CHAPTER 347

FORMERLY

HOUSE BILL NO. 507

AN ACT TO AMEND CHAPTER 20, TITLE 16, DELAWARE CODE RELATING TO UNIFORM HEALTH DATA.

OE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend Chapter 20, Title 16 of the Delaware Code by deleting said Chapter in its entirety and by substituting in lieu thereof the following:

"Chapter 20. Uniform Health Data. §2001. Purpose.

It is the purpose of this chapter to establish a health information data base that will assist the health care system to advance the general well-being of the population by better directing and improving the availability of health care services.

It is the policy of this State to foster appropriate and efficient use of health care resources by requiring information necessary for evaluating utilization patterns and costs to the community and the State for health care services. This information shall be available to health care purchasers, health care insurers, health care providers, health care planners and the general public without compromise of patient confidentiality. Such information will improve decision making with regards to access, identified needs, patterns of health care delivery, charges and use of health care services.

§2002. Definitions.

The following words, terms and phrases, when used in this chapter, shall have meaning ascribed to them in this section, except where the context indicates a different meaning:

(1) 'Delaware uniform claims and billing data set' shall mean that data approved for use by the State Uniform Billing Committee.

(2) 'Hospital" shall mean any non-federal facility licensed as such pursuant to Chapter 10 of this title.

(3) 'Individual' shall mean a singular human being.

(1) 'Nursing home' shall mean any non-federal facility
licensed as such pursuant to Chapter 11 of this title and more particularly §§57 (Skilled Care) and 58 (Intermediate Care) of the State Board of Health Regulations.

(2) 'Person' shall mean an individual, trust or estate, a partnership, a corporation (including associations, joint stock companies and insurance companies), or a state or political subdivision or instrumentality (including a municipal corporation) of a state.

(3) 'Raw data shalt mean any information collected pursuant to this chapter which has not been approved for release by the State agency.

(4) 'State agency' shall mean the Bureau of Health Planning and Resources Management within the Department of Health and Social Services. The Bureau of Health Planning and Resources
Management shall serve as the designated statistical agency under Public Law 95-623 for data analysis and statistical research related to The National Center for Health Statistics activities and for the designation of Health Manpower Shortage Areas (HMSAs) and Medically Underserved Areas (MUAs) by the U.S. Department of Health and Social Services.

   

(8) 'Third-party payers' shall mean any person authorized to transact health insurance or to engage in the business of a health service corporation in this State.

§2003. Duties and Authority of State Agency.

(a) The State agency shall compile, correlate, analyze and develop data which it collects pursuant to this chapter. The State agency
shall prepare and distribute or make available reports to health care purchasers, health care insurers, health care providers and the genera? public. The data shall be collected In the most efficient and cost-effective manner.Data collected shall be limited to that
contained in the Delaware uniform claims and billing data set (UB-82 or successor form).

(b) The State agency shall periodically compile and disseminate reports on the data collected such as, but not limited to: charge levels, age-specific utilization patterns, morbidity patterns, patient origin and trends in health care charges.Prior to release or
dissemination of any compilations, the State agency shall provide a specified time period for hospitals and nursing homes to review the information they have submitted and to submit corrections. The State agency shall incorporate any valid corrections prior to release. Hospitals and nursing homes shall have the right to provide independent data interpretation which shall be disseminated along with the report.

(c) The State agency shall adopt such policies and procedures as necessary to carry out this chapter.

(d) The State agency shall establish a technical advisory committee with an appropriate number of hospital and nursing home representatives from the Association of Delaware Hospitals and the Delaware Health Care Facilities Association, to study issues such as the collection, compilation, dissemination and confidentiality of data. The State Agency may establish other committees as deemed
appropriate.

(e) The State agency shall issue annual reports to the General Assembly outlining actions and accomplishments as well as
recommendations for changes needed to further the purpose of this chapter.

(f) The State agency may study and issue reports on special medical needs, demographic characteristics, access to health care services and need for financing of health care services for the entire population or various population subgroups.

(g) the State agency may also study and issue reports on health status issues such as:

(1) The incidence of medical and surgical procedures;

(2) Mortality rates for specified diagnoses and treatments;

(3) Rates of infection for specified diagnoses and treatments;

(4) Morbidity rates for specified diagnoses and treatments;

(5) Readmission rates for specified diagnoses and treatments; and

(6) Rate of incidence for selected diagnoses and procedures. §2004. Reporting Requirements.

