128675-128810
HEALTH AND SAFETY CODE
SECTION 128675-128810
128675. This chapter shall be known as the Health Data and Advisory
Council Consolidation Act.
128680. The Legislature hereby finds and declares that:
(a) Significant changes have taken place in recent years in the
health care marketplace and in the manner of reimbursement to health
facilities by government and private third-party payers for the
services they provide.
(b) These changes have permitted the state to reevaluate the need
for, and the manner of data collection from health facilities by the
various state agencies and commissions.
(c) It is the intent of the Legislature that as a result of this
reevaluation that the data collection function be consolidated in a
single state agency. It is the further intent of the Legislature that
the single state agency only collect that data from health
facilities that are essential. The data should be collected, to the
extent practical on consolidated, multipurpose report forms for use
by all state agencies.
(d) It is the further intent of the Legislature to eliminate the
California Health Facilities Commission and the State Advisory Health
Council, and to create a single advisory commission to assume
consolidated data collection and planning functions.
(e) It is the Legislature's further intent that the review of the
data that the state collects be an ongoing function. The office, with
the advice of the advisory commission, shall annually review this
data for need and shall revise, add, or delete items as necessary.
The commission and the office shall consult with affected state
agencies and the affected industry when adding or eliminating data
items. However, the office shall neither add nor delete data items to
the Hospital Discharge Abstract Data Record or the quarterly reports
without prior authorizing legislation, unless specifically required
by federal law or judicial decision.
(f) The Legislature recognizes that the authority for the
California Health Facilities Commission is scheduled to expire
January 1, 1986. It is the intent of the Legislature, by the
enactment of this chapter, to continue the uniform system of
accounting and reporting established by the commission and required
for use by health facilities. It is also the intent of the
Legislature to continue an appropriate, cost-disclosure program.
128681. The office shall conduct, under contract with a qualified
consulting firm, a comprehensive review of the financial and
utilization reports that hospitals are required to file with the
office and similar reports required by other departments of state
government, as appropriate. The contracting consulting firm shall
have a strong commitment to public health and health care issues, and
shall demonstrate fiscal management and analytical expertise. The
purpose of the review is to identify opportunities to eliminate the
collection of data that no longer serve any significant purpose, to
reduce the redundant reporting of similar data to different
departments, and to consolidate reports wherever practical. The
contracting consulting firm shall evaluate specific reporting
requirements, exceptions to and exemptions from the requirements, and
areas of duplication or overlap within the requirements. The
contracting consulting firm shall consult with a broad range of data
users, including, but not limited to, consumers, payers, purchasers,
providers, employers, employees, and the organizations that represent
the data users. It is expected that the review will result in
greater efficiency in collecting and disseminating needed hospital
information to the public and will reduce hospital costs and
administrative burdens associated with reporting the information.
128685. Intermediate care facilities/developmentally
disabled-habilitative, as defined in subdivision (e) of Section 1250,
are not subject to this chapter.
128690. Intermediate care facilities/developmentally
disabled--nursing, as defined in subdivision (h) of Section 1250, are
not subject to this chapter.
128695. There is hereby created the California Health Policy and
Data Advisory Commission to be composed of 13 members.
The Governor shall appoint nine members, one of whom shall be a
hospital chief executive officer, one of whom shall be a chief
executive officer of a hospital serving a disproportionate share of
low-income patients, one of whom shall be a long-term care facility
chief executive officer, one of whom shall be a freestanding
ambulatory surgery clinic chief executive officer, one of whom shall
be a representative of the health insurance industry involved in
establishing premiums or underwriting, one of whom shall be a
representative of a group prepayment health care service plan, one of
whom shall be a representative of a business coalition concerned
with health, and two of whom shall be general members. The Speaker of
the Assembly shall appoint two members, one of whom shall be a
physician and surgeon and one of whom shall be a general member. The
Senate Rules Committee shall appoint two members, one of whom shall
be a representative of a labor coalition concerned with health, and
one of whom shall be a general member.
The Governor shall designate a member to serve as chairperson for
a two-year term. No member may serve more than two, two-year terms as
chairperson. All appointments shall be for four-year terms. No
individual shall serve more than two, four-year terms.
128700. As used in this chapter, the following terms mean:
(a) "Ambulatory surgery procedures" mean those procedures
performed on an outpatient basis in the general operating rooms,
ambulatory surgery rooms, endoscopy units, or cardiac catheterization
laboratories of a hospital or a freestanding ambulatory surgery
clinic.
(b) "Commission" means the California Health Policy and Data
Advisory Commission.
(c) "Emergency department" means, in a hospital licensed to
provide emergency medical services, the location in which those
services are provided.
(d) "Encounter" means a face-to-face contact between a patient and
the provider who has primary responsibility for assessing and
treating the condition of the patient at a given contact and
exercises independent judgment in the care of the patient.
(e) "Freestanding ambulatory surgery clinic" means a surgical
clinic that is licensed by the state under paragraph (1) of
subdivision (b) of Section 1204.
(f) "Health facility" or "health facilities" means all health
facilities required to be licensed pursuant to Chapter 2 (commencing
with Section 1250) of Division 2.
(g) "Hospital" means all health facilities except skilled nursing,
intermediate care, and congregate living health facilities.
(h) "Office" means the Office of Statewide Health Planning and
Development.
(i) "Risk-adjusted outcomes" means the clinical outcomes of
patients grouped by diagnoses or procedures that have been adjusted
for demographic and clinical factors.
128705. On and after January 1, 1986, any reference in this code to
the Advisory Health Council shall be deemed a reference to the
California Health Policy and Data Advisory Commission.
128710. The California Health Policy and Data Advisory Commission
shall meet at least once every two months, or more often if necessary
to fulfill its duties.
128715. The members of the commission shall receive per diem of one
hundred dollars ($100) for each day actually spent in the discharge
of official duties and shall be reimbursed for any actual and
necessary expenses incurred in connection with their duties as
members of the commission.
128720. The commission may appoint an executive secretary subject
to approval by the Secretary of Health and Welfare. The office shall
provide other staff to the commission as the office and the
commission deem necessary.
