reglab/statecodes huggingface dataset:
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97247 - Approval Criteria

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  following requirements must be met for a report to be approved by the
				  Department:
(1) Complete transmittal
				  information must be submitted with each report.
(2) The facility identification number stated
				  in the transmittal information must be consistent with the facility
				  identification number on each of the records in the report.
(3) The report period stated in the
				  transmittal information must be consistent with all of the records in the
				  report.
(4) The number of records
				  stated in the transmittal information must be consistent with the number of
				  records contained in the report.
(5) All records required to be reported
				  pursuant to 97213(a) must be reported.
(6) The data must be reported in compliance
				  with the format specifications in Section
				  97215.
(7) For report periods beginning on or after
				  January 1, 2015, all records must contain a valid Principal
				  Diagnosis.
(8) The data must be at,
				  or below, the Error Tolerance Level specified in Section
				  97248.
(9) The data must be consistent with the
				  reporting facility's anticipated trends and comparisons, except as in (A)
				  below:
(A) If data are correctly reported and
				  yet fail to meet approval criteria due to inconsistency with the reporting
				  facility's anticipated trends and comparisons, the reporting facility may
				  submit to the Department, in writing, a detailed explanation of why the data
				  are correct as reported. The Department may determine, upon review of a written
				  explanation, that it will approve a report.
(10) Each report must contain only one type
				  of record as specified in Subsections (1), (2), and (3) of Subsection (a) of
				  Section 97213.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97249 - Hours of Operation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Department's online submission system will be supported
					 from 8:00 a.m. to 5:00 p.m., Monday through Friday (except for Official State
					 Holidays). System maintenance may cause intermittent unavailability. Contact
					 the Patient Data Program at (916) 326-3935 to report possible transmission
					 problems.
1. New
					 section filed 9-23-2003; operative 9-23-2003 pursuant to Government Code
					 section
					 11343.4
					 (Register 2003, No. 39).
2. Amendment of section and NOTE filed
					 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
3. Amendment filed 12-31-2009; operative
					 12-31-2009 pursuant to Government Code section
					 11343.4
					 (Register 2010, No. 1).
4. Change without regulatory effect amending
					 section filed 5-9-2018 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2018, No. 19).
5. Change without regulatory
					 effect amending section filed 12-13-2019 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2019, No. 50).
6. Change without regulatory
					 effect amending section filed 1-24-2023 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2023, No. 4).
Note: Authority cited: Section
						128755,
						Health and Safety Code. Reference: Sections
						128735,
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97250 - Failure to File a Data Report

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Any health facility which does not file any report
					 completed as required by this article is liable for a civil penalty of one
					 hundred dollars ($100) a day to be assessed and recovered in a civil action
					 brought in the name of the people of the State of California by the Department
					 for each day that the filing of the report is delayed, considering all approved
					 extensions of the due date as provided in Section
					 97241. Assessed penalties may be
					 appealed pursuant to Section
					 97052. Within fifteen days after
					 the date the reports are due, the Department shall notify the health facility
					 of reports not yet received, the amount of the liability, and potential future
					 liability for failure to file reports when due. Sixty days after an original
					 report due date as specified in Section
					 97211(c), the
					 Department's online submission system will close for that report period. No
					 report for the period will be accepted after the system closure. No additional
					 penalties will accrue for outstanding reports after the system closure for a
					 report period.
1. New
					 section filed 9-23-2003; operative 9-23-2003 pursuant to Government Code
					 section
					 11343.4
					 (Register 2003, No. 39).
2. Amendment of section heading and NOTE
					 filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
3. Amendment filed 11-21-2006; operative
					 11-21-2006 pursuant to Government Code section
					 11343.4
					 (Register 2006, No. 47).
4. Change without regulatory effect
					 amending section filed 12-13-2019 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2019, No. 50).
5. Change without regulatory
					 effect amending section filed 1-24-2023 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2023, No. 4).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128735,
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97251 - Definition of Data Element for ED and AS-Date of Birth

