WSR 07-09-091

PERMANENT RULES

DEPARTMENT OF HEALTH


[ Filed April 18, 2007, 10:30 a.m. , effective May 23, 2007 ]


     Effective Date of Rule: May 23, 2007.

     Purpose: Revising chapter 246-455 WAC, Hospital inpatient discharge information reporting, also known as the comprehensive hospital abstract reporting system (CHARS).

     This rule is a response to the pending revision to the federal Uniform Billing Form (UB-04)/Centers for Medicare and Medicaid Services (CMS) in the spring of 2007. CHARS utilizes this billing document as the source of information and the rule needs to reflect the federal changes. The list of data elements collected from hospitals will increase to provide more complete data.

     Citation of Existing Rules Affected by this Order: Repealing WAC 246-455-030; and amending WAC 246-455-001, 246-455-010, 246-455-020, 246-455-040, 246-455-050, 246-455-080, and 246-455-090.

     Statutory Authority for Adoption: RCW 43.70.040 and 43.70.052.

      Adopted under notice filed as WSR 06-24-049 on December 1, 2006.

     Changes Other than Editing from Proposed to Adopted Version: WAC 246-455-090(3), the term "confidential elements" will be deleted from this section since it is both duplicative and not defined in WAC 246-455-010. The draft WAC had the term "direct identifiers" and was defined in WAC 246-455-010(11). However, we also used language relating to "individually identifiable health information." Since the phrase "individually identifiable health information" is more appropriate we incorporated the definition of "direct identifiers" into "individually identifiable health information" and changed the term "direct identifiers" to "individually identifiable health information" in the rest of the WAC. The changes are in WAC 246-455-010(10), (11) and (12), 246-455-090(2) and 246-455-090 (3)(a).

     The payer identification item was clarified by adding the parenthetical (up to three) and the words payer identification number per the CHARS procedure manual identifying each payer group from which the hospital may expect some payment of the bill.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 2, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 5, Repealed 1.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 7, Repealed 1.

     Date Adopted: April 16, 2007.

Mary C. Selecky

Secretary

OTS-9309.6


AMENDATORY SECTION(Amending WSR 03-13-029, filed 6/10/03, effective 7/11/03)

WAC 246-455-001   Purpose.   This chapter is adopted by the Washington state department of health pursuant to RCW 43.70.040, 43.70.052, and 70.170.010 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 [43.]70.170. 03-13-029, § 246-455-001, filed 6/10/03, effective 7/11/03. 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 03-13-029, filed 6/10/03, effective 7/11/03)

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 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 National Uniform Billing Committee 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) "HHA" means a home health agency.

     (10) "IV" means intravenous.

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

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

     (5) "CHARS Procedure Manual" means the written instructions for reporting hospital discharge data to the department.

     (6) "CHARS 837 Companion Guide" means the written technical guidelines for creating the ASC X12 837 Health Care Claim file for CHARS.

     (7) Uniform Billing "UB-92/UB-04 data set" means the data element specifications developed by the National Uniform Billing Committee which can be found at www.NUBC.org. The UB-92 specifications will be used until they are replaced by the UB-04 of the National Uniform Billing Committee. Data elements are completely defined in the CHARS Procedure Manual which may be obtained on the department's web site or by contacting the department.

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

     (9) "Office of Management and Budget" means a body within the Executive Office of the President of the United States which is tasked with coordinating United States Federal agencies and can be found at www.whitehouse.gov/OMB.

     (10) "Individually identifiable health information" means any health information that can be linked or traced to an individual or family. It includes but is not limited to: Past, present and future health care; billings or payments for health care; physical or mental health conditions; and physical or mental health diagnosis. This includes names and parts of names, Social Security numbers and parts of Social Security numbers, date of birth, admission date, exact discharge date, procedure date, nine-digit zip code and identifiers and patient control numbers assigned by a hospital for record retrieval.