128725. The functions and duties of the commission shall include
the following:
(a) Advise the office on the implementation of the new,
consolidated data system.
(b) Advise the office regarding the ongoing need to collect and
report health facility data and other provider data.
(c) Annually develop a report to the director of the office
regarding changes that should be made to existing data collection
systems and forms. Copies of the report shall be provided to the
Senate Health and Human Services Committee and to the Assembly Health
Committee.
(d) Advise the office regarding changes to the uniform accounting
and reporting systems for health facilities.
(e) Conduct public meetings for the purposes of obtaining input
from health facilities, other providers, data users, and the general
public regarding this chapter and Chapter 1 (commencing with Section
127125) of Part 2 of Division 107.
(f) Advise the Secretary of Health and Welfare on the formulation
of general policies which shall advance the purposes of this part.
(g) Advise the office on the adoption, amendment, or repeal of
regulations it proposes prior to their submittal to the Office of
Administrative Law.
(h) Advise the office on the format of individual health facility
or other provider data reports and on any technical and procedural
issues necessary to implement this part.
(i) Advise the office on the formulation of general policies which
shall advance the purposes of Chapter 1 (commencing with Section
127125) of Part 2 of Division 107.
(j) Recommend, in consultation with a 12-member technical advisory
committee appointed by the chairperson of the commission, to the
office the data elements necessary for the production of outcome
reports required by Section 128745.
(k) (1) The technical advisory committee appointed pursuant to
subdivision (j) shall be composed of two members who shall be
hospital representatives appointed from a list of at least six
persons nominated by the California Association of Hospitals and
Health Systems, two members who shall be physicians and surgeons
appointed from a list of at least six persons nominated by the
California Medical Association, two members who shall be registered
nurses appointed from a list of at least six persons nominated by the
California Nurses Association, one medical record practitioner who
shall be appointed from a list of at least six persons nominated by
the California Health Information Association, one member who shall
be a representative of a hospital authorized to report as a group
pursuant to subdivision (d) of Section 128760, two members who shall
be representative of California research organizations experienced in
effectiveness review of medical procedures or surgical procedures,
or both procedures, one member representing the Health Access
Foundation, and one member representing the Consumers Union. Members
of the technical advisory committee shall serve without compensation,
but shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of the technical
advisory committee.
(2) The commission shall submit its recommendation to the office
regarding the first of the reports required pursuant to subdivision
(a) of Section 128745 no later than January 1, 1993. The technical
advisory committee shall submit its initial recommendations to the
commission pursuant to subdivision (d) of Section 128750 no later
than January 1, 1994. The commission, with the advice of the
technical advisory committee, may periodically make additional
recommendations under Sections 128745 and 128750 to the office, as
appropriate.
( l) (1) Assess the value and usefulness of the reports required
by Sections 127285, 128735, and 128740. On or before December 1,
1997, the commission shall submit recommendations to the office to
accomplish all of the following:
(A) Eliminate redundant reporting.
(B) Eliminate collection of unnecessary data.
(C) Augment data bases as deemed valuable to enhance the quality
and usefulness of data.
(D) Standardize data elements and definitions with other health
data collection programs at both the state and national levels.
(E) Enable linkage with, and utilization of, existing data sets.
(F) Improve the methodology and data bases used for quality
assessment analyses, including, but not limited to, risk-adjusted
outcome reports.
(G) Improve the timeliness of reporting and public disclosure.
(2) The commission shall establish a committee to implement the
evaluation process. The committee shall include representatives from
the health care industry, providers, consumers, payers, purchasers,
and government entities, including the Department of Managed Health
Care, the departments that comprise the Health and Welfare Agency,
and others deemed by the commission to be appropriate to the
evaluation of the data bases. The committee may establish
subcommittees including technical experts.
(3) In order to ensure the timely implementation of the provisions
of the legislation enacted in the 1997-98 Regular Session that
amended this part, the office shall present an implementation work
plan to the commission. The work plan shall clearly define goals and
significant steps within specified timeframes that must be completed
in order to accomplish the purposes of that legislation. The office
shall make periodic progress reports based on the work plan to the
commission. The commission may advise the Secretary of Health and
Welfare of any significant delays in following the work plan. If the
commission determines that the office is not making significant
progress toward achieving the goals outlined in the work plan, the
commission shall notify the office and the secretary of that
determination. The commission may request the office to submit a plan
of correction outlining specific remedial actions and timeframes for
compliance. Within 90 days of notification, the office shall submit
a plan of correction to the commission.
(m) (1) As the office and the commission deem necessary, the
commission may establish committees and appoint persons who are not
members of the commission to these committees as are necessary to
carry out the purposes of the commission. Representatives of area
health planning agencies shall be invited, as appropriate, to serve
on committees established by the office and the commission relative
to the duties and responsibilities of area health planning agencies.
Members of the standing committees shall serve without compensation,
but shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of these
committees.
(2) Whenever the office or the commission does not accept the
advice of the other body on proposed regulations or on major policy
issues, the office or the commission shall provide a written response
on its action to the other body within 30 days, if so requested.
(3) The commission or the office director may appeal to the
Secretary of Health and Welfare over disagreements on policy,
procedural, or technical issues.
128730. (a) Effective January 1, 1986, the office shall be the
single state agency designated to collect the following health
facility or clinic data for use by all state agencies:
(1) That data required by the office pursuant to Section 127285.
(2) That data required in the Medi-Cal cost reports pursuant to
Section 14170 of the Welfare and Institutions Code.
(3) Those data items formerly required by the California Health
Facilities Commission that are listed in Sections 128735 and 128740.
Information collected pursuant to subdivision (g) of Section 128735
and Sections 128736 and 128737 shall be made available to the State
Department of Health Care Services and the State Department of Public
Health. The departments shall ensure that the patient's rights to
confidentiality shall not be violated in any manner. The departments
shall comply with all applicable policies and requirements involving
review and oversight by the State Committee for the Protection of
Human Subjects.
