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

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 .