07 LC
37 0380
House
Bill 628
By:
Representatives Sheldon of the
105th,
Channell of the
116th,
Scott of the
153rd,
Cooper of the
41st,
Cox of the
102nd,
and others
A
BILL TO BE ENTITLED
AN ACT
AN ACT
To
amend Title 31 of the Official Code of Georgia Annotated, relating to health, so
as to provide for health care data to be made available to consumers; to provide
for definitions; to provide for criteria for the website available to consumers;
to provide for reporting to the Department of Community Health by heath care
facilities regarding acquired infections and adverse incidents; to provide for
rights of citizens to health care information; to amend Article 6 of Chapter 4
of Title 26 of the Official Code of Georgia Annotated, relating to pharmacies,
so as to provide for pharmacies to submit performance and outcome data to the
Department of Community Health; to provide for an effective date; to repeal
conflicting laws; and for other purposes.
BE
IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION
1.
Title
31 of the Official Code of Georgia Annotated, relating to health, is amended by
designating the existing provisions of Chapter 5A, relating to the Department of
Community Health, as Article 1 and adding new articles to read as
follows:
"ARTICLE
2
31-5A-30.
This
article shall be known and may be cited as the 'Health Care Quality and
Transparency Act.'
31-5A-31.
As
used in this article, the term:
(1)
'Acquired infection' means any localized or system patient condition that
resulted from the presence of an infectious agent or agents, or its toxin or
toxins, as determined by clinical examination or by laboratory testing and was
not found to be present or incubating at the time of admission unless the
infection was related to a previous admission to the same setting.
(2)
'Health care facility' means those facilities defined pursuant to Code Section
31-6-2, including hospitals, nursing homes, personal care homes, hospices, and
home health agencies.
(3)
'Health care provider' means dentists, physicians, and podiatrists defined under
Chapters 11, 34, and 35 of Title 43, respectively.
(4)
'Health insurer' means any health care corporation as defined in Code Section
33-20-3, any managed care entity as defined in Code Section 33-20A-3, any health
maintenance organization as defined in Code Section 33-21-1, or any similar
entity and any self-insured health benefit plan not subject to the exclusive
jurisdiction of the federal Employee Retirement Income Security Act of 1974, 29
U.S.C. Section 1001, et seq., which entity provides for the financing or
delivery of health care services through a health benefit plan, or the plan
administrator of any health benefit plan established pursuant to Article 1 of
Chapter 18 of Title 45.
(5)
'Home health agency' shall have the meaning set forth in paragraph (2) of Code
Section 31-7-150.
(6)
'Hospice' shall have the meaning set forth in Code Section
31-7-172.
(7)
'Indigent person' means any person having as a maximum allowable income level an
amount corresponding to 125 percent of the federal poverty
guideline.
(8)
'Nursing home' shall have the meaning set forth in paragraph (3) of Code Section
31-8-163.
(9)
'Pharmacy' shall have the meaning set forth in Article 1 of Chapter 4 of Title
26.
31-5A-32.
(a)
The department shall develop a website supporting health care transparency so
that consumers of the State of Georgia may access information to perform a
comparative analysis of the cost and quality of health care provided in this
state. In making the health care information available on the website, the
department shall:
(1)
Provide for the website to be organized in a manner that enables the public to
use it easily;
(2)
Exclude from the website any information that compromises patient
privacy;
(3)
Include links to websites of health care facilities and providers to enable the
public to obtain additional information about hospitals, including hospital
programs designed to enhance quality and safety;
(4)
Allow other websites, in the department´s discretion, to link to the
website for the purposes of increasing the website´s
availability;
(5)
To the extent possible, include state and federal benchmarks for the performance
measures; and
(6)
Clearly identify the sources of data used in the website and explain the
methodology used to develop the performance measures.
