Rule 86-1 CONCERNING COLLECTION OF DATA I. Authority.

This regulation is promulgated under the authority of Sections 25-28-104(2)(a) and (b), Colorado Revised Statutes.

II. Purpose.

A. The purpose of this regulation is to collect and disseminate hospital specific data to encourage competition and informed decisions by users in the health care industry.

B. This regulation details the process for submission of data to the commission.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

(1) “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

(2) “Hospital” means any facility required to be licensed by Section 25-3-101, Colorado Revised Statutes, except a rehabilitation center, convalescent a center, community mental health center, facility for the mentally retarded, chiropractic hospital, maternity hospital, nursing home facility, rehabilitative nursing facility, or hospice care facility for terminally ill individuals.

(3) “Inpatient” means any patient admitted to a designated inpatient care area.

(4) “Ambulatory surgery” means scheduled surgical services provided to patients who remain in the hospital less than 24 hours. Surgical services include any operative procedure classified as such in the International Classification of Diseases, 9th Edition, Clinical Modification (ICD 9 CM), procedure codes numbered 0.10 through 86.99 inclusive, and performed in any of the following: specially designated surgical suites for outpatient surgery, surgical suites also used for inpatient surgery, cardiac laboratory procedure rooms, radiology procedure rooms, or designated procedure rooms within the emergency department.

IV. Identification of hospitals required to submit data.

A. Beginning July 1, 1986, every hospital with 50 or more beds, except specialty hospitals, other than children's hospitals, which are exempt from Medicare's prospective payment system, must collect inpatient data required by this regulation.

B. Beginning January 1, 1987, all hospitals must collect inpatient data required by this regulation.

C. Beginning April 1, 1988, all hospitals must collect ambulatory surgery data required by this regulation.

V. Description of data to be submitted.

A. The following data shall be submitted for each inpatient discharge specific to the diagnosis related groups as established by the commission. Hospitals must submit these data for ambulatory surgery discharges with the exception of item 18, total charge components.

1. Patient ID - medical record number 2. Date of birth 3. Sex 4. Patient zip code 5. Hospital identification 6. Admission date 7. Type of case: inpatient, ambulatory surgery 8. Discharge date 9. Attending physician ID number 10. Operating physician ID number 11. Principal diagnosis 12. Secondary diagnoses 13. Principal procedure and date 14. Secondary procedures and dates 15. Patient disposition 16. Total charges 17. Expected source of payment 18. Beginning January 1, 1987, total charge components shall be collected and reported at the following summary levels:

(A) Laboratory;

(B) Radiology, including CT scans/nuclear medicine;

(C) Pharmacy;

(D) All other ancillary charges;

(E) Routine charges, including room & nursing care.

B. Patient discharge data shall be submitted on computer-readable data tapes or disks in a format acceptable to the commission. Hospitals with less than 50 beds may submit patient discharge data on paper if no computer capacity is available.

C. The number of diagnoses, procedures as well as the type of data elements to be submitted shall be consistent with the methodology used to group patients into Diagnostic Related Groups(DRGs) for the purposes of Medicare reimbursement.

VI. Frequency of Data Submissions.

Data required by subsection V. shall be submitted to the Commission on a quarterly basis and within ninety days following the close of a calendar quarter; i.e., data for calendar quarters ending March 31, June 30, September 30 and December 31 shall be submitted on or before June 29, September 26, December 29, and March 31, respectively. The first reporting deadline under this regulation will be December 29, 1986 for hospitals with 50 or more beds and June 29, 1987 for all other hospitals. November 1991 86-2 CONCERNING VERIFICATION OF ACCURACY OF DATA I. Authority.

This regulation is promulgated under the authority of Section 25-28-104(5), Colorado Revised Statutes, and is intended to implement Section 25-28-104(3)(c), Colorado Revised Statutes.

II. Purpose.

The purpose of this regulation is to establish a procedure for providers of data to the commission to verify the accuracy of information pertaining to the provider prior to release or dissemination of compilations of data by the commission.

III. Definition.

As used in this regulation, unless the context otherwise requires:

(1) “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

(2) “Data source” includes:

A. Any facility required to be licensed by section 25-3-101, Colorado Revised Statutes; and B. The state Medicaid program as defined in Section 25-28-102(2), Colorado Revised Statutes.

IV. Verification of accuracy of data.

Data sources shall be given an opportunity to review and verify the accuracy of information pertaining to them in compilations prepared by the commission as follows:

(1) Data required to be submitted to the commission shall be due no later than the ninetieth day after the close of each calendar quarter; i.e., March 31, June 30, September 30 and December 31.

(2) Data shall be compiled by the commission or any other corporation, association, or entity authorized to act on behalf of the commission as expeditiously as possible.

(3) After preparation of compilations by the commission, health care providers and third-party payers identified in the compilations will be notified in writing that the compilations are available and that they may have an opportunity to review those portions of the compilations specifically related to them.

(4) A data source who wishes to review portions of commission compilations specifically related to it shall within fifteen (15) days of the date of the commission's written notification file a request in writing with the commission asking for an opportunity to review those portions of the compilations specifically relating to it. The commission shall respond to this request within ten days of its receipt.

(5) Following receipt of requested portions of commission compilations, the data source who believes it is necessary to review underlying data collected by and furnished to the commission as that data relates to those portions of the compilations relating to the data source, the data source shall make a request in writing to the commission to review that data within thirty days of the commission's release of compilations to the data source. The commission shall respond to these requests as expeditiously as possible.

(6) Within thirty days of the commission's release of the requested portions of the compilations to the data source or within thirty days of the commission's release of requested data to the data source, the data source shall respond in writing to the commission challenging those portions of the compilations or underlying data pertaining to it which the data source believes is inaccurate along with arguments as to why it is inaccurate and any data which would assist in clarifying the possible inaccuracies.

(7) If the commission finds any error, such errors shall be corrected before the release of compilations for public use; notification of corrections shall be provided to the appropriate data source by the commission in writing. If the commission finds changes to the report are unnecessary or unwarranted, it shall notify the appropriate health care provider or third-party payer of this conclusion in writing, including a brief but complete explanation of its determination.