(b) The office shall consolidate any and all of the reports listed
under this section or Sections 128735 and 128740, to the extent
feasible, to minimize the reporting burdens on hospitals, provided,
however, that the office shall neither add nor delete data items from
the Hospital Discharge Abstract Data Record or the quarterly reports
without prior authorizing legislation, unless specifically required
by federal law or regulation or judicial decision.
128735. An organization that operates, conducts, owns, or maintains
a health facility, and the officers thereof, shall make and file
with the office, at the times as the office shall require, all of the
following reports on forms specified by the office that shall be in
accord, if applicable, with the systems of accounting and uniform
reporting required by this part, except that the reports required
pursuant to subdivision (g) shall be limited to hospitals:
(a) A balance sheet detailing the assets, liabilities, and net
worth of the health facility at the end of its fiscal year.
(b) A statement of income, expenses, and operating surplus or
deficit for the annual fiscal period, and a statement of ancillary
utilization and patient census.
(c) A statement detailing patient revenue by payer, including, but
not limited to, Medicare, Medi-Cal, and other payers, and revenue
center, except that hospitals authorized to report as a group
pursuant to subdivision (d) of Section 128760 are not required to
report revenue by revenue center.
(d) A statement of cashflows, including, but not limited to,
ongoing and new capital expenditures and depreciation.
(e) A statement reporting the information required in subdivisions
(a), (b), (c), and (d) for each separately licensed health facility
operated, conducted, or maintained by the reporting organization,
except those hospitals authorized to report as a group pursuant to
subdivision (d) of Section 128760.
(f) Data reporting requirements established by the office shall be
consistent with national standards, as applicable.
(g) A Hospital Discharge Abstract Data Record that includes all of
the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) ZIP Code.
(5) Principal language spoken.
(6) Patient social security number, if it is contained in the
patient's medical record.
(7) Prehospital care and resuscitation, if any, including all of
the following:
(A) "Do not resuscitate" (DNR) order at admission.
(B) "Do not resuscitate" (DNR) order after admission.
(8) Admission date.
(9) Source of admission.
(10) Type of admission.
(11) Discharge date.
(12) Principal diagnosis and whether the condition was present at
admission.
(13) Other diagnoses and whether the conditions were present at
admission.
(14) External cause of injury.
(15) Principal procedure and date.
(16) Other procedures and dates.
(17) Total charges.
(18) Disposition of patient.
(19) Expected source of payment.
(20) Elements added pursuant to Section 128738.
(h) It is the intent of the Legislature that the patient's rights
of confidentiality shall not be violated in any manner. Patient
social security numbers and other data elements that the office
believes could be used to determine the identity of an individual
patient shall be exempt from the disclosure requirements of the
California Public Records Act (Chapter 3.5 (commencing with Section
6250) of Division 7 of Title 1 of the Government Code).
(i) A person reporting data pursuant to this section shall not be
liable for damages in an action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(g).
(j) A hospital shall use coding from the International
Classification of Diseases in reporting diagnoses and procedures.
128736. (a) Each hospital shall file an Emergency Care Data Record
for each patient encounter in a hospital emergency department. The
Emergency Care Data Record shall include all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) Ethnicity.
(5) Principal language spoken.
(6) ZIP Code.
(7) Patient social security number, if it is contained in the
patient's medical record.
(8) Service date.
(9) Principal diagnosis.
(10) Other diagnoses.
(11) Principal external cause of injury.
(12) Other external cause of injury.
(13) Principal procedure.
(14) Other procedures.
(15) Disposition of patient.
(16) Expected source of payment.
(17) Elements added pursuant to Section 128738.
(b) It is the expressed intent of the Legislature that the patient'
s rights of confidentiality shall not be violated in any manner.
Patient social security numbers and any other data elements that the
office believes could be used to determine the identity of an
individual patient shall be exempt from the disclosure requirements
of the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(c) No person reporting data pursuant to this section shall be
liable for damages in any action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(a).
(d) Data reporting requirements established by the office shall be
consistent with national standards as applicable.
(e) This section shall become operative on January 1, 2004.
128737. (a) Each general acute care hospital and freestanding
ambulatory surgery clinic shall file an Ambulatory Surgery Data
Record for each patient encounter during which at least one
ambulatory surgery procedure is performed. The Ambulatory Surgery
Data Record shall include all of the following:
(1) Date of birth.
(2) Sex.
(3) Race.
(4) Ethnicity.
(5) Principal language spoken.
(6) ZIP Code.
(7) Patient social security number, if it is contained in the
patient's medical record.
(8) Service date.
(9) Principal diagnosis.
(10) Other diagnoses.
(11) Principal procedure.
(12) Other procedures.
(13) Principal external cause of injury, if known.
(14) Other external cause of injury, if known.
(15) Disposition of patient.
(16) Expected source of payment.
(17) Elements added pursuant to Section 128738.
(b) It is the expressed intent of the Legislature that the patient'
s rights of confidentiality shall not be violated in any manner.
Patient social security numbers and any other data elements that the
office believes could be used to determine the identity of an
individual patient shall be exempt from the disclosure requirements
of the California Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
(c) No person reporting data pursuant to this section shall be
liable for damages in any action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of subdivision
(a).
(d) Data reporting requirements established by the office shall be
consistent with national standards as applicable.
(e) This section shall become operative on January 1, 2004.
128738. (a) The office, based upon review and recommendations of
the commission and its appropriate committees, shall allow and
provide for, in accordance with appropriate regulations, additions or
deletions to the patient level data elements listed in subdivision
(g) of Section 128735, Section 128736, and Section 128737, to meet
the purposes of this chapter.
(b) Prior to any additions or deletions, all of the following
shall be considered:
(1) Utilization of sampling to the maximum extent possible.
(2) Feasibility of collecting data elements.
(3) Costs and benefits of collection and submission of data.
(4) Exchange of data elements as opposed to addition of data
elements.
(c) The office shall add no more than a net of 15 elements to each
data set over any five-year period. Elements contained in the
uniform claims transaction set or uniform billing form required by
the Health Insurance Portability and Accountability Act of 1996 (42
U.S.C. Sec. 300gg) shall be exempt from the 15-element limit.