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For online transmission of data reports
				  as electronic data files, the patient's date of birth shall be reported in
				  numeric form as follows: the 4-digit year, the 2-digit month, and the 2-digit
				  day. The numeric form for days and months from 1 to 9 must have a zero as the
				  first digit.
(b) For online entry
				  of individual records, the patient's date of birth shall be reported in numeric
				  form as follows: the 2-digit month, the 2-digit day, and the 4-digit year. The
				  numeric form for days and months from 1 to 9 must have a zero as the first
				  digit.
(c) When the complete date
				  of birth is unknown, as much of the date as is known shall be reported. At a
				  minimum, an approximate year of birth shall be reported. If only the age is
				  known, the estimated year of birth shall be reported and the month and day can
				  be reported as 01 for month and 01 for day.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97252 - Definition of Data Element for ED and AS-Sex

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The patient's sex shall be reported as male, female or
					 unknown. Unknown indicates that the patient's sex was undetermined or not
					 available from the medical record.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
2. Change without regulatory effect
					 amending section filed 7-20-2016 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2016, No. 30).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97253 - Definition of Data Element for ED and AS-Race

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Effective with encounters occurring on
				  and after January 1, 2019, the race shall be as self-reported by the patient or
				  patient's guardian in cases where the patient is not capable of providing the
				  information. The patient's race shall be reported as up to five choices from
				  the following list of alternatives:
(1)
				  American Indian or Alaska Native
(2) Asian
(3) Black or African American
(4) Native Hawaiian or Other Pacific
				  Islander
(5) White
(6) Other Race
(7) Unknown
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97254 - Definition of Data Element for ED and AS-Ethnicity

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The ethnicity shall be as self-reported by the patient or
					 patient's guardian in cases where the patient is not capable of providing the
					 information. The patient's ethnicity shall be reported as one choice from the
					 following list of alternatives:
(a)
				  Hispanic or Latino Ethnicity
(b)
				  Non Hispanic or Latino Ethnicity
(c) Unknown
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
2. Amendment filed 1-11-2018; operative
					 4-1-2018 (Register 2018, No. 2).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97255 - Definition of Data Element for ED and AS - Patient Address

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Effective with encounters occurring on or after January 1, 2023, the patient's
				  address shall be reported. The address shall include the address number and
				  street name, city, state, and ZIP Code. Do not report the address of the
				  hospital. If more than one address is available for the patient, report the
				  address of the patient's usual residence. If exact address is unknown or the
				  patient is experiencing homelessness, provide as much information as possible.
(1) The address number and street name shall
				  be reported.
(A) If the address number and/or
				  street name are unknown, leave blank.
(B) If the address number and street name are
				  not part of the United States, leave blank.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97256 - Definition of Data Element for ED and AS-Patient Social Security Number

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The patient's social security number is to be reported as a
					 9-digit number. If the patient's social security number is not recorded in the
					 patient's medical record, the social security number shall be reported as "not
					 in medical record," by reporting the social security number as "000000001." The
					 number to be reported is to be the patient's social security number, not the
					 social security number of some other person, such as the mother of a newborn or
					 the insurance beneficiary under whose account the hospital's bill is to be
					 submitted.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97257 - Definition of Data Element for ED and AS-Service Date

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For online transmission of data reports
				  as electronic data files, the patient's service date shall be reported in
				  numeric form as follows: the 4-digit year, the 2-digit month, and the 2-digit
				  day. The numeric form for days and months from 1 to 9 must have a zero as the
				  first digit.
(b) For online entry
				  of individual records, the patient's service date shall be reported in numeric
				  form as follows: the 2-digit month, the 2-digit day, and the 4-digit year. The
				  numeric form for days and months from 1 to 9 must have a zero as the first
				  digit.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97258 - Definition of Data Element for ED and AS-Principal Diagnosis