(8) An extension of the time limits specified in these subparts may be granted by the chairman of the commission upon request for cause shown.

July, 1992 Regulation 86-3 Concerning Exemption From Collection of Data I. Authority.

This regulation is promulgated under the authority of Section 25-28-104(5), Colorado Revised Statutes.

II. Purpose.

The purpose of this regulation is to establish the basis for exemption of certain data sources from the data collection efforts of the commission and to provide for the adjudication by the Colorado Health Data Commission of Petitions for exemption from collection of Data.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

A. “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

B. “Data source” includes:

1. Any facility required to be licensed by section 25-3-101, Colorado Revised Statutes; and 2. The state medicaid program as defined in Section 25-28-102(2), Colorado Revised Statutes.

C. “Director” means the Executive Director of the Colorado Health Data Commission, 1313 Sherman Street, Room 518, Denver, Colorado 80203.

D. “Net patient revenue” means the amount equal to gross patient billings minus revenues not collected due to deductions from revenue such as uncompensated care, patient discounts, or discounts for Medicare or Medicaid.

IV. Exemption from collection of data.

A. The commission may exempt a data source from the collection of data if it finds that compliance would impose undue economic hardship on the data source, or if it determines that data from such data source are not useful to its data base and its efforts to encourage competition and informed decisions by users in the health care industry. In determining whether compliance will constitute an undue economic hardship, the commission will consider the cost to the data source, both in relation to initial cost to attain the capability to generate data, and the routine cost of generating such data compared to the ability of the data source to absorb the additional cost of such production. A data source may file with the commission a request for exemption. Such request must document the undue economic hardship or the basis for determining that the data are not useful to the data base or the efforts of the commission to meet its statutory mandate.

B. If the hospital demonstrates to the Commission that the annual incremental costs of providing the Commission with data exceeds an amount equal to one-half of one percent of net patient revenues for the most recent fiscal year shall be exempt from providing the Commission with data.

V. Exemption orders.

A. Any data source may petition the Commission for an order exempting the data source from some or all collection of data requested by the Commission.

B. A petition filed pursuant to this rule shall be submitted to the director.

C. Any petition filed pursuant to this rule shall set forth for the following:

1. The name and address of the petitioner.

2. The grounds for exemption to which the petitioner relates.

3. A concise statement of all of the facts relied upon by the petitioner to justify the exemption from collection of data.

D. The director shall review the facts presented in the petition. Based upon the facts presented in the petition and upon facts disclosed by investigation by the director, the director shall make a written proposed decision within 30 days of receipt of the petition. The proposed decision shall include a statement of facts relied upon by the director. The director shall promptly notify in writing the petitioner of the proposed decision.

E. If the data source disagrees with the proposed decision of the director, it must notify in writing the commission within 30 days of the date that the proposed decision is mailed. If there is no appeal, the proposed decision shall be presented to the commission for action.

F. The commission may rule upon the petition based solely upon the facts presented in the petition and in the proposed decision of the director. In such a case:

1. Any ruling of the commission will apply only to the extent of the facts presented in the petition and any amendment to the petition and upon the facts presented in the proposed decision of the director.

2. The commission may order the petitioner to file a written brief, memorandum or statement of position.

3. The commission may dispose of the petition on the sole basis of the matters set forth in the petition.

4. The commission may request the petitioner to submit additional facts, in writing. In such event, such additional facts will be considered as an amendment to the petition.

5. The commission may take administrative notice of facts pursuant to the administrative procedures act {C.R.S. 1973, 24-4-105(8)} and may utilize its experience, technical competence and specialized knowledge in the disposition of the petition.

6. If the commission rules upon the petition without a hearing, it shall notify the petitioner of its decision.

G. The commission may set the petition for hearings:

1. The commission may, in it discretion, set the petition for hearing, upon due notice to petitioner, for the purpose of obtaining additional facts or information or to determine the truth of any facts set forth in the petition or to hear oral argument on the petition. The notice to the petitioner setting such hearing shall set forth, to the extent known, the factual or other matters into which the commission intends to inquire. For the purpose of such hearing, to the extent necessary, the petitioner shall have the burden of proving all of the facts stated in the petition, all of the facts necessary to show the nature of the controversy or uncertainty and the manner in which the statute, rule or order in question applies or potentially applies to the petitioner and any other facts the petitioner desires the commission to consider.

2. The commission may take administrative notice of facts pursuant to the administrative procedures act {C.R.S. 1973, 24-4-105(B)} and may utilize its experience, technical competence and specialized knowledge in the disposition of the petition.

3. The commission shall notify the petitioner in writing of its decision. July, 1992 Rule 86-4 CONCERNING UNIFORM HOSPITAL AND HEALTH CARE PROVIDER BILLING FORMS I. Authority.

This regulation is promulgated under the authority of Section 25-28-104(5) and is intended to implement Section 25-28-104(3)(a), Colorado Revised Statutes.

II. Purpose.

A. The purpose of this regulation is to adopt a uniform hospital billing form and a uniform health care provider form which must be used by all third-party payers and health care providers by January 1, 1987.

B. Nothing in this regulation shall prohibit third-party payers and health care providers from requiring additional information, including, but not limited to, itemized bills, necessary to distinguish eligibility for benefits or liability for reimbursement for services provided.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

A. “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

B. “Health care providers” includes all licensed providers of health care.

C. “Third-party payer” means any insurer offering sickness and accident insurance as authorized pursuant to Article 1 or Article 8 of Title 10, Colorado Revised Statutes, as amended; any health maintenance organization as authorized pursuant to Article 17 of Title 10, Colorado Revised Statutes, as amended; any non-profit hospital and health service corporation as authorized by Article 16 of Title 10, Colorado Revised Statutes, as amended; the state compensation system which reimburses or otherwise provides health care services as authorized by Article 65 of Title 8, Colorado Revised Statutes, amended; any programs funded or administered by the State of Colorado for the provision of health care services; or any corporation, organization, association, person, or entity which delivers, purchases, reimburses, or otherwise provides health care services to any person.

