CHAPTER He-C 1500 DATA SUBMISSION
AND RELEASE OF HEALTH CARE FACILITY DISCHARGE DATA
Statutory
Authority: RSA 126:27
PART He-C
1501 PURPOSE AND SCOPE
He-C 1501.01 Purpose and Scope. This chapter contains the provisions for
submission and release of health care facility discharge data from acute care
hospitals, specialty hospitals, freestanding hospital emergency facilities, and
walk-in urgent care centers.
Source. #4069, eff 6-6-86; ss by #4542, eff 12-12-88;
ss by #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
PART He-C
1502 DEFINITIONS
He-C 1502.01 Definitions.
(a)
“Acute care hospital” means a health care facility that is licensed by
the state of New Hampshire under RSA 151:2 as a general hospital.
(b)
“Agent” means a person engaged under contractual agreement with the
department for the performance of services pursuant to RSA 126:25.
(c)
“Cell size” means the count of patients that share a set of characteristics
in a statistical table.
(d)
“Clinical data” means the health care, hospital and non-hospital health
care facility data, and all other data collected in accordance with the rules
adopted pursuant to RSA 126:27.
(e)
“Commissioner” means the commissioner of the New Hampshire department of
health and human services or his or her designee.
(f)
“Confidential data” means individual or collective data elements
contained in the data set that:
(1) Have not been revealed previously to the general
public; and
(2) Directly identify a patient.
(g)
“Confidential research data set” means a data set available for
research, subject to the provisions in He-C 1504.05 below, which contains
confidential data and does not contain information that can be used to directly
identify individual health care practitioners.
(h)
“Data” mean factual information used as a basis for calculating or
measuring.
(i) “Data set” means a collection of individual
data records.
(j)
“Database” means a collection of data organized especially for search
and retrieval.
(k)
“Department” means the New Hampshire department of health and human
services.
(l)
“Direct patient identifiers” means any information, other than
information used to create anonymous or encrypted data, that plainly discloses
the identity of an individual, including, but not limited to, those data
elements specified in RSA 91-A:10, I(e).
(m)
“Disclosure” means the communication of clinical data to a person not
already in possession of that information.
(n)
“Element” means a constituent part of a database to which values can be
assigned.
(o)
“Freestanding hospital emergency facility” means a health care facility
that is licensed by the state of New Hampshire under RSA 151:2 as a freestanding
hospital emergency facility.
(p)
“Health care data” means information consisting of, or derived directly
from patient discharge data. “Health
care data” does not include analysis, reports, or studies containing
information from health care data sets, if those analyses, reports, or studies
have already been released in response to another request for information or as
part of a general distribution of public information by the department.
(q)
“Health care facility” means, in this chapter, a public or private,
proprietary or not-for-profit entity or institution providing health services
licensed under RSA 151:2 that is an:
(1) Acute care hospital;
(2) Specialty hospital;
(3) Freestanding hospital emergency facility; or
(4) Walk-in urgent care center.
(r)
“Health care practitioner” means physicians and all persons licensed or
registered as a health care provider in the state of New Hampshire including,
but not limited to:
(1) Nurses;
(2) Podiatrists;
(3) Optometrists;
(4) Pharmacists;
(5) Chiropractors;
(6) Physical therapists;
(7) Dentists;
(8) Psychologists;
(9) Licensed clinical social workers;
(10) Marriage and family therapists;
(11) Professional counselors; and
(12) Physicians’ assistants.
(s)
“Indirect patient identifier” means information that used in conjunction
with another data set that contains direct patient identifiers which could
identify patients, but used alone do not identify patients, including:
(1) All geographic subdivisions of New Hampshire
or any state or province, including census tracts, blocks, and block groups,
cities, towns, and zip codes, except county or areas made up of 10 or more
municipalities; and
(2) All elements of dates, except year, for dates
related to a patient, including birth date, admission date, discharge date,
date of death, and all ages over 89 and all elements of dates, including year, indicative of such age, except that such elements
may be aggregated into a single category of age 90 and older.
(t)
“Inpatient acute care discharges” means records or data from discharges
of patients who are admitted to a health care facility and are coded as
“Inpatient” as described in He-C 1503.04(a)(5), “type of bill”.
