Source: http://www.healthinfolaw.org/comparative-analysis/provider-charge-data-reporting-50-state-comparison
Timestamp: 2019-04-25 12:07:09+00:00

Document:
Health care providers may be required by state law to report charge data to the state department of health. States often collect charge or price information in an effort to make prices more transparent to consumers (who can make more informed decisions) and to lower health care costs. As shown in the map, states vary in whether providers are required to report charge data, and among those states that require reporting, there is variation in how much of the charge data must be reported. Some states require providers to report charges for all health care services, while others require the most common procedures be reported. In addition, the charge data to be reported varies from chargemasters to actual prices paid to cost reports from providers.
A.R.S. § 36-125-.05: Hospitals must report average charge per day to the Department of Health. Emergency departments must report charges for outpatient services to the Department. All reports must be available for public inspection.
A.R.S. § 36-436: A new hospital or nursing facility must file a schedule of its rates and charges (and rules that relate to those rates and charges) with the Director of the Department of Health Services for review.
A.C.A. § 20-7-303: All licensed hospitals and outpatient surgery centers must submit the information described under § 20-7-305 to the Director of the Division of Health.
Health & Safety Code § 1339.56: Each hospital must compile a list of 25 common outpatient and inpatient procedures and annually submit to the Office of Statewide Health Planning and Development the hospital’s average charges for those procedures.
Health & Safety Code § 128735: Any organization that operates, conducts, owns, or maintains a health care facility, (or its officers) must report the total charges for each discharged patient to the Office of Statewide Health Planning and Development.
C.R.S.A. § 10-16-111: Non-profit hospitals, medical-surgery, and health services corporations must file with the Commissioner an annual statement that states amounts actually paid for hospital, medical-surgery, and health services for the subscribers or members.
C.R.S.A. § 25.5-6-202: Nursing facilities must file cost reports with the State Department.
C.R.S.A. § 25-3-705: Each hospital in the state must submit a report to the Hospital Association to determine the charges for the 25 most common inpatient diagnostic-related groups.
C.R.S.A. § 10-16-134: Each carrier must submit annually, to the Division of Insurance, its average reimbursement rates (either statewide or by geographic area) for the average inpatient day or for the 25 most common inpatient procedures based on the most commonly reported diagnostic-related groups.
C.G.S.A.: § 19a-681: Each hospital must file with the Office of Health Care Access its current pricemaster, which must include each charge in its detailed schedule of charges.
16 Del. Code § 2004: The Delaware uniform claims and billing data set must be completed for all hospital and nursing home inpatient discharges and be submitted by the hospitals to the Division of Public Health.
F.S.A. § 408.061: The Agency for Health Care Administration must require health care facilities, providers, and health insurers to submit actual charge data by diagnostic group to the Agency.
Ga. Code Ann. § 31-7-280: Each health care provider (defined as a licensed hospital, ambulatory surgery or obstetrical facility) must submit an annual report of health care information to the Department of Community Health, that must contain total charges and summary of charges by plan or payer.
20 ILCS 2215/4-2: Each licensed hospital and ambulatory surgery center must submit to the Department of Public Health inpatient and outpatient claims and encounter data for surgical and invasive procedures performed on each patient within 60 days of the end of each calendar quarter.
Ind. Code § 16-21-6-6: Each hospital must file with the State Department of Health inpatient and outpatient discharge data reports that include total charge for the stay.
K.S.A. § 65-6801: All health care providers and third-party payers must supply the information necessary for a review and comparison of utilization patterns, cost, quality and quantity of health care services provided to the healthcare database.
K.R.S. § 216.2929: The Cabinet on Health and Family Services must make available on its website information on charges for health care services in easy to understand language that allows consumers to make comparisons between each hospital and ambulatory facility by payer and for other provider groups as data becomes available. Any charge information compiled by the Cabinet must include the median charge and other percentiles to describe the typical charges, and include the total number of patients represented by all charges. The report must clearly identify data sources.
L.S.A. § 40:1300.114: All state agencies, health professional licensing agencies or boards that collect, maintain or distribute health data must provide the Department of Health and Hospitals with all necessary data.
L.S.A. § 40:1300.112: The Department of Health and Hospitals with the Health Data Panel must identify the health care cost, quality, and performance data elements to be reported to the Department using existing national standards to allow consumers to meaningfully compare costs of specific health care services among various health care providers.
Maine Rev. Stat. § 8712: The Maine Health Data Organization must produce an annual report that compares the 15 most common diagnostic-related groups and the 15 most common outpatient procedures for all hospitals in the state and the 15 most common procedures for nonhospital health care facilities in the state to similar data available from other states. The Organization must also provide an annual report of the 10 procedures most commonly provided by osteopathic and allopathic physicians in private office settings in the state.
