The agency is proposing these rule amendments to strike January 2010 references, update the internet submission URL, and change the Florida Center name effective July 1, 2016. The amendment deletes the initial due date extension and fine language; ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals

RULE NOS.:RULE TITLES:

59E-7.012Inpatient Data Reporting Instructions

59E-7.021Definitions

59E-7.022Inpatient Data Reporting and Audit Procedures.

59E-7.023Schedule for Submission of Inpatient Data and Extensions.

59E-7.025Certification, Audits and Resubmission Procedures.

59E-7.026Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.

59E-7.027Header Record.

59E-7.028Inpatient Data Elements, Codes and Standards.

59E-7.029Public Records.

59E-7.030General Provisions.

PURPOSE AND EFFECT: The agency is proposing these rule amendments to strike January 2010 references, update the internet submission URL, and change the Florida Center name effective July 1, 2016. The amendment deletes the initial due date extension and fine language; shortens resubmission time, and modifies the fine matrix to include a violation rate reset following non-delinquent submission periods. Additional revisions are amended for clarification, addition of comp rehab charge element, and update data release criteria.

SUMMARY: The agency is proposing these rule amendments to strike January 2010 references, update the internet submission URL, change the Florida Center name, delete outdated language, add an element.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein:

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 408.15(8), 408.061, 408.08, FS.

LAW IMPLEMENTED: 408.061, 408.062, 408.063, 408.08, 408.05, 408.07(2), 408.15(11) FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: August 24, 2017, 10 a.m.

PLACE: Agency for Health Care Administration, First Floor Conference Room C, Building 3, 2727 Mahan Drive, Tallahassee, Florida 32308. . Interested parties that would like to join the workshop by phone can do so by using a call-in number and passcode: Call-in Number: 1(888)670-3525, Participant Passcode: 535-061-8829#.

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 3 days before the workshop/meeting by contacting: Nancy Tamariz at [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Nancy Tamariz at 850-412-3741 or [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

CHAPTER 59E-7

INPATIENT PATIENT DATA COLLECTION

59E-7.012 Inpatient Data Reporting Instructions.

Beginning with the inpatient data report for the 1st quarter of the year 2010, All hospitals reporting their inpatient discharge data reporting facilities shall submit a zipped inpatient discharge data file by Internet according to the specifications in subsections (1) through (3).

(1) The Internet address for the receipt of inpatient data is https://apps.ahca.myflorida.com/patientdata/ https://ahcaxnet.fdhc.state.fl.us/patientdata.

(2) Data reported before fourth quarter 2017 submitted to the Internet address shall be electronically transmitted with the zipped inpatient data in a XML file using the Inpatient Data XML Schema available at: http://ahca.myflorida.com/xmlschemas/PD10-3.xsd. The Inpatient Data XML Schema (effective 10/01/2015) is incorporated by reference at http://www.flrules.org/Gateway/reference.asp?No=Ref-05412

(3) Beginning with fourth quarter 2017 data reporting period as defined in 59E-7.023(1)(c), Inpatient patient Data must be submitted using the Inpatient Data XML Schema available at: http://ahca.myflorida.com/xmlschemas/PD10-4.xsd. The Inpatient Data XML Schema (effective 10/01/2017) is incorporated by reference at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX.

(3)  Renumber. No change.

Rulemaking Authority 408.061(1)(e) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 12-15-96, Amended 1-4-00, 7-11-01, 7-12-05, 5-22-07, 1-1-10, 10-1-15, 10-01-17.

 

59E-7.021 Definitions.

As used in Rules 59E-7.021 through 59E-7.030, F.A.C., beginning with the inpatient data reporting for the 1st quarter of the year 2010:

(1) through (10) No change.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History–New 1-1-10, Amended 12-5-10, Formerly 59E-7.011, Amended 10-1-15, 10-1-17.

 

59E-7.022 Inpatient Data Reporting and Audit Procedures.

(1) Hospitals licensed under Chapter 395, F.S., except state-operated hospitals, in operation for all or any of the reporting periods described in subsection 59E-7.023(1), F.A.C., below, shall submit hospital inpatient discharge data to the Agency according to the provisions in Rules 59E-7.012 and 59E-7.021 through 59E-7.030, F.A.C. The amendments appearing herein are effective with the report period starting January 1, 2010.

(2) through (3) No change.

(4) Upon notification by the AHCA Agency staff, all hospitals shall provide access to all required information from the medical records and billing documents underlying and documenting the hospital inpatient discharge reports submitted, as well as other inpatient related documentation deemed necessary to conduct complete inpatient data audits of hospital data, subject to the limitations as set forth in Section 408.061(1)(d), F.S. No inpatient discharge records that support inpatient discharge data are exempt from disclosure to the Agency AHCA for audit purposes.

Rulemaking Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.05, 408.08(1) FS. History–New 1-1-10, Formerly 59E-7.012, Amended 10-1-17.

 

59E-7.023 Schedule for Submission of Inpatient Data and Extensions.

