1. (a) All hospitals in operation for all or any of the reporting periods described in §1301.13 of this title (relating to Schedule for Filing Discharge Reports) shall submit discharge claims as specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes) on all discharged inpatients to the Council. To the extent the admission, treatment, or discharge is made by a health professional, other than a physician, data elements specified in §1301.19(d)(36)-(41) shall be filled accordingly or data elements (38) or (41) shall be marked with one of the Council approved temporary "Physician" or "Other health professional" code numbers and data elements (36)(A-C) or (39)(A-C) may be left blank. Hospitals owned by the federal government and hospitals exempted as rural providers may submit hospital discharge claim.

2. (b) All inpatient discharges shall be reported. Except as noted in paragraphs (1)-(4) of this subsection, one or more discharge claims shall be submitted for each patient for each discharge covering all services and charges from admission through discharge.

   1. (1) Separate discharge claims shall be submitted for mothers and newborns.
   2. (2) Hospitals shall either submit separate discharge claims corresponding to each interim, revised, or final discharge claims or submit a single consolidated final discharge claim for each discharged patient.
   3. (3) For all patients for which the hospital prepares one or more bills for inpatient services, the hospital shall submit a discharge claim corresponding to each bill containing the data elements required by §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes). For all patients for which the hospital does not prepare a bill for inpatient services, the hospital shall submit a discharge claim containing the required minimum data set.
   4. (4) For all patients that are covered by 42 USC 290dd-2 and 42 CFR Part 2.1, a hospital shall submit a discharge claim containing the required data elements specified by §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes). The hospital shall replace the patient identifying information with the default values specified in §1301.19(e) of this title (relating to Discharge Reports--Records, Data Fields and Codes) or submit the patient identifying information if release of patient identifying information is authorized in writing by the patient or patient's guardian.
3. (c) All hospitals shall file discharge reports by electronic filing unless the hospital receives an exemption letter from the Council.
4. (d) All hospitals shall submit discharge claims and discharge reports in the format specified in §1301.19 of this title (relating to Discharge Reports--Records, Data Fields and Codes).
5. (e) Hospitals shall submit discharge reports, data certifications, exemption requests and other required information to the Council or its agents at physical or telephonic addresses specified by the executive director. The executive director shall notify all hospitals and submitters in writing and by publication in the Texas Register at least 30 calendar days before any change in the addresses.
6. (f) Hospitals may submit discharge reports, or may designate an agent to submit the reports. If a hospital designates an agent, it shall inform the Council of the designation in writing at least 30 calendar days prior to the agent's submission of any discharge report. The hospital shall inform the Council in writing at least 30 calendar days prior to changing agents or making the submissions itself. Designation of an agent does not relieve the hospital of responsibility for compliance with this chapter or other related law.
7. (g) If requested by the Council, a hospital shall provide the executive director or the director's agent, the Texas Department of Health, access to, copies of and/or information from the hospital documents and records underlying and documenting the discharge reports submitted, as well as other patient related documentation deemed necessary to audit hospital data to verify its accuracy and reliability. Each request from the Council shall detail the reasons for such request, provide the hospital with at least 14 calendar days advance notice, and ensure that confidentiality of patient records is maintained.

Source Note:The provisions of this §421.2 adopted to be effective August 19, 1997, 22 TexReg 7490; amended to be effective December 29, 1997, 22 TexReg 12494; amended to be effective July 26, 1998, 23 TexReg 7365; amended to be effective February 21, 1999, 24 TexReg 948; amended to be effective July 29, 2001, 26 TexReg 5408; amended to be effective July 6, 2003, 28 TexReg 4915; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842.