(d) The commission and the office, in order to minimize costs and
administrative burdens, shall consider the total number of data
elements required from hospitals and freestanding ambulatory surgery
clinics, and optimize the use of common data elements.
128740. (a) Commencing with the first calendar quarter of 1992, the
following summary financial and utilization data shall be reported
to the office by each hospital within 45 days of the end of every
calendar quarter. Adjusted reports reflecting changes as a result of
audited financial statements may be filed within four months of the
close of the hospital's fiscal or calendar year. The quarterly
summary financial and utilization data shall conform to the uniform
description of accounts as contained in the Accounting and Reporting
Manual for California Hospitals and shall include all of the
following:
(1) Number of licensed beds.
(2) Average number of available beds.
(3) Average number of staffed beds.
(4) Number of discharges.
(5) Number of inpatient days.
(6) Number of outpatient visits.
(7) Total operating expenses.
(8) Total inpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(9) Total outpatient gross revenues by payer, including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(10) Deductions from revenue in total and by component, including
the following: Medicare contractual adjustments, Medi-Cal contractual
adjustments, and county indigent program contractual adjustments,
other contractual adjustments, bad debts, charity care, restricted
donations and subsidies for indigents, support for clinical teaching,
teaching allowances, and other deductions.
(11) Total capital expenditures.
(12) Total net fixed assets.
(13) Total number of inpatient days, outpatient visits, and
discharges by payer, including Medicare, Medi-Cal, county indigent
programs, other third parties, self-pay, charity, and other payers.
(14) Total net patient revenues by payer including Medicare,
Medi-Cal, county indigent programs, other third parties, and other
payers.
(15) Other operating revenue.
(16) Nonoperating revenue net of nonoperating expenses.
(b) Hospitals reporting pursuant to subdivision (d) of Section
128760 may provide the items in paragraphs (7), (8), (9), (10), (14),
(15), and (16) of subdivision (a) on a group basis, as described in
subdivision (d) of Section 128760.
(c) The office shall make available at cost, to any person, a hard
copy of any hospital report made pursuant to this section and in
addition to hard copies, shall make available at cost, a computer
tape of all reports made pursuant to this section within 105 days of
the end of every calendar quarter.
(d) The office, with the advice of the commission, shall adopt by
regulation guidelines for the identification, assessment, and
reporting of charity care services. In establishing the guidelines,
the office shall consider the principles and practices recommended by
professional health care industry accounting associations for
differentiating between charity services and bad debts. The office
shall further conduct the onsite validations of health facility
accounting and reporting procedures and records as are necessary to
assure that reported data are consistent with regulatory guidelines.
This section shall become operative January 1, 1992.
128745. (a) Commencing July 1993, and annually thereafter, the
office shall publish risk-adjusted outcome reports in accordance with
the following schedule:
Procedures and
Publication Period Conditions
Date Covered Covered
July 1993 1988-90 3
July 1994 1989-91 6
July 1995 1990-92 9
Reports for subsequent years shall include conditions and
procedures and cover periods as appropriate.
(b) The procedures and conditions required to be reported under
this chapter shall be divided among medical, surgical, and obstetric
conditions or procedures and shall be selected by the office, based
on the recommendations of the commission and the advice of the
technical advisory committee set forth in subdivision (j) of Section
128725. The office shall publish the risk-adjusted outcome reports
for surgical procedures by individual hospital and individual surgeon
unless the office in consultation with the technical advisory
committee and medical specialists in the relevant area of practice
determines that it is not appropriate to report by individual
surgeon. The office, in consultation with the technical advisory
committee and medical specialists in the relevant area of practice,
may decide to report nonsurgical procedures and conditions by
individual physician when it is appropriate. The selections shall be
in accordance with all of the following criteria:
(1) The patient discharge abstract contains sufficient data to
undertake a valid risk adjustment. The risk adjustment report shall
ensure that public hospitals and other hospitals serving primarily
low-income patients are not unfairly discriminated against.
(2) The relative importance of the procedure and condition in
terms of the cost of cases and the number of cases and the
seriousness of the health consequences of the procedure or condition.
(3) Ability to measure outcome and the likelihood that care
influences outcome.
(4) Reliability of the diagnostic and procedure data.
(c) (1) In addition to any other established and pending reports,
on or before July 1, 2002, the office shall publish a risk-adjusted
outcome report for coronary artery bypass graft surgery by hospital
for all hospitals opting to participate in the report. This report
shall be updated on or before July 1, 2003.
(2) In addition to any other established and pending reports,
commencing July 1, 2004, and every year thereafter, the office shall
publish risk-adjusted outcome reports for coronary artery bypass
graft surgery for all coronary artery bypass graft surgeries
performed in the state. In each year, the reports shall compare
risk-adjusted outcomes by hospital, and in every other year, by
hospital and cardiac surgeon. Upon the recommendation of the
technical advisory committee based on statistical and technical
considerations, information on individual hospitals and surgeons may
be excluded from the reports.
(3) Unless otherwise recommended by the clinical panel established
by Section 128748, the office shall collect the same data used for
the most recent risk-adjusted model developed for the California
Coronary Artery Bypass Graft Mortality Reporting Program. Upon
recommendation of the clinical panel, the office may add any clinical
data elements included in the Society of Thoracic Surgeons'
database. Prior to any additions from the Society of Thoracic
Surgeons' database, the following factors shall be considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Exchange of data elements as opposed to addition of data
elements.
(4) Upon recommendation of the clinical panel, the office may add,
delete, or revise clinical data elements, but shall add no more than
a net of six elements not included in the Society of Thoracic
Surgeons' database, to the data set over any five-year period. Prior
to any additions or deletions, all of the following factors shall be
considered:
(A) Utilization of sampling to the maximum extent possible.
(B) Feasibility of collecting data elements.
(C) Costs and benefits of collection and submission of data.
(D) Exchange of data elements as opposed to addition of data
elements.
(5) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model for the
coronary artery bypass graft report.
(6) Patient medical record numbers and any other data elements
that the office believes could be used to determine the identity of
an individual patient shall be exempt from the disclosure
requirements of the California Public Records Act (Chapter 3.5
(commencing with Section 6250) of Division 7 of Title 1 of the
Government Code).
