall be filed semiannually by each
hospital or its designee not later than six months after the end of
each semiannual period, and shall be available from the office no
later than six months after the date that the report was filed.
(2) For patient discharges on or after January 1, 2000, through
December 31, 2000, the reports shall be filed semiannually by each
hospital or its designee not later than three months after the end of
each semiannual period. The reports shall be filed by electronic
tape, diskette, or similar medium as approved by the office. The
office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the date that the report
is approved.
(3) For patient discharges on or after January 1, 2001, the
reports shall be filed by each hospital or its designee for report
periods and at times determined by the office. The reports shall be
filed by online transmission in formats consistent with national
standards for the exchange of electronic information. The office
shall approve or reject each report within 15 days of receiving it.
If a report does not meet the standards established by the office, it
shall not be approved as filed and shall be rejected. The report
shall be considered not filed as of the date the facility is notified
that the report is rejected. A report shall be available from the
office no later than 15 days after the date that the report is
approved.
(d) The reports required by subdivision (a) of Section 128736
shall be filed by each hospital for report periods and at times
determined by the office. The reports shall be filed by online
transmission in formats consistent with national standards for the
exchange of electronic information. The office shall approve or
reject each report within 15 days of receiving it. If a report does
not meet the standards established by the office, it shall not be
approved as filed and shall be rejected. The report shall be
considered not filed as of the date the facility is notified that the
report is rejected. A report shall be available from the office no
later than 15 days after the report is approved.
(e) The reports required by subdivision (a) of Section 128737
shall be filed by each hospital or freestanding ambulatory surgery
clinic for report periods and at times determined by the office. The
reports shall be filed by online transmission in formats consistent
with national standards for the exchange of electronic information.
The office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the report is approved.
(f) Facilities shall not be required to maintain a full-time
electronic connection to the office for the purposes of online
transmission of reports as specified in subdivisions (c), (d), and
(e). The office may grant exemptions to the online transmission of
data requirements for limited periods to facilities. An exemption may
be granted only to a facility that submits a written request and
documents or demonstrates a specific need for an exemption.
Exemptions shall be granted for no more than one year at a time, and
for no more than a total of five consecutive years.
(g) The reports referred to in paragraph (2) of subdivision (a) of
Section 128730 shall be filed with the office on the dates required
by applicable law and shall be available from the office no later
than six months after the date that the report was filed.
(h) The office shall post on its Internet Web site and make
available to any person a copy of any report referred to in
subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision
(a) of Section 128736, subdivision (a) of Section 128737, Section
128740, and, in addition, shall make available in electronic formats
reports referred to in subdivision (a), (b), (c), (d), or (g) of
Section 128735, subdivision (a) of Section 128736, subdivision (a) of
Section 128737, Section 128740, and subdivisions (a) and (c) of
Section 128745, unless the office determines that an individual
patient's rights of confidentiality would be violated. The office
shall make the reports available at cost.
(a) On and after January 1, 1986, those systems of health
facility accounting and auditing formerly approved by the California
Health Facilities Commission shall remain in full force and effect
for use by health facilities but shall be maintained by the office.
(b) The office shall allow and provide, in accordance with
appropriate regulations, for modifications in the accounting and
reporting systems for use by health facilities in meeting the
requirements of this chapter if the modifications are necessary to do
any of the following:
(1) To correctly reflect differences in size of, provision of, or
payment for, services rendered by health facilities.
(2) To correctly reflect differences in scope, type, or method of
provision of, or payment for, services rendered by health facilities.
(3) To avoid unduly burdensome costs for those health facilities
in meeting the requirements of differences pursuant to paragraphs (1)
and (2).
(c) Modifications to discharge data reporting requirements. The
office shall allow and provide, in accordance with appropriate
regulations, for modifications to discharge data reporting format and
frequency requirements if these modifications will not impair the
office's ability to process the data or interfere with the purposes
of this chapter. This modification authority shall not be construed
to permit the office to administratively require the reporting of
discharge data items not specified pursuant to Section 128735.
(d) Modifications to emergency care data reporting requirements.