D. “Uniform hospital billing form” means form UB-82 HCFA-1450, the hospital billing form developed by the National Billing Form Committee or the form's electronic media equivalent.

E. “Uniform health care provider billing form” means form HCFA 1500, health care provider billing form developed by the Health Care Finance Administration, United States Department of Health and Human Services, or the form's electronic media equivalent.

IV. Uniform definition for the uniform hospital billing form. Definitions for the use of the uniform hospital billing form shall be in accordance with the manual developed by the National Uniform Billing Committee as adapted and finalized by the Colorado Uniform Billing Committee, Colorado Uniform Billing Data Elements Specifications, published in the “Uniform Bill UB-82/HCFA 1450 Reference Manual,” State Uniform Bill Committee, April 1, 1986.

V. Uniform definitions for the uniform provider billing form. Definitions for the use of the uniform health care provider billing form shall be in accordance with the Health Care Finance Administration Carriers Manual.

VI. Use of uniform hospital and health care provider billing forms. On or after the effective date of this regulation, all third-party payers and all hospitals shall use the uniform hospital billing form (Form UB-82 HCFA-1450) and all third-party payers and all physicians shall use the uniform health care provider billing form (HCFA 1500).

VII. Incorporated Materials.

This rule does not include later amendments to or editions of the incorporated material contained herein. The director, who is located at 1313 Sherman Street, Room 518, Denver, Colorado 80203, shall provide information regarding how the incorporated material may be obtained. VIII. Effective date.

This regulation shall be effective on January 1, 1987.

July, 1992 Regulation 86-6 CONCERNING RULES GOVERNING DATA ACCESSIBILITY AND CONFIDENTIALITY I. Authority.

This regulation is promulgated under the authority of section 25-28-104(5), Colorado Revised Statutes (hereinafter “C.R.S.”).

II. Purpose:

The commission, in fulfilling the duties required by section 25-28-104, C.R.S., will collect confidential information concerning patients. This regulation governs the access to collected data and the confidentiality of patient data.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

A. “Commission” means the Colorado Health Data Commission created by section 25-28-103, C.R.S.

B. “Compilations” means the arrangement of data collected by and furnished to the commission (or any other corporation, association or entity acting under agreement with the commission) for release and dissemination to the public.

C. “Interested persons” means those persons or entities defined by IV.A who may have access to certain data collected by and furnished to the commission under terms and conditions established by the commission.

D. “Patient identification number” means that number used by a health care provider for purposes of identifying or locating a patient and the medical records of that patient. “Patient identification number” does not include an encoded identification number used by third-party payers.

IV. Data collected by and furnished to the commission - not the public record. The data collected by and furnished to the commission (or to any corporation, association, or entity authorized to act on behalf of the commission) pursuant to section 25-28-104 shall not be public records accessible under part 2 of article 72 of title 24, C.R.S., but be released by the commission only to interested persons.

A. An “interested person” shall mean:

1. Health care providers who have submitted data to the commission, either directly or indirectly through third-party payers, and who request to review data for purposes of verifying information in commission compilations pertaining to the provider.

2. Third-party payers who have submitted data to the commission and who request to review data for purposes of verifying information in commission compilations pertaining to the third-party payer.

B. Commission approval of all requests by interested persons for data which has been submitted to the commission and which is not a public record shall be required.

C. Providers and third-party payers shall be given an opportunity to review and verify information pertaining to them in compilations prepared by the commission as provided in Regulation 86-2.

V. Requests for special compilations.

Any person, organization, governmental agency, or other entity may request from the commission the preparation of compilations of data collected by and furnished to the commission in a specific manner or format not already used by the commission. This part includes requests for subsets of information already available from the commission in compiled form.

A. All requests for special compilations of data shall be made in writing to the Colorado Health Data Commission, 1313 Sherman Street, Fifth Floor, Denver, Colorado 80203. The written request shall at least contain the name, address, and telephone number of the requester; a description of the requested compilation of data; a short, plain statement of the reason for the request; and the relationship of the requested compilation to a legitimate purpose. A “legitimate purpose” is a purpose consistent with the intent, policies, and purposes of the commission as provided by section 25-28-103(1).

B. The commission shall review each request for special compilations and determine whether to approve or deny the request. The commission shall notify the public of requests made for compilations by listing the requester and providing a short description of the request on its official meeting agenda. The approval or denial by the commission of requests for compilations of data shall be within the discretion of the commission. The commission may deny a request for compilation for reasons including, but not limited to, unavailability of data; the requested compilation is already available from the commission or another source; the requested compilation would significantly endanger patient confidentiality; the commission lacks sufficient resources to fulfill the request; and the request is not related to a legitimate purpose.

C. The commission shall notify the requester in writing of its decision. Denial of a request shall include a brief explanation of the reason for the denial.

D. Providers and third-party payers shall be given an opportunity to review and verify information pertaining to them in compilations prepared by the commission pursuant to requests made under this rule in accordance with the procedures detailed in Regulation 86-2, unless the opportunity for review and verification of that information had been given to the provider or third-party payer at an earlier time.

E. All fees or costs associated with the request for compilations shall be borne by the requester. Upon request, the commission shall provide an estimate of the costs of the requested compilations, including staff time, computer time, copying costs, and supplies. All final charges shall be subject to the approval of the commission.

VI. Compilations - public.

Compilations prepared for release and dissemination from the data collected by the commission are public records under part 2 of article 72 of title 24, C.R.S. Compilations are not available for release and dissemination and are not public records until the verification process has been completed in accordance with Regulation 86-2.

A. Public records are available for inspection and copying at the Colorado Health Data Commission, 1313 Sherman Street, Fifth Floor, Denver, Colorado 80203, during regular business hours from 8:00 a.m. to 5:00 p.m. Requests for copies of public records may be made in person, by telephone, or in writing; detailed requests should be made in writing. Copying costs shall be borne by the requester.

B. Compilations of data prepared by the commission for dissemination shall not contain the patient identification number or any other number developed by the commission to access patient identifying information received by the commission.