(u)
“Limited use research data set” means a data set available for research,
subject to provisions in He-C 1504.04 below, from which all direct patient
identifiers have been encrypted in such a way as to not allow direct
identification and that does not contain information that can be used to
directly identify individual health care practitioners.
(v)
“Patient” means any person in a data set that is the subject of the
activities of the claim performed by the health care provider.
(w)
“Principal investigator” means the person in charge of a project that
makes use of limited use research or research health care claims data
sets. The principal investigator is the
custodian of the data and is responsible for the observance of all conditions
of use and for establishment and maintenance of security arrangements to prevent
unauthorized use.
(x)
“Provided by law” means use and disclosure as permitted or required by
New Hampshire state law governing programs or activities undertaken by the
state or its agencies, or required by federal law.
(y)
“Public use data set” means a data set which contains no confidential
data, and from which all known direct or indirect identifiers about individual
patients, health care practitioners and employers or purchaser groups have been
removed, and that contains the data elements specified in He-C 1504.02 below.
(z)
“Release” means to make all or part of the claims data set available for
inspection and analysis to persons other than the department.
(aa)
“Specialty hospital” means a health care facility licensed by the state
of New Hampshire under RSA 151:2 as a specialty hospital that is engaged in
providing psychiatric, substance abuse, physical rehabilitation, long term
acute care, or other services to patients under the supervision of a physician.
(ab)
“Statistical table” means single or multivariate counts based on the
information contained in a data set and which does not include any direct
identifiers.
(ac)
“Walk-in urgent care center” means a health care facility licensed under
RSA 151:2 by the state of New Hampshire as part of a larger general hospital,
freestanding hospital emergency facility, or outpatient
clinic that provides patients access to prompt medical care for minor illnesses
or injury without an appointment.
Source. #4069, eff 6-6-86; EXPIRED 6-6-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
PART He-C 1503
HEALTH CARE FACILITY DISCHARGE DATA SET SUBMISSION REQUIREMENTS
He-C 1503.01 Licensed Health Care Facilities Required
to Submit Discharge Data Sets. All
health care facilities defined in He-C 1502.01(q) shall be required to submit
discharge data sets.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.02 Health Care Data Set Submission
Description. Beginning with
discharges occurring on January 1, 2010, and continuing at least quarterly
thereafter, health care facilities shall submit to the department, or its
agent, a completed health care data set for all patient discharges. Each health care facility shall also ensure
submittal of all health care data processed by any sub-contractor or other
third party on its behalf.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.03 General Requirements for Data Set Submission.
(a)
Health care facilities shall submit data to the department, or its
agent, as standard claims transactions in a format compliant with the Official
UB-04 Data Specifications Manual published by the National Uniform Billing
Committee.
(b) Unless otherwise specified in He-C 1503.04,
the Official UB-04 Data Specifications Manual shall be the code source to be
utilized for discharge data submission.
(c)
Unless otherwise specified in He-C 1503.04, data elements shall be
required as defined by the UB-04 reporting standard in the Official UB-04 Data
Specifications Manual.
(d)
Data submissions shall be made using the ANSI ASC X12N 837 electronic
file format pursuant to 45 CFR 162.
(e)
Data submissions shall be made to the department or its agent utilizing
secure socket layer (SSL) protocol.
E-mail attachments and paper submissions shall not be acceptable.
Source. #4074, eff 6-27-86; EXPIRED 6-27-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.04 Required Data Elements.