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For encounters occurring on and after
				  October 1, 2015: The patient's principal diagnosis, defined as the condition,
				  problem, or other reason established to be the chief cause of the encounter for
				  care, shall be coded according to the ICD-10-CM.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
2. Amendment filed 4-3-2014; operative
					 7-1-2014 (Register 2014, No. 14).
3. Amendment filed 9-4-2014;
					 operative 10-1-2014 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2014, No. 36).
4. Change without regulatory effect
					 repealing subsection (a) and relettering subsections filed 7-20-2016 pursuant
					 to section
					 100, title 1, California Code of
					 Regulations (Register 2016, No. 30).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97259 - Definition of Data Element for ED and AS - Other Diagnoses

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
				  encounters occurring on or after January 1, 2023: The patient's other diagnoses
				  are defined as all conditions that coexist at the time of the encounter for
				  emergency or ambulatory surgery care, that develop subsequently during the
				  encounter, or that affect the treatment received. ICD-10-CM Social Determinants
				  of Health codes (Z55-65) shall be included if they are documented in the
				  medical record. Diagnoses shall be coded according to the ICD-10-CM. ICD-10-CM
				  codes from External Causes of Morbidity (V00-Y99) shall not be reported as
				  other diagnoses.
Note: Authority cited: Section
						128810, Health and Safety Code.
						Reference: Sections
						128736 and
						128737, Health and Safety
						Code.
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97260 - Definition of Data Element for ED and AS-External Causes of Morbidity

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For encounters
				  occurring on and after October 1, 2015: The external causes of morbidity shall
				  be coded according to the ICD-10-CM External Causes of Morbidity (V00-Y99). The
				  external cause of morbidity that resulted in the injury or health condition
				  shall be listed first. Additional cause of morbidity codes shall be reported if
				  necessary to describe the mechanisms that contributed to, or the causal events
				  surrounding, the injury or health condition.
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
2. Amendment filed 11-21-2006; operative
					 11-21-2006 pursuant to Government Code section
					 11343.4
					 (Register 2006, No. 47).
3. Amendment filed 12-31-2009; operative
					 12-31-2009 pursuant to Government Code section
					 11343.4
					 (Register 2010, No. 1).
4. Amendment section heading and section
					 filed 4-3-2014; operative 7-1-2014 (Register 2014, No. 14).
5.
					 Amendment filed 9-4-2014; operative 10-1-2014 pursuant to Government Code
					 section
					 11343.4(b)(3)
					 (Register 2014, No. 36).
6. Change without regulatory effect
					 repealing subsection (a) and relettering subsections filed 7-20-2016 pursuant
					 to section
					 100, title 1, California Code of
					 Regulations (Register 2016, No. 30).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97261 - Definition of Data Element for ED and AS-Other External Cause of Injury. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
2. Amendment filed 11-21-2006; operative
					 11-21-2006 pursuant to Government Code section
					 11343.4
					 (Register 2006, No. 47).
3. Amendment filed 12-31-2009; operative
					 12-31-2009 pursuant to Government Code section
					 11343.4
					 (Register 2010, No. 1).
4. Amendment filed 4-3-2014; operative
					 7-1-2014 (Register 2014, No. 14).
5. Amendment filed 9-4-2014;
					 operative 10-1-2014 pursuant to Government Code section
					 11343.4(b)(3)
					 (Register 2014, No. 36).
6. Change without regulatory effect
					 repealing section filed 7-20-2016 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2016, No. 30).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97262 - Definition of Data Element for ED and AS-Principal Procedure

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The patient's principal procedure is one that is surgical
					 in nature, or carries a procedural risk, or carries an anesthetic risk. The
					 procedure related to the principal diagnosis, as the chief reason for the
					 encounter, shall be selected as the principal procedure. The procedure shall be
					 coded according to the Current Procedural Terminology, Fourth Edition
					 (CPT-4).
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97263 - Definition of Data Element for ED and AS-Other Procedures