VII. Release of information - confidentiality.

A. In the collection, compilation, and dissemination of data by the commission (or any other corporation, association, or entity authorized to act on behalf of the commission), patient confidentiality shall be protected and the laws of this state in regard to patient confidentiality shall apply. The commission shall not be required to prepare and release compilations which significantly endanger patient confidentiality.

B. Release of information to the commission - lawful.

1. The commission may provide information requested pursuant to section 25-28-104, as follows:

(a) From hospitals, third-party payers, and other persons to the executive director of the department of health, the commissioner of insurance, or the executive director of the department of social services;

(b) From the executive director of the department of health, the commissioner of insurance, or the executive director of the department of social services to the commission; and (c) From the commission or its designee to interested persons.

2. Information provided pursuant to section 25-28-104 shall not identify a patient by name, address, or patient identification number unless authorized by the patient.

C. Release of information to another entity.

The commission may release information requested and received by it to any other corporation, association, or entity under agreement with the commission pursuant to the provisions of section 25-28- 104(1), or the commission may authorize another corporation, association, or entity to receive information on its behalf. Such other corporation, association, or entity, or any of their respective agents and employees, are bound by the confidentiality provisions of article 28 of title 25, C.R.S., in the same manner in which the commission is bound and shall not release information received from or on behalf of the commission except as authorized by the commission and in accordance with commission rules.

D. Release of information - civil liability.

Data furnished to the commission pursuant to section 25-28-104 shall not be public records under part 2 of article 72 of title 24, C.R.S. A cause of action in the nature of defamation, invasion of privacy, or negligence shall not arise against a person for disclosing information in accordance with section 25-28- 104, unless the act of omission was wanton, willful, or grossly negligent. However, this section shall not provide immunity for disclosing or furnishing confidential information with malice or willful intent to injure a person.

Regulation 86-7 CONCERNING UNIFORM DENTAL, VISION CARE AND PRESCRIPTION DRUG FORMS I. Authority.

This regulation is promulgated under the authority of section 25-28-104(3)(a), Colorado Revised Statutes.

II. Purpose.

A. The purpose of this regulation is to adopt uniform dental, vision care and prescription drug billing forms which must be used by all third-party payers and health care providers for the above named services by January 1, 1987.

B. Nothing in this regulation shall prohibit third-party payers and health care providers from requiring additional information, including, but not limited to, itemized bills, necessary to distinguish eligibility for benefits or liability for reimbursement for services provided.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

A. “Commission” means the Colorado Health Data Commission created by section 25-28-103, C.R.S.

B. “Health Care Providers” includes all licensed providers of health care.

C. “Third-Party Payer” means any insurer offering sickness and accident insurance as authorized pursuant to Article 1 or Article 8 of Title 10, C.R.S., as amended; any health maintenance organization as authorized pursuant to Article 17 of Title 10, C.R.S., as amended; any non-profit hospital and health service corporation as authorized by Article 16 of Title 10, C.R.S., as amended; the state compensation system which reimburses or otherwise provides health care services, as amended; any programs funded or administered by the State of Colorado for the provision of health care services, or any corporation, organization, association, person or entity which delivers, purchases, reimburses, or otherwise provides health care services to any person.

D. “Attending Dentist's Statement” means the 1985 form developed by the Health Insurance Association of America (HIAA), or the form's electronic media equivalent.

E. “Vision Care Benefits Statement” means the form approved by the Advisory Committee on Vision Care Benefits Plans of the American Optometric Association (AOA), 1980, or the form's electronic media equivalent.

F. “Prescription Drug Form” means the pharmacy billing form developed by the National Council for Prescription Drug Programs (NCPDP)(1979), or the form's electronic media equivalent.

IV. Uniform definitions for the attending dentist's statement. Definitions for the use of the attending dentist's statement shall be in accordance with the Health Insurance Association of America.

I. Uniform definitions for the vision care benefits statement. Definitions for the use of the vision care benefits statement shall be in accordance with the American Optometric Association.

VI. Uniform definitions for the prescription drug form. Uniform definitions for the prescription drug form shall be in accordance with the National Council for Prescription Drug Programs.

VII. Use of the attending dentist's, vision care and prescription drug forms. On or after the effective date of this regulation, all third-party payers and all licensed health care providers rendering dental, vision care services and dispensing prescription drugs shall use the HIAA Attending Dentist's Statement, American Optometric Association Vision Care Benefits Statement, and the National Council for Prescription Drug Programs Form, as such forms are appropriate to their scope of services rendered.

VIII. INCORPORATED MATERIAL.

This rule does not include later amendments to or editions of the incorporated material contained hering. The Director, who is located at 1313 Sherman Street, Room 518, Denver, Colorado 80203, shall provide information regarding how the incorporated material may be obtained.

IX. Effective date.

This regulation shall be effective on January 1, 1987.

COPY RIGHT _ National Council for Prescription Drug Programs - Reproduction prohibited. Quantities of this form are available to retail pharmacies from drug wholesalers. Any questions or for further information, contact: National Council for Prescription Drug Programs, 3900 Cambelback Road, Suite 506, Phoenix, Arizona 85108, telephone (602) 957-9105.

Regulation 87-1 CONCERNING COLLECTION OF DATA FROM THIRD PARTY PAYERS I. Authority.

This regulation is promulgated under the authority of Sections 25-28-104(2)(a) and (b), Colorado Revised Statutes.

II. Purpose.

A. The purpose of this regulation is to collect and disseminate physician charge data to encourage competition and informed decisions by users in the health care industry.

B. This regulation details the process for submission of data by third party payers to the commission.

III. Definitions.

A. “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

B. “Physician providers” includes all providers of health care licensed under section 12-36-114, Colorado Revised Statutes.

C. “Third-party payer” means any insurer offering sickness and accident insurance as authorized pursuant to Article 1 or Article 8 of Title 10, Colorado Revised Statutes, as amended; any health maintenance organization as authorized pursuant to Article 17 of Title 10, Colorado Revised Statutes, as amended; any non-profit hospital and health service corporation as authorized by Article 16 of Title 10, Colorado Revised Statutes, as amended; the state compensation system which reimburses or otherwise provides health care services as authorized by Article 65 of Title 8, Colorado Revised Statutes, as amended; any programs funded or administered by the State of Colorado for the provision of health care services, or any corporation, organization, association, person, or entity which delivers, purchases, reimburses, or otherwise provides health care services to any person.