(a)
The following elements from the UB-04 reporting standard shall be
submitted as follows:
(1) UB-04 Form Locator 01, “billing provider
name, address and telephone number”;
(2) UB-04 Form Locator 02, “pay-to name and
address”;
(3) UB-04 Form Locator 03a, “patient control
number”;
(4) UB-04 Form Locator 03b, “medical/health
record number”, which shall be required on all claims;
(5) UB-04 Form Locator 04, “type of bill”;
(6) UB-04 Form Locator 05, “federal tax ID
number”;
(7) UB-04 Form Locator 06, “statement covers
period”;
(8) UB-04 Form Locator 08, “patient
name/identifier”, which shall:
a. Be encrypted using a standard methodology and
software provided by the department or its agent before submission to the
department or its agent; and
b. Be divided into 4 distinct components of
patient last name, patient first name, patient middle name, and patient
generational identifier suffix, all provided in upper case prior to encryption;
(9) UB-04 Form Locator 09, “patient address”;
(10) UB-04 Form Locator 10, “patient birth date”;
(11) UB-04 Form Locator 11, “patient sex”;
(12) UB-04 Form
Locator 12, “admission/start of care date”, which shall be required on all
claims;
(13) UB-04 Form Locator 13, “admission hour”,
which shall be required on all claims;
(14) UB-04 Form Locator 14, “priority (type) of
visit”;
(15) UB-04 Form Locator 15, “point of origin for
admission or visit”;
(16) UB-04 Form Locator 16, “discharge hour”,
which shall be required on all inpatient and observation stay claims;
(17) UB-04 Form Locator 17, “patient discharge
status”;
(18) UB-04 Form Locator 18 through 28, “condition
codes”, which shall:
a. Be submitted as recorded; and
b. Be collected, recorded, and submitted where
applicable for:
1. 02 = Condition is Employment-Related; and
2. P1 = Do Not Resuscitate Order (DNR);
(19) UB-04 Form Locator 31 through 34, “occurrence
codes and dates 1 – 4”, which shall:
a. Be submitted as recorded; and
b. Be collected, recorded, and submitted where
applicable for 04 = Accident/employment related date;
(20) UB-04 Form Locator 39 through 41, “value
codes and amounts”, which shall:
a. Be submitted as recorded; and
b. Be collected, recorded, and submitted where
applicable for:
1. 54 = Newborn Birth Weight in Grams; and
2. P0 = For newborns, mother’s medical record
number;
(21) UB-04 Form Locator 42, “revenue code”;
(22) UB-04 Form Locator 44, “HCPCS or CPT/accommodation
rates/HIPPS rate codes”, except the length limit shall not apply;
(23) UB-04 Form Locator 45, “service date”;
(24) UB-04 Form Locator 46, “service units”;
(25) UB-04 Form Locator 47, “total charges”;
(26) UB-04 Form Locator 50, “payer name”, except
the length limit shall not apply;
(27) UB-04 Form Locator 51, “health plan
identification number”;
(28) UB-04 Form Locator 56, “national provider
identifier – billing provider”;
(29) UB-04 Form Locator 57, “other (billing)
provider identifier”;
(30) UB-04 Form Locator 59, “patient’s
relationship to insured”;
(31) UB-04 Form Locator 64, “document control
number”;
(32) UB-04 Form Locator 65, “employer”, which
shall:
a. When the employer is not known, be recorded
as “UNKNOWN”; and
b. When not employed, be recorded as “NA.”;
(33) UB-04 Form Locator 66, “diagnosis and
procedure code qualifier”;
(34) UB-04 Form Locator 67, “principal diagnosis
code and present on admission indicator” which for the present on admission
(POA) element shall only be recorded on inpatient acute care discharges;
(35) UB-04 Form Locator 67A-Q, “other diagnosis
codes and present on admission indicator” which for the POA element shall only
be recorded on inpatient acute care discharges;
(36) UB-04 Form Locator 69, “admitting diagnosis
code”;
(37) UB-04 Form Locator 70A-C, “patient’s reason
for visit”;
(38) UB-04 Form Locator 72A-C, “external cause of
injury code (ECI) and present on admission indicator”, which shall be reported
in order for every applicable principal and other diagnoses;
(39) UB-04 Form Locator 74, “principal procedure
code and date”;
(40) UB-04 Form Locator 74A-E, “other procedure
codes and dates”;
(41) UB-04 Form Locator 76, “attending provider
name and identifiers”;
(42) UB-04 Form Locator 77, “operating physician
name and identifiers”;
(43) UB-04 Form Locator 78 and 79, “other provider
(individual) names and identifiers”;
(44) UB-04 Form Locator 80, “remarks”; and
(45) UB-04 Form Locator 81A-D, “code-code field”,
which shall:
a. Be submitted as recorded; and
b. Be collected, recorded, and submitted where
applicable for B1 (race and ethnicity).
(b)
The health care facility shall submit information regarding primary
language spoken as an integer numeric element which health care facilities
shall code consistently.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.05 Registration.