(b)
Each health care facility and health care provider shall submit, when
applicable, a report to the department which includes, but is not limited
to:
(1)
A copy of the balance sheet, including a statement describing the
hospital´s total assets and total liabilities;
(2)
A copy of the income statement;
(3)
A statement of changes in financial position;
(4)
A statement of changes in fund balance;
(5)
Accountant notes pertaining to the report;
(6)
Net patient revenue; and
(7)
A statement including:
(A)
Medicare gross revenue;
(B)
Medicaid gross revenue;
(C)
Revenue from state programs;
(D)
Revenue from local government programs;
(E)
Local tax support;
(F)
Charitable contributions;
(G)
Other third-party payments;
(H)
Gross inpatient revenue;
(I)
Gross outpatient revenue;
(J)
Contractual allowance;
(K)
Any other deductions from revenue;
(L)
Charity care to indigent persons, including the number of persons treated; the
number of inpatients and outpatients; total patient days; total number of
patients categorized by county of residence; and the indigent care costs
incurred by the health care provider by county of residence;
(M)
Itemization of bad debt expense;
(N)
The public, profit, or nonprofit status of the health care facility and whether
or not the provider is a teaching hospital;
(O)
The number of board certified physicians, by specialty, on the staff of the
health care facility;
(P)
The number of nursing hours per day for each hospital and per patient visit for
each ambulatory surgical or obstetrical facility;
(Q)
For ambulatory surgical or obstetrical facilities, the types of surgery
performed and emergency back-up systems available for that surgery;
(R)
The availability of emergency services, trauma centers, intensive care units,
and neonatal intensive care units for hospitals;
(S)
Procedures health care facilities specialize in and the number of such
procedures performed annually;
(T)
Cesarean section rates by number and as a percentage of deliveries for
hospitals; and
(U)
Depreciation expenses based on the expected useful life of the property and
equipment used.
(c)
Each health care facility and health care provider shall submit to the
department, in a manner prescribed by rules and regulations of the department,
data which include, but are not limited to:
(1)
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 types of data obtained during a 12 month period during
each reporting period:
(A)
Unique longitudinal nonidentifying patient code;
(B)
The patient´s birth date, sex, race, geopolitical subdivision code, ZIP
Code, and county of residence;
(C)
Type of bill;
(D)
Beginning and ending service dates, date of admission, discharge date, and
disposition of the patient;
(E)
Medical or health record number;
(F)
Principal and secondary diagnoses and principal and secondary procedures and
procedure dates;
(G)
External cause of injury codes;
(H)
Diagnostic related group (DRG) number and DRG procedure coding
used;
(I)
Revenue codes and total charges and summary of charges by revenue
code;
(J)
Payor or plan identification, or both;
(K)
Place of service code such as the uniform hospital identification number and
hospital name; and
(L)
Attending physician and other ordering, referring, or performing physician
identification number, and specialty code; and
(2)
Aggregate data, which include, but are not limited to:
(A)
Case mix data;
(B)
Hospital admission data which shall include the number of patients treated in
the emergency department of a licensed hospital reported by patient acuity
level;
(C)
Number of patients treated as a result of a transfer from another
hospital;
(D)
Data on health care facility acquired infections, including Class I surgical
site infections, ventilator-associated pneumonia, central line-related
bloodstream infections, and other categories of infections that may be
established by rule by the department;
(E)
Data on complications and readmission data with patient and provider specific
identifiers included; and
(F)
Price lists which shall include but not be limited to:
(i)
Usual and customary room and board charges for each level of care within the
hospital, including, but not limited to, private rooms, semiprivate rooms, other
multiple patient rooms, and intensive care and other specialty
units;
(ii)
Rates charged for nursing care; and
(iii)
Usual and customary charges, stated separately for inpatients and outpatients if
different charges are imposed, for any of the following services provided by the
health care facility:
(I)
The 30 most common x-ray and radiological procedures;
(II)
The 30 most common laboratory procedures;
(III)
Emergency room services;
(IV)
Operating room services;
(V)
Delivery room services;
(VI)
Physical, occupational, and pulmonary therapy services; and
(VII)
Indication as to whether the charges listed include fees for the services of
hospital-based anesthesiologists, radiologists, pathologists, and emergency room
physicians.
