WSR 03-05-024

PROPOSED RULES

DEPARTMENT OF HEALTH


(Center for Health Statistics)

[ Filed February 10, 2003, 1:26 p.m. ]

Original Notice.

Preproposal statement of inquiry was filed as WSR 02-11-106.

Title of Rule: Chapter 246-455 WAC, Hospital patient discharge information reporting.

Purpose: The establishment of the collection and maintenance of patient discharge data, including data necessary for identification of discharges by diagnosis-related groups.

Statutory Authority for Adoption: RCW 43.70.040 and [43.]70.170.

Statute Being Implemented: RCW 43.70.040.

Summary: The proposed rule amendment will shorten the correction and certification time for hospitals as a result of electronic submission of data and online correction. The proposal will change the data quality requirements to be reviewed on a more aggregate basis. Rule amendment also responds to current and pending Federal UB92/UB02 Center for Medicare and Medicaid Services (CMS) reporting requirements.

Reasons Supporting Proposal: Recommended changes will improve both timeliness and data quality. Rule amendments will also facilitate the modernization of a secure, Internet application.

Name of Agency Personnel Responsible for Drafting, Implementation and Enforcement: Larry Hettick, Department of Health, Center for Health Statistics, (360) 236-4210.

Name of Proponent: Center for Health Statistics, governmental.

Rule is not necessitated by federal law, federal or state court decision.

Explanation of Rule, its Purpose, and Anticipated Effects: The rule provides for the collection and maintenance of inpatient discharge records from Washington hospitals. This information is useful for the general public to help understand health care issues and to become better consumers. Purchasers, payers and providers use this information to make health care choices and to negotiate payments. Public officials use this data to develop state health policy and to analyze health care issues. Researchers use this information for disease surveillance, medical efficiencies, and to monitor hospitalizations and disease outbreaks. This information aids in the delivery of more efficient and cost-effective health care in the state.

Proposal Changes the Following Existing Rules: The proposed amendments to WAC 246-455-010 allows for the pending federal change in the uniform billing document from UB-92 to UB-02.

The proposed amendments to WAC 246-455-020 places the data element definitions in the CHARS (comprehensive hospital abstract reporting system) procedure manual rather than in WAC.

The proposed amendment to WAC 246-455-070 reduces the number of days from fourteen to seven to make corrections and return them to the department.

The proposed amendments to WAC 246-455-090 reduces the number of days from fourteen to seven that the hospital has to certify in writing that their data is accurate. This also changes the accuracy rate from within 95% for total discharges and total charges to an aggregate error rate not to exceed 1.0%.

The proposed amendment to WAC 246-455-100 removes the monetary penalty for reporting violations since the statutory authority of RCW 70.170.100 has been repealed.

No small business economic impact statement has been prepared under chapter 19.85 RCW. The proposed amendments to chapter 246-455 WAC do not require hospitals to submit any additional information or incur any additional expense. Furthermore, all hospitals in the state have more than fifty employees, and as such do not qualify as a small business under the Regulatory Fairness Act, RCW 19.85.020(1).

RCW 34.05.328 does not apply to this rule adoption. This is not a significant rule since it imposes no penalty for violation, it does not set qualifications for a license or permit and it does not significantly amend a policy or regulatory program.

Hearing Location: Eastside Plaza, 1101 S.E. Quince Street, Conference Room 6, Olympia, WA 98504, on April 2, 2003, at 9:00 a.m.

Assistance for Persons with Disabilities: Contact Larry Hettick by March 19, 2003, TDD (800) 833-6388.

Submit Written Comments to: Larry Hettick, 1102 S.E. Quince Street, P.O. Box 47811, Olympia, WA 98504-7811, fax (360) 664-8579, by March 19, 2003.

Date of Intended Adoption: April 16, 2003.

M. C. Selecky

Secretary

OTS-6047.4


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-001   Purpose.   This chapter is adopted ((by the Washington state department of health pursuant to)) under RCW ((70.170.100)) 43.70.040 relating to the collection and maintenance of patient discharge data, including data necessary for identification of discharges by diagnosis-related groups.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-001, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-001, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-010, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-010   Definitions.   As used in this chapter, unless the context requires otherwise,

(1) "Department" means department of health.

(2) "Diagnosis-related groups" is a classification system that groups hospital patients according to principal and secondary diagnosis, presence or absence of a surgical procedure, age, presence or absence of significant comorbidities or complications, and other relevant criteria.

(3) "Hospital" means any health care institution ((which is required to qualify for a license)) licensed under RCW 70.41.020(2); or as a psychiatric hospital under chapter 71.12 RCW.

(4) Uniform Billing "UB-92/UB-02 data set" means the data element specifications developed by the ((Washington state)) National Uniform Billing Committee ((and set forth in the state of Washington UB-92 Procedure Manual, which is available to the public upon request)) which can be found at www.NUBC.org.