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
All significant procedures are to be reported. A
					 significant procedure is one that is surgical in nature, or carries a
					 procedural risk, or carries an anesthetic risk. Procedures shall be coded
					 according to the Current Procedural Terminology, Fourth Edition
					 (CPT-4).
1. New
					 section filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section
					 11343.4
					 (Register 2005, No. 18).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97266 - Freestanding Ambulatory Surgery Encounter Fee Assessment

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Department shall mail an annual
				  notice of special fee assessment, as provided in Section
				  90417, and a remittance advice
				  form to each freestanding ambulatory surgery clinic. The annual notice of
				  special fee assessment and remittance advice form shall be mailed at least 20
				  days before the fee due date. The remittance advice form shall be completed by
				  each surgical clinic and returned to the Department with full payment of the
				  special fee amount. The fee shall be due on July 1st and delinquent on July
				  31st of each year. The basis of assessment is the number of ambulatory surgery
				  data records submitted to the Department for encounters in the preceding
				  calendar year.
(b) New surgical
				  clinics which had no encounters in the previous calendar year are not liable
				  for the initial special fee.
(c)
				  New surgical clinics that have been operating for less than 12 months in the
				  previous calendar year are liable for the special fee based on the number of
				  ambulatory surgery data records submitted to the Department for encounters
				  during the period of their licensed operations in the previous calendar
				  year.
(d) Where there was a change
				  in licensee during the prior calendar year, the current licensee shall be
				  assessed a special fee based on the number of ambulatory surgery data records
				  submitted to the Department for encounters that occurred during the time of
				  their licensure.
(e) The Department
				  shall determine the basis of assessment for special fee amounts due from
				  surgical clinics in those circumstances not specifically covered
				  above.
(f) To enforce payment of
				  delinquent special fees, the Department shall notify the State Department of
				  Health Services not to issue a license and not to renew the existing license of
				  the delinquent surgical clinic until the special fees have been paid, pursuant
				  to Section
				  127280,
				  Health and Safety Code. A copy of the Department notice to the State Department
				  of Health Services shall be sent to the delinquent surgical clinic.
1. New
					 section filed 11-21-2006; operative 11-21-2006 pursuant to Government Code
					 section
					 11343.4
					 (Register 2006, No. 47).
2. Change without regulatory effect
					 amending subsections (a) and (c)-(f) filed 1-24-2023 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2023, No. 4).
Note: Authority cited: Sections
						127150,
						127280
						and
						128810,
						Health and Safety Code. Reference: Sections
						127280
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97267 - Definition of Data Element for ED and AS-Preferred Language Spoken

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Effective with encounters occurring on or after January 1,
					 2011, the patient's preferred language spoken shall be reported using one of
					 the following three alternatives:
(a)
				  If the patient's preferred language spoken is known and is included in the
				  following list of alternatives, report the code from the list:
ENG -- English
AMH -- Amharic
ARA -- Arabic
ARM -- Armenian
YUE -- Cantonese (Yue Chinese)
CHI -- Chinese
HRV -- Croatian
PES -- Farsi
FRE -- French
CPF -- French Creole
GER -- German
GRE -- Greek
GUJ -- Gujarati
HEB -- Hebrew
HIN -- Hindi
HMN -- Hmong
HUN -- Hungarian
ILO -- Ilocano (Iloko)
IND -- Indonesian
ITA -- Italian
JPN -- Japanese
KOR -- Korean
LAO -- Lao
CMN -- Mandarin
IUM -- Mien (Iu Mien)
MKH -- Mon-Khmer
NAV -- Navajo
PAN -- Panjabi (Punjabi)
PER -- Persian
POL -- Polish
POR -- Portuguese
RUS -- Russian
SMO -- Samoan
SRP -- Serbian
SGN -- Sign Language
SPA -- Spanish
SWA -- Swahili
TGL -- Tagalog
TEL -- Telugu
THA -- Thai
TON -- Tonga
UKR -- Ukrainian
URD -- Urdu
VIE -- Vietnamese
YID -- Yiddish
YOR -- Yoruba
(b) If the preferred language spoken is
				  known, but is not listed in subsection (a), report the full name of the
				  language.
(c) If the preferred
				  language spoken is unknown, report the three digit code 999.
1. New
					 section filed 11-13-2008; operative 11-13-2008 pursuant to Government Code
					 section
					 11343.4
					 (Register 2008, No. 46).
2. Amendment of subsection (a) and repealer
					 of subsections (a)(1)-(30) filed 12-31-2009; operative 12-31-2009 pursuant to
					 Government Code section
					 11343.4
					 (Register 2010, No. 1).
3. Amendment of first paragraph and
					 subsection (a) filed 10-26-2010; operative 1-1-2011 pursuant to Government Code
					 section
					 11343.4(b)
					 (Register 2010, No. 44).
4. Change without regulatory effect
					 amending section heading and section filed 8-5-2014 pursuant to section
					 100, title 1, California Code of
					 Regulations (Register 2014, No. 32).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736
						and
						128737,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 10 - Health Facility Data › Article 8 - Patient Data Reporting Requirements › Section 97268 - Definition of Data Element for ED and as - Total Charges