(a)
Each health care facility shall submit a registration to the department,
or its agent, within one month of the effective date of these rules, and
annually thereafter, with the following information:
(1) Health care facility name and mailing
address;
(2) Health care facility federal tax
identification number;
(3) Health care facility national provider
identification number(s); and
(4) Name, e-mail address, and mailing address of
the person completing the registration.
(b)
Health care facilities becoming operational at a later date shall submit
a registration within one month of becoming operational, and annually
thereafter.
(c)
When any of the information in (a) above changes, health care facilities
shall submit the new information.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.06 Transmittal Record. With each submission of data, a transmittal
record shall also be supplied that contains the following information:
(a)
Submitting health care facility;
(b)
If different from submitting health care facility, the name and address
of the location where discharges in the submitted records occurred;
(c)
File name;
(d)
Contact person name;
(e)
Contact person address;
(f)
Contact person telephone number;
(g)
Contact person e-mail address;
(h)
Period beginning date;
(i) Period ending date;
(j)
Record count;
(k)
Date processed;
(l)
Submission date; and
(m)
Explanatory notes to assist with processing of the file.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.07 Submission of Test Data.
(a)
Each health care facility shall submit to the department, or its agent,
a test data submission for the purpose of determining compliance with required
data submission standards.
(b)
Each test data submission shall contain 3 months
worth of discharges.
(c)
Test data submission shall be required:
(1) At least 3 months prior to the first required
data submission date; and
(2) When a facility changes systems or processes.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES:
9-18-17
He-C 1503.08 Submission Periods.
(a)
The submission period for health care facilities submission of data sets
shall, at a minimum, be quarterly.
(b)
Data set submissions shall be made no later than 2 months after the end
of each quarter, as follows:
(1) February 28, for those patients discharged
between October 1 and December 31;
(2) May 31, for those patients discharged between
January 1 and March 31;
(3) August 31, for those patients discharged
between April 1 and June 30; and
(4) November 30, for those patients discharged
between July 1 and September 30.
(c)
Health care facilities may request up to 3 months additional time to
file their first 2 submissions by submitting the request in writing to the
department, including an explanation of the reason for the request. The
department shall approve such requests.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.09 Monthly Submission. Health care facilities wishing to submit data
on a monthly basis shall request prior approval from the department. Monthly submission shall be granted if the
department determines that the integrity of the data will not be jeopardized by
monthly submission. Monthly data set
submissions shall be made no later than 2 months after the end of each month
for which a data set applies.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.10 Automated Submission.
(a)
Health care facilities wishing to submit data on an automated basis
shall request prior approval from the department.
(b)
Automated submission shall be granted if the following criteria are met:
(1) All required data elements are able to be
processed by the health care facility and the department, or its agent, on a
daily or continual basis in the format specified in section He-C 1503.03; and
(2) The department determines that the integrity
of the data will not be jeopardized by automated submission.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES:
9-18-17
He-C 1503.11 Submission Compliance. With each submission, health care data sets
shall comply with the following reporting requirements:
(a)
The applicable code for each data element shall be within the eligible
values for the element;
(b)
Coding values indicating “data not available”, “data unknown”, or the
equivalent shall not be used for individual data elements unless specified as
an eligible value for the element;
(c)
Patient sex, diagnosis and procedure codes, date of birth, and all other
data fields shall be consistent within an individual record;
(d)
No duplicate records shall be submitted; and
(e)
The volume of records submitted by type of bill shall be within 10
percent of the immediately proceeding submission, and
if not, health care facilities shall provide information to the department
explaining the change in volume.
Source.. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.12 Non-Compliant Data Submission.
(a)
Each health care facility shall be notified when data submissions do not
meet the standards described in this rule, including the specific file and the
data elements that do not meet the standards.
(b)
Each health care facility notified of a non-compliant data submission
shall respond within 30 days of the notification by making the changes
necessary to meet the standards and resubmit the entire data submission.
Source.. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New.
#12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1503.13 Primary Language Code Set.
(a)
Within 2 months of the effective date of these rules, each health care
facility shall provide to the department the meaning of the primary language
codes currently in use at the facility.
(b)
For its first required data submission, and whenever primary language
codes change, each health care facility shall submit the meaning of the codes
submitted pursuant to He-C 1503.04(b).
Source..
