2019 Tennessee Code
Title 68 - Health, Safety and Environmental Protection
Health
Chapter 11 - Health Facilities and Resources
Part 3 - Medical Records Act of 1974
§ 68-11-310. Report of hospital statistics.

(a)

• (1) All hospitals licensed by the department of health or by the department of mental health and substance abuse services shall, within one hundred fifty (150) days after the end of each individual hospital's fiscal year, submit to the department of health a joint annual report of the statistical particulars relative to their patients for the fiscal year.

• (2) If a hospital closes during the fiscal year, the owner of the hospital at the beginning of the fiscal year shall file a joint annual report with the department of health for the period of time that the hospital was owned or operated. The joint annual report shall be submitted within one hundred five (105) days after closure. If a hospital changes ownership during the fiscal year, the owner of the hospital at the beginning of the fiscal year shall either:

  • (A) File a joint annual report with the department of health within one hundred five (105) days of the sale for the period of time that the hospital was owned or operated; or

  • (B) Provide a notarized statement to the department of health within one hundred five (105) days of the sale indicating that the required data for the period of time that the hospital was owned or operated has been provided to the purchaser who shall submit a report for the full year.

• (3) If the department of health determines that there are errors in the joint annual report, the hospital shall be notified of the errors and shall be required to provide corrections to the department of health within fifteen (15) business days of notification.

• (4) All hospitals that submit a joint annual report to the department of health as designated in this section shall also submit to the department, at the same time they send the signed paper copy of the report, a notarized statement from their chief financial officer stating that the financial data reported on the joint annual report is consistent with the audited financials for the hospitals for that reporting year. The notarized statement shall also be attested to by the chief executive officer of the hospital.

(b) The commissioner shall determine, through the promulgation of rules and regulations, the contents of the report, but may request early completion of the report, portions of the report or special reports when requested to do so by the office of the comptroller or at other times, but only after consultation with the Tennessee Hospital Association. In no event shall the department of health authorize the reporting of a hospital's statistics for less than a full twelve-month period, unless the hospital was not open during the entire twelve-month period. Any hospital that is open for less than the full twelve-month period shall report for the entire period of its operation.

(c)

• (1) Hospitals that fail to file their joint annual report in a timely manner, as referenced in § 68-1-109, or that file a joint annual report that does not include all of the required data elements or includes data that does not pass the department's editing, shall receive a deficiency from the department. Within fifteen (15) business days from receipt of the deficiency, the hospital shall be required to return a plan of correction indicating:

  • (A) How the deficiency will be corrected;

  • (B) The date upon which each deficiency will be corrected;

  • (C) What measures or systemic changes will be put in place to ensure that the deficient practice does not recur; and

  • (D) How the corrective action will be monitored to ensure that the deficient practice does not recur.

• (2) Either failure to submit a plan of correction in a timely manner or a finding by the department that the plan of correction is unacceptable shall subject the hospital's license to possible disciplinary action.

(d) The department of health shall compile, finalize and make available to the public an electronic compilation of the statistics reported by the hospitals for the fiscal years ending during a calendar year by November 30 of the following year.