D. For the purposes of this rule, “claim” means a request for benefits under a group plan which provides hospital, surgical and/or major medical benefits. “Claim” does not include any benefit request for disability loss of income, medicare supplemental, dental services, optical services, hospital confinement indemnity, accident only, or prescription drug services.

IV. Description of data to be submitted.

A. All third-party payers must report the information required on or before September 1 for claims incurred in Colorado between April 1 and June 30.

B. Data to be submitted includes.

For each medical, surgical, or other procedure identified by the commission:

1. Number of claims incurred;

2. Total amount of procedure charges;

3. Lowest procedure charge; and, 4. Highest procedure charge.

Data is to be reported in subgroups defined by:

5. Colorado 3-digit zip code of the provider.

C. Data is to be submitted according to forms provided by the commission. These forms will be available from the Colorado Health Data Commission 1313 Sherman Street, Room 518, Denver, Colorado 80203.

D. The forms may be submitted in a computer-readable format acceptable to the commission.

E. The content of the proposed data reporting forms shall be made public for 30 days before the commission considers the final format of the forms and the final format of the forms shall be determined by the commission after consideration of input from the public.

V. Frequency of data submissions Information required by subsection IV. shall be submitted to the commission by September 1 of each year beginning with September 1, 1988.

RULE 87-2 CONCERNING THE REPORTING OF HOSPITAL QUALITY INDICATORS I. Authority.

This regulation is promulgated under the authority of Section 25-28-104(3)(b), Colorado Revised Statutes.

II. Purpose.

A. The purpose of this regulation is to collect, analyze, and disseminate data related to hospital quality indicators in order to encourage competition and informed decisions by users in the health care industry.

III. Definitions.

As used in this regulation, unless the context otherwise requires:

(1) “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

(2) “Hospital” means any facility required to be licensed by Section 25-3-101, Colorado Revised Statutes, except a community clinic, rehabilitation center, convalescent center, community mental health center, facility for the mentally retarded, chiropractic hospitals, nursing home facility, rehabilitative nursing facility, or hospice care facility for terminally ill individuals and except specialty hospitals, other than children's hospitals, which are exempt from Medicare's prospective payment system.

(3) “Quality indicator” means a characteristic of a hospital's structure, processes, or outcomes that describes service availability, the methods used to assure quality, and the results of quality monitoring.

IV. Description of the data to be reported.

A. From time to time, the Commission will distribute to hospitals a quality indicators survey questionnaire including, but not limited to, the following topics:

(1) Medical staff membership, functions, reappointment, and peer review;

(2) Nursing staff composition and availability;

(3) Availability of hospital services;

(4) Quality assurance methods and results;

(5) Radiology and laboratory services;

(6) Patient satisfaction surveys;

(7) Hospital accreditation and special certifications;

(8) Procedure frequency.

B. Each hospital will have 30 calendar days from the date of receipt of the survey to complete the survey and return it to the Commission.

C. The content of any proposed questionnaire shall be made public for 30 days before the commission considers the final form of the questionnaire and the final form of the questionnaire shall be determined by the commission after consideration of input from the public. REGULATION 87-3 Concerning the measurement and reporting of hospital inpatient uniform clinical data for reporting of severity-adjusted medical outcome rates.

I. Authority This regulation is promulgated under the authority of Section 25-28-104(3)(b), Colorado Revised Statutes.

II. Purpose A. The purpose of this regulation is to collect, analyze, and disseminate uniform clinical data related to severity-adjusted medical outcome rates in order to encourage competition and informed decisions by users in the health care industry.

III. Definitions A. As used in this regulation, unless the context otherwise requires:

(1) “Commission” means the Colorado Health Data Commission created by Section 25-28-103, Colorado Revised Statutes.

(2) “Hospital” means any facility required to be licensed by Section 23-3-101, Colorado Revised Statutes, except a community clinic, rehabilitation center, convalescent center, community mental health center, facility for the mentally retarded, chiropractic hospital, nursing home facility, rehabilitative nursing facility, or hospice care facility for terminally ill individuals and except specialty hospitals, other than children's hospitals, which are exempt from Medicare's prospective payment system.

(3) “Severity-adjusted medical outcome rates” means the proportion of hospital patients in an admission severity group by case type who had decreased, increased or continued morbidity or mortality.

IV. Hospitals required to submit data A. All hospitals with one-hundred-twenty-five or more licensed beds must collect and submit inpatient data required by this regulation on a quarterly basis as defined in regulation 86-1 beginning July 1, 1990.

B. Starting, January 1, 1995 the data collected and submitted shall be required only for those hospital cases where the patient's discharge diagnosis falls into fifty-six diagnosis related groups. These diagnosis related groups are listed below:

(1) From and after the submission dates herein a uniform data set shall be reported to the commission for each hospital inpatient discharge that is classified into one or more of the following diagnosis related groups (DRGS):

a. DRG 14 and 15 - Stroke and Transient Ischemic Attack b. DRG 75 - Major Chest Procedures c. DRG 79, 80, and 81 - Respiratory Infections d. DRG 89, 90, and 91 - Pneumonia e. DRG 106 and 107 - Open Heart f. DRG 112 - Major Vascular Reconstruction g. DRG 121, 122, and 123 - Acute Myocardial Infraction h. DRG 124 and 125 - Cardiac Catheterization i. DRG 127 - Heart Failure and Shock j. DRG 138 and 139 - Cardiac Arrhythmia k. DRG 140 and 143 - Chest Pain and Angina Pectoris l. DRG 148 and 149 - Bowel Procedures m. DRG 154, 155, and 156 - Stomach, Esophageal and Duodenum Procedures n. DRG 175 and 175 - Gastro-Intestinal Hemorrhage o. DRG 183, 183, and 184 - Gastroenteritis p. DRG 195, 196, 197, and 198 - Cholecystectomy q. DRG 209 - Major Joint Procedure r. DRG 243 - Medical Back s. DRG 277, 278, and 279 - Cellulitis t. DRG 336 and 337 - Prostatectomy u. DRG 358 and 359 - Uterine and Adnexal Procedures v. DRG 416 and 417 - Septicemia w. DRG 493 and 494 - Laparoscopic Cholecystectomy C. The commission, upon hearing and for good cause shown, may grant waivers to hospitals required to submit data under this regulation, delaying the date on which collection or submission shall begin. Such waivers may be general or on a hospital-by-hospital basis, as determined by the commission. Waivers shall be to a certain date.