# 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139,
INTERIM, eff 3-22-17, EXPIRES: 9-18-17
PART He-C 1504 RELEASE OF HEALTH
CARE FACILITY DISCHARGE DATA SETS
He-C 1504.01 Purpose and Scope. This part establishes the requirements for
the release from the department of health care facility discharge data sets
collected in accordance with He-C 1503.
Source. #4168-a, eff 11-18-86; EXPIRED 11-18-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.02 Public Use Data Sets. Public use data sets shall consist of the
following health care data elements:
(a)
Type of bill;
(b)
Patient county, state, and country, as coded by the department from
patient address;
(c)
Patient sex;
(d)
Patient age if under 90, and if 90 or over patient age aggregated into a
single category of age 90 or older;
(e)
Patient race;
(f)
Patient ethnicity;
(g)
Admission year;
(h)
Admission hour;
(i) Admission type;
(j)
Priority of visit;
(k)
Admission source;
(l)
Length of stay;
(m)
Discharge year;
(n)
Discharge hour;
(o)
Discharge patient status;
(p)
Condition codes;
(q)
Occurrence codes;
(r)
Value codes and amounts;
(s)
Revenue codes;
(t)
Accommodation rates/HCPCS and HIPPS rates;
(u)
Service units;
(v)
Total charges;
(w)
Payer type, as coded by the department into Commercial, Medicare,
Medicaid, Other Federal Government, Workers Compensation, Uninsured, Self-Pay,
and Other;
(x)
Patient’s relationship to insured;
(y)
Diagnosis and procedure code qualifier;
(z)
Principal diagnosis code, and present on admission indicator;
(aa)
Other diagnosis codes;
(ab)
Admitting diagnosis;
(ac)
Patient’s reason for visit;
(ad)
Diagnosis related group (DRG), as coded by the department where data is
sufficient;
(ae)
E-codes;
(af) Principal procedure code;
(ag)
Other procedure codes;
(ah)
Health care facility name;
(ai)
Health care facility type, as coded by the department according to
facility license; and
(aj) Record type flag for inpatient and
outpatient, as coded by the department from type of bill.
Source. #4168-a, eff 11-18-86; EXPIRED 11-18-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.03 Release of Public Use Data Sets.
(a)
Public use data sets shall be released upon written request.
(b)
Records of releases of public use data sets shall be maintained and made
available for public inspection, upon request.
(c)
Any interested party that wants to be notified by electronic mail when a
new year of data is available for release shall request such notice from the
department or its agent.
Source. #4168-a, eff 11-18-86; EXPIRED 11-18-92
New. #5844, eff 7-1-94, EXPIRED: 7-1-00
New. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.04 Release of Limited Use Facility Discharge
Data Sets. Except as otherwise
provided by law, limited use facility discharge data sets shall be released to
principal investigators for the purposes of research under the following
conditions.
(a)
The principal investigator shall submit a written application on a form
provided by the department containing:
(1) The principal investigator’s:
a. Name, address, and phone number;
b. Organizational affiliation;
c. Professional qualification; and
d. Name and phone number of principal
investigator’s contact person, if any;
(2) The names and qualifications of additional
research staff, if any, who will have access to the data;
(3) A research protocol containing:
a. A summary of background, purposes, and origin
of the research;
b. A statement of the health-related problem or
issue to be addressed by the research;
c. The research design and methodology,
including either the topics of exploratory research or the specific research
hypotheses to be tested;
d. The procedures that will be followed to
maintain the confidentiality of any data or copies of records provided to the
principal investigator; and
e. The intended research completion date; and
(4) Information about the data set being
requested, including:
a. The time period of the data requested;
b. The minimum needed data elements required;
c. A justification for the need for any data
elements that are potentially indirect patient identifiers and specification of
how the data should be recoded by the department to
make the data element less of a potentially indirect patient identifier;
d. The selection criteria for the minimum needed
data records required; and
e. Any special format or layout of data
requested by the principal investigator.
