Code of Massachusetts Regulations › 957 CMR - CENTER FOR HEALTH INFORMATION AND ANALYSIS › Title 957 CMR 5.00 - HEALTH CARE CLAIMS, CASE MIX AND CHARGE DATA RELEASE PROCEDURES › Section 5.02 - Definitions

Current through Register 1525, July 5, 2024
All defined terms in
				957 CMR 5.00 are capitalized.
				As used in
				957 CMR 5.00, unless the
				context otherwise requires, the following words shall have the following
				meanings:
Acute Hospital Case Mix Databases
. The
				CHIA databases housing Case Mix Data and Charge Data, including the outpatient
				emergency department database, the inpatient discharge database and the
				outpatient observation database.
APCD.
The All Payer Claims
				Database.
APCD Data
. Information submitted to
				CHIA by Payers including, but not limited to, data regarding member
				eligibility, products, providers, encounters, and medical, pharmacy, or dental
				claims.
Applicant
. An individual or
				organization that requests Data or a Summarized Data Report in accordance with
				957 CMR 5.00.
Case Mix Data
. Case specific,
				diagnostic discharge data that describe socio-demographic characteristics of
				the patient, the medical reason for the admission, treatment and services
				provided to the patient, and the duration and status of the patient's stay in
				the hospital. Case Mix data includes hospital inpatient data, outpatient
				observation data, and hospital outpatient emergency department data.
Charge Data
. The full, undiscounted
				total and service-specific charges billed by the hospital to the general
				public. Charge Data includes hospital inpatient data, outpatient observation
				data, and hospital outpatient emergency department data, and associated
				administrative bulletins.
CHIA.
The Center for Health
				Information and Analysis.
CMS
. The federal Centers for Medicare
				and Medicaid Services.
Data.
APCD Data, Case Mix Data or
				Charge Data as defined in 957 CMR 5.02.
Data Recipient
. Any entity that
				receives Data pursuant to
				957 CMR 5.00.
Data Subject
. Any individual whose
				personal patient identifiers are subject to release under
				957 CMR 5.00.
Data Use Agreement
. A document
				detailing a Data Recipient's commitments to data privacy and security, as well
				as restrictions on the disclosure and use of Data.
De-identified Data
. Information that
				does not identify an individual patient and with respect to which there is no
				reasonable basis to believe the data can be used to identify an individual
				patient. CHIA shall de-identify Data using the standards and methods required
				by the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C.
				§ 1320d through 1320d-8, and its implementing regulations, including 45
				C.F.R. Parts 160, 162 and 164.
Direct Patient Identifiers
. Personal
				information, such as name, social security number, and date of birth, that
				uniquely identifies an individual or that can be combined with other readily
				available information to uniquely identify an individual.
Disclosure
. The release, transfer,
				provision of, access to, or divulging in any manner of Claims Data, Case Mix
				Data or Charge Data.
Government Agency
. For purposes of
				957 CMR 5.00, Government
				Agency shall mean any state agency, department or authority of the Commonwealth
				of Massachusetts, as well as federal agencies and departments of the United
				States of America and excludes the governments of other states as well as other
				political subdivisions of the Commonwealth of Massachusetts. Data requests from
				Government Agencies shall be reviewed pursuant to
				957 CMR
				5.03 while Data requests from other
				governmental bodies shall be reviewed pursuant to
				957 CMR
				5.06.
Payer.
An entity that submits health
				care claims data to CHIA pursuant to M.G.L. c. 12C, § 10.
Protected Health Information
.
				Protected Health Information includes any individually identifiable health
				information (including any combination of data elements) that relates to the
				past, present, or future physical or mental health or condition of an
				individual; or the past, present or future payment for the provision of health
				care to an individual; and
(a) identifies an individual; or
(b) with respect to which there is a reasonable basis to
				believe that the information can be used to identify an individual
				patient.
Provider
. A health care provider that
				submits data to CHIA pursuant to M.G.L. c. 12C, § 8 and/or M.G.L. c. 12C,
				§ 9.
Provider Organization
. A health care
				provider organization that submits data to CHIA pursuant to M.G.L. c. 12C,
				§ 8 and/or M.G.L. c. 12C, § 9.
Researchers
. Academic researchers,
				including those affiliated with public and private universities and medical
				schools, as well as other organizations and researchers undertaking health care
				research or health care related projects funded by CMS, the National Institute
				of Health, Government Agencies and other governmental bodies.
Treatment and Coordination of Care
.
				Treatment and Coordination of Care means the provision, coordination or
				management of health care services.
Website
. The website of the Center for
				Health Information and Analysis located at
www.chiamass.gov
.