MD Code § 19-133: The Medical Care Database must collect charge information for each patient encounter with a provider or facility.
M.G.L.A. 12C § 8: The Center for Health Information and Analysis must require the uniform reporting of revenues, charges, costs, prices, and utilization of health care services by institutional providers, their parent organizations, and affiliated entities. The Center must require acute and non-acute hospitals to file the charge book, cost data, audited financial statements, and merged billing and discharge data with the Center.
M.G.L.A. 12C § 10: The Center requires hospital inpatient and outpatient cost data as well as relative prices paid to each hospital, registered provider organization, physician group, ambulatory surgery center, and other health care facilities, by provider type, with separately listed inpatient and outpatient prices by product, to be submitted from private health care payers.
M.S.A. § 62J.82: The Minnesota Hospital Association must develop a web-based system available to the public for reporting of charge information, including number of discharges, average length of stay, average charge, average charge per day, and median charge for the 50 most common inpatient diagnosis related groups and the 25 most common outpatient surgical procedures, as determined by the Minnesota Hospital Association.
M.S.A. § 62U.04: The Commissioner must publicly report the providers' total cost, total resource use, total quality, and the results of the total care portion of the peer grouping process, information on providers' condition-specific cost, condition-specific resource use, and condition-specific quality, and the results of the condition-specific portion of the peer grouping process, annually.
V.A.M.S. § 192.667: Under the statute, health care providers must report charge data to the Department at least annually, while hospitals must report patient abstract data and financial data annually.
N.R.S. § 439A-220: The Department of Health and Human Services must establish a program that includes the collection and maintenance of the total number of discharged patients, average length of stay, and average billed charges, reported by diagnosis-related groups for the 50 most useful medical treatments for outpatients for each hospital, and any other information related to the costs charged and the quality of care provided in the hospitals determined by the Department to be useful to consumers, nationally recognized, and reported in a standard manner.
N.R.S. § 439A-240: The Department of Health and Human Services must establish a program that includes the collection of the total number of discharged patients, average length of stay, and average billed charges, reported by diagnosis-related groups for the 50 most useful medical treatments for outpatients for each ambulatory surgical center.
N.H. Rev. Stat. § 126:25: Each nursing home, acute care hospital, residential care facility, specialty hospital, or other licensed health care facility must file with the Commissioner of the Department of Health and Human Services charge data. For acute care or specialty hospitals with less than a 30 day average stay, charge by discharge, and for specialty hospitals and nursing homes, the average patient day charge must be filed.
N.J.S.A. § 26:2H-5: The Commissioner also has the power the promulgate regulations regarding the establishment of requirements for a uniform statewide reporting system on health care quality and costs, and the certification of rates, payments, reimbursements or grants for health care services.
NY Public Health § 2816: Regulations pertaining to the statewide planning and research cooperative system must specify the type and form of data that must be reported. These data must include (1) inpatient hospitalization and emergency department data from general hospitals; (2) ambulatory surgery data from facilities that provide ambulatory surgery services; (3) “outpatient, clinical laboratory, and prescription data” from general hospitals, pharmacies, and other providers; (4) “covered person and claims data;" and (5) the identity of patients that are transferred, treated, or admitted following a medical procedure at health care facility.
N.C.G.S.A. § 131E-214.4: A statewide data processor must make available annually a report that includes the 35 most frequently reported charges of hospital and freestanding ambulatory surgical centers to the Division of Health Service Regulation of the Department of Health and Human Services.
NDCC § 23-.01.1-.02: In order to provide information to the public on price competition in the health care market, the health care data committee may compile to the average aggregate charges by diagnosis for the 25 most common diagnoses, annual operating costs, revenues, capital expenditures, and utilization for every nonfederal acute care hospital in the state, and average charges by source of payment and level of service for each long term facility.
NDCC § 23-.01.1-.02.1: The health care data committee must create a data collection, processing, retention, and reporting system that will allow the distribution of comparative average charge information by licensed physicians. Insurers, nonprofit health service corporations, health maintenance organizations, and state agencies must provide this information.
Ohio Rev. Code § 3727.34: Each hospital must annually submit to the Director of Health, for patients in each of the sixty most commonly treated diagnosis-related groups for the previous calendar year, the mean, median, and range of total hospital charges. Each hospital must annually submit to the Director of Health the mean and median of total hospital charges for the services relating to outpatient services for each of the sixty categories of outpatient services most frequently provided by the hospital as represented by outpatient discharges for the previous calendar year.
63 Okl. St. Ann. § 1-119: The Division of Health Care Information within the Department of Health, with the advice of the Health Care Information Advisory Committee must collect health care information from information providers, including financial information, such as consumption of resources to provide services, reimbursement, costs of operation, revenues, assets, liabilities, fund balances, rates, charges, and wage/ salary data.