(d) The annual reports shall compare the risk-adjusted outcomes
experienced by all patients treated for the selected conditions and
procedures in each California hospital during the period covered by
each report, to the outcomes expected. Outcomes shall be reported in
the five following groupings for each hospital:
(1) "Much higher than average outcomes," for hospitals with
risk-adjusted outcomes much higher than the norm.
(2) "Higher than average outcomes," for hospitals with
risk-adjusted outcomes higher than the norm.
(3) "Average outcomes," for hospitals with average risk-adjusted
outcomes.
(4) "Lower than average outcomes," for hospitals with
risk-adjusted outcomes lower than the norm.
(5) "Much lower than average outcomes," for hospitals with
risk-adjusted outcomes much lower than the norm.
(e) For coronary artery bypass graft surgery reports and any other
outcome reports for which auditing is appropriate, the office shall
conduct periodic auditing of data at hospitals.
(f) The office shall publish in the annual reports required under
this section the risk-adjusted mortality rate for each hospital and
for those reports that include physician reporting, for each
physician.
(g) The office shall either include in the annual reports required
under this section, or make separately available at cost to any
person requesting it, risk-adjusted outcomes data assessing the
statistical significance of hospital or physician data at each of the
following three levels: 99-percent confidence level (0.01 p-value),
95-percent confidence level (0.05 p-value), and 90-percent confidence
level (0.10 p-value). The office shall include any other analysis or
comparisons of the data in the annual reports required under this
section that the office deems appropriate to further the purposes of
this chapter.
128747. Commencing July 1, 2002, and biennially thereafter, the
office shall evaluate the impact of the office's published
risk-adjusted outcome reports required by Sections 128745 and 128746
on mortality rates in California and on any other measure of quality
the office deems appropriate. The office shall also coordinate with
other state agencies in promoting prevention and educational
initiatives on those reported procedures and conditions.
128748. (a) This section shall apply to any risk-adjusted outcome
report that includes reporting of data by an individual physician.
(b) (1) The office shall obtain data necessary to complete a
risk-adjusted outcome report from hospitals. If necessary data for an
outcome report is available only from the office of a physician and
not the hospital where the patient received treatment, then the
hospital shall make a reasonable effort to obtain the data from the
physician's office and provide the data to the office. In the event
that the office finds any errors, omissions, discrepancies, or other
problems with submitted data, the office shall contact either the
hospital or physician's office that maintains the data to resolve the
problems.
(2) The office shall collect the minimum data necessary for
purposes of testing or validating a risk-adjusted model. Except for
data collected for purposes of testing or validating a risk-adjusted
model, the office shall not collect data for an outcome report nor
issue an outcome report until the clinical panel established pursuant
to this section has approved the risk-adjusted model.
(c) For each risk-adjusted outcome report on a medical, surgical,
or obstetric condition or procedure that includes reporting of data
by an individual physician, the office director shall appoint a
clinical panel, which shall have nine members. Three members shall be
appointed from a list of three or more names submitted by the
physician specialty society that most represents physicians
performing the medical, surgical, and obstetric procedure for which
data is collected. Three members shall be appointed from a list of
three or more names submitted by the California Medical Association.
Three members shall be appointed from lists of names submitted by
consumer organizations. At least one-half of the appointees from the
lists submitted by the physician specialty society and the California
Medical Association, and at least one appointee from the lists
submitted by consumer organizations, shall be experts in collecting
and reporting outcome measurements for physicians or hospitals. The
panel may include physicians from another state. The panel shall
review and approve the development of the risk-adjustment model to be
used in preparation of the outcome report.
(d) For the clinical panel authorized by subdivision (c) for
coronary artery bypass graft surgery, three members shall be
appointed from a list of three or more names submitted by the
California Chapter of the American College of Cardiology. Three
members shall be appointed from list of three or more names submitted
by the California Medical Association. Three members shall be
appointed from lists of names submitted by consumer organizations. At
least one-half of the appointees from the lists submitted by the
California Chapter of the American College of Cardiology, and the
California Medical Association, and at least one appointee from the
lists submitted by consumer organizations, shall be experts in
collecting and reporting outcome measurements for physicians and
surgeons or hospitals. The panel may include physicians from another
state. The panel shall review and approve the development of the
risk-adjustment model to be used in preparation of the outcome
report.
(e) Any report that includes reporting by an individual physician
shall include, at a minimum, the risk-adjusted outcome data for each
physician. The office may also include in the report, after
consultation with the clinical panel, any explanatory material,
comparisons, groupings, and other information to facilitate consumer
comprehension of the data.
(f) Members of a clinical panel shall serve without compensation,
but shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of the clinical
panel.
128750. (a) Prior to the public release of the annual outcome
reports, the office shall furnish a preliminary report to each
hospital that is included in the report. The office shall allow the
hospital and chief of staff 60 days to review the outcome scores and
compare the scores to other California hospitals. A hospital or its
chief of staff that believes that the risk-adjusted outcomes do not
accurately reflect the quality of care provided by the hospital may
submit a statement to the office, within the 60 days, explaining why
the outcomes do not accurately reflect the quality of care provided
by the hospital. The statement shall be included in an appendix to
the public report, and a notation that the hospital or its chief of
staff has submitted a statement shall be displayed wherever the
report presents outcome scores for the hospital.
(b) (1) Prior to the public release of any outcome report that
includes data by a physician, the office shall furnish a preliminary
report to each physician that is included in the report. The office
shall allow the physician 30 days from the date the office sends the
report to the physician to review the outcome scores and compare the
scores to other California physicians. A physician who believes that
the risk-adjusted outcome does not accurately reflect the quality of
care provided by the physician may submit a statement to the office
within the 30 days, explaining why the outcomes do not accurately
reflect the quality of care provided by the physician.
(2) The office shall promptly review the physician's statement and
shall respond to the physician with one of the following
conclusions:
(A) The physician's statement reveals a flaw in the accuracy of
the reported data relating to the physician that materially
diminishes the validity of the report. If this finding is made, the
data for that physician shall not be included in the report until the
flaw in the physician's data is corrected.