(5) "Patient discharge" means the termination of an inpatient admission or stay, including an admission as a result of a birth, in a Washington hospital.

(6) "HMO" means a health maintenance organization.

(7) "SNF" means a skilled nursing facility.

(8) "HCF" means a health care facility.

(9) (("ICF" means an intermediate care facility.

(10))) "HHA" means a home health agency.

(((11))) (10) "IV" means intravenous.

(((12))) (11) "UPIN" means unique physician identification number.

(((13))) (12) "CHARS" means comprehensive hospital abstract reporting system.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-010, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-010, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.39.180. 85-17-020 (Order 85-05, Resolution No. 85-05), 261-50-020, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-020, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-020   Reporting of UB-92/UB-02 data set information.   (((1))) Effective with all hospital patient discharges on or after April 1, 1994, hospitals shall collect and report the following UB-92 or UB-02 data set elements to the department((:)) as prescribed and defined by the department in the CHARS Procedure Manual. A copy of the CHARS Procedure Manual may be obtained by contacting the department or on the department's website. Proposed changes to the manual will be addressed annually. Each hospital will be notified ninety days prior to the effective date of any changes and will be provided an opportunity to comment.

(((a))) (1) Patient control number.

((Patient's unique alpha-numeric number assigned by the hospital to facilitate retrieval of individual patient records. This number should be constructed to allow prompt hospital access to the patient's discharge record for data verification.

(b))) (2) Type of bill.

((This three-digit code requires 1 digit each, in the following sequence form: Type of facility, bill classification, frequency.

Digit #1 must be "1" to indicate a hospital.
Digit #2 must be a "1," a "2" or an "8" to indicate an inpatient.
Digit #3 must be a "1" to indicate admit through discharge claim.
(c))) (3) Medicare provider number.

((This is the number assigned to the provider by Medicare.

(d))) (4) Statement covers period: The beginning and ending dates of the period included on the UB-92/UB-02 (MMDDYYYY).

(5) Patient identifier.

((The patient identifier shall be composed of the first two letters of the patient's last name, the first two letters of the patient's first name, or one or two initials if no first name is available, or when the last name is a single letter add three letters of first name, and the patient's birthdate.

(e))) (6) Patient ZIP Code.

((Patient's five or nine digit ZIP Code. In the case of a foreign country, enter the first nine characters of the name.

(f))) (7) Patient birthdate.

((The patient's date of birth in MMDDYYYY format.

(g))) (8) Patient sex.

((Patient's sex in M/F format.

(h))) (9) Admission date.

((Admission date in MMDDYY format.

(i))) (10) Type of admission.

((This field is filled with one of the following codes:


1 Emergency
2 Urgent
3 Elective
4 Newborn

(j))) (11) Source of admission.

((This field is completed with one of the following codes:


1 Physician referral
2 Clinic referral
3 HMO referral
4 Transfer from another hospital
5 Transfer from a SNF
6 Transfer from another HCF
7 Emergency room
8 Court/law enforcement
9 Other

When type of admission is a "4 newborn," enter one of the following for source of admission:


1 Normal delivery
2 Premature delivery
3 Sick baby
4 Extramural birth
5 Multiple birth

(k))) (12) Patient status.

((Patient discharge disposition in one of the following codes:


01 Discharged home or self care
02 Discharged to another short-term general hospital
03 Discharged to SNF
04 Discharged to an ICF
05 Discharged to another type institution
06 Discharged to home under care of HHA
07 Left against medical advice
08 Discharged/transferred to home under care of home IV provider
20 Expired

(l) Statement covers period

This is the beginning and ending dates for which the UB-92 covers.

(m))) (13) Revenue codes.

((The Medicare required revenue code (as defined in the UB-92 Procedure Manual), which identifies a specific accommodation, ancillary service or billing calculation.

(n))) (14) Units of service.

((The Medicare required units of service (as defined in the UB-92 Procedure Manual) which provide a quantitative measure of services rendered by revenue category to or for the patient. Where no units of service are required by Medicare, the units of service may be those used by the hospital.

(o))) (15) Total charges by revenue code category.

((Total charges pertaining to the related revenue code.

(p))) (16) Payer identification #1.

((Enter the three-digit code that identifies the primary payer. The required code options include:


001 for Medicare
002 for Medicaid
004 for health maintenance organizations
006 for commercial insurance
008 for workers' compensation which includes state fund, self-insured employers, and labor and industries crime victims claims
009 for self pay
610 for health care service contractors, e.g., Blue Cross, county medical bureaus, Washington Physicians Service
625 for other sponsored patients, e.g., CHAMPUS, Indian health
630 charity care, as defined in chapter 70.170 RCW

(q))) (17) Payer identification #2.

((Same requirements as in payer identification #1. This field should only be completed when a secondary payer has been identified.

(r))) (18) Principal diagnosis code.

((ICD-9-CM code describing the principal diagnosis (the condition established after study to be chiefly responsible for causing the admission of the patient for care).

