1. (a) DSHS records are public records under Government Code, Chapter 552, except as specifically exempted by Health and Safety Code, §§108.010, 108.011 and 108.013 or other state or federal law. Copies of such records may be obtained upon request and upon payment of user fees established by DSHS. The public use data file shall be available for public inspection during normal business hours. Event claims in the original format as submitted to DSHS are not available to the public, are not stored at DSHS and are exempt from disclosure pursuant to Health and Safety Code, §§108.010, 108.011 and 108.013, and shall not be released. Likewise, patient and physician identifying data collected by the DSHS through editing of facility data shall not be released.

2. (b) Creation of codes and identifiers. DSHS shall develop the following codes and identifiers, as listed in paragraphs (1) - (2) of this subsection, required for creation of the public use data file and for other purposes.

   1. (1) DSHS shall create a process for assigning uniform patient identifiers, uniform physician identifiers and uniform other health professional identifiers using data elements collected. This process is confidential and not subject to public disclosure. Any documents or records produced describing the process or disclosing the person associated with an identifier are confidential and not subject to public disclosure.
   2. (2) DSHS shall create a process for assigning geographic identifiers to each event record.
3. (c) Requests for outpatient event data files including data on one or more providers are matters of public record and copies of all requests shall be maintained by DSHS in accordance with DSHS records retention schedule.
4. (d) All users including Texas state agencies that request outpatient event data shall abide by the data use agreement.
5. (e) DSHS shall establish procedures for screening all requests to assure that filling the request will not violate the confidentiality provisions of Health and Safety Code, Chapter 108.
6. (f) The data elements specified for outpatient event reports in this section do not constitute "Provider Quality Data" as discussed in Health and Safety Code, §108.010.

7. (g) Creation of public use data file. DSHS will create a public use data file by creating a single record for each reportable outpatient event and adding, modifying or deleting data elements in the following manner as listed in this subsection:

   1. (1) delete patient and insured name, Social Security number, address and certificate data elements, any patient identifying information, and patient control and medical record numbers;
   2. (2) convert patient birth date to age;
   3. (3) convert procedure dates to a code for the day of the week;
   4. (4) convert occurrence dates to day values;
   5. (5) delete physician and other health professional names and numbers and assign a alphanumeric uniform physician identifier for the physicians and other health professionals who were reported as "rendering," "operating or other" or "other provider" on patients;
   6. (6) assign codes indicating the primary and secondary sources of payment;
   7. (7) the minimum cell size required by Health and Safety Code, §108.011(i)(2), shall be five, unless DSHS determines that a higher cell size is required to protect the confidentiality of an individual patient or physician;
   8. (8) convert all procedure codes to HCPCS codes (in the version that is current for the date the data was due to be submitted or the version in effect at the date of service);
   9. (9) add nationally accepted risk and severity adjustment scores utilizing an algorithm approved by DSHS, when available and applicable;

   10. (10) data elements to be included in the public use data file:

