KRS § 216.2925 — KY Code / Title XVIII / Chapter 216 / Section 216.2925
216.2925 Administrative regulations -- Reports, lists, forms, and formats required
Status: in_force

216.2925 Administrative regulations -- Reports, lists, forms, and formats required.

(1) The Cabinet for Health and Family Services shall establish by promulgation of

administrative regulations pursuant to KRS Chapter 13A those data elements

required to be submitted to the cabinet by all hospitals and ambulatory facilities,

including a timetable for submission and acceptable data forms. Each hospital and

ambulatory facility shall be required to report on a quarterly basis information

regarding the charge for and quality of the procedures and health-care services

performed therein, and as stipulated by administrative regulations promulgated

pursuant to KRS Chapter 13A. The cabinet shall accept data that, at the option of

the provider, is submitted through a third party, including but not limited to

organizations involved in the processing of claims for payment, so long as the data

elements conform to the requirements established by the cabinet. The cabinet may

conduct statistical surveys of a sample of hospitals, ambulatory facilities, or other

providers in lieu of requiring the submission of information by all hospitals,

ambulatory facilities, or providers. On at least a biennial basis, the cabinet shall

conduct a statistical survey that addresses the status of women's health, specifically

including data on patient age, ethnicity, geographic region, and payor sources. The

cabinet shall rely on data from readily available reports and statistics whenever

possible.

(2) The cabinet shall require for submission to the cabinet by any group of providers,

except for physicians providing services or dispensaries, first aid stations, or clinics

located within business or industrial establishments maintained solely for the use of

their employees, including those categories within the definition of provider

contained in KRS 216.2920 and any further categories determined by the cabinet, at

the beginning of each fiscal year after January 1, 1995, and within the limits of the

state, federal, and other funds made available to the cabinet for that year, and as

provided by cabinet promulgation of administrative regulations pursuant to KRS

Chapter 13A, the following:

(a) A list of medical conditions, health services, and procedures for which data on

charge, quality, and outcome shall be collected and published;

(b) A timetable for filing information provided for under paragraph (a) of this

subsection on a quarterly basis;

(c) A list of data elements that are necessary to enable the cabinet to analyze and

disseminate risk-adjusted charge, quality, and outcome information, including

mortality and morbidity data;

(d) An acceptable format for data submission that shall include use of the

uniform:

1. Health claim form pursuant to KRS 304.14-135 or any other universal

health claim form to be determined by the cabinet if in the form of hard

copy; or

2. Electronic submission formats as required under the federal Health

Insurance Portability and Accountability Act of 1996, 42 U.S.C. sec.

300gg et seq., in the form of magnetic computer tape, computer

diskettes, or other electronic media through an electronic network;

(e) Procedures to allow health care providers at least thirty (30) days to review

information generated from any data required to be submitted by them, with

any reports generated by the cabinet to reflect valid corrections by the

provider before the information is released to the public; and

(f) Procedures pertaining to the confidentiality of data collected.

(3) The cabinet shall coordinate but not duplicate its data-gathering activities with other

data-collection activities conducted by the Department of Insurance, as well as

other state and national agencies that collect health-related service, utilization,

quality, outcome, financial, and health-care personnel data, and shall review all

administrative regulations promulgated pursuant to KRS 216.2920 to 216.2929 to

prevent duplicate filing requirements. The cabinet shall periodically review the use

of all data collected under KRS 216.2920 to 216.2929 to assure its use is consistent

with legislative intent.

(4) The cabinet shall conduct outcome analyses and effectiveness studies and prepare

other reports pertaining to issues involving health-care charges and quality.

(5) The cabinet may independently audit any data required to be submitted by providers

as needed to corroborate the accuracy of the submitted data. Any audit may be at

the expense of the cabinet and shall, to the extent practicable, be coordinated with

other audits performed by state agencies.

(6) The cabinet may initiate activities set forth in subsection (1) or (2) of this section at

any time after July 15, 1996.

(7) The Cabinet for Health and Family Services shall collect all data elements under

this section using only the uniform health insurance claim form pursuant to KRS

304.14-135, the Professional 837 (ASC X12N 837) format, the Institutional 837

(ASC X12N 837) format, or its successor as adopted by the Centers for Medicare

and Medicaid Services.