(B) The physician's statement reveals a flaw in the
risk-adjustment model that materially diminishes the value of the
report for all physicians. If this finding is made, the report using
that risk-adjustment model shall not be issued until the flaw is
corrected.
(C) The physician's statement does not reveal a flaw in either the
accuracy of the reported data relating to the physician or the
risk-adjustment model in which case the report shall be used, unless
the physician chooses to use the procedure set forth in paragraph
(3).
(3) If a physician is not satisfied with the conclusion reached by
the office, the physician shall notify the office of that fact. Upon
receipt of the notice, the office shall forward the physician's
statement to the appropriate clinical panel appointed pursuant to
Section 128748. The office shall forward the physician's statement
with any information identifying the physician or the physician's
hospital redacted, or shall adopt other means to ensure the physician'
s identity is not revealed to the panel. The clinical panel shall
promptly review the physician statement and the conclusion of the
office and shall respond by either upholding the conclusion or
reaching one of the other conclusions set forth in this subdivision.
The panel decision shall be the final determination regarding the
physician's statement. The process set forth in this subdivision
shall be completed within 60 days from the date the office sends the
report to each physician included in the report. If a decision by
either the office or the clinical panel cannot be reached within the
60-day period, then the outcome report may be issued but shall not
include data for the physician submitting the statement.
(c) The office shall, in addition to public reports, provide
hospitals and the chiefs of staff of the medical staffs with a report
containing additional detailed information derived from data
summarized in the public outcome reports as an aid to internal
quality assurance.
(d) If, pursuant to the recommendations of the office, based on
the advice of the commission, in response to the recommendations of
the technical advisory committee made pursuant to subdivision (d) of
this section, the Legislature subsequently amends Section 128735 to
authorize the collection of additional discharge data elements, then
the outcome reports for conditions and procedures for which
sufficient data is not available from the current abstract record
will be produced following the collection and analysis of the
additional data elements.
(e) The recommendations of the technical advisory committee for
the addition of data elements to the discharge abstract should take
into consideration the technical feasibility of developing reliable
risk-adjustment factors for additional procedures and conditions as
determined by the technical advisory committee with the advice of the
research community, physicians and surgeons, hospitals, consumer or
patient advocacy groups, and medical records personnel.
(f) The technical advisory committee at a minimum shall identify a
limited set of core clinical data elements to be collected for all
of the added procedures and conditions and unique clinical variables
necessary for risk adjustment of specific conditions and procedures
selected for the outcomes report program. In addition, the committee
should give careful consideration to the costs associated with the
additional data collection and the value of the specific information
to be collected.
(g) The technical advisory committee shall also engage in a
continuing process of data development and refinement applicable to
both current and prospective outcome studies.
128755. (a) (1) Hospitals shall file the reports required by
subdivisions (a), (b), (c), and (d) of Section 128735 with the office
within four months after the close of the hospital's fiscal year
except as provided in paragraph (2).
(2) If a licensee relinquishes the facility license or puts the
facility license in suspense, the last day of active licensure shall
be deemed a fiscal year end.
(3) The office shall make the reports filed pursuant to this
subdivision available no later than three months after they were
filed.
(b) (1) Skilled nursing facilities, intermediate care facilities,
intermediate care facilities/developmentally disabled, and congregate
living facilities, including nursing facilities certified by the
state department to participate in the Medi-Cal program, shall file
the reports required by subdivisions (a), (b), (c), and (d) of
Section 128735 with the office within four months after the close of
the facility's fiscal year, except as provided in paragraph (2).
(2) (A) If a licensee relinquishes the facility license or puts
the facility licensure in suspense, the last day of active licensure
shall be deemed a fiscal year end.
(B) If a fiscal year end is created because the facility license
is relinquished or put in suspense, the facility shall file the
reports required by subdivisions (a), (b), (c), and (d) of Section
128735 within two months after the last day of active licensure.
(3) The office shall make the reports filed pursuant to paragraph
(1) available not later than three months after they are filed.
(4) (A) Effective for fiscal years ending on or after December 31,
1991, the reports required by subdivisions (a), (b), (c), and (d) of
Section 128735 shall be filed with the office by electronic media,
as determined by the office.
(B) Congregate living health facilities are exempt from the
electronic media reporting requirements of subparagraph (A).
(c) A hospital shall file the reports required by subdivision (g)
of Section 128735 as follows:
(1) For patient discharges on or after January 1, 1999, through
December 31, 1999, the reports shall be filed semiannually by each
hospital or its designee not later than six months after the end of
each semiannual period, and shall be available from the office no
later than six months after the date that the report was filed.
(2) For patient discharges on or after January 1, 2000, through
December 31, 2000, the reports shall be filed semiannually by each
hospital or its designee not later than three months after the end of
each semiannual period. The reports shall be filed by electronic
tape, diskette, or similar medium as approved by the office. The
office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the date that the report
is approved.
(3) For patient discharges on or after January 1, 2001, the
reports shall be filed by each hospital or its designee for report
periods and at times determined by the office. The reports shall be
filed by online transmission in formats consistent with national
standards for the exchange of electronic information. The office
shall approve or reject each report within 15 days of receiving it.
If a report does not meet the standards established by the office, it
shall not be approved as filed and shall be rejected. The report
shall be considered not filed as of the date the facility is notified
that the report is rejected. A report shall be available from the
office no later than 15 days after the date that the report is
approved.
(d) The reports required by subdivision (a) of Section 128736
shall be filed by each hospital for report periods and at times
determined by the office. The reports shall be filed by online
transmission in formats consistent with national standards for the
exchange of electronic information. The office shall approve or
reject each report within 15 days of receiving it. If a report does
not meet the standards established by the office, it shall not be
approved as filed and shall be rejected. The report shall be
considered not filed as of the date the facility is notified that the
report is rejected. A report shall be available from the office no
later than 15 days after the report is approved.