O.R.S. § 442.460: In order to obtain regional or statewide utilization information, the Office for Oregon Health Policy and Research may receive information on utilization and cost identified by the Administrator, from physicians, insurers, employers, or other third party purchasers of health care services.
35 Pa. Stat. Ann. § 449.6: Providers must submit information on total charges of and actual payments to the facility, and charges of and actual payments to each professional rendering service, about each covered service to the health care cost containment council, which will collect the data using electronic data processing.
R.I. Gen. Laws § 23-17.17-10: Insurers, health care providers, insurers, and governmental agencies must file reports, data, and schedules, including information related to hospital finance and other information relating to health care costs, prices, utilization, quality, or resources required to be filed by the Director.
SDCL § 34-12E-11: All licensed hospitals must report to the South Dakota Association of Healthcare Organizations, the charge information for the hospital’s All Patient Refined Diagnosis-Related Groups for which that hospital had at least ten cases during the previous year.
T.C.A. § 68-1-108: Each licensed hospital must quarterly report all claims data for each inpatient and outpatient discharge to the Commissioner of Health.
T.C.A. § 68-1-119: Each licensed ambulatory surgical treatment center (ASTC) and each licensed outpatient diagnostic center (ODC) must make a joint quarterly report of all claims data for each discharge to the Commissioner of Health.
V.T.C.A. Health and Safety Code § 108.006: The Texas Health Care Information Council must develop a statewide health care data collection system to collect health care charges, utilization data, provider quality data and outcome data.
U.C.A. § 26-33a-106.1: The committee must develop a plan for collecting data from data suppliers to determine costs and reimbursements for risk adjusted episodes of care. It must also report on geographic variances in medical care and costs and rate and price increases by health care providers.
18 V.S.A. § 9405b: The Commissioner of the Department of Financial Regulation with other health care stakeholders must establish a standard format for hospital community reports, which must include valid, reliable, and useful measures for comparison of charges for higher volume health care services.
18 V.S.A. § 9410: The Commissioner of the Department of Financial Regulation must establish and maintain a unified health care database in order to compare costs between treatment settings and approaches and provide information to consumers and purchasers of health care. The Commissioner may require a health plan covering 5% of covered lives to file a consumer health care price and quality information plan with the Commissioner.
VA Code Ann. § 32.1-276.5:1: In order to promote transparency of health care information for consumers to make informed decisions, the Insurance Commissioner must negotiate and contract with a nonprofit entity for annual survey of health insurance carriers. The survey will determine the reimbursement paid for at least 25 of the most commonly reported health care services, including inpatient and outpatient diagnostic services, surgical services, or treatment of certain conditions or diseases. Each carrier must report the average reimbursement for a specific service from all providers and provider types, including hospitals, outpatient/ambulatory surgery centers, and physicians. The survey should also include average reimbursement rates for the same services from Medicare and Medicaid fee-for-service plans.
VA Code Ann. § 32.1-276.6: General hospitals, outpatient surgical hospitals, other facilities, physicians, and providers providing surgical services must report outpatient surgical data as set forth by this law. The outpatient data may be reported directly to the non-profit organization. Patient level data elements must include total charges.
W. Va. Code § 16-5F-4: All covered facilities and related organizations must also file with the Board a complete schedule of the covered facility’s then current rates with costs allocated to each category of costs, a copy of reports made or filed with the federal health care financing administration, a statement of charges and salaries for all goods and services rendered to the covered facility for the reported time period that exceeds $55,000, and a statement of charges and fees collected by the covered facility that exceeds $55,000.
W.S.A. § 146.903: The Department of Health Services must, for each type of provider, annually identify the 25 most common conditions for which the provider provides services. Health care providers must submit a single document that lists the median billed charge, Medicare payment to the provider, and average allowable payment from third party payers for the 25 most common conditions the provider treats. Each hospital must prepare a single document containing the median billed charge, Medicare payment to the provider, and average allowable payment from third party for 75 specific diagnosis-related groups for inpatient care and 75 specific outpatient surgical procedures.

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 § 36
 § 20
 § 20
 § 1339
 § 128735
 § 10
 § 25
 § 25
 § 10
 § 19
 § 2004
 § 408
 § 31
 § 16
 § 65
 § 216
 § 40
 § 40
 § 8712
 § 19
 § 8
 § 10
 § 62
 § 62
 § 192
 § 439
 § 439
 § 126
 § 26
 § 2816
 § 131
 § 23
 § 23
 § 3727
 § 1
 § 442
 § 449
 § 23
 § 34
 § 68
 § 68
 § 108
 § 26
 § 9405
 § 9410
 § 32
 § 32
 § 16
 § 146