20 CAR pt. 54, Appendix D
REFERENCES
D1 RESOURCE LIST D2 RULES AND REGULATIONS PERTAINING TO HOSPITAL DISCHARGE DATA SYSTEM D3 ARKANSAS CODE – “STATE HEALTH DATA CLEARING HOUSE ACT” D4 UB-04
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Published by the American Medical Association; ISBN 3-89970-792-0.
May be purchased from:
Order Department Reference OP054194HA American Medical Association PO Box 10950 Chicago, IL 60610 (800) 621-8335
Official UB-04 Data Specifications Manual 2013, Version 7.00, July 2013
CMS Manual System, Pub100-04 Medicare Claims Processing, Transmittal 1104, November 3, 2006, Department of Health and Human Services, Centers for Medicare & Medicaid Services or www.cms.hhs.gov/transmittals/downloads/R1104CP.pdf
Published by the Centers for Medicare and Medicaid Service, (formerly HCFA)
Published by the Centers for Medicare and Medicaid Service, and the National Center for Health Statistics.
The materials published by the Centers for Medicare and Medicaid Service may be purchased from:
Government Printing Office U.S. Government Bookstore 710 North Capitol Street N.W. Washington, DC http://bookstore.gpo.gov/
Authored by Hasnain-Wynia, R., Pierce, D., Haque, A., Hedges Greising, C., Prince, V., Reiter, j. (2007). hretdisparities.org.
Some materials may also be purchased from large commercial bookstores and from medical office supply firms. These documents are also available for use by the general public at the Arkansas State Library and may be available from your local library by an interlibrary loan.
Arkansas State Library Documents Service One Capitol Mall Little Rock, AR 72201 (501) 682-2326
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The following Rules and Regulations pertaining to the Hospital Discharge Data System are duly adopted and promulgated by the Arkansas Board of Health pursuant to the authority expressly conferred by the State of Arkansas including, without limitation, Act 670 of 1995 (the Act), as amended, the same being Ark. Code Ann. § 20-7-301 et seq. The Act established the State Health Data Clearing House within the Arkansas Department of Health. The Clearing House is mandated by the Act to acquire and disseminate health care information in order to understand patterns and trends in the availability, use and costs of health care services in the state. Subsection (h) of the Act directs the Arkansas State Board of Health to prescribe and enforce such rules and regulations as may be necessary to carry out the purpose of this Act.
It is the purpose of these regulations to provide direction about the required collection, submission, management and dissemination of health data.
For the purposes of these Regulations, the following words and phrases when used herein shall be construed as follows:
A. "Act" means the State Health Data Clearing House Act 670 of 1995, Ark. Code Ann. § 20-7-301 et seq;
B. "Aggregate data set" means a compilation of raw data that has been subject to a critical edit check and consists of at least a small cell count. Aggregate data sets shall not include the following data elements: hospital control number; patient control number; attending physician number, or any element which might be used to identify an individual patient;
C. "Board" or "State Board" means the Arkansas State Board of Health;
D. "Confidential information" means that information which the State Board has defined to be confidential in these regulations and procedures;
E. "Department" means the Arkansas Department of Health;
F. "Director" means the director of the Arkansas Department of Health;
G. "Hospital" means any institution, place, building or agency, public or private, whether organized for profit or not-for-profit, which is subject to licensure by the Arkansas Department of Health (Ark. Code Ann. § 20-9-201 et seq);
H. "Submit," "submission" or "submittal" means, with respect to data, reports, surveys, statements and documents required to be filed with the Department: 1) delivery to the Arkansas Department of Health, by the close of business on the prescribed filing date, or 2) deposit with the United States Postal Service, postage prepaid, addressed to the Arkansas Department of Health, in sufficient time so that the mailed materials will arrive by the close of business on the prescribed filing date;
I. "Guide(s)" means the Hospital Discharge Data Submittal Guide(s) published by the Arkansas Department of Health. The Guide(s) contains technical information relating to data format, media and submittal time frames.
All terms used in any one gender or number shall be construed to include any other gender or number.
Each Arkansas hospital shall submit patient data to the Department in a manner that complies with the provisions of the Guide(s), which includes all inpatient hospital discharges occurring on or after January 1, 1996 and all emergency department discharges on or after January 1, 2012.
In addition to data prescribed for submission in the Guide(s), the following data must be submitted according to the schedule provided: Each hospital shall provide a complete and accurate copy of the American Hospital Association's Annual Survey to the Arkansas Department of Health or the Arkansas Hospital Association. The required submission date will be published annually with the distribution of the survey.
The State Board or the Director shall, upon a showing of good cause and if time permits, extend the time allowed for the performance of any function or duty required by the provisions of the Act or of these regulations and rules. In making any determination with regard to good cause, the Board and the Director shall give due consideration to all relevant facts and circumstances, including such considerations as the complexity of the issues or the existence of extraordinary circumstances or unforeseen events which have led to the request for an extension of time. The State Board or the Director shall act upon a request for an extension of time within thirty (30) days of receiving the written request by the hospital. Failure to act within thirty (30) days shall be deemed as a grant of the extension.