(e) The reports required by subdivision (a) of Section 128737
shall be filed by each hospital or freestanding ambulatory surgery
clinic for report periods and at times determined by the office. The
reports shall be filed by online transmission in formats consistent
with national standards for the exchange of electronic information.
The office shall approve or reject each report within 15 days of
receiving it. If a report does not meet the standards established by
the office, it shall not be approved as filed and shall be rejected.
The report shall be considered not filed as of the date the facility
is notified that the report is rejected. A report shall be available
from the office no later than 15 days after the report is approved.
(f) Facilities shall not be required to maintain a full-time
electronic connection to the office for the purposes of online
transmission of reports as specified in subdivisions (c), (d), and
(e). The office may grant exemptions to the online transmission of
data requirements for limited periods to facilities. An exemption may
be granted only to a facility that submits a written request and
documents or demonstrates a specific need for an exemption.
Exemptions shall be granted for no more than one year at a time, and
for no more than a total of five consecutive years.
(g) The reports referred to in paragraph (2) of subdivision (a) of
Section 128730 shall be filed with the office on the dates required
by applicable law and shall be available from the office no later
than six months after the date that the report was filed.
(h) The office shall post on its Web site and make available to
any person a copy of any report referred to in subdivision (a), (b),
(c), (d), or (g) of Section 128735, subdivision (a) of Section
128736, subdivision (a) of Section 128737, Section 128740, and, in
addition, shall make available in electronic formats reports referred
to in subdivision (a), (b), (c), (d), or (g) of Section 128735,
subdivision (a) of Section 128736, subdivision (a) of Section 128737,
Section 128740, and subdivisions (a) and (c) of Section 128745,
unless the office determines that an individual patient's rights of
confidentiality would be violated. The office shall make the reports
available at cost.
128760. (a) On and after January 1, 1986, those systems of health
facility accounting and auditing formerly approved by the California
Health Facilities Commission shall remain in full force and effect
for use by health facilities but shall be maintained by the office
with the advice of the Health Policy and Data Advisory Commission.
(b) The office, with the advice of the commission, shall allow and
provide, in accordance with appropriate regulations, for
modifications in the accounting and reporting systems for use by
health facilities in meeting the requirements of this chapter if the
modifications are necessary to do any of the following:
(1) To correctly reflect differences in size of, provision of, or
payment for, services rendered by health facilities.
(2) To correctly reflect differences in scope, type, or method of
provision of, or payment for, services rendered by health facilities.
(3) To avoid unduly burdensome costs for those health facilities
in meeting the requirements of differences pursuant to paragraphs (1)
and (2).
(c) Modifications to discharge data reporting requirements. The
office, with the advice of the commission, shall allow and provide,
in accordance with appropriate regulations, for modifications to
discharge data reporting format and frequency requirements if these
modifications will not impair the office's ability to process the
data or interfere with the purposes of this chapter. This
modification authority shall not be construed to permit the office to
administratively require the reporting of discharge data items not
specified pursuant to Section 128735.
(d) Modifications to emergency care data reporting requirements.
The office, with the advice of the commission, shall allow and
provide, in accordance with appropriate regulations, for
modifications to emergency care data reporting format and frequency
requirements if these modifications will not impair the office's
ability to process the data or interfere with the purposes of this
chapter. This modification authority shall not be construed to permit
the office to require administratively the reporting of emergency
care data items not specified in subdivision (a) of Section 128736.
(e) Modifications to ambulatory surgery data reporting
requirements. The office, with the advice of the commission, shall
allow and provide, in accordance with appropriate regulations, for
modifications to ambulatory surgery data reporting format and
frequency requirements if these modifications will not impair the
office's ability to process the data or interfere with the purposes
of this chapter. The modification authority shall not be construed to
permit the office to require administratively the reporting of
ambulatory surgery data items not specified in subdivision (a) of
Section 128737.
(f) Reporting provisions for health facilities. The office, with
the advice of the commission, shall establish specific reporting
provisions for health facilities that receive a preponderance of
their revenue from associated comprehensive group-practice prepayment
health care service plans. These health facilities shall be
authorized to utilize established accounting systems, and to report
costs and revenues in a manner that is consistent with the operating
principles of these plans and with generally accepted accounting
principles. When these health facilities are operated as units of a
coordinated group of health facilities under common management, they
shall be authorized to report as a group rather than as individual
institutions. As a group, they shall submit a consolidated income and
expense statement.
(g) Hospitals authorized to report as a group under this
subdivision may elect to file cost data reports required under the
regulations of the Social Security Administration in its
administration of Title XVIII of the federal Social Security Act in
lieu of any comparable cost reports required under Section 128735.
However, to the extent that cost data is required from other
hospitals, the cost data shall be reported for each individual
institution.
(h) The office, with the advice of the commission, shall adopt
comparable modifications to the financial reporting requirements of
this chapter for county hospital systems consistent with the purposes
of this chapter.
128765. (a) The office, with the advice of the commission, shall
maintain a file of all the reports filed under this chapter at its
Sacramento office. Subject to any rules the office, with the advice
of the commission, may prescribe, these reports shall be produced and
made available for inspection upon the demand of any person, and
shall also be posted on its Web site, with the exception of discharge
and encounter data that shall be available for public inspection
unless the office determines, pursuant to applicable law, that an
individual patient's rights of confidentiality would be violated.
(b) The reports published pursuant to Section 128745 shall include
an executive summary, written in plain English to the maximum extent
practicable, that shall include, but not be limited to, a discussion
of findings, conclusions, and trends concerning the overall quality
of medical outcomes, including a comparison to reports from prior
years, for the procedure or condition studied by the report. The
office shall disseminate the reports as widely as practical to
interested parties, including, but not limited to, hospitals,
providers, the media, purchasers of health care, consumer or patient
advocacy groups, and individual consumers. The reports shall be
posted on the office's Internet Web site.