(b)
The principal investigator shall submit a signed data use agreement that
specifies that the principal investigator shall:
(1) Use the data for only the purpose specified
in the application;
(2) Establish appropriate safeguards to protect
the confidentiality of the data and prevent unauthorized use of the data;
(3) Not use or further disclose or sell the data
set or statistical tabulations derived from the data set to any person or
organization other than as described in the application and as permitted by the
data use agreement without the written consent of the department;
(4) Not use or further disclose the information
as otherwise required by law;
(5) Not seek to ascertain or disclose the
identity of patients, employer groups or purchaser groups revealed in the
limited use data set;
(6) Not seek to ascertain or disclose any of the
information removed from the data or encrypted as specified in He-C 1502.01(u)
above that specifies the exclusions from the limited use data set;
(7) Not publish or make public the content of
cells that contain counts of patients in statistical tables in which the cell
size is more than 0 and less than 5;
(8) Not publish or make public any information
that could be used to ascertain the identity of providers of abortion services;
(9) Report to the department, within 5 days, any
unauthorized use or disclosure of the information, of which the principal
investigator becomes aware, that is contrary to the agreement;
(10) Provide the department with a preview copy of
a proposed release at least 15 days prior to any publication or release of any
reports or publications containing information derived from the data set for review
and verification that the conditions of the agreement have been met;
(11) Not release any document determined to breach
the conditions of the agreement;
(12) Acknowledge the department as the source of
the data in any and all public reports, publications, or presentations
generated by the principal investigator from these data;
(13) Specify that the analyses, conclusions, and
recommendations drawn from such data are solely those of the principal
investigator and are not necessarily those of any agency of the State of New
Hampshire;
(14) Retain the data only for the period of time
necessary to fulfill the requirements of the data request;
(15) Return the data within 30 days of the
scheduled completion date of the project, or destroy the data, so certifying by
submitting a written notice to the department, or reapply for approval within
60 days of scheduled completion if the principal investigator determines the
end date of the project needs to be extended; and
(16) Acknowledge that failure to adhere to the
data use agreement shall be cause for immediate recall of the data, revocation
of permission to use the data, and application of any applicable criminal
liability under New Hampshire state law.
(c)
Applications for the release of limited use data sets shall be approved
when the department determines that:
(1) The application submitted is complete
pursuant to (a) above and the principal investigator has signed the data use
agreement as specified in (b) above;
(2) Procedures to ensure the confidentiality of
any patient and any confidential data are documented;
(3) The qualifications of the investigator and
research staff are documented by:
a. Training and
previous research, including prior publications; and
b. An affiliation
with a university, private research organization, medical center, state agency,
or other institution that will provide sufficient research resources; and
(4) No other state or federal law, or federal
regulation, prohibits release of the requested information.
(d)
The department shall provide notification of denial or approval within
30 days of receipt of the application.
(e)
Notification of denial shall include a written statement identifying of
the specific criteria that are the basis for denial of the application.
(f)
Studies taking longer than 2 years shall require annual application
after the first 2-year period.
(g)
The principal investigator shall comply with the conditions in the data
use agreement in (b) above.
(h)
In the event the department determines that any report or publication
referenced in (b) above might lead to direct or indirect identification of
patients, employers, or other group purchasers, the department shall provide a
written statement to the researcher stating specifically the problematic
sections in the publication. The
requesting party shall modify the report or publication prior to its release by
fully addressing the problematic sections.
No cause other than direct or indirect identification of patients,
employers or other group purchasers shall be given to prevent publication of
information derived from the data.
(i) When multiple reports of a similar nature
will be created from the data, upon request the department shall waive the
requirement that any subsequent reports or publications be provided to the
department prior to release by the requesting party.
(j)
Any draft reports or publications supplied to the department shall be
treated as confidential and shall not be released by the department.
(k)
Information regarding release of limited use data sets and records of
the review of publications shall be made available upon request.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.05 Release of Confidential Health Care
Research Data Sets. Except as
otherwise provided by law, upon the approval of the Comprehensive Health Care
Information System privacy review committee established by He-W 950.07,
confidential health care research data sets shall be released to principal
investigators for the purposes of research under the following conditions:
(a)
When the principal investigator submits a completed written application
developed by the department that contains the following:
(1) The principal investigator’s:
a. Name, address, and phone number;
b. Organizational affiliation;
c. Professional qualification; and
d. Name and phone number of principal
investigator’s contact person, if any;
(2) The names and qualifications of additional
research staff, if any, who will have access to the data;
(3) A research protocol which contains:
a. A summary of background, purposes, and origin
of the research;
b. A statement of the health-related problem or
issue to be addressed by the research;
c. The research hypothesis or hypotheses to be
tested or the specific statistical quantities or dependencies to be measured;
and
d. The research design and methodology which
shall include:
1. A clear definition of exactly how the records
needed for the research will be selected and how the patients and or employer
groups who are the subject of the research are defined;
2. Method of data analysis;
3. The way in which the requested data will be
used;
4. The procedures
for contacting any persons or facilities named in records, if applicable;
5. The procedures to obtain informed consent
from the patients, employer groups or other group purchasers, if applicable;
6. The procedures that will be followed to
maintain the confidentiality of any data or copies of records provided to the
principal investigator; and
7. The intended research completion date; and
(4) Information about the data set being
requested including:
a. The time period of the data requested;
b. The minimum needed specific data items or
fields of information required;
c. The minimum needed specificity of those data
items;
d. The selection criteria for the minimum needed
data records required; and
e. Any special format or layout of data
requested by the principal investigator.