Information reported to the Department shall not be disclosed except as authorized by the Arkansas law. See Ark. Code Ann. § 20-7-305 as amended.
All reports generated by the Department from the aggregate data set for a member of the general public are open for public inspection. The Department shall provide copies of these reports, upon request, at a cost of $.25 per page. The Department shall determine fees to be charged to cover the direct and indirect costs for providing other information requests or special compilations from aggregate data sets. The fee shall include staff time, computer time, copying costs, postage and supplies.
Ark. Code Ann. § 20-7-301 et seq. sets forth civil and criminal penalties for non-compliance with provisions of the Act and of rules and regulations adopted by the Arkansas State Board of Health to implement the Act, as follows:
A. Any person, firm, corporation, organization or institution that violates any of the provisions of Ark. Code Ann. § 20-7-301 et seq., or any rules or regulations promulgated thereunder, regarding confidentiality of information, shall be guilty of a misdemeanor and, upon conviction thereof, shall be fined not less than one hundred dollars ((100) nor more than ()500), or by imprisonment not exceeding one month, or both. Each day of violation shall constitute a separate offense. B. Any person, firm, corporation, organization or institution knowingly violating any of the provisions of Ark. Code Ann. § 20-7-301 et seq., or any rules or regulations promulgated thereunder, shall be guilty of a misdemeanor and, upon a plea of guilty, a plea of nolo contendere or conviction, shall be fined not more than five hundred dollars ($500). C. Every person, firm, corporation, organization or institution that violates any of the rules or regulations adopted by the Arkansas State Board of Health or that violates any provision of Act 670 may be assessed a civil penalty by the Board. The penalty shall not exceed two hundred fifty dollars ((250) for each violation. No civil penalty may be assessed until the person charged with the violation has been given the opportunity for a hearing on the violation pursuant to the Arkansas Administrative Procedure Act, Ark. Code Ann. )25-15-101, et seq.
Hearings and appeals will be conducted according to the Adjudication and Rule Making Sections of the Department's Administrative Procedures previously promulgated by the Department and any revisions thereto.
All pages of these regulations and rules, and of the Hospital Discharge Data Submittal Guide(s), issued by the Department are dated at the bottom. As changes occur, replacement pages will be issued or replacement guide(s) will be issued. All replacement pages will be dated so that users may be certain they are referring to the most recent information.
The following documents are hereby incorporated by reference:
A. The most recent edition of the International Classification of Diseases, Clinical Modifications. Copies are available from the National Center for Health Statistics, 3311 Toledo Road, Hyattsville, Maryland 20782 or website, www.cdc.gov/nchs/icd.htm. B. Uniform Hospital Billing Form 2004 (UB04/CMS-1450). Copies are available from the Office of Public Affairs, Center for Medicare and Medicaid Services, Humphrey Building, Room 428-H, 200 Independence Avenue S.W., Washington, D.C. 20201 or website,
www.cms.hhs.gov/cmsforms/. All incorporated material is available for public review at the central administrative office of the Department.
If any provision of these Rules and Regulations or the application thereof to any person or circumstances is held invalid, such invalidity shall not affect other provisions or applications of these Rules and Regulations which can give effect without the invalid provisions or applications, and to this end the provisions hereto are declared severable.
All regulations and parts of regulations in conflict herewith are hereby repealed.
This will certify that the foregoing Rules and Regulations for the Hospital Discharge Data System were adopted by the Arkansas Board of Health at a regular session of the Board held in Little Rock Arkansas, on the 26th day of January, 2012.
Secretary, Arkansas Board of Health
Arkansas Code Annotated 20-7-301 et seq.
This subchapter shall be entitled the 'State Health Data Clearing House Act.'
History. Acts 1995, No. 670, § 1.
The General Assembly finds that as a result of rising health care costs, the shortage of health professionals and health care services in many areas of the state, and the concerns expressed by care providers, consumers, third party payers, and others involved with planning for the provision of health care, there is an urgent need to understand patterns and trends in the availability, use, and costs of these services. Therefore, in order to establish an information base for patients, health professionals, and hospitals, to improve the appropriate and efficient usage of health care services, and to provide for appropriate protection for confidentiality and privacy, the Department of Health shall act as a state health data clearing house for the acquisition and dissemination of data from state agencies and other appropriate sources to carry out the purposes of this subchapter.
History. Acts 1995, No. 670, § 2.
(a) The Director of the Department of Health shall, with the approval of the State Board of Health, compile and disseminate health data collected by the Department of Health.