The office shall allow and provide, in accordance with appropriate
regulations, for modifications to emergency care data reporting
format and frequency requirements if these modifications will not
impair the office's ability to process the data or interfere with the
purposes of this chapter. This modification authority shall not be
construed to permit the office to require administratively the
reporting of emergency care data items not specified in subdivision
(a) of Section 128736.
(e) Modifications to ambulatory surgery data reporting
requirements. The office shall allow and provide, in accordance with
appropriate regulations, for modifications to ambulatory surgery data
reporting format and frequency requirements if these modifications
will not impair the office's ability to process the data or interfere
with the purposes of this chapter. The modification authority shall
not be construed to permit the office to require administratively the
reporting of ambulatory surgery data items not specified in
subdivision (a) of Section 128737.
(f) Reporting provisions for health facilities. The office shall
establish specific reporting provisions for health facilities that
receive a preponderance of their revenue from associated
comprehensive group practice prepayment health care service plans.
These health facilities shall be authorized to utilize established
accounting systems, and to report costs and revenues in a manner that
is consistent with the operating principles of these plans and with
generally accepted accounting principles. When these health
facilities are operated as units of a coordinated group of health
facilities under common management, they shall be authorized to
report as a group rather than as individual institutions. As a group,
they shall submit a consolidated income and expense statement.
(g) Hospitals authorized to report as a group under this
subdivision may elect to file cost data reports required under the
regulations of the Social Security Administration in its
administration of Title XVIII of the federal Social Security Act in
lieu of any comparable cost reports required under Section 128735.
However, to the extent that cost data is required from other
hospitals, the cost data shall be reported for each individual
institution.
(h) The office shall adopt comparable modifications to the
financial reporting requirements of this chapter for county hospital
systems consistent with the purposes of this chapter.
(a) The office shall maintain a file of all the reports
filed under this chapter at its Sacramento office. Subject to any
rules the office may prescribe, these reports shall be produced and
made available for inspection upon the demand of any person, and
shall also be posted on its Web site, with the exception of discharge
and encounter data that shall be available for public inspection
unless the office determines, pursuant to applicable law, that an
individual patient's rights of confidentiality would be violated.
(b) The reports published pursuant to Section 128745 shall include
an executive summary, written in plain English to the maximum extent
practicable, that shall include, but not be limited to, a discussion
of findings, conclusions, and trends concerning the overall quality
of medical outcomes, including a comparison to reports from prior
years, for the procedure or condition studied by the report. The
office shall disseminate the reports as widely as practical to
interested parties, including, but not limited to, hospitals,
providers, the media, purchasers of health care, consumer or patient
advocacy groups, and individual consumers. The reports shall be
posted on the office's Internet Web site.
(c) Copies certified by the office as being true and correct
copies of reports properly filed with the office pursuant to this
chapter, together with summaries, compilations, or supplementary
reports prepared by the office, shall be introduced as evidence,
where relevant, at any hearing, investigation, or other proceeding
held, made, or taken by any state, county, or local governmental
agency, board, or commission that participates as a purchaser of
health facility services pursuant to the provisions of a publicly
financed state or federal health care program. Each of these state,
county, or local governmental agencies, boards, and commissions shall
weigh and consider the reports made available to it pursuant to the
provisions of this subdivision in its formulation and implementation
of policies, regulations, or procedures regarding reimbursement
methods and rates in the administration of these publicly financed
programs.
(d) The office shall compile and publish summaries of individual
facility and aggregate data that do not contain patient-specific
information for the purpose of public disclosure. The summaries shall
be posted on the office's Internet Web site. The office may initiate
and conduct studies as it determines will advance the purposes of
this chapter.
(e) In order to assure that accurate and timely data are available
to the public in useful formats, the office shall establish a public
liaison function. The public liaison shall provide technical
assistance to the general public on the uses and applications of
individual and aggregate health facility data and shall provide the
director with an annual report on changes that can be made to improve
the public's access to data.