(b)
The application shall include written evidence of prior consent for its
disclosure from the patients who are the subject of the information.
(c)
When the data set requested identifies employer or group purchasers, the
application shall include written evidence of prior consent for its disclosure
from the employer or group purchasers that are the subject of the information.
(d)
The principal investigator shall submit a signed data use agreement that
specifies that the principal investigator shall:
(1) Use the data for only the purpose specified
in the application;
(2) Establish appropriate safeguards to protect
the confidentiality of the data and prevent unauthorized use of the data;
(3) Not use or further disclose or sell the data
set or statistical tabulations derived from the data set to any person or
organization other than as described in the application and as permitted by the
data use agreement without the written consent of the department;
(4) Not use or further disclose the information
as otherwise required by law;
(5) Not seek to ascertain or disclose the
identity of patients or employers or other group purchasers revealed in the
data set for any purpose except as approved as part of the study;
(6) Not publish or make public the content of
cells that contain counts of patients in statistical tables in which the cell
size is more than 0 and less than 5;
(7) Not publish or make public any information
that could be used to ascertain the identity of providers of abortion services;
(8) Report to the
department, within 5 days, any unauthorized use or disclosure of the
information, of which the principal investigator becomes aware, that is
contrary to the agreement;
(9) Provide the department with a preview copy of
a proposed release at least 15 days prior to any publication or release of any
reports or publications containing information derived from the data set for
review and verification that the conditions of the agreement have been met;
(10) Not release any document which is deemed
determined to breach the conditions of the agreement;
(11) Acknowledge the department as the source of
the data in any and all public reports, publications, or presentations
generated by the principal investigator from these data;
(12) Specify that the analyses, conclusions, and
recommendations drawn from such data are solely those of the principal
investigator and are not necessarily those of any agency of the State of New
Hampshire;
(13) Retain the data only for the period of time
necessary to fulfill the requirements of the data request;
(14) Return the data within 30 days of the
scheduled completion date of the project, or destroy the data, so certifying by
submitting a written notice to the department, or reapply for approval within
60 days of scheduled completion if the principal investigator determines the
end date of the project needs to be extended; and
(15) Acknowledge that failure to adhere to the
data use agreement will be cause for immediate recall of the data, revocation
of permission to use the data, and application of any applicable criminal
liability under New Hampshire state law.
(e)
Confidential research data sets shall be released when:
(1) The application submitted is complete
pursuant to (a) through (c) above and the principal investigator has signed the
data use agreement as specified in (d) above;
(2) Procedures to ensure the confidentiality of
patients, employer groups, or other group purchasers are documented;
(3) The study, if carried out according to the
application submitted, will be able to answer the research hypothesis as stated
in the application;
(4) There is no evidence that the applicant is
seeking the requested data for other purposes in addition to research purposes;
(5) The applicant is seeking only the data
necessary to fulfill the specific requirements of the research study;
(6) The qualifications of the principal
investigator and research staff are documented by:
a. Training and previous research, including
prior publications in the proposed or related area; and
b. An affiliation with a university, private
research organization, medical center, state agency, or other institution that
will provide sufficient research resources;
(7) No other state or federal law or federal
regulation prohibits release of the requested information; and
(8) Approval has been obtained from the
researcher’s affiliated Institutional Review Board operating in accordance with
45 CFR 46, if the researcher intends to contact patients in the study.
(f)
Studies taking longer than 2 years shall require annual application
after the first 2-year period.
