Pennsylvania Code › Title 28 - HEALTH AND SAFETY › Part VI - Health Care Cost Containment Council › Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE › GENERAL PROVISIONS › Section 915.2 - Principles governing data access

Current through Register Vol. 54, No. 28, July 13, 2024
(a)
Confidentiality
				  principle
. The Council, under the mandates of and authority provided
				  in the act will assure the confidentiality of information received as a result
				  of the enactment and implementation of the act. This chapter establishes
				  policies and procedures to protect and maintain the confidentiality of
				  individual patient information which is submitted to the Council. These
				  policies and procedures assure that information and data will not be released
				  or be accessible if the release of the information or data could reasonably be
				  expected to reveal the identity of an individual patient. If conflicts between
				  patient confidentiality and release of data arise, patient confidentiality will
				  take priority.
(b) Other
				  principles.
(1) The Council will facilitate
				  the continuing provision of quality, cost-effective health services throughout
				  this Commonwealth by providing data and information to the purchasers and
				  consumers of health care on the cost and quality of health care
				  services.
(2) The Council will
				  assure that information and data received by the Council will be utilized by
				  the Council for the benefit of the public.
(3) The Council will assure that data will
				  not be released or be accessible that does not simultaneously disclose charge
				  or payment as well as provider quality and provider service
				  effectiveness.
(4) The Council will
				  assure that data will not be released or be accessible which could reasonably
				  be expected to reveal the identity of a purchaser, other than a purchaser
				  requesting data on its own group or an entity entitled to the purchaser's data
				  under the act.
(5) The Council will
				  assure that data will not be released or be accessible which relates to actual
				  payments to an identified provider made by a purchaser, except that this does
				  not apply to a purchaser requesting data on the group for which it purchases or
				  otherwise provides covered services or access to that same data by an entity
				  entitled to the purchaser's data under the act.
(6) The Council will assure that data which
				  discloses discounts or differentials between payments accepted by providers for
				  services and their billed charges obtained by identified payors from identified
				  providers will not be released or accessible unless comparable data on other
				  payors is also released and the Council determines that the release of the
				  information is not prejudicial or inequitable to an individual payor or
				  provider or group thereof.
(7) The
				  Council will assure that access to data, as defined in this chapter, by a
				  party, including, but not limited to, purchasers, collective bargaining
				  representatives, general public and Council members, will be in accordance with
				  the procedures contained in this chapter.
(8) The Council is required to uphold the act
				  and to prohibit the unauthorized use of Council data as set forth in the
				  act.
(9) The Council will be very
				  restrictive with regard to the release of data. Requests for data will be
				  reviewed in accordance with the confidentiality protections, as enumerated in
				  §§
											915.21-915.25 (relating to
				  confidentiality protections). If the Council determines that the request
				  violates the Council's confidentiality protections, the Council may seek to
				  amend cell sizes, propose alternative ways to examine data, propose alternative
				  ways to look at specific issues and otherwise amend the scope of the report or
				  deny the request.