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Total Charges is defined as all charges for services
					 rendered during the encounter for patient care at the facility, based on the
					 facility's full established rates. Charges shall include, but not be limited
					 to, ancillary services and any patient care services. Physician fees shall be
					 excluded. Prepayment (e.g. deposits and prepayments) shall not be deducted from
					 Total Charges.
1. New
					 section filed 1-11-2018; operative 4-1-2018 (Register 2018, No.
					 2).
Note: Authority cited: Section
						128810,
						Health and Safety Code. Reference: Sections
						128736,
						128737
						and
						128738,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 1 - Chapter Definitions › Section 97300 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following definitions shall apply to the regulations
					 contained in this Chapter:
(a)
				  "APCD-CDLT" means one of the following:
(1)
				  For monthly data files submitted or resubmitted pursuant to this Chapter on or
				  before February 16, 2024, the Common Data Layout for All-Payer Claims
				  Databases, Version 2.1, released July 1, 2021, as developed by the University
				  of New Hampshire and the National Association of Health Data Organizations
				  (NAHDO), and hereby incorporated by reference. This document is available
				  through the APCD Council website; or
(2) For monthly data files submitted or
				  resubmitted pursuant to this Chapter on or after February 17, 2024, the Common
				  Data Layout for All-Payer Claims Databases, Version 3.0.1, released April 1,
				  2023, as developed by the University of New Hampshire and NAHDO, and hereby
				  incorporated by reference. This document is available through the APCD Council
				  website.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 2 - Voluntary Participation in the Program › Section 97305 - Voluntary Participation in the Program

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) To
				  request to become a voluntarily participating entity, an entity or their
				  authorized agent shall submit to the Department a written request to
				  participate in the Program.
(b)
				  Each request shall provide the voluntarily participating entity's business type
				  (as described in Section
				  97300(s)(1)-(6)),
				  the number of covered lives, the types of coverage offered, and contact
				  information.
(c) The Department
				  shall notify requestors if they are approved to participate in the
				  Program.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.2,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.2,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 3 - General Provisions › Section 97310 - Plan Size Thresholds

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  health plan, health insurer, or public self-insured plan that has fewer than
				  40,000 California members is exempt from the requirements of this Chapter,
				  unless it is a Qualified Health Plan.
(1) The
				  number of California members shall be calculated by adding together the
				  California members in all of the entity's Medicare Advantage plans, private
				  health plan products, and private health insurance products, as of December 31
				  of each calendar year. For purposes of this subsection, "private" refers to
				  products that are not Medi-Cal or Medicare products.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 3 - General Provisions › Section 97314 - Qualified Health Plans