(d)
In addition to the data set forth in paragraphs (b) and (c) of this Code
section, hospitals, nursing homes, home health agencies, hospices, and personal
care homes shall be required to submit to the department in a format as
prescribed by rules and regulations information regarding:
(1)
Percent of occupancy;
(2)
Data regarding staff, which includes:
(A)
The number of licensed and unlicensed staff directly responsible for the care of
the patient; and
(B)
Languages spoken by staff;
(3)
Data on types of services provided;
(4)
Data from admission assessment that reflects:
(A)
Race or ethnicity, age group, and medical condition of a patient;
(B)
Most frequently reported medical condition of patients;
(C)
Most frequently reported medical condition of patients receiving a change in
assessment; and
(D)
The percentage of patients who require no assistance, limited assistance, or
extensive assistance with respect to mobility, eating, and other basic life
functions;
(5)
Data regarding patient utilization of Medicaid, medicare, or other
insurer;
(6)
Data regarding percentage of patients who are private payors;
(7)
Data regarding key deficiencies resulting from complaint investigation and
number of uncorrected deficiencies;
(8)
Data regarding terminations from Medicaid or medicare programs and reasons for
terminations;
(9)
Data regarding number of locations by county;
(10)
Discharge data indicating the inpatient facility from which the patient
originated such as a hospital, rehabilitation facility, nursing home, or other
entity and the reason for discharge as well as data regarding the discharge
disposition of the patient subsequent to receipt of care;
(11)
Average length of stay by age group;
(12)
Average number of hours per home health visit based on diagnosis;
(13)
Utilization data including the number of patients who are readmitted for
service;
(14)
Number of admissions to acute care and reasons for admissions;
(15)
Number of deaths by age groups and race or ethnicity;
(16)
Indicators of the nature and amount of nursing care directly provided by
licensed nurses, including, but not limited to, the average ratio of registered
nurses to patients and the average skill mix ratio of licensed and supervised
unlicensed personnel to patients;
(17)
Medication errors, number and grade of pressure sores, number of injuries,
number of nosocomial infections and number of preventable
hospitalizations;
(18)
Documentation of defined nursing intervention such as clinical assessment by a
licensed provider, pain measurement and management, skin integrity management,
patient education, and discharge planning; and
(19)
Documentation of patient safety measures such as restraint checks, seizure
precautions, and suicidal precautions.
(e)
In addition to the data prescribed in sections (b) and (c) of this Code section,
health care providers shall provide data regarding:
(1)
The 30 most commonly performed services provided in a nonoffice
setting;
(2)
The 30 most commonly performed services provided in an office
setting;
(3)
Medicare and Medicaid participation;
(4)
The ten most common clinical presentations requiring diagnostic imaging and for
each category the number of patients that received imaging examinations and the
average charge for the examination;
(5)
Other such data which are reasonably necessary to study utilization patterns as
required by department rules and regulations; and
(6)
Certification of data submitted by the appropriate duly authorized
representative or employee of the health care provider or health care facility
that the information submitted is true and accurate.
(f)
Health insurers shall be required to submit to the department as prescribed by
rules and regulations information regarding claims, premium, administration, and
other financial information. Data submitted shall be certified by the chief
financial officer or his or her designee.
(g)
In addition to the data prescribed in sections (b) and (c) of this Code section,
imaging centers providing outpatient services shall provide a report which
includes:
(1)
Average patient volume for imaging per month;
(2)
Documentation noting the frequency of inspections of x-ray equipment, ultrasound
equipment, and nuclear imaging equipment and the individual performing the
inspection;
(3)
Hours of operation and number of certified radiologists on site;
(4)
Number, type, and age of diagnostic imaging equipment, including magnetic
strength, when applicable, and whether the diagnostic imaging equipment is fixed
or mobile;
(5)
The number of procedures performed by CPT code;
(6)
The number of repeat procedures taken which were conducted in order to obtain a
sufficient image relating to the patient´s image order;
(7)
The number and type of complications associated with sedation and the
administration of contrast agents;
(8)
The number of patients who required hospitalization as a result of a
complication within 24 hours of a procedure;
(9)
The number of diagnostic procedures performed and the number that revealed
negative findings; and
(10)
The number of clinical images audited and the number of cases in which there was
a variance between audited findings and the original findings.
(h)
Data submitted to the department by health care facilities, health care
providers, or health insurers shall not include specific provider contract
reimbursement.
(i)
The department shall identify those prescription drugs for which price
information shall be collected from pharmacies in accordance with Code Section
26-4-119. Such information shall include the usual and customary price, known
as the retail price. If the drug is available in generic form, price data shall
be reported for the generic drug and brand-name equivalent.
(j)
Specifications for data to be collected under this Code section shall be
developed by the department with input from the Health Strategies Council, or
its successors, established affected entities, consumers, purchasers, and such
other interested parties as may be determined by the department. The department
shall determine which medical conditions and procedures, performance outcomes,
and patient charge data to include on the website. When determining which
conditions and procedures to include, the department shall consider such factors
as volume, severity of the illness, urgency of admission, individual and
societal costs, whether the condition is acute or chronic, variation in costs,
variation in outcomes, and magnitude of variations and other relevant
information. When determining which performance outcomes to include, the
department shall consider such factors as volume of cases, average patient
charges, average lengths of stay, complication rates, mortality rates, and
infection rates, among others, which shall be adjusted for case mix and
severity, if applicable; provided, however, that the department may also
consider such additional measures that are adopted by the federal Centers for
Medicare and Medicaid Services, the National Quality Forum, the Joint Commission
on Accreditation of Healthcare Organizations, the federal Agency for Healthcare
Research and Quality, or a similar national entity that establishes standards to
measure the performance of health care providers or such additional measures
adopted by other states. Performance outcome indicators shall be risk adjusted
or severity adjusted, as applicable, using nationally recognized risk adjustment
methodologies, consistent with the standards of the Agency for Healthcare
Research and Quality and as selected by the department. When determining which
patient charge data to include, the department shall consider such measures as
average charge, average net revenue per adjusted patient day, average cost per
adjusted patient day, and average cost per admission, among others.