(a) Notwithstanding Section 128765 or any other provision
of law, the office, upon request, shall disclose information
collected pursuant to subdivision (g) of Section 128735 and Sections
128736 and 128737, to any California hospital and any local health
department or local health officer in California as set forth in Part
3 (commencing with Section 101000) of Division 101. The office shall
disclose this same information to the United States Department of
Health and Human Services or any of its subsidiary agencies,
including the National Center for Health Statistics or any other unit
of the Centers for Disease Control and Prevention, the Agency for
Healthcare Research and Quality, the Centers for Medicare and
Medicaid Services, the Health Resources and Services Administration,
the Indian Health Service, Tribal Epidemiology Centers, which are
defined as public health authorities pursuant to the federal Indian
Health Care Improvement Act (25 U.S.C. Sec. 1601 et seq.), the
National Institutes of Health, or the National Cancer Institute, or
the Veterans Health Care Administration within the United States
Department of Veterans Affairs, for the purposes of conducting a
statutorily authorized activity. All disclosures made pursuant to
this section shall be consistent with the standards and limitations
applicable to the disclosure of limited data sets as provided in
Section 164.514 of Part 164 of Title 45 of the Code of Federal
Regulations, relating to the privacy of health information.
(b) Any hospital that receives information pursuant to this
section shall not disclose that information to any person or entity,
except in response to a court order, search warrant, or subpoena, or
as otherwise required or permitted by the federal medical privacy
regulations contained in Parts 160 and 164 of Title 45 of the Code of
Federal Regulations. In no case shall a hospital, contractor, or
subcontractor reidentify or attempt to reidentify any information
received pursuant to this section.
(c) No disclosure shall be made pursuant to this section if the
director of the office has determined that the disclosure would
create an unreasonable risk to patient privacy. The director shall
provide a written explanation of the determination to the requester
within 60 days.
(a) Any health facility or freestanding ambulatory surgery
clinic that does not file any report as required by this chapter with
the office is liable for a civil penalty of one hundred dollars
($100) a day for each day the filing of any report is delayed. No
penalty shall be imposed if an extension is granted in accordance
with the guidelines and procedures established by the office.
(b) Any health facility that does not use an approved system of
accounting pursuant to the provisions of this chapter for purposes of
submitting financial and statistical reports as required by this
chapter shall be liable for a civil penalty of not more than five
thousand dollars ($5,000).
(c) Civil penalties are to be assessed and recovered in a civil
action brought in the name of the people of the State of California
by the office. Assessment of a civil penalty may, at the request of
any health facility or freestanding ambulatory surgery clinic, be
reviewed on appeal, and the penalty may be reduced or waived for good
cause.
(d) Any money that is received by the office pursuant to this
section shall be paid into the General Fund.
(a) Any health facility or freestanding ambulatory surgery
clinic affected by any determination made under this part by the
office may petition the office for review of the decision. This
petition shall be filed with the office within 15 business days, or
within a greater time as the office may allow, and shall specifically
describe the matters which are disputed by the petitioner.
(b) A hearing shall be commenced within 60 calendar days of the
date on which the petition was filed. The hearing shall be held
before an employee of the office, or an administrative law judge
employed by the Office of Administrative Hearings. If held before an
employee of the office, the hearing shall be held in accordance with
any procedures as the office shall prescribe. If held before an
administrative law judge employed by the Office of Administrative
Hearings, the hearing shall be held in accordance with Chapter 5
(commencing with Section 11500) of Part 1 of Division 3 of Title 2 of
the Government Code. The employee or administrative law judge shall
prepare a recommended decision including findings of fact and
conclusions of law and present it to the office for its adoption. The
decision of the office shall be in writing and shall be final. The
decision of the office shall be made within 60 calendar days after
the conclusion of the hearing and shall be effective upon filing and
service upon the petitioner.
(c) Judicial review of any final action, determination, or
decision may be had by any party to the proceedings as provided in
Section 1094.5 of the Code of Civil Procedure. The decision of the
office shall be upheld against a claim that its findings are not
supported by the evidence unless the court determines that the
findings are not supported by substantial evidence.
(d) The employee of the office, or the administrative law judge
employed by the Office of Administrative Hearings or the Office of
Administrative Hearings, may issue subpoenas and subpoenas duces
tecum in a manner and subject to the conditions established by
Article 11 (commencing with Section 11450.10) of Chapter 4.5 of Part
1 of Division 3 of Title 2 of the Government Code.