(b) The Department of Health, in consultation with advisory groups appointed by the director with representation from hospitals, outpatient surgery centers, health profession licensing boards, and other state agencies, should:
(1)(A) Identify the most practical methods to collect, transmit, and share required health data as described in § 20-7-304;
(B) Utilize, wherever practical, existing administrative databases and modalities of data collection to provide the required data;
(C) Develop standards of accuracy, timeliness, economy, and efficiency for the provision of the data; and
(D) Ensure confidentiality of data by enforcing appropriate rules and regulations.
(2) In order to maximize limited resources and to prevent duplication of effort, the Department of Health may, when appropriate, consider contracting with private entities for the collection of data as set forth in this section subject to the provisions of this subchapter.
(c)(1) All state agencies, including health profession licensing, certification, or registration boards and commissions, which collect, maintain, or distribute health data, including data relating to the Medicaid program, shall make available to the Department of Health such data as are necessary for the Department of Health to carry out its responsibilities as prescribed by this subchapter or such rules and regulations as may be adopted as provided in § 20-7-305.
(2) If health data are already reported to another organization or governmental agency in the same manner, form, and content or in a manner, form, and content acceptable to the department, the director may obtain a copy of such data from said organization or agency, and no duplicative report need be submitted by the organization.
(3) All hospitals and outpatient surgery centers licensed by the state shall submit information in a form and manner as prescribed by rules and regulations by the State Board of Health pursuant to § 20-7-305; however, if the same information is being collected by another state agency, the Department of Health shall obtain such data from the other state agency.
History. Acts 1995, No. 670, § 2.
The Director of the Department of Health shall be empowered to release data collected pursuant to this subchapter, except that data released shall not include any information which identifies or could be used to identify any individual patient, provider, institution, or health plan except as provided in § 20-7-305.
History. Acts 1995, No. 670, § 2.
(a) The State Board of Health shall prescribe and enforce such rules and regulations as may be necessary to carry out the purpose of this subchapter, including the manner in which data are collected, maintained, compiled, and disseminated, and including such rules as may be necessary to promote and protect the confidentiality of data reported under this subchapter.
(b) Provided further, that data collected under this subchapter which identifies, or could be used to identify, any individual patient, provider, institution, or health plan shall not be subject to discovery pursuant to the Arkansas Rules of Civil Procedure or the Freedom of Information Act of 1967, § 25-19-101 et seq.
(c) The Department of Health and Human Services may, only for purposes of research and aggregate statistical reporting, provide data to the Arkansas Center for Health Improvement and the Agency for Healthcare Research and Quality for its Healthcare
Cost and Utilization Project. The data shall be treated in a manner consistent with all state and federal privacy requirements, including, without limitation, the federal Health Insurance Portability and Accountability Act of 1996 privacy rule, specifically 45 C.F.R. § 164.512(i). Furthermore, any identifiable data provided, collected, or disseminated under this subsection shall not be subject to discovery pursuant to the Arkansas Rules of Civil Procedure or the Freedom of Information Act of 1967, § 25-19-101 et seq.
(d) It shall be unlawful for the center to release any patient-identifying information to any nongovernmental third party.
History. Acts 1995, No. 670, § 2.
(a) The Director of the Department of Health shall prepare and submit a biennial report to the Governor and the House and Senate Interim Committees on Public Health, Welfare, and Labor or appropriate subcommittees thereof.
(b) The Department of Health shall provide assistance to the House and Senate Interim Committees on Public Health, Welfare, and Labor or appropriate subcommittees thereof in the development of information necessary in the examination of health care issues.
History. Acts 1995, No. 670, § 2; 1997, No. 179, § 22.
(a)(1) Any person, firm, corporation, organization, or institution that violates any of the provisions of this subchapter or any rules and regulations promulgated hereunder regarding confidentiality of information shall be guilty of a misdemeanor and, upon conviction thereof, shall be punished by a fine of not less than one hundred dollars ($100) nor more than five hundred dollars ($500) or by imprisonment not exceeding one (1) month, or both.
(2) Each day of violation shall constitute a separate offense.
(b) Any person, firm, corporation, organization, or institution knowingly violating any of the provisions of this subchapter or any rules and regulations promulgated hereunder shall be guilty of a misdemeanor and, upon a
plea of guilty, a plea of nolo contendere, or conviction, shall be punished by a fine of not more than five hundred dollars ($500).
(c)(1) Every person, firm, corporation, organization, or institution that violates any of the rules and regulations adopted by the State Board of Health or that violates any provision of this subchapter may be assessed a civil penalty by the board.
(2) The penalty shall not exceed two hundred fifty dollars ($250) for each violation.
(3) However, no civil penalty may be assessed until the person charged with the violation has been given the opportunity for a hearing on the violation pursuant to the Arkansas Administrative Procedure Act, § 25-15-201 et seq.
History. Acts 1995, No. 670, § 3.
All laws and parts of laws in conflict with this subchapter are hereby repealed, except that nothing herein shall be interpreted to repeal any provision which authorizes the Health Services Agency to gather such data as may be necessary to conduct permit of approval activities.
History. Acts 1995, No. 670, § 6.
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