(a) The Delaware uniform claims and billing data set (UB-82 or successor form) shall be completed for all hospital inpatient discharges and shall be submitted by all hospitals to the State agency according to a schedule established pursuant to subsection (d) of this section. All third-party payers shall be required to accept this uniform claims and billing form. The State agency shall recognize the capabilities of each hospital in specifying the medium or mediums to be used in submitting data (hard copy, data tape or other appropriate electronic media).

(b) the Delaware uniform claims and billing data set (UB-82 or successor form) shall be completed for all nursing home inpatient discharges beginning not sooner than June 30, 1995, and shall be submitted by all nursing homes to the State agency according to a schedule established pursuant to subsection (d) of this section. All third-party payers shall be required to accept the Delaware uniform claims and billing form. Prior to this time, nursing homes shall
continue to submit data in a medium and format as agreed to by the State agency and the Delaware Health Care Facilities Association.

(c) The State agency shall assure that any report of data specific to hospitals or nursing homes presents data that are reliable, valid and informative. Such data shall reflect as appropriate, factors
including, but not limited to, the number of patients, patient severity at admission, age of patients, the actual versus expected

number of deaths, average length of stay and case mix. The report

shall explain each of these adjustments. The report also shall

include information necessary to adequately represent the operations of the individual hospital or nursing home such as whether or not physician charges are included in the hospital charges, whether or not the hospital maintains medical education programs, and the hospital's payor mix. The State agency shall consult with the Association of Delaware Hospitals and the Delaware Health Care Facilities Association in identifying the various adjustment factors and information to be included.

(d) The State agency shall establish schedules for the timely submission of data and information collected pursuant to this section. The State agency may grant waivers from such schedules for good cause shown.

§2005. Confidentiality and Access to Data.

(a) The collection, compilation, data analysis and dissemination of reports and studies shall be done in a manner that protects the privacy of any individual about whom information is given. The State agency shall consider confidential any information that explicitly or implicitly identifies an individual. Raw data shall not be available
for public inspection nor is it a public record within the meaning of the Delaware Freedom of Information Act.

(b) All compilations prepared and authorized by the State agency for release and dissemination shall be public records and efforts will be made to assure their accessibility.

§2006. Sanctions.

(a) A hospital or nursing home which willfully violates this chapter shall be reported to the State Board of Health which may take such action as deemed appropriate to enforce compliance. No action shall be taken by the Board without first providing an opportunity to the hospital or nursing home for a fair hearing.

(b) A hospital or nursing home which is aggrieved by any action taken by the State Board of Health pursuant to this section may, within 30 days of being notified of such action, appeal to the Superior Court.

§2007. Immunity.

No person shall be subject to, and all persons shall be immune from, any claim, suit, liability, damages or any other recourse, civil or criminal, arising from any act or proceeding, decision or determination undertaken or performed, or recommendation made while discharging any duty or authority under this chapter, so long as such person acted in good faith, without malice, and within the scope of his duty or authority under this chapter or any other provisions of the Delaware law, federal law or regulations or duly adopted rules andregulations providing for the administration of this chapter, good faith being presumed until proven otherwise, with malice required to be shown by the complainant.

§2008. Data from Other Providers.

The Delaware Health Care Commission or Its successor agency shall complete an analysis of the merits and feasibility of collecting data from providers other than hospitals and nursing homes. Other providers to be considered shall Include, but not be limited to, physicians, freestanding surgical centers, freestanding birthing centers and freestanding emergency centers licensed in the State of Delaware. The results of such analysis along with proposed enabling legislation, as appropriate, shall be submitted to the Governor and the General Assembly by December 31, 1995."

Section 2. Severability.

If any clause, sentence, section, provision or part of this Act shall be adjudged to be unconstitutional or invalid for any reason by any court of competent jurisdiction, such judgment shall not impair, invalidate or affect the remainder of this Act which shall remain in full force and effect.

Section 3. Repealing Clause.

All laws and parts of laws in conflict herewith are hereby repealed to the extent of such conflict.

Section 4. Effective Date.

This Act shall become effective immediately.

Approved July 8, 1994.