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A Qualified Health Plan that has been granted an exemption
					 from reporting information to the Program by the California Health Benefit
					 Exchange is not required to register with or submit data files to the data
					 portal.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 3 - General Provisions › Section 97318 - Coordination of Data Submissions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If
				  a plan contracts with other entities to administer plan benefits, the plan
				  shall be responsible for the submission of all data for the plan's members.
				  Entities that are contracted to administer plan benefits may include, but are
				  not limited to, pharmacy benefit managers, behavioral health organizations,
				  and, for a health plan, entities with a restricted or limited license under the
				  Knox-Keene Health Service Plan Act of 1975. The plan shall either:
(1) Obtain necessary data from the contracted
				  entity and submit the data to the system, or
(2) Ensure that the contracted entity submits
				  the data directly to the system.
(A) The plan
				  shall identify each contracted entity through the registration
				  process.
(B) Each contracted entity
				  shall register pursuant to Article 4 and this entity will be referred to as a
				  delegated submitter.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 4 - Data Portal Registration › Section 97330 - Plan Registration Requirement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) A
				  non-exempt health plan, health insurer, or public self-insured plan shall
				  register with the Program each year by the last calendar day of
				  January.
(b) A voluntarily
				  participating entity shall register, directly or through their authorized
				  agent, with the Program each year by the last calendar day of January.
(1) Prior to registering, the entity must
				  have been approved pursuant to Section
				  97305.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 4 - Data Portal Registration › Section 97331 - Submitter Registration Requirement

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If
				  a plan is submitting data directly to the system, the plan shall also register
				  to submit data through the data portal after it has registered with the Program
				  pursuant to Section
				  97330.
(b) After a plan registers with the Program
				  pursuant to Section
				  97330, each of its delegated
				  submitters, if any, shall register separately from the plan to submit data
				  through the data portal.
(c) Plans
				  and delegated submitters shall register under this Section each year by the
				  last calendar day of February.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 4 - Data Portal Registration › Section 97332 - Registration Process

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) For
				  registrations under Sections
				  97330 and
				  97331, plans and any delegated
				  submitters must do all the following:
(1)
				  register through the data portal;
(2) follow the Data Submission Guide's
				  registration instructions; and
(3)
				  provide all required information as specified in the Data Submission
				  Guide.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 4 - Data Portal Registration › Section 97334 - Registration Information Update

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Each plan or other entity that has registered pursuant to
					 this Article must update registration information within 15 calendar days of
					 any change in the required contact information.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5 - Monthly Data File Submission › Section 97340 - Monthly Data Submission

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Plans shall submit data files monthly through the data portal.
(b) Except as stated in subsection (c), each
				  monthly file shall be submitted by the first business day of the second month
				  after the report month.
(c) The
				  monthly data file submission for January 2024 shall be submitted no earlier
				  than February 17, 2024, and by March 1, 2024.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5 - Monthly Data File Submission › Section 97342 - Data File Contents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The
				  following files, as specified in the Data Submission Guide in conjunction with
				  the APCD-CDLT, shall be submitted.
(1) Member
				  Eligibility File (ME)--contains demographic information for each individual
				  member residing in California, regardless of whether the member utilized
				  services during the reporting period.
(2) Medical Claims File (MC)--contains
				  service-level medical claims and encounter data processed during the reporting
				  period, that were not fully denied, except as prohibited by federal or state
				  law.
(3) Pharmacy Claims File
				  (PC)--contains detailed pharmacy claims and encounter data processed during the
				  reporting period, that were not fully denied, except as prohibited by federal
				  or state law.
(4) Dental Claims
				  File (DC)--contains service-level dental claims and encounter data processed
				  during the reporting period, that were not fully denied, except as prohibited
				  by federal or state law.
(5)
				  Provider File (PV)--contains demographic-type data on every provider included
				  on the ME, MC, PC, or DC files during the reporting period.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5 - Monthly Data File Submission › Section 97344 - Data File Technical Requirements