       1. (A) Event Year and Quarter;
       2. (B) Provider Name (Facility Name);
       3. (C) THCIC Identification Number;
       4. (D) Facility Type Indicators;
       5. (E) Patient Sex/Gender;
       6. (F) Patient ZIP Code;
       7. (G) County Code;
       8. (H) Health Service Region Code;
       9. (I) Patient State;
       10. (J) Patient Race;
       11. (K) Patient Ethnicity;
       12. (L) Claim Type Indicator;
       13. (M) Type of Bill;
       14. (N) Principal Diagnosis Code (Current version of ICD codes at the time data is submitted);
       15. (O) Other Diagnosis Codes (Up to 24 diagnosis codes can be submitted and reported. Current version of ICD codes at the time data is submitted);
       16. (P) Procedure codes (Up to 24 procedure codes can be submitted and reported. Current version of HCPCS codes at the time data is submitted);
       17. (Q) Reason For Visit (Current version of ICD or HCPCS codes at the time data is submitted);
       18. (R) External Cause of Injury (E-codes), (if applicable) (Current version of ICD codes at the time data is submitted. Up to nine (9) E-codes can be submitted and reported);
       19. (S) Related Cause Code, (if applicable) (Up to three (3) codes can be submitted and reported);
       20. (T) Day of Week Patient is provided services code (Sunday = 1, Monday = 2, Tuesday = 3, Wednesday = 4, Thursday = 5, Friday = 6, Saturday = 7);
       21. (U) Age group of patient;
       22. (V) CRG Code (and associated codes if applicable);
       23. (W) APG Code (Obtained from 3M APG Grouper) if applicable (Up to 10);
       24. (X) APG Category Code (Obtained from 3M APG Grouper) if applicable (Up to 10);
       25. (Y) APG Type Code (Obtained from 3M APG Grouper) if applicable (Up to 10);
       26. (Z) Final APG Assignment Code (Obtained from 3M APG Grouper) if applicable (Up to 10);
       27. (AA) Final APG Category Code (Obtained from 3M APG Grouper) if applicable (Up to 10);
       28. (BB) APC Procedure Code (if applicable) (Up to 10);
       29. (CC) APC Procedure Status Indicator Code (if applicable) (Up to 10);
       30. (DD) APC Diagnosis Edits (if applicable) (Up to 10);
       31. (EE) APC Procedure Code Edits (if applicable) (Up to 10);
       32. (FF) APC Weight (if applicable) (Up to 10);
       33. (GG) APC Base Procedure (if applicable) (Up to 10);
       34. (HH) Clinical Classification Software Category Codes and associated codes, if applicable;
       35. (II) Uniform Physician Identifier assigned to Rendering Physician or Rendering Other Health Professional;
       36. (JJ) Uniform Physician Identifier assigned to Operating Physician or Other Physician or Other Health Professional;
       37. (KK) Uniform Physician Identifier assigned to Other Provider or Other Health Professional;
       38. (LL) Ancillary Service--Other Charges;
       39. (MM) Ancillary Service--Pharmacy Charges;
       40. (NN) Ancillary Service--Medical/Surgical Supply Charges;
       41. (OO) Ancillary Service--Durable Medical Equipment Charges;
       42. (PP) Ancillary Service--Used Durable Medical Equipment Charges;
       43. (QQ) Ancillary Service--Physical Therapy Charges;
       44. (RR) Ancillary Service--Occupational Therapy Charges;
       45. (SS) Ancillary Service--Speech Pathology Charges;
       46. (TT) Ancillary Service--Inhalation Therapy Charges;
       47. (UU) Ancillary Service--Blood Charges;
       48. (VV) Ancillary Service--Blood Administration Charges;
       49. (WW) Ancillary Service--Operating Room Charges;
       50. (XX) Ancillary Service--Lithotripsy Charges;
       51. (YY) Ancillary Service--Cardiology Charges;
       52. (ZZ) Ancillary Service--Anesthesia Charges;
       53. (AAA) Ancillary Service--Laboratory Charges;
       54. (BBB) Ancillary Service--Radiology Charges;
       55. (CCC) Ancillary Service--MRI Charges;
       56. (DDD) Ancillary Service--Outpatient Services Charges;
       57. (EEE) Ancillary Service--Emergency Service Charges;
       58. (FFF) Ancillary Service--Ambulance Charges;
       59. (GGG) Ancillary Service--Professional Fees Charges;
       60. (HHH) Ancillary Service--Organ Acquisition Charges;
       61. (III) Ancillary Service--ESRD Revenue Setting Charges;
       62. (JJJ) Ancillary Service--Clinic Visit Charges;
       63. (KKK) Total Charges--Ancillary;
       64. (LLL) Total Non-Covered Ancillary Charges;
       65. (MMM) Total Charges;
       66. (NNN) Total Non-Covered Charges;
       67. (OOO) Encounter Identifier--a unique number for each encounter for the quarter;
       68. (PPP) Service Line Revenue Code;
       69. (QQQ) Service Line Procedure Code;
       70. (RRR) HCPCS/HIPPS Procedure Code;
       71. (SSS) HCPCS/HIPPS Procedure Modifiers (Up to 4 may be submitted and reported);
       72. (TTT) Service Line Charge Amount;
       73. (UUU) Service Line Unit Code;
       74. (VVV) Service Line Unit Count;
       75. (WWW) Service Line Non-Covered Charge Amount; and
       76. (XXX) Patient Country (when the address is not in United States of America and confidentiality can be maintained).

8. (h) Release of public use data files. DSHS shall release in an aggregate form, without uniform patient, physician or other health professional identifiers, public use data relating to facilities described by the Health and Safety Code, §108.0025(1), that are not rural providers because they do not meet the requirements of Health and Safety Code, §108.0025(2).

   1. (1) DSHS will make available a public use data file on electronic, magnetic or optical media for each quarter.
   2. (2) DSHS shall release public use data from facilities that have certified the data as required by §421.66 of this title (relating to Certification of Compiled Event Data). A facility's failure to execute the certification form by the dates specified in §421.66(d) of this title, or election to not certify the discharge encounter data shall not prevent the DSHS from releasing the facility's data if DSHS believes the data submitted is reasonably accurate and complete. DSHS may suppress for any quarter's data one or more data elements if deemed necessary to comply with provisions of the statute.
   3. (3) If additional event claims (not previously submitted as specified in §421.65(b)(4) of this title (relating to Acceptance of Event Files and Correction of Data Content Errors), excluding replacement, adjustments and void/cancel claims become available after the initial release of the public use data file for any quarter, DSHS will add the discharge claims, that are received on or prior to the dates specified in §421.63(a)(1) - (4) of this title (relating to Schedule for Filing Event Files) of the following quarter, to the public use data file and make the additional records available to the public.
   4. (4) A public use data file which is disseminated to a requestor shall not be considered a report issued by DSHS as referenced in Health and Safety Code, §108.011(f), and requires no additional opportunity for the facility to review or comment on the data.
   5. (5) With any public use data file prepared by the DSHS, DSHS shall attach all comments submitted by providers, which relate to any data included in the file. DSHS shall also make these comments available at DSHS offices and on the DSHS Internet site.

9. (i) An outpatient event research data file may be released provided the following criteria are met:

   1. (1) the DSHS Outpatient Data Research Data File Request Form is completed and submitted to DSHS;
   2. (2) the requestor has made payment according to DSHS' fee schedule;
   3. (3) the Institutional Review Board reviews the research request and has determined the proposed research outcome can be achieved with the requested data;
   4. (4) the Institutional Review Board grants authorization to the request or restricts access to specified data elements determined to be inappropriate for the research proposal in accordance with §421.10 of this title (relating to Institutional Review Board);
   5. (5) the requestor agrees to dispose of the research data using authorized methods by the established end date stated on the written data use agreement; and
   6. (6) the requestor has signed a written data use agreement.
10. (j) This section is effective 90 calendar days after being published in the Texas Register. The department will not implement or enforce this section until July 1, 2009, at the earliest.

Source Note:The provisions of this §421.68 adopted to be effective February 26, 2009, 33 TexReg 9694.