216.2925 Administrative regulations -- Reports, lists, forms, and formats required.
758 words·~3 min read·
/ky/chapter-216/216-2925A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
(1)The Cabinet for Health and Family Services shall establish by promulgation of
administrative regulations pursuant to KRS Chapter 13A those data elements
required to be submitted to the cabinet by all hospitals and ambulatory facilities,
including a timetable for submission and acceptable data forms. Each 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 that, 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.
(2)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 that 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)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.
(3)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 that 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.
(4)The cabinet shall conduct outcome analyses and effectiveness studies and prepare
other reports pertaining to issues involving health-care charges and quality.
(5)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.
(6)The cabinet may initiate activities set forth in subsection
(1)or
(2)of this section at
any time after July 15, 1996.
(7)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.