(s))) (19) Other diagnoses codes.

((ICD-9-CM codes identifying up to eight additional conditions that coexist at the time of admission, or develop subsequently, and which have an effect on the treatment received or the length of stay).

(t))) (20) Principal procedure code.

((The ICD-9-CM code that identifies the principal procedure performed during the patient admission.

(u))) (21) Other procedure codes.

((ICD-9-CM codes identifying up to five significant procedures other than the principal procedure performed during the admission.

(v))) (22) Attending physician identification.

((The UPIN number of the licensed physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the patient's medical care and treatment. For physicians who do not have a UPIN number, the state Medicaid number or the state license number should be used.

(w))) (23) Other physician identification.

((The UPIN number of the licensed physician who performed the principal procedure. For physicians who do not have a UPIN number, the state Medicaid number or the state license number should be used. If no principal procedure was performed, this field should be left blank.

(2) The hospital shall report all inpatients discharge data described in WAC 246-455-020. Each patient discharge must carry a separate, unique patient control number on a separate UB-92 record. For example, a mother and her newborn require separate UB-92s, each with a separate, unique patient control number.))

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-020, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-020, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 87-08-037 (Order 87-02, Resolution No. 87-02), 261-50-030, filed 3/30/87; 87-04-008 (Order 87-01, Resolution No. 87-01), 261-50-030, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), 261-50-030, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), 261-50-030, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-030, filed 10/1/84.]


AMENDATORY SECTION(Amending Order 121, filed 12/27/90, effective 1/31/91)

WAC 246-455-030   Reporting of E-Codes.   Effective with hospital patient discharges occurring on or after January 1, 1989, hospitals shall collect and report ((up to two)) one ICD-9-CM code((s)) identifying the external cause of injury and poisoning (E-Codes), when applicable.

[Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-030, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), 261-50-035, filed 7/29/88.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-040   Acceptable media for submission of data.   Hospitals shall submit data in the form prescribed by the department in the CHARS Procedure Manual. A copy of the CHARS Procedure Manual may be obtained by contacting the department or on the department's website.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-040, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-040, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), 261-50-040, filed 7/29/88; 87-04-008 (Order 87-01, Resolution No. 87-01), 261-50-040, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), 261-50-040, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), 261-50-040, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-040, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-070   Revisions to submitted data.   (((1))) All data revisions required as a result of the edits performed pursuant to WAC 246-455-020 shall be corrected and returned to the department or its designee within ((fourteen)) seven working days.

(((2) The department may assess a civil penalty as provided in RCW 70.170.070 and WAC 246-455-100 for the costs associated with more than one cycle of edits as described in WAC 246-455-060.))

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-070, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-070, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.39.180. 85-17-020 (Order 85-05, Resolution No. 85-05), 261-50-065, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-065, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-080   Confidentiality of data.   (1) The department and any of its contractors or agents shall maintain the confidentiality of any information which may in any manner identify individual patients((.)) per RCW 70.170.090 and federal regulations implementing the Health Insurance Portability and Accountability Act.

The following confidential data elements are not public data: Patient control number, patient identifier, patient birthdate, admission date, discharge day, and nine-digit ZIP Code. The following data elements are public data: Patient's age at admission, discharge month and year, length of stay, and a five-digit ZIP Code.

(2) Records containing confidential data elements may be disclosed for research purposes after approval from the ((human research)) Washington state institutional review board in accordance with RCW 42.48.020.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-080, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-080, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), 261-50-070, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-090   Certification of data accuracy.   The department shall furnish each hospital a report of its quarterly discharge data contained in the department's discharge data system. The chief executive officer of the hospital shall, within ((fourteen calendar)) seven working days of receipt of the report, certify that the information contained in the department's discharge data system is complete and accurate ((to within ninety-five percent of the total discharges and total charges)) with an aggregate error rate not to exceed 1.00% experienced at the hospital during that quarter, or submit the necessary corrections to the data to permit such certification.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-090, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-090, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 87-08-037 (Order 87-02, Resolution No. 87-02), 261-50-075, filed 3/30/87.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-100   ((Penalties for)) Violation.   ((RCW 70.170.070 describes the penalty for violation of any valid orders, rules, regulations, and reporting requirements.)) If a hospital violates the reporting requirements in this chapter, the department may proceed with legal action under RCW 43.70.190 to compel compliance. The department may grant extensions of time to file the information((, in which cases)) upon written request by the hospital. If an extension is granted, failure to file the information shall not ((constitute)) be considered a violation until the extension period has expired.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, 246-455-100, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as 246-455-100, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), 261-50-090, filed 7/29/88; 87-08-037 (Order 87-02, Resolution No. 87-02), 261-50-090, filed 3/30/87; 87-04-008 (Order 87-01, Resolution No. 87-01), 261-50-090, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), 261-50-090, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), 261-50-090, filed 8/13/85.]

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