Amends TCA Section 68-1-119; Section 68-11-1615 and Section 68-11-310.

CLAIMS DATA DISCHARGE REPORTS Present law requires each licensed ambulatory surgical treatment center (ASTC) and each licensed outpatient diagnostic center (ODC) to report all claims data found on the appropriate form on every discharge to the executive director of the health facilities commission. This bill changes the present law by requiring, instead, each ASTC and each ODC to report such claims data to the commissioner of health. JOINT ANNUAL REPORTS Present law requires ASTCs and ODCs to file joint annual reports as required by the health facilities commission. ASTCs and ODCs must submit the data through third party entities approved by the health facilities commission for the purpose of editing the data according to rules and regulations established by the executive director. The ASTCs and ODCs must be responsible for the costs associated with processing of the data by the approved vendors. An ASTC and an ODC must report the claims data at least quarterly to the executive director. Present law prohibits information from being made available to the public by the executive director that reasonably could be expected to reveal the identity of any patient. The claims data reported to the executive director under existing law are confidential and not available to the public until the executive director processes and verifies the data. The executive director must prescribe conditions under which the processed and verified data are available to the public and must establish policies for the release of HIPAA compliant limited use data sets. This bill changes the present law by requiring ASTCs and ODCs to file joint annual reports as required by the department of health. ASTCs and ODCs must submit the data through third party entities approved by the department of health for the purpose of editing the data according to rules and regulations established by the executive director. CLAIMS DATA Present law requires a licensed ASTC and ODC to pay to the executive director a civil penalty of 5 cents for each day the claims data discharge report is delinquent. A claims data report is delinquent if the executive director does not receive it before 60 days after the end of the quarter. If the executive director receives the report in incomplete form, then the executive director must notify the ASTC and ODC and provide 15 additional days to correct the error. The notice must provide the ASTC and ODC an additional 15 days to complete the form and return it to the executive director prior to the imposition of any civil penalty. The maximum civil penalty for a delinquent report is $10 for each discharge record. The executive director must issue an assessment of the civil penalty to the ASTC and ODC. The ASTC and ODC has a right to an informal conference with the executive director, if the ASTC and ODC requests the conference within 30 days of receipt of the assessment. After the informal conference or, if no conference is requested, after the time for requesting the informal conference has expired, the executive director may proceed to collect the penalty by setting the penalty off against funds owed to the ASTC and ODC or by instituting litigation. In its request for an informal conference, the ASTC and ODC may request the executive director to waive the penalty. The executive director may waive the penalty in cases of an act of God or other acts beyond the control of the ASTC and ODC. Waiver of the penalty is in the sole discretion of the executive director. This bill requires the claims data required to be reported to be collected and reported only to the extent it is collected and reported in the normal billing process, unless other claims data is deemed by the executive director to be essential to the development or use of the ASTC claims data reporting system, in which case the identified data that is outside the normal billing process must be collected and reported; however, other claims data that may be required to be collected and reported must be consistent with data required to be collected and reported by other healthcare providers. Any data that is submitted to the executive director must be made available to the public no more frequently and no sooner after the data is submitted than the data collected and reported by licensed hospitals pursuant to existing law. The bill changes the existing law by replacing the executive director with the commissioner of health in all of the above provisions. Additionally, this bill changes the existing law by including birthing centers to be mentioned alongside ASTC and ODC, wherever they both appear together. REPORT OF HOSPITAL STATISTICS Present law requires all hospitals licensed by the health facilities commission or by the department of mental health and substance abuse services to, within 150 days after the end of each individual hospital's fiscal year, submit to the department of health a joint annual report of the statistical particulars relative to their patients for the fiscal year. Present law provides that if a hospital closes during the fiscal year, then the owner of the hospital at the beginning of the fiscal year must file a joint annual report with the department of health for the period of time that the hospital was owned or operated. The joint annual report must be submitted within 105 days after closure. This bill deletes this provision entirely. Present law requires all hospitals that submit a joint annual report to the department of health to also submit to the department, at the same time they send the signed paper copy of the report, a notarized statement from their chief financial officer stating that the financial data reported on the joint annual report is consistent with the audited financials for the hospitals for that reporting year. The notarized statement must also be attested to by the chief executive officer of the hospital. This bill adds to the present law by providing that this notarized statement validates that the hospital has submitted accurate and complete data such that the department of health is not required to independently audit the hospital's internal processes. This bill also requires all hospitals to submit accurate and complete data. The department of health is not responsible for validating hospitals' internal data as reported in accordance with the above provisions. REVIEW AND VERIFICATION OF JOINT ANNUAL REPORT Present law requires the commissioners of health, mental health and substance abuse services, and intellectual and developmental disabilities to establish policies and procedures to ensure independent review and verification of information submitted by healthcare providers for inclusion in the joint annual report. This bill deletes this provision.