V. Data to be submitted A. From and after the submission dates required herein a uniform clinical data set shall be submitted by hospitals with one hundred and twenty-five or more licensed beds to the commission for each of the following:

(1) Patient history a. Angina or myocardial infarction b. Autoimmune Disease c. Cancer d. Cerebral Palsy e. Chronic Anemia f. Chronic liver disease g. Chronic lung disease h. Chronic renal disease i. Congenital anomaly j. Congenital heart disease k. Congestive heart failure l. Coronary artery by-pass graft m. Current medication anticoagulant n. Current medication immunosuppressive therapy o. Current medication insulin p. Cystic fibrosis q. Developmental delay r. Diabetes s. Growth retardation t. Head trauma u. Heart valve prosthesis v. HIV positive w. Immunocomprimised x. Mental retardation y. Percutaneous transluminal coronary angioplasty z. Permanent Pacemaker aa. Prematurity ab. Product of high risk pregnancy ac. Respiratory distress syndrome ad. Seizures ae. Stroke or transient ischemic attack af. Syncope ag. Trisomy (2) Pre/Post Treatment a. 2* heart block b. A-V dissociation c. Acinetobacter d. Admission weight <2.5 kilograms e. Agitation f. Albumin g. Albumin-done h. Albumin-transfused i. Alkaline phosphatase> 200 units/liter j. Alkaline phosphatase- done k. Amnio-RH disease l. Amniocentesis-done m. Amputated n. Anaerobic culture o. Anesthesia-general p. Anesthesia grade q. Anesthesia-other r. Anesthesia-spinal s. Anesthesia Time t. Aorta aneurysm-greater than 3.0 cm u. Aortic arch abnormality v. Aphasia: acute w. Aphasia: Chronic x. Apneic episode y. Appendicitis: acute z. Apraxia: acute aa. Apraxia: chronic ab. Arrest w/resuscitation(review 1)

ac. Arrest w/resuscitation (review 2 and 3)

ad. Ascites ae. Ataxia: acute af. Ataxia: chronic ag. Atresia ah. Atrial fibrillation ai. Atrial flutter aj. Auto transfusion ak. Autoimmune disease al. Bacillus am. Bacteroides an. Bands-done ao. Bands: percentage or absolute ap. Benign tumor aq. Biliary stone ar. Bleeding as. Blood culture-done at. Blood culture-positive au. Blood pressure diastolic> 120 mm/Hg av. Blood urea nitrogen aw. Blood urea-nitrogen-done ax. Bordetella ay. Bowel inflammation az. Bradycardia rate less than 40 per minute ba. Brain cyst bb. Brain low density bc. Brain mass bd. Brucella be. Burns bf. Cachexia bg. Calcific density bh. Calcium <8.0 or > 11.0 mg%; or < 4.0 or > 5.5 MEQ/L bi. Calcium-done bj. Camplyobacter bk. Cancer in situ bl. Cardiac pathology positive bm. Cardiomegaly bn. Catatonia bo. Central total parenteral nutrition bp. Cerebral spinal fluid culture-done bq. Cerebro spinal fluid culture-positive br. Cerebral spinal fluid-done bs. Cerebral spinal fluid greater than 30 WBC's bt. Cerebral spinal fluid less than 5 WBC's bu. Chlamydobacteriaceae bv. Cholecystitis: acute bw. Chorioamnionitis bx. Cirrhosis by. Close psychiatric observation bz. Clostridium ca. Coma or Stupor cb. Combative cc. Complex fracture cd. Congestive heart failure ce. Cord base excess cf. Cord base excess-done cg. Cord-PH ch. Cord-PH done ci. Cord/root compression cj. Corneal deformity ck. Corneal scar cl. Coronary artery disease-circumflex artery>=50% occlusion cm. Coronary artery disease-left anterior descending artery> =50% occlusion cn. Coronary artery disease-left main artery>/=50% occlusion co. Coronary artery disease-right main artery >/= 50% occlusion cp. Coronary artery disease-total number of vessels cq. Corynebacterium cr. Cranial Nerve Deficit: acute cs. Cranial Nerve Deficit: Chronic ct. Creatine phosphokinase (MB)% -done cu. Creatine phosphokinase (MB) 4-30% cv. Creatine phosphokinase> 150 units/liter cw. Creatine phosphokinase Absolute> 25 cx. Creatine phosphokinase - done cy. Creatinine> 1.7 cz. Creatinine-done da. Cyanosis db. Cyst dc. Cyst: ovary dd. Decreased contractility de. Decreased shortening fraction df. Deep vein thrombosis dg. Depression dh. Depression: moderate di. Diaphragmatic hernia dj. Dilated chambers heart dk. Direct bilirubin dl. Direct bilirubin-done dl. Atrial flutter dm. Disoriented dn. Ectopic pregnancy do. Edema dp. Ejection fraction dq. Electroconvulsive therapy dr. Endometriosis ds. Enlarged brain ventricles dt. Enterobacter du. Escherichia dv. Ethmoid clouding dw. Factor replacement dx. Hematocrit dy. Failed percutaneous transluminal coronary angioplasty(PTCA) dz. Failure outpatient management ea. Fibroid eb. Fistula ec. Flaccid: acute ed. Flaccid: chronic ee. Foot deformity ef. Forced expiratory volume in one second(FEV1)-done eg. Forced expiratory volume in one second(FEV1)

