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216.2925
Administrative regulations -- Reports, lists, forms, and formats
required.
(1)
(2)
The Cabinet for Health and Family Services shall establish by promulgation of
administrative regulations pursuant to KRS Chapter 13A, no later than January
1, 1995, those data elements required to be submitted to the cabinet by all
licensed hospitals and ambulatory facilities, including a timetable for
submission and acceptable data forms. Thereafter, every hospital and
ambulatory facility shall be required to report on a quarterly basis information
regarding the charge for and quality of the procedures and health-care services
performed therein, and as stipulated by administrative regulations promulgated
pursuant to KRS Chapter 13A. The cabinet shall accept data which, at the
option of the provider is submitted through a third party, including but not
limited to organizations involved in the processing of claims for payment, so
long as the data elements conform to the requirements established by the
cabinet. The cabinet may conduct statistical surveys of a sample of hospitals,
ambulatory facilities, or other providers in lieu of requiring the submission of
information by all hospitals, ambulatory facilities, or providers. On at least a
biennial basis, the cabinet shall conduct a statistical survey that addresses the
status of women's health, specifically including data on patient age, ethnicity,
geographic region, and payor sources. The cabinet shall rely on data from
readily available reports and statistics whenever possible.
The cabinet shall require for submission to the cabinet by any group of
providers, except for physicians providing services or dispensaries, first aid
stations, or clinics located within business or industrial establishments
maintained solely for the use of their employees, including those categories
within the definition of provider contained in KRS 216.2920 and any further
categories determined by the cabinet, at the beginning of each fiscal year after
January 1, 1995, and within the limits of the state, federal, and other funds
made available to the cabinet for that year, and as provided by cabinet
promulgation of administrative regulations pursuant to KRS Chapter 13A, the
following:
(a) A list of medical conditions, health services, and procedures for which
data on charge, quality, and outcome shall be collected and published;
(b) A timetable for filing information provided for under paragraph (a) of this
subsection on a quarterly basis;
(c) A list of data elements that are necessary to enable the cabinet to
analyze and disseminate risk-adjusted charge, quality, and outcome
information, including mortality and morbidity data;
(d) An acceptable format for data submission which shall include use of the
uniform:
1.
Health claim form pursuant to KRS 304.14-135 or any other
universal health claim form to be determined by the cabinet if in the
form of hard copy; or
2.
Electronic submission formats as required under the federal Health
Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec.
300gg et seq., in the form of magnetic computer tape, computer
diskettes, or other electronic media through an electronic network;
(e)
(3)
(4)
(5)
(6)
(7)
Procedures to allow health-care providers at least thirty (30) days to
review information generated from any data required to be submitted by
them, with any reports generated by the cabinet to reflect valid corrections
by the provider before the information is released to the public; and
(f) Procedures pertaining to the confidentiality of data collected.
The cabinet shall coordinate but not duplicate its data-gathering activities with
other data-collection activities conducted by the Department of Insurance, as
well as other state and national agencies which collect health-related service,
utilization, quality, outcome, financial, and health-care personnel data, and
shall review all administrative regulations promulgated pursuant to KRS
216.2920 to 216.2929 to prevent duplicate filing requirements. The cabinet
shall periodically review the use of all data collected under KRS 216.2920 to
216.2929 to assure its use is consistent with legislative intent.
The cabinet shall conduct outcome analyses and effectiveness studies and
prepare other reports pertaining to issues involving health-care charges and
quality.
The cabinet may independently audit any data required to be submitted by
providers as needed to corroborate the accuracy of the submitted data. Any
audit may be at the expense of the cabinet and shall, to the extent practicable,
be coordinated with other audits performed by state agencies.
The cabinet may initiate activities set forth in subsection (1) or (2) of this
section at any time after July 15, 1996.
The Cabinet for Health and Family Services shall collect all data elements
under this section using only the uniform health insurance claim form pursuant
to KRS 304.14-135, the Professional 837 (ASC X12N 837) format, the
Institutional 837 (ASC X12N 837) format, or its successor as adopted by the
Centers for Medicare and Medicaid Services.
Effective:July 15, 2010
History: Amended 2010 Ky. Acts ch. 24, sec. 319, effective July 15, 2010. -Amended 2008 Ky. Acts ch. 71, sec. 2, effective July 15, 2008. -- Amended
2005 Ky. Acts ch. 99, sec. 475, effective June 20, 2005. -- Amended 1998 Ky.
Acts ch. 426, sec. 420, effective July 15, 1998; and ch. 427, sec. 10, effective
July 15, 1998. -- Amended 1996 Ky. Acts ch. 371, sec. 27, effective July 15,
1996. -- Created 1994 Ky. Acts ch. 512, Pt. 2, sec. 8, effective July 15, 1994.
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