(k)
The department shall have the right to review any and all documentation upon
which data submitted are based upon reasonable notice and in accordance with
department rules and regulations.
(l)
Portions of patient records obtained or generated by the department containing
the name, residence or business address, telephone number, social security or
other identifying number, or photograph of any person or the spouse, relative,
or guardian of such person, or any other identifying information which is
patient specific or otherwise identifies the patient, either directly or
indirectly, are confidential and exempt from disclosure.
(m)
Any health care facility or health care provider that fails to provide data to
the department in accordance with the provisions of this Code section shall be
subject to the provisions of Code Section 31-7-280 and shall be subject to
having its certificate of need modified or sanctioned by the department as may
be authorized pursuant to Article 3 of Chapter 6 of this title.
31-5A-33.
(a)
Each health care facility shall furnish to the department a report regarding
acquired infection that shall include the specific infectious agents or toxins
and site of each infection, the clinical department or unit within the facility
where the patient first became infected, the patient´s diagnoses and any
relevant specific surgical, medical, or diagnostic procedure performed during
the current admission.
(b)
Health care facilities shall be required to report information to the department
on hospital acquired infections that involve:
(1)
Surgical site infections;
(2)
Ventilator-associated pneumonia;
(3)
Central line-related bloodstream; and
(4)
Any other category prescribed by the rules and regulations of the
department.
(c)
The department shall establish rules and regulations outlining guidelines,
definitions, criteria, standards, and coding for hospital identification,
tracking, and reporting of acquired infections which shall be consistent with
the recommendations of recognized centers of expertise in the identification and
prevention of acquired infections, including, but not limited to, the National
Health Care Safety Network of the Centers for Disease Control and Prevention or
its successor.
(d)
The department shall collaborate with the Health Strategies Council, its
successor, and other interested groups to evaluate the quality and accuracy of
data reported under this Code section and the data collection, analysis, and
dissemination methodologies.
(e)
The department shall be authorized to use the data for the transparency website
created pursuant to Code Section 31-5A-32. The information on acquired
infections shall be risk adjusted or severity adjusted, as applicable, using
nationally recognized risk adjustment methodologies. The acquired infection
data shall be organized so that a comparative analysis may be performed among
health care facilities with respect to infection control.
(f)
The department shall be prohibited from disclosing the annual report, or any
portion thereof, that contains information that directly or indirectly
identifies a patient, employee of a health care facility, or licensed health
care professional in connection with a specific acquired infection
incident.
(g)
Any health care facility or health care provider that fails to provide data to
the department in accordance with the provisions of this Code section shall be
subject to the provisions of Code Section 31-7-280 and shall be subject to
having its certificate of need modified or sanctioned by the department as may
be authorized pursuant to Article 3 of Chapter 6 of this title.
31-5A-34.
(a)
Each health care facility shall submit a report to the department regarding
adverse incidents in a manner prescribed by department rules and regulations.