eh. Foreign body ei. Fraction inspired O2 ej. Fraction inspired O2-done ek. Fungus el. Gait abnormality em. Gangrene en. Gastrointestinal bleed eo. Gastrointestinal inflammation ep. Genitourinary stone eq. Glascow Coma Score er. Glucose es. Glucose-done et. Gradient eu. Guaiac-done ev. Haemophilus ew. Hand deficit ex. Hematocrit ey. Hematocrit-done ez. Hemoglobin fa. Hemoglobin-done fb. Hepatitis fc. Hernia fd. Homicidal ideation fe. Hydronephrosis ff. Hypertrophy fg. Hypoplastic heart fh. Ileus fi. Imperforate anus fj. Infiltrate fk. Inflammation fl. Internal abscess fm. Internal culture-done fn. Internal culture-positive fo. Internal damage fp. Internal infarction fq. internal rupture fr. Intracranial hemorrhage fs. Intraocular pressure ft. Intraoperative units fu. Intrauterine (IU) growth retardation fv. Involuntary commitment fw. Irritable fx. Kidney pathology-positive fy. Klebsiella fz. Left axis deviation ga. Legionella gb. Lesion gc. Lethargy gd. Listeria ge. Lobe/lung collapse gf. Major cardiac anomaly gg. Malignant Tumor gh. Mass-excludes brain gi. Mechanical ventilation gj. Meconium aspiration gk. Mixed organism gl. Multifocal arterial tachycardia gm. Murmur gn. Muscle weakness: acute go. Muscle weakness: chronic gq. Myocardial infarction: acute gr. Neisseria gs. Non-gastrointestinal inflammation gt. Obstruction gu. Oliguria gv. Open defect gw. Open fracture gx. Orthopedic tear gy. Ossicular deformity gz. Osteomyelitis ha. Other aneurysm hb. Other organism, except fungus hc. Oxygen saturation done hd. Oxygen saturation less than 85 percent he. Pacemaker malfunction hf. Packed cells hg. Pancreatitis hh. Pancreas pseudocyst hi. Papilledema hj. Parenteral psychotropic drug hk. Paresis: acute hl. Paresis: chronic hm. Partial obstruction hn. Partial thromboplastin time> 35.9 seconds ho. Partial thromboplastin time-done hp. Patent ductus arteriosus hq. PCO2-done hr. PCO2 greater than 45 hs. Peptic Ulcer ht. PH done hu. PH less than 7.35 or PH greater than 7.45 hv. Placenta/cervical culture- done hw. Placenta/cervical culture positive hx. Plasma hy. Platelets-done hz. Platelets less than 100.00 ia. Platelets transfused ib. Pleural effusion ic. Pneumothorax id. PO2<75.0 ie. PO2-done if. Polyp ig. Potassium-done ih. Potassium less than 2.5 or potassium greater than 5.3 ii. Pre-operative units ij. Pre-transfusion Hematocrit ik. Pre-transfusion hemoglobin il. Pre-transfusion pulse im. Pre-transfusion systolic blood pressure in. Premature ventricular contractions io. Products of conception ip. Proprioception iq. Prosthesis/graft failure ir. Proteus is. Prothrombin> 15.5 seconds it. Prothrombin-done iu. Providencia iv. Pseudomonas iw. Psychosis: acute ix. Pulmonary artery pressure iy. Pulmonary edema iz. Pulmonary embolism ja. Pulmonary vascular disease jb. Pulse high or low jc. Recovery Room Time jd. Regurgitation je Respirations jf. Retinal Detachment jg. Revised Trauma score jh. Ruptured Aorta ji. S3 Gallop jj. Salmonella jk. Scoliosis jl. Sensory deficit: acute jm. Sensory deficit: chronic jn. Serratia jp. Serum glutamic oxaloacetic transaminase> 80 jq. Serum glutamic oxaloacetic transaminase-done jr. Shigella js. Shunt: Left to Right> 1.5 jt. Shunt: right to left ju. Sino-atrial dysfunction jv. Skin Tumor jw. Social isolation jx. Socially damaging behavior jy. Sodium done jz. Sodium less than 130 or sodium greater than 150 ka. Speech deficit: acute kb. Speech deficit: chronic kc. Spinal Cord C1-C4: acute kd. Spinal Cord C1-C4: Chronic ke. Spinal Cord C5-L5: Acute kf. Spinal Cord C5-L5: Chronic kg. Spinal Cord S1-S5: Acute kh. Spinal Cord S1-S5: Chronic ki. Sputum Culture-done kj. Sputum Culture-positive kk. Staphylococcus kl. Staphylococcus aureus km. Staphylococcus epidermis kn. Stool culture-done ko. Stool Culture-positive kp. Strabismus kq. Strain pattern kr. Streptobacillus ks. Streptococcus B kt. Streptococcus excluding B ku. Stress test positive kv. Stridor kw. Substance abuse: acute kx. Suicidal attempt ky. Suicidal ideation kz. Systolic blood pressure la. T4-done lb. T4 less than 4.5 or T4 greater than 12.5 lc. Tear ld. Temperature-oral equivalent le. Tense fontanelle lf. Trauma Score lg. Thoracic aneurysm lh. Total bilirubin li. Total bilirubin - done lj. Transplant rejection lk. Transposition ll. Tremors: acute lm. Tremors: Chronic ln. Umbilical Culture-done lo. Umbilical culture-positive lp. Urine protein(24 hour)>2 grams lq. Urine protein done lr. Urine protein greater than 4 + ls. Vaginal prolapse-grade 3 or 4 lt. Valve Area lu. Valve atresia lv. Ventricular standstill lw. Ventricular tachycardia lx. Wedge pressure ly. Weightbearing fracture lz. White blood cells> 16.9 ma. White blood cells - done mb. Whole blood mc. Withdrawn md. Witnessed seizure me. Wound dehiscence mf. Wound infection: Deep mg. Wound infection-superficial mh. yersinia mi. Active herpes mj. Actual Multiple Gestation mk. Apgar ml. Apgar (at 5 minutes) <7 mm. Blood Pressure, Diastolic> 119 mn. Birth Gestational Age mo. Birth Trauma mp. Birth Weight mq. Estimated Gestational Age mr. Estimated Gestational Age - no labor <27 weeks ms. Expected Multiple Gestation mt. Failure to Progress mu. Fetal Death> 19 Weeks gestation mv. Fetal Scalp Sample, P.H. <7.25 mw. in Utero Death mx. Late Deceleration/Loss Variability my. Malpresentation, Breech mz. Malpresentation, excluding breech na. Parity nb. Pitocin Augmentation nc. Pitocin Induction nd. Placenta Abruptio/Previa ne. Premature Rupture of Membranes> =24 hours nf. Previous Multiple Gestation ng. Previous Perinatal Death nh. Previous preterm pregnancy ni. Previous spontaneous abortion nj. Previous C-Section nk. Previous Pregnancy related Hemorrhage nl. Prolapsed Cord nm. Urine Protein = 4 + (3) Identifier information a. Hospital identifier b. Patient identifier c. Admission date and hour d. Discharge date e. Physician identifiers f. Diagnosis Related Group g. Sex h. Birth Date i. Discharge Disposition j. Procedure Codes (principal and 5 associated)