(e) This section shall become operative on July 1, 1997.
Notwithstanding any other provision of law, the disclosure
aspects of this chapter shall be deemed complete with respect to
district hospitals, and no district hospital shall be required to
report or disclose any additional financial or utilization data to
any person or other entity except as is required by this chapter.
Notwithstanding any other provision of law, upon the
request of a small and rural hospital, as defined in Section 124840,
the office shall do all of the following:
(a) If the hospital did not file financial reports with the office
by electronic media as of January 1, 1993, the office shall, on a
case-by-case basis, do one of the following:
(1) Exempt the small and rural hospital from any electronic filing
requirements of the office regarding annual or quarterly financial
disclosure reports specified in Sections 128735 and 128740.
(2) Provide a one-time reduction in the fee charged to the small
and rural hospital not to exceed the maximum amount assessed pursuant
to Section 127280 by an amount equal to the costs incurred by the
small and rural hospital to purchase the computer hardware and
software necessary to comply with any electronic filing requirements
of the office regarding annual or quarterly financial disclosure
reports specified in Sections 128735 and 128740.
(b) The office shall provide a one-time reduction in the fee
charged to the small and rural hospital not to exceed the maximum
amount assessed pursuant to Section 127280 by an amount equal to the
costs incurred by the small and rural hospital to purchase the
computer software and hardware necessary to comply with any
electronic filing requirements of the office regarding reports
specified in Sections 128735, 128736, and 128737.
(c) The office shall provide the hospital with assistance in
meeting the requirements specified in paragraphs (1) and (2) of
subdivision (c) of Section 128755 that the reports required by
subdivision (g) of Section 128735 be filed by electronic media or by
online transmission. The assistance shall include the provision to
the hospital by the office of a computer program or computer software
to create an electronic file of patient discharge abstract data
records. The program or software shall incorporate validity checks
and edit standards.
(d) The office shall provide the hospital with assistance in
meeting the requirements specified in subdivision (d) of Section
128755 that the reports required by subdivision (a) of Section 128736
be filed by online transmission. The assistance shall include the
provision to the hospital by the office of a computer program or
computer software to create an electronic file of emergency care data
records. The program or software shall incorporate validity checks
and edit standards.
(e) The office shall provide the hospital with assistance in
meeting the requirements specified in subdivision (e) of Section
128755 that the reports required by subdivision (a) of Section 128737
be filed by online transmission. The assistance shall include the
provision to the hospital by the office of a computer program or
computer software to create an electronic file of ambulatory surgery
data records. The program or software shall incorporate validity
checks and edit standards.
On January 1, 1986, all regulations previously adopted by
the California Health Facilities Commission that relate to functions
vested in the office and that are in effect on that date, shall
remain in effect and shall be fully enforceable to the extent that
they are consistent with this chapter, as determined by the office,
unless and until readopted, amended, or repealed by the office.
Pursuant to Section 16304.9 of the Government Code, the
Controller shall transfer to the office the unexpended balance of
funds as of January 1, 1986, in the California Health Facilities
Commission Fund, available for use in connection with the performance
of the functions of the California Health Facilities Commission to
which it has succeeded pursuant to this chapter.
All officers and employees of the California Health
Facilities Commission who, on December 31, 1985, are serving the
state civil service, other than as temporary employees, and engaged
in the performance of a function vested in the office by this chapter
shall be transferred to the office. The status, positions, and
rights of persons shall not be affected by the transfer and shall be
retained by them as officers and employees of the office, pursuant to
the State Civil Service Act except as to positions exempted from
civil service.
The office shall have possession and control of all
records, papers, offices, equipment, supplies, moneys, funds,
appropriations, land, or other property, real or personal, held for
the benefit or use of the California Health Facilities Commission for
the performance of functions transferred to the office by this
chapter.
The office may enter into agreements and contracts with any
person, department, agency, corporation, or legal entity as are
necessary to carry out the functions vested in the office by this
chapter or any other law.
The office shall administer this chapter and shall make all
regulations necessary to implement the provisions and achieve the
purposes stated herein.