Adverse incidents shall be defined as:
(1)
Surgery performed on a wrong body part that is not consistent with the
documented informed consent for that patient;
(2)
Surgery performed on the wrong patient;
(3)
The wrong surgical procedure performed on a patient that is not consistent with
the documented informed consent for that patient;
(4)
Retention of a foreign object in a patient after surgery or other procedure,
excluding objects intentionally implanted as part of a planned intervention and
objects present prior to surgery that are intentionally retained;
(5)
Death during or immediately after surgery of a normal, healthy patient who has
no organic, physiologic, biochemical, or psychiatric disturbance and for whom
the pathologic processes for which the operation is to be performed are
localized and do not entail a systemic disturbance;
(6)
Patient death or serious disability associated with the use or function of a
device in patient care in which the device is used or functions other than as
intended. The term 'device' includes, but is not limited to, catheters, drains,
and other specialized tubes, infusion pumps, and ventilators;
(7)
Patient death or serious disability associated with intravascular air embolism
that occurs while being cared for in a facility, excluding deaths associated
with neurosurgical procedures known to present a high risk of intravascular air
embolism;
(8)
An infant discharged to the wrong person;
(9)
Patient death or serious disability associated with patient disappearance for
more than four hours, excluding events involving adults who have decision-making
capacity;
(10)
Patient suicide or attempted suicide resulting in serious disability while being
cared for in a facility due to patient actions after admission to the facility,
excluding deaths resulting from self-inflicted injuries that were the reason for
admission to the facility;
(11)
Patient death or serious disability associated with a medication error,
including, but not limited to, errors involving the wrong drug, the wrong dose,
the wrong patient, the wrong time, the wrong rate, the wrong preparation, or the
wrong route of administration, excluding reasonable differences in clinical
judgment on drug selection and dose;
(12)
Patient death or serious disability associated with a hemolytic reaction due to
the administration of ABO-incompatible blood or blood products;
(13)
Maternal death or serious disability associated with labor or delivery in a
low-risk pregnancy while being cared for in a facility, including events that
occur within 42 days post-delivery and excluding deaths from pulmonary or
amniotic fluid embolism, acute fatty liver of pregnancy, or
cardiomyopathy;
(14)
Patient death or serious disability directly related to hypoglycemia, the onset
of which occurs while the patient is being cared for in a facility;
(15)
Death or serious disability, including kernicterus, associated with failure to
identify and treat hyperbilirubinemia in neonates during the first 28 days of
life. 'Hyperbilirubinemia' means bilirubin levels greater than 30 milligrams
per deciliter;
(16)
Stage 3 or 4 ulcers acquired after admission to a facility, excluding
progression from stage 2 to stage 3 if stage 2 was recognized upon
admission;
(17)
Patient death or serious disability due to spinal manipulative
therapy;
(18)
Patient death or serious disability associated with an electric shock while
being cared for in a facility, excluding events involving planned treatments
such as electric countershock;
(19)
Any incident in which a line designated for oxygen or other gas to be delivered
to a patient contains the wrong gas or is contaminated by toxic
substances;
(20)
Patient death or serious disability associated with a burn incurred from any
source while being cared for in a facility;
(21)
Patient death associated with a fall while being cared for in a facility;
and
(22)
Patient death or serious disability associated with the use of or lack of
restraints or bedrails while being cared for in a facility.
(b)
The department shall be authorized to use information regarding adverse
incidents for the transparency web site created pursuant to Code Section
31-5A-32. The department shall be prohibited from disclosing information that
directly or indirectly identifies a patient, employee of a health care facility,
or licensed health care professional in connection with the adverse
incident.
ARTICLE
3
31-5A-40.
This
article shall be known and may be cited as 'Georgia´s Patient´s Bill
of Rights and Responsibilities.'
31-5A-41.
It
is the intent of the General Assembly that health care providers understand
their responsibility to give their patients a general understanding of the
procedures to be performed on them and to provide information pertaining to
their health care so that they may make decisions in an informed manner after
considering the information relating to their condition, the available treatment
alternatives, and substantial risks and hazards inherent in the treatments.
This Code section shall not be used for any purpose in any civil or
administrative action and neither expands nor limits any rights or remedies
provided under any other law.
31-5A-42.
(a)
Each health insurer, health care provider, and health care facility as defined
under Code Section 31-5A-31, as well as pharmacies defined under Code Section
31-5A-31, shall make available on its website a link to the performance outcome
and financial data that is published by the department pursuant to Code Section
31-5A-32.
(b)
Health insurers shall include in every policy delivered or issued for delivery
to any person in this state or in any materials provided to any person notice
that such information is available electronically and the address of its
website.
(c)
Health care facilities and health care providers may indicate that the pricing
information is based on a compilation of charges for the average patient and
that each patient´s bill may vary from the average depending upon the
severity of illness and resources consumed. The health care facilities and
providers may also indicate that the price of service is negotiable for eligible
patients based upon the patient´s ability to pay."
SECTION
2.
Article
6 of Chapter 4 of Title 26 of the Official Code of Georgia Annotated, relating
to pharmacies, is amended by adding a new Code section to read as
follows:
"26-4-119.
All
pharmacies licensed under this article shall be required to submit performance
and outcome data, as well as pricing information, to the Department of Community
Health as specified by the department pursuant to Code Section 31-5A-32. Such
data shall be submitted on a time basis as prescribed by the
department."
SECTION
3.
This
Act shall become effective on July 1, 2007.
SECTION
4.
All
laws and parts of laws in conflict with this Act are repealed.