     (11) "Minimum necessary use" means that the use and disclosure of individually identifiable health information will be limited to the minimum amount necessary to accomplish the authorized purpose.

     (12) "Data sharing agreement" means a signed agreement between government agencies, or researchers having an Institutional Review Board approval for transmitting, receiving and using records containing individually identifiable health information. Sharing such records requires each agency to have independent statutory authority to receive and disclose the information. The agreement specifies, at a minimum, what information will be exchanged, and the conditions or restrictions under which the information will be used and protected.

[Statutory Authority: RCW 43.70.040 and [43.]70.170. 03-13-029, § 246-455-010, filed 6/10/03, effective 7/11/03. 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 03-13-029, filed 6/10/03, effective 7/11/03)

WAC 246-455-020   Reporting of UB-92/UB-04 data set information.   (1) Effective ((with)) for all hospital patient discharges on or after April 1, 1994, hospitals shall collect and report the following UB-92 or ((UB-02)) UB-04 data set elements to the department:

     (a) 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) 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) Medicare provider number

((This is the number assigned to the provider by Medicare.)) (UB-92), National Provider Identifier (UB-04), or department assigned identifier, as applicable

     (d) 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.)) last name (at least the first four letters)

     (e) ((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) Birthdate

The patient's date of birth in MMDDYYYY format.

     (g) Sex

Patient's sex in M/F format.

     (h) Admission date

Admission date in MMDDYY format.

     (i) Type of admission

This field is filled with one of the following codes:


((1 Emergency
2 Urgent
3 Elective
4 Newborn))

     (j) 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) 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) Revenue code

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

     (n) 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) Total charges by revenue code category

Total charges pertaining to the related revenue code.

     (p) 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) Payer identification #2

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

     (r) 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) 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) Principal procedure code

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

     (u) Other procedure codes

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

     (v) 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) 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.)) Patient first name (at least the first three letters)

     (f) Patient middle initial

     (g) Patient Social Security number (at least the last four digits)

     (h) Patient zip code (U.S.A.)

     (i) Patient country code (outside U.S.A.)

     (j) Patient's date of birth

     (k) Sex

     (l) Admission date

     (m) Type of admission

     (n) Source of admission

     (o) Patient discharge status

     (p) Statement covers period (from - through)

     (q) Revenue code

     (r) Units of service

     (s) Total charges

     (t) Payer identification (up to three): Payer identification number per the CHARS procedure manual identifying each payer group from which the hospital may expect some payment of the bill

     (u) Principal diagnosis code

     (v) Other diagnosis codes

     (w) External cause of injury (ECI) code

     (x) Principal procedure code

     (y) Other procedure code

     (z) Attending provider identifier (legacy ID for UB-92); National Provider Identifier or legacy for UB-04 according to Centers for Medicare and Medicaid Services (CMS) schedule

     (aa) Operating physician identifier (legacy ID for UB-92); National Provider Identifier or legacy for UB-04 according to CMS schedule, as applicable

     (bb) Other provider identifiers (legacy ID for UB-92); National Provider Identifier or legacy for UB-04 according to CMS schedule, as applicable

     (cc) Admission hour

     (dd) Race - per minimum Office of Management and Budget (OMB) standards

     (ee) Ethnicity - per minimum OMB standards

     (ff) Discharge hour

     (gg) Procedure date

     (hh) Present on admission status

     (ii) Health care provider taxonomy code

     (jj) Health care common procedure coding system (HCPCS)

     (kk) Service date

     (2) The hospital shall report all ((inpatients)) patient discharge data described in WAC 246-455-010 and 246-455-020 according to UB-92/UB-04 specifications unless noted otherwise. ((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 [43.]70.170. 03-13-029, § 246-455-020, filed 6/10/03, effective 7/11/03. 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 WSR 03-13-029, filed 6/10/03, effective 7/11/03)

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 and CHARS 837 Companion Guide. Additional information not listed in WAC 246-455-020 may be required by the department to successfully process data submission files. ((A copy)) Copies of the CHARS Procedure Manual and CHARS 837 Companion Guide may be obtained on the department's web site or by contacting the department ((or on the department's web site)).