(1) All hospitals reporting their inpatient discharge data shall report according to the following schedule. commencing with 1st quarter data 2010.

(a) through (d) No change.

(2) Extensions to the due dates in subsection 59E-7.023(1), F.A.C., will be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee for a maximum of 30 days from the initial submission due date in response to a written request signed by the hospital’s chief executive officer or chief financial officer or authorized executive officer designee. The request must be received prior to the initial submission due date and the delay must be due to unforeseen factors beyond the control of the reporting hospital. These factors must be specified in the written request for the extension along with documentation of efforts undertaken to meet the filing requirements. Extensions shall not be granted verbally.

(2)(3) Failure to file the report on or before the certification initial submission due date as specified in paragraphs 59E-7.023(1)(a)-(d), F.A.C., without an extension, and failure to correct a report which has been filed but contains errors or deficiencies by the certification deadline is punishable by fine pursuant to Rule 59E-7.026, F.A.C. The Agency shall send notification of errors or deficiencies by certified mail, electronic mail, or fax. Rejected reports must be corrected, resubmitted and certified by the certification due date.

Rulemaking Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.05, 408.07(2), 408.15(11) FS. History–New 1-1-10, Formerly 59E-7.012, Amended 10-1-17.

 

59E-7.025 Certification, Audits and Resubmission Procedures.

(1)    Data submissions for aAll hospitals centers must be submitting data in compliance with Rules 59E-7.012 and 59E-7.021 through 59E-7.030, F.A.C., The executive officer or administrator shall certify that the data quarterly as  data submitted for each quarter period is accurate, complete and verifiable by completing and signing using Certification Form for Inpatient Patient Data, AHCA Form 4200-002, July 2017, dated 10/93, revised 04/27/2009, and incorporated by reference and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-XXXX.  The completed certification form attests The Agency will send a final certification packet to the reporting entity containing their summary reports generated by the Agency, the Certification of Ambulatory Patient Data certification form, and Agency contact information and instructions. The facility must complete and sign the certification form thereby “certifying” that they have examined the inpatient data report has been examined and, to the best of their knowledge and belief, the information contained in this report is true, accurate, and complete, and has been prepared from the books and records of this facility, except as noted. The completed certification form must be either mailed to the Agency for Health Care Administration, 2727 Mahan Drive, MS #16, Tallahassee, Florida 32308. Attention: Florida Center for Health Information and Transparency Policy Analysis; or by facsimile to the Agency’s office; or a scanned certification submitted by electronic mail by the certification due date. The Agency will send a certification package to the reporting entity once their data file is complete for certification.  Upon receipt of a facility’s facilities signed certification form by the Agency, the facility is considered “certified” for the reporting quarter.

(2) Beginning with the inpatient data reporting for the 1st quarter of the year 2010, Hhospitals whose data is not certified within five (5) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59E-7.026, F.A.C. Extensions to this five (5) month period will be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee for a maximum of 30 days following the certification due date in response to a written request signed by the hospital’s chief executive officer, chief financial officer, or authorized executive officer designee. A facility will not be penalized for delays caused by AHCA which is documented by the reporting facility to include on-line reporting system downtime or delays in receipt of reports from AHCA.

(3) Changes or corrections to certified hospital data may will be accepted from hospitals to improve their data quality for a period of twelve (12) eighteen (18) months following the initial submission due date. The Agency may grant approval if it determines that resubmission will significantly impact data quality.  The executive officer  or administrator must provide a signed written request to the Agency to request resubmission. The Administrator, Office of Data Collection and Quality Assurance, or Agency designee, will grant approval for resubmitting previously certified data in response to a written request signed by the hospital’s chief executive officer or chief financial officer, or authorized executive officer designee. The written request must specify the reason for the corrections or changes, explain the cause contributing to the inaccurate reporting, describe a corrective action plan to prevent future errors, the total number of records affected by quarters and years, the data type and the date that the replacement file will be submitted to the Agency. Any changes to a hospital’s data after this twelve eighteen-month period shall be subject to penalties pursuant to Rule 59E-7.026, F.A.C. Resubmission of previously certified data must be certified within thirty (30) days following receipt of the data file from the facility.

(4) The Agency must be notified when a change of the facility contact responsible for handling the data submission or the facility CEO or Administrator occur.  Information must include full names, title, applicable phone and fax numbers, and email adddress.

Rulemaking Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.08(1), (2), 408.15(11), 408.08(1)(2) FS. History–New 1-1-10, Formerly 59E-7.012, Amended 10-1-17.

 

59E-7.026 Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.

(1) through (3) No change.

(4) The penalty period will begin on the first calendar day following the initial due date and the first calendar day following the certification due date for purposes of penalty assessments.

(5) Any hospital which is delinquent for a certification deadline as specified in Rule 59E-7.023, F.A.C., shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1,000 per day of violation for the third and all subsequent violations. Following four consecutive non-delinquent quarters, the fine violation matrix will reset to the first violation rate. Violations will be considered those activities which necessitate the issuance of an administrative complaint by the Agency unless the administrative complaint is withdrawn or final order dismissing the administrative complaint is entered. Any hospital which files false information to the Agency shall be subject to a fine not exceeding $1000 per day per violation, in addition to any other fine imposed hereunder.

