Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO: KRS 61.870-61.884,
216.2920,
216.2927,
216.2929
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
216.2923(2)(b) requires the
Cabinet for Health and Family Services to promulgate administrative regulations
for its transactions related to
KRS
216.2920 to
216.2929.
KRS
216.2927 mandates that personally identifying
data collected by the Cabinet for Health and Family Services from health care
providers not be released to the general public nor be allowed public
inspection under
KRS
61.870 to
61.884.
This administrative regulation establishes the guidelines for distribution and
publication of data collected by the cabinet pursuant to
900 KAR
7:030, while maintaining patient confidentiality and
further protecting personally identifying information.
Section 1. Definitions.
(1) "Cabinet" is defined by
KRS
216.2920(2).
(2) "Data" means the information collected
pursuant to
900 KAR
7:030.
(3)
"Encounter-level" means the data record of a single instance of
hospitalization, outpatient service, ambulatory surgery, emergency department,
or observation stay billing record contained in a data file.
(4) "Health care provider" is defined by
KRS
216.2920(5).
(5) "Public" means a person or group not
directly responsible for the collection, maintenance, custody, or dissemination
of data for purposes of this administrative regulation.
(6) "Report" means a summary or compilation
of data disseminated to the public.
Section 2. Encounter-Level Data.
Encounter-level data shall be released in an electronic text file and shall
include the following data elements:
|
Encounter-Level Data
|
|
Provider ID
|
|
Quarter and Year of Discharge
|
|
Patient Gender
|
|
Patient Age Group
|
|
Patient Race or Ethnicity
|
|
Patient Resident County
|
|
Type of Admission
|
|
Source of Admission
|
|
All Diagnoses Available for Each Individual
Record
|
|
All Procedures Available for Each Individual
Record
|
|
Patient Zip Code
|
|
Length of Stay
|
|
Total Charges
|
|
Discharge Status
|
|
Payer 1 (Primary)
|
|
Payer 2
|
|
Payer 3
|
|
Do not resuscitate indicator
|
|
Diagnosis present on admission indicator
|
Section
3. Summary Data.
(1) The cabinet
shall not release data if
KRS
216.2927 prohibits its release.
(2) The cabinet may include the following
data elements, in any combination thereof, for encounter-level, aggregate, and
summary report formats:
(a) Diagnoses and
procedures, primary, and any other level;
(b) Diagnosis and procedure groupings,
including diagnostic related groups, major diagnostic categories, and agency
for health care policy and research clinical classification system;
(c) Patient gender;
(d) Age or age grouping;
(e) Discharge status;
(f) Payor category, all levels;
(g) Charge information, total and
ancillary;
(h) County of patient
residence;
(i) County of
provider;
(j) Ancillary department
information;
(k) Length of stay,
total, and average;
(l) External
cause of injury;
(m) Race or
ethnicity; or
(n) Mortality rate.
Reports including mortality rates shall be adjusted by severity of illness by
reputable grouping software, either on a contract basis or by the
cabinet.
(3) Data shall
not be withheld from the public or another interested party based solely on an
unfavorable profile of a provider or group of providers, if the data is deemed
reliable, accurate, and sufficiently free of error, as determined by the
cabinet and pursuant to
900 KAR
7:030.
Section 4. Release of Data.
(1) A person or agency shall, as a condition
for receiving data from the cabinet, sign an Agreement for Use of Kentucky
Health Claims Data. A person or agency receiving data shall agree to adhere to
the confidentiality requirements established in subsection (2) of this section
and
KRS
216.2927.
(2) To protect patient confidentiality:
(a) A report or summary of data that consists
of five (5) or fewer records shall not be released or made public;
(b) A person or agency receiving data shall
not redistribute or sell data in the original format;
(c) A person or agency receiving data shall
not redistribute or sell a subset of the data or an aggregate product of the
data;
(d) Distribution of data
received by the cabinet shall be approved by the custodial agency prior to
receipt of the data;
(e) The data
collected pursuant to
900 KAR
7:030 shall be used only for the purpose of health
statistical reporting and analysis or as specified in the user's written
request for the data; and
(f) A
user shall not attempt to link the public use data set with an individually
identifiable record from another data set.
Section 5. Fees.
(1) The cabinet shall charge a fee not to
exceed $1,500 for the purchase of a single copy of an annual, public-use data
set.
(2) A public-use data set
shall be available for purchase no later than sixty (60) days after the end of
the facility reporting period as established in
900 KAR
7:030. Special requests for data shall be prioritized
and completed at the discretion of the custodial agency.
Section 6. Incorporation by Reference.
(1) "Agreement for Use of Kentucky Health
Claims Data", May 2017, is incorporated by reference.
(2) This material may be inspected, copied,
or obtained, subject to applicable copyright law, at the Cabinet for Health and
Family Services, Office of Health Policy, 275 East Main Street 4WE, Frankfort,
Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m.
STATUTORY AUTHORITY:
KRS
194A.050(1),
216.2923(2)(b)