[Statutory Authority: RCW 43.70.040 and [43.]70.170. 03-13-029, § 246-455-040, filed 6/10/03, effective 7/11/03. 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 246-455-050   Time deadline for submission of data.   ((The)) Hospitals shall submit data to the department or its designee within forty-five days following the end of each calendar month.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-050, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-050, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), § 261-50-050, filed 7/29/88; 87-04-008 (Order 87-01, Resolution No. 87-01), § 261-50-050, filed 1/23/87; 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-050, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 03-13-029, filed 6/10/03, effective 7/11/03)

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

     ((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.

     Records containing confidential data elements may be disclosed for research purposes after approval from the Washington state institutional review board in accordance with RCW 42.48.020.)) (2) The department shall institute security and system safeguards to prevent and detect unauthorized access, modification, or manipulation of individually identifiable health information. Accordingly, the safeguards will include:

     (a) Documented formal procedures for handling the information;

     (b) Physical safeguards to protect computer systems and other pertinent equipment from intrusion;

     (c) Processes to protect, control and audit access to the information;

     (d) Processes to protect the information from unauthorized access or disclosure when it is transmitted over communication networks;

     (e) Processes to protect the information when it is physically moved from one location to another;

     (f) Processes to ensure the information is encrypted when:

     (i) It resides in an area that is readily accessible by individuals who are not authorized to access the information (e.g., shared network drives or outside the agency data centers);

     (ii) It is stored in a format that is easily accessible by individuals who are not authorized to access the information (e.g., text files and spreadsheets);

     (iii) It is stored on removable media, or portable devices (e.g., tapes, electronic disks, thumb drives, external hard drives, laptops and handheld devices).

[Statutory Authority: RCW 43.70.040 and [43.]70.170. 03-13-029, § 246-455-080, filed 6/10/03, effective 7/11/03. 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.)) Release of the data.   ((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 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 experienced at the hospital during that quarter, or submit the necessary corrections to the data to permit such certification.)) (1) To acknowledge the need to protect patient privacy, federal privacy rules are used as models for deidentification of individually identifiable health information and for minimum necessary disclosure of individually identifiable health information in the release of CHARS data.

     (2) Individually identifiable health information will not be released to the public.

     (3) Confidential data sets may contain all or portions of the individually identifiable health information. Confidential data sets will be released under the following conditions:

     (a) Data sets containing any of the individually identifiable health information will be constructed by applying the standard of inclusion of the minimum elements necessary for the recipient's project requirements.

     (b) Research projects may receive these data sets following approval by Washington state institutional review board, and receipt of a signed data use agreement with the board and the department of health.

     (c) Projects of state, local and federal agencies directly related to quality assurance or quality improvement of the data activities, hospitalization payment rate setting, program evaluation or public health surveillance may receive these data sets through a signed contract that includes a data use agreement.

     The department reserves the right to determine whether a use is appropriate.

     (4) The data sharing agreements for confidential data sets must include language which:

     (a) Establishes who will use and receive the data set;

     (b) Requires that the data not be used to identify or contact individuals;

     (c) Requires appropriate safeguards to prevent the use or disclosure of the information other than as provided for in the agreement;

     (d) Establishes the permitted use of the data set and excludes other uses;

     (e) Requires immediate notification to DOH of any suspected security breach;

     (f) Requires a report to DOH of any use or disclosure not permitted in the agreement;

     (g) Contains penalties for violation of the agreement;

     (h) Requires that the data set be destroyed or returned; and

     (i) Requires all users, including contractors and subcontractors, to read the agreement, abide by its provisions and sign it.

[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.]


REPEALER

     The following section of the Washington Administrative Code is repealed:
WAC 246-455-030 Reporting of E-Codes.

© Washington State Code Reviser's Office