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Data files shall comply with file format, technical
					 specifications, and other standards specified in the Data Submission Guide and
					 the APCD-CDLT.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5 - Monthly Data File Submission › Section 97346 - Submission Completion

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If a registered plan has identified one or more delegated
					 submitters to submit information directly to the data portal on behalf of the
					 plan, the plan's data submission shall not be considered complete until all
					 required files have been received.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5 - Monthly Data File Submission › Section 97348 - Test File Submission

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Registered submitters may use the data portal to submit
					 test files to confirm and test their ability to create data files meeting the
					 data submission standards. Test files will be identified as specified in the
					 Data Submission Guide. Test files will not be considered to have been submitted
					 to the Program.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673.4,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673.4,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5.5 - Special Rules for Program Opening and Historical Data Submission › Section 97349 - Initial Registrations for Program Opening

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
A dental plan subject to this Chapter, and its delegated
					 submitters, if any, must complete their initial registrations with the Program
					 pursuant to Sections
					 97330,
					 97331 and
					 97332 by March 29, 2024.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673
						and
						127673.1,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5.5 - Special Rules for Program Opening and Historical Data Submission › Section 97350 - Preparation for Historical Data Submission

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Each registered submitter shall use the test function to prepare for historical
				  data file submission.
(b) Plans,
				  except dental plans, shall successfully complete the testing process by July
				  29, 2022.
(c) Dental plans shall
				  successfully complete the testing process by July 31, 2024.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5.5 - Special Rules for Program Opening and Historical Data Submission › Section 97351 - Historical Data Files

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Plans, except dental plans, shall submit data files, excluding dental data, in
				  accordance with Sections
				  97342 and
				  97344 for the time period from
				  June 29, 2017 through December 2021 by October 28, 2022.
(b) All plans shall submit dental data in
				  accordance with Sections
				  97342 and
				  97344 for the time period from
				  June 29, 2017 through December 2021 by October 31, 2024.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
Note: Authority cited: Section
						127673,
						Health and Safety Code. Reference: Sections
						127671.1
						and
						127673,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 5.5 - Special Rules for Program Opening and Historical Data Submission › Section 97352 - Initiation of Monthly Data File Reporting

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Plans, except dental plans, shall do the following:
(1) Begin regular monthly reporting with
				  monthly data files, excluding dental data, for the month of November 2022, or
				  an earlier month at their election.
(2) By February 1, 2023, submit all remaining
				  data files, excluding dental data, for the months of 2022 prior to their first
				  regular monthly submission.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 6 - Data Acceptance and Correction › Section 97360 - Data Acceptance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
				  Data files that are submitted to the data portal but do not meet the file
				  intake specifications detailed in the Data Submission Guide will not be
				  accepted.
(b) Registered submitters
				  will be notified within 3 business days of submission whether a data file has
				  been accepted or rejected.
Note: Authority cited: Sections
						127673
						and
						127673.4,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673.1
						and
						127673.4,
						Health and Safety Code.
Note: Authority cited: Sections
						127673
						and
						127673.4,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673.1
						and
						127673.4,
						Health and Safety Code.
California Code of Regulations › Title 22 - Social Security › Division 7 - Health Planning and Facility Construction › Chapter 11 - Health Care Payments Data Program › Article 6 - Data Acceptance and Correction › Section 97362 - Data Review and Correction

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
If the Department determines that a previously accepted
					 file contains initially unidentified errors, the file shall be flagged and the
					 submitter required to address the issues by either confirming that the file is
					 correct or correcting and resubmitting the file within 45 days of notification
					 by the Department.
Note: Authority cited: Sections
						127673
						and
						127673.4,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673.1
						and
						127673.4,
						Health and Safety Code.
Note: Authority cited: Sections
						127673
						and
						127673.4,
						Health and Safety Code. Reference: Sections
						127671.1,
						127673.1
						and
						127673.4,
						Health and Safety Code.