Rulemaking Authority 408.061(1)(e), 408.15(8), 408.813, FS. Law Implemented 408.08(2),(3),(5), 408.813 FS.. History–New 1-1-10, Amended 12-5-10, Formerly 59E-7.014, Amended 10-1-15, 10-1-17.

 

59E-7.027 Header Record.

Beginning with the inpatient data reporting for the 1st quarter of the year 2010, Tthe first record in the data file shall be a header record containing the information described below.

(1) through (3) No change.

(4) Data Type. Enter PD10-4 PD10-3 for Inpatient Data. A required field.

(5) through (6) No change.

(7) AHCA Facility Number. Enter the identification number of the facility as assigned by the Agency AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than ten (10) digits. A required field.

(8) through (16) No change

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Formerly 59E-7.014, Amended 10-1-15, 10-1-17.

 

59E-7.028 Inpatient Data Elements, Codes and Standards.

Beginning with the inpatient data reporting for the 1st quarter of the year 2010, Aall hospitals submitting data in compliance with Rules 59E-7.012 and 59E-7.021 through 59E-7.030, F.A.C., shall report the required data elements and data element codes listed below as stipulated by the Agency.

(1) AHCA Facility Number. Enter the identification number of the hospital as assigned by the Agency AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than ten (10) digits. A required field.

(2) Patient Control Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate retrieval of the individual’s account of services (accounts receivable) containing the financial billing records and any postings of payment. The ‘Patient Control Number’ is defined as ‘Record id’ in the schema. Up to twenty four (24) characters. Duplicate patient control numbers are not permitted. A required field. The hospital must maintain a key list to locate actual records upon request by the Agency AHCA.

(3) No change.

(4) Patient Social Security Number. The social security number (SSN) of the patient. The SSN is a nine (9) digit number issued by the Social Security Administration used to facilitate retrieval of individual case records, track multiple patient discharges and for medical research. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful or the patient is under two (2) years of age and does not have a SSN or for patients who are non-U.S. citizens who have not been issued SSNs. If only the last four digits of a patients SSN are known, report 77777XXXX where XXXX represent the last known four digits of the patient SSN. The last four digit SSN format must be used only when the full SSN is unknown and not as a substitute for all nine digit SSN’s.  A required entry.

(5) through (56) No change.

(57) Comp Rehab Room Charges. Charges for comprehensive rehabilitation room charges for revenue codes 0118, 0128, 0138, 0148, 0158 as used in the UB-04. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report zero (0) if there are no charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(57) through (65) renumbered (58) through (66) No change.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended 12-5-10, Formerly 59E-7.014, Amended 10-1-15, 10-1-17.

 

59E-7.029 Patient Data Release. Public Records.

(1) No change.

(2) Patient-specific records collected by the Agency pursuant to Rules 59E-7.021-.030, F.A.C., are exempt from disclosure pursuant to Section 408.061(7), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).

(a) The patient-specific record shall be modified to protect patient confidentiality as follows:

1. Patient Control Number as assigned by the facility. Delete. Substitute sequential number.

2. Patient Social Security Number. Delete. Deleted. Indicators of readmission at any Florida reporting hospital within 30 days of discharge will be substituted when available. Readmission data will not be released for any quarter until each subsequent quarter is 100% percent certified.

3. Patient Birth Date. Substitute age in years and an indicator of Age < 29 Days except for persons 100 and older, substitute age > 100 years.

4. Admission Date. Delete. Deleted. (admit month cannot be substituted)

5. through 7. No change.

8. Infant Linkage ID. Delete. Deleted.

9. Medical or Health Record Number. Delete. Substitute sequential number.

10. No changes

(b) through (d) No change.

(3) Aggregate reports derived from patient-specific hospital records collected pursuant to Rules 59E-7.021 through 59E-7.030, F.A.C., are public records and shall be released as described in this rule, provided that the aggregate reports do not include the patient control number as assigned by the facility, patient social security number, record linkage number, patient birth date, admission date, discharge date, principal procedure date, other procedure date, ED date of arrival, infant linkage identifier or medical or health record number and provided the aggregate reports contain the combination of five or more records for any data disclosed.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061 FS. History–New 1-1-10, Formerly 59E-7.015, Amended. 10-1-17.

 

59E-7.030 General Provisions.

Hospitals submitting inpatient discharge data pursuant to the provisions contained in these rules shall be directed by the following specific general provisions for inpatient data reporting: beginning 1st quarter 2010:

(1) through (3) No change.

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Formerly 59E-7.016, Amended. 10-1-17. 

PROPOSED EFFECTIVE DATE: October 1, 2017

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Nancy Tamariz.

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Justin M Senior

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: June 01, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: April 12, 2017