Pennsylvania Code
Title 28 - HEALTH AND SAFETY
Part VI - Health Care Cost Containment Council
Chapter 915 - DATA ACCESS CRITERIA AND PROCEDURE
CONFIDENTIALITY PROTECTIONS
Section 915.23 - Release of protected data

Universal Citation: 28 PA Code ยง 915.23

Current through Register Vol. 54, No. 44, November 2, 2024

Protected data, as set forth in Appendix B, will only be released upon approval by the Council and if the release is in accordance with the following criteria and under the following conditions:

(1) Data will be released only if there are a minimum of ten cases in a cell, except for data which is a monetary figure. Cells with less than ten cases will be suppressed.

(2) If there are less than ten cases in a cell, the Council may create categories or may aggregate data to provide some detail on the data element to the data requester.

(3) The following data may be released only to a purchaser and only for those individuals for whom the purchaser provided covered health care services:

(i) Estimated responsibility.

(ii) Prior payments-payor and patient.

(iii) Estimated amount due.

(iv) Payor group number.

(v) Employer name.

(vi) Primary payor payments.

(vii) Other payments.

(4) A data requester may request, and the Council may approve, a different aggregation or categorization of the protected data. There shall be at least ten cases in a cell for data to be released. A requester shall state the reasons for requesting a variation of the standard aggregation process.

(5) The council may, based on a determination of an individual request, release proxy patient identifiers which will preserve patient confidentiality.

(6) Year of birth/age will be released in 5-year categories, beginning with age category 0-4 up to a maximum age category of age 85 and above. If there are less than ten cases in a category, the category will be expanded by grouping it with the next higher or lower categories until there are a minimum of ten cases in the combined category.

(7) Five digit patient zip codes will not be available for geographic places that have fewer than 100,000 people. Small area analyses for geographic places of less than 100,000 people will be prepared by Council staff as a special request. For access to that information, a requester shall submit a request for a special report under § 915.41 (relating to procedure for requesting special reports to be prepared by Council).

(8) If the cell size is less than ten for a code, the Council will develop categories, such as, but not limited to:

(i) Patient is insured.

(ii) Relative of insured.

(iii) Employe of insured.

(iv) Other.

(v) Unknown.

(9) The Council will monitor combinations of certain data elements as follows:

(i) Combinations of certain data elements may enable the identification of an individual patient. Data elements with this potential include, but are not limited to: year of birth/age, patient sex, zip code, race and patient relationship to insured. Before data are released by the Council which include two or more of these data elements, the Council will examine the cell sizes resulting from the combination of these data elements. Data will only be released when the resulting cell size is at least ten cases.

(ii) If there are less than ten cases in the cells as a result of a combination of these data elements, the Council will suppress the zip code first. If the combination of the remaining data elements does not result in cell sizes of at least ten, race will be suppressed, then patient sex will be suppressed, then patient relationship to insured will be suppressed as the final element.

This section cited in 28 Pa. Code § 915.2 (relating to principles governing data access); and 28 Pa. Code § 915.51 (relating to procedures for access to Council data by data sources).

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