Title 31, Chapter 7, Section 280
( 31-7-280)
(a) As used in this article, the term: (1) "Health care provider" means any hospital or ambulatory
surgical or obstetrical facility having a license or permit issued
by the department under Article 1 of this chapter. (2) "Indigent person" means any person having as a maximum
allowable income level an amount corresponding to 125 percent of
the federal poverty guideline. (3) "Third-party payer" means any entity which provides health
care insurance or a health care service plan, including but not
limited to providers of major medical or comprehensive accident or
health insurance, whether or not through a self-insurance plan,
Medicaid, hospital service nonprofit corporation plans, health
care plans, or nonprofit medical service corporation plans, but
does not mean a specified disease or supplemental hospital
indemnity payer. (b) There shall be required from each health care provider in this
state an annual report of certain health care information to be
submitted to the department. The report shall be due on the last
day of January and shall cover the 12 month period preceding each
such calendar year. (c) The report required under subsection (b) of this Code section
shall contain the following information: (1) Total gross revenues; (2) Bad debts; (3) Amounts of free care extended, excluding bad debts; (4) Amounts of contractual adjustments; (5) Amounts of care provided under a Hill-Burton commitment; (6) Amounts of charity care provided to indigent persons; (7) Amounts of outside sources of funding from governmental
entities, philanthropic groups, or any other sources, including
the proportion of any such funding dedicated to the care of
indigent persons; (8) For cases involving indigent persons: (A) The number of persons treated; (B) The number of inpatients and outpatients; (C) Total patient days; (D) The total number of patients categorized by county of
residence; (E) The indigent care costs incurred by the health care provider
by county of residence;
(9) The public, profit, or nonprofit status of the health care
provider and whether or not the provider is a teaching hospital; (10) The number of board certified physicians, by specialty, on
the staff of the health care provider; (11) The number of nursing hours per day for each hospital and per
patient visit for each ambulatory surgical or obstetrical
facility; (12) For ambulatory surgical or obstetrical facilities, the types
of surgery performed and emergency back-up systems available for
that surgery; (13) For hospitals: (A) The availability of emergency services, trauma centers,
intensive care units, and neonatal intensive care units; (B) Procedures hospitals specialize in and the number of such
procedures performed annually; and (C) Caesarean section rates by number and as a percentage of
deliveries; and (14) Data available on a recognized uniform billing statement or
substantially similar form generally used by health care providers
which reflect, but are not limited to, the following type of data
obtained during a 12 month period during each reporting period:
unique longitudinal nonidentifying patient code, the patient's
birth date, sex, race, geopolitical subdivision code, ZIP Code,
county of residence, type of bill, beginning and ending service
dates, date of admission, discharge date, disposition of the
patient, medical or health record number, principal and secondary
diagnoses, principal and secondary procedures and procedure dates,
external cause of injury codes, diagnostic related group number
(DRG), DRG procedure coding used, revenue codes, total charges and
summary of charges by revenue code, payor or plan identification,
or both, place of service code such as the uniform hospital
identification number and hospital name, attending physician and
other ordering, referring, or performing physician identification
number, and specialty code. (d) The department shall provide a form for the report required by
subsection (b) of this Code section and may provide in such form for
further categorical divisions of the information listed in
subsection (c) of this Code section. (e) The department shall, within a period of one year following July
1, 1989, in cooperation with representatives of such consumer groups
and associations and health care providers as it shall designate,
study and determine such quality indicators and such additional or
alternative information related to the intent and purpose of this
article as the department shall determine are in the best interests
of the residents of this state. (f) In the event that the department does not receive from a health
care provider an annual report containing the data and information
required by this article within 30 days following the date such
report was due or receives a timely but incomplete report, the
department shall notify the health care provider regarding the
deficiencies, by certified mail or statutory overnight delivery,
return receipt requested. In the event such deficiency continues
for 15 days after said notification has been given, the health care
provider shall be liable for a penalty in the amount of $1,000.00
for such violation and an additional penalty of $500.00 for each day
during which such violation continues and be subject to appropriate
sanctions otherwise authorized by law, including, but not limited
to, suspension or revocation of that provider's permit or license. |