(c) Copies certified by the office as being true and correct
copies of reports properly filed with the office pursuant to this
chapter, together with summaries, compilations, or supplementary
reports prepared by the office, shall be introduced as evidence,
where relevant, at any hearing, investigation, or other proceeding
held, made, or taken by any state, county, or local governmental
agency, board, or commission that participates as a purchaser of
health facility services pursuant to the provisions of a publicly
financed state or federal health care program. Each of these state,
county, or local governmental agencies, boards, and commissions shall
weigh and consider the reports made available to it pursuant to the
provisions of this subdivision in its formulation and implementation
of policies, regulations, or procedures regarding reimbursement
methods and rates in the administration of these publicly financed
programs.
(d) The office, with the advice of the commission, shall compile
and publish summaries of individual facility and aggregate data that
do not contain patient-specific information for the purpose of public
disclosure. The summaries shall be posted on the office's Internet
Web site. The commission shall approve the policies and procedures
relative to the manner of data disclosure to the public. The office,
with the advice of the commission, may initiate and conduct studies
as it determines will advance the purposes of this chapter.
(e) In order to assure that accurate and timely data are available
to the public in useful formats, the office shall establish a public
liaison function. The public liaison shall provide technical
assistance to the general public on the uses and applications of
individual and aggregate health facility data and shall provide the
director and the commission with an annual report on changes that can
be made to improve the public's access to data.
128766. (a) Notwithstanding Section 128765 or any other provision
of law, the office, upon request, shall disclose information
collected pursuant to subdivision (g) of Section 128735 and Sections
128736 and 128737, to any California hospital and any local health
department or local health officer in California as set forth in Part
3 (commencing with Section 101000) of Division 101. The office shall
disclose this same information to the National Center for Health
Statistics or any other unit of the Centers for Disease Control and
Prevention, or the Agency for Healthcare Research and Quality of the
United States Department of Health and Human Services, for the
purposes of conducting a statutorily authorized activity. All
disclosures made pursuant to this section shall be consistent with
the standards and limitations applicable to the disclosure of limited
data sets as provided in Section 164.514 of Part 164 of Title 45 of
the Code of Federal Regulations, relating to the privacy of health
information.
(b) Any hospital that receives information pursuant to this
section shall not disclose that information to any person or entity,
except in response to a court order, search warrant, or subpoena, or
as otherwise required or permitted by the federal medical privacy
regulations contained in Parts 160 and 164 of Title 45 of the Code of
Federal Regulations. In no case shall a hospital, contractor, or
subcontractor reidentify or attempt to reidentify any information
received pursuant to this section.
(c) No disclosure shall be made pursuant to this section if the
director of the office has determined that the disclosure would
create an unreasonable risk to patient privacy. The director shall
provide a written explanation of the determination to the requester
within 60 days.
128770. (a) Any health facility or freestanding ambulatory surgery
clinic that does not file any report as required by this chapter with
the office is liable for a civil penalty of one hundred dollars
($100) a day for each day the filing of any report is delayed. No
penalty shall be imposed if an extension is granted in accordance
with the guidelines and procedures established by the office, with
the advice of the commission.
(b) Any health facility that does not use an approved system of
accounting pursuant to the provisions of this chapter for purposes of
submitting financial and statistical reports as required by this
chapter shall be liable for a civil penalty of not more than five
thousand dollars ($5,000).
(c) Civil penalties are to be assessed and recovered in a civil
action brought in the name of the people of the State of California
by the office. Assessment of a civil penalty may, at the request of
any health facility or freestanding ambulatory surgery clinic, be
reviewed on appeal, and the penalty may be reduced or waived for good
cause.
(d) Any money that is received by the office pursuant to this
section shall be paid into the General Fund.
128775. (a) Any health facility or freestanding ambulatory surgery
clinic affected by any determination made under this part by the
office may petition the office for review of the decision. This
petition shall be filed with the office within 15 business days, or
within a greater time as the office, with the advice of the
commission, may allow, and shall specifically describe the matters
which are disputed by the petitioner.
(b) A hearing shall be commenced within 60 calendar days of the
date on which the petition was filed. The hearing shall be held
before an employee of the office, an administrative law judge
employed by the Office of Administrative Hearings, or a committee of
the commission chosen by the chairperson for this purpose. If held
before an employee of the office or a committee of the commission,
the hearing shall be held in accordance with any procedures as the
office, with the advice of the commission, shall prescribe. If held
before an administrative law judge employed by the Office of
Administrative Hearings, the hearing shall be held in accordance with
Chapter 5 (commencing with Section 11500) of Part 1 of Division 3 of
Title 2 of the Government Code. The employee, administrative law
judge, or committee shall prepare a recommended decision including
findings of fact and conclusions of law and present it to the office
for its adoption. The decision of the office shall be in writing and
shall be final. The decision of the office shall be made within 60
calendar days after the conclusion of the hearing and shall be
effective upon filing and service upon the petitioner.
(c) Judicial review of any final action, determination, or
decision may be had by any party to the proceedings as provided in
Section 1094.5 of the Code of Civil Procedure. The decision of the
office shall be upheld against a claim that its findings are not
supported by the evidence unless the court determines that the
findings are not supported by substantial evidence.
(d) The employee of the office, the administrative law judge
employed by the Office of Administrative Hearings, the Office of
Administrative Hearings, or the committee of the commission may issue
subpoenas and subpoenas duces tecum in a manner and subject to the
conditions established by Article 11 (commencing with Section
11450.10) of Chapter 4.5 of Part 1 of Division 3 of Title 2 of the
Government Code.
(e) This section shall become operative on July 1, 1997.
128780. Notwithstanding any other provision of law, the disclosure
aspects of this chapter shall be deemed complete with respect to
district hospitals, and no district hospital shall be required to
report or disclose any additional financial or utilization data to
any person or other entity except as is required by this chapter.
128782. Notwithstanding any other provision of law, upon the
request of a small and rural hospital, as defined in Section 124840,
the office shall do all of the following:
(a) If the hospital did not file financial reports with the office
by electronic media as of January 1, 1993, the office shall, on a
case-by-case basis, do one of the following:
(1) Exempt the small and rural hospital from any electronic filing
requirements of the office regarding annual or quarterly financial
disclosure reports specified in Sections 128735 and 128740.
(2) Provide a one-time reduction in the fee charged to the small
and rural hospital not to exceed the