k. Date of principal procedure l. Surgeon (principal procedure only)

m. Diagnosis codes (principal and 8 associated)

B. On or before November 15, 1990, the Commission will make available to reporting hospitals a detailed set of instructions for the definitions and reporting of the variables describing each data category in the data set.

C. On or before November 15, 1990, the commission shall approve one or more data abstraction training programs.

D. The first commission training program shall take place on or before February 14, 1990.

E. All hospitals with one-hundred-twenty-five or more licensed beds shall send at least one employee to a commission approved data abstraction training program in order to comply with this regulation.

F. Upon approval by the commission a hospital may elect to use its own system for data abstraction and collection.

G. To obtain commission approval to use its own data collection and abstraction system, a hospital must demonstrate to the commission that the proposed collection method is identical to the abstraction programs described in Section V,B above.

VI. The data collected pursuant to this regulation shall be made available on request to the public at the Commission's discretion and according to Regulation 86-6.

VII. WAIVER A. All of the rules pertaining to waiver and exemption as described in Health Data Commission Regulations 86-3 and Regulation 86-5 apply to this rule.

B. Hospitals that can demonstrate to the satisfaction of the Commission that they serve a population that is statistically underrepresented in Commission data bases thereby precluding statistically valid analyses or for which the risk adjustment methodology is inappropriate or unavailable for such specific population shall be exempt for this rule. REGULATION 92-1 DECLARATORY ORDERS 1.1 Applicability: Any entity may petition the Colorado Health Data Commission (“Commission”) for a declaratory order to terminate controversies or to remove uncertainties as to the applicability to the petitioner of any statutory provisions or any rule or order of the Commission as required by CRS 24-4-105(11).

1.2 Initial Determination:

(A) The Commission will determine, at its discretion and without notice to petitioner, whether to rule upon the filed petition. If the Commission decides not to rule upon the petition, the petitioner shall promptly be notified of the action. The notice shall state the reasons for the action.

(B) In determining whether to rule upon a petition filed pursuant to this rule, the Commission will consider the following matters, among others:

(1) Whether a ruling on the petition will terminate a controversy or remove uncertainties as to the applicability to the petitioner or any statutory provision, rule or order of the Commission.

(2) Whether the petition involves any subject, question or issue which is the subject of a formal or informal matter or investigation currently pending before the Commission or a court but not involving any petitioner.

(3) Whether the petition seeks a ruling on a moot or hypothetical question or will result in an advisory ruling or opinion.

1.3 Content of petition: any petition filed pursuant to this rule shall set forth the following:

(A) The name and address of the petitioner and the relationship of the petitioner to the Commission whether a hospital, person required to abide by one of the Commission's rules, a citizen or other relationship.

(B) The statute, rule or order to which the petition relates.

(C) A concise statement of all the facts necessary to show the nature of the controversy or uncertainty and the manner in which the statute, rule or order in question applies or potentially applies to the petitioner.

1.4 Procedure for ruling: If the Commission decides to rule on the petition, the following procedures will apply:

(A) The Commission may rule upon the petition based solely upon the facts presented in the petition. In such a case:

(1) Any ruling of the Commission will apply only to the extent of the facts presented in the petition and any amendment to the petition.

(2) The Commission may order the petitioner to file a written brief, memorandum or statement of position.

(3) The Commission may set the petition, upon due notice to petitioner, for a non- evidentiary hearing.

(4) The Commission may dispose of the petition on the sole basis of the matters set forth in the petition.

(5) The Commission may request the petitioner to submit additional facts, in writing. In that event, the additional facts will be considered as an amendment to the petition.

(6) The Commission or the petitioner may take administrative notice of facts pursuant to the Administrative Procedures Act, CRS 24-4-105(8), and may utilize the experience, technical competence and specialized knowledge of an administrative law judge in the disposition of the petition.

(7) If the Commission rules upon the petition without a hearing, the petitioner shall be promptly notified of the decision.

(B) The Commission, at its discretion, may set the petition for hearing under CRS 24-4-105, as amended, upon due notice to petitioner, for the purpose of obtaining additional facts or information or to determine the truth of any facts set forth in the petition or to hear oral argument on the petition. The notice to the petitioner setting the hearing shall set forth, to the extent known, the factual or other matters into which the Secretary intends to inquire. The petitioner shall have the burden of proving all of the facts stated in the petition, all of the facts necessary to show the nature of the controversy or uncertainty, the manner in which the statute, rule or order in question applies or potentially applies to the petitioner and any other facts the petitioner desires the Commission to consider.

1.5 Parties and Intervention: the parties to any proceeding pursuant to this rule shall be the Commission and the petitioner. Any other person may seek leave of the Commission to intervene in the proceedings. Leave to intervene will be granted at the sole discretion of the Commission. A petition to intervene shall set forth the same information as required by paragraph 1.3. Any reference to a “petitioner” in this rule also refers to any person who has been granted leave to intervene by the Commission.

1.6 Final Commission Action: Any declaratory order or other order disposing of a petition pursuant to this rule shall constitute Commission action subject to judicial review pursuant to CRS 24-4- 106(2).

1.7 Effective Date: These rules are effective July 18, 1992.