(g)
The principal investigator shall comply with the conditions in the data
use agreement as described in (d) above.
(h)
In the event the department determines that any report or publication
resulting from the study, might lead to direct or indirect identification of
patients, employers or other group purchasers unless approved as part of the
study design, the department shall provide a written statement to the
researcher stating specifically the problematic sections in the
publication. The requesting party shall
modify the report or publication prior to its release by fully addressing the
problematic sections.
(i) When multiple reports of a similar nature will
be created from the data, upon request the department shall waive the
requirement that any subsequent report or publication be provided to the
department prior to release by the requesting party.
(j)
Any draft reports or publications reviewed by the department shall be
kept confidential and shall not be released by the department.
(k)
Information regarding release of limited use data sets and records of
the review of publications shall be made available upon request.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.06 Fees.
Fees for data sets released under this section shall be as follows:
(a)
For each public use discharge data sets, the fee shall be $325 per year;
and
(b)
For each non-public use data set, the fee shall be based on the actual
salary, benefits, indirect, administrative, and material and postage costs of
providing the data in the format requested as calculated by the department.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.07 Payment of Fees.
(a)
All persons requesting data shall submit payment of fees prior to the
release of data with the exception of persons granted an exemption in accordance
with He-C 1504.08.
(b)
Payment shall be made by cash, check or money order payable to "NH
DHHS".
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.08 Exemption from Fees. The following parties shall be exempt from
the fees set forth in He-C 1504.06:
(a)
Those covered by the fee provisions of RSA 151-C:15, I, pursuant to RSA
126:30;
(b)
Local and county governments within the state of New Hampshire,
including school districts; and
(c)
Parties acting under contract on behalf of another entity exempt from
paying fees.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
He-C 1504.09 Exemption from Release Rule. The release of data by the department to its
agents shall be exempt from this rule provided agents are contracted and those
contracts include signed business associate agreements.
Source. # 9436, eff 3-21-09, EXPIRED: 3-21-17
New. #12139, INTERIM, eff 3-22-17, EXPIRES: 9-18-17
PARTS He-C 1505-1549
– RESERVED
PART He-C
1550 SUBMISSION OF HEALTH CARE FACILITY
FINANCIAL DATA
Statutory
Authority: RSA 126:27, I-III, V
He-C 1550.01 Purpose and Scope. This part contains the requirements for the
submission of health care facility financial information from nursing homes,
acute care hospitals, residential care facilities, specialty hospitals, or
other health care facilities licensed under RSA 151.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.02 Definitions.
(a)
“Certified financial statements” means the annual financial statements
that have been subject to an independent audit in accordance with generally
accepted auditing standards, including a certificate of audit or the
independent auditor report that expresses an opinion as to whether or not the
accompanying financial statements are presented fairly in accordance with
generally accepted accounting principles.
(b)
“Commissioner” means the commissioner of the New Hampshire department of
health and human services or his or her designee.
(c)
“Confidential financial information” means any financial information
filed either by a hospital or nursing home in accordance with data disclosure
under RSA 126:25:.
(1) That has not yet been revealed to persons
other than:
a. Employees, agents, or attorneys of the
hospital;
b. Persons or entities with which the hospital
is jointly participating in an effort to obtain financing; and
c. Persons or entities to which the hospital has
applied for financing;
(2) That would, if revealed, substantially,
predictably, and adversely affect the ability of the hospital or its affiliated
interests to obtain financing on reasonable terms in competition with others
seeking similar types of capital; and
(3) That could lawfully be concealed under
applicable laws governing financial transactions.
(d)
“Department” means the New Hampshire department of health and human
services.
(e)
“Financial statements” means documents including, but not limited, to a
balance sheet, a statement of operations, a cash flow statement, and notes to
financial statements, and, if applicable, consolidating and supplemental
financial schedules.
(f)
“Health care facility” means a public or private, proprietary or
not-for-profit entity or institution providing health services licensed under
RSA 151:2 including, but not limited to:
(1) Hospitals and infirmaries;
(2) Home health care providers;
(3) Laboratories performing tests or analyses of
human samples;
(4) Facilities or portions of a facility
operating as an outpatient rehabilitation clinic, ambulatory surgical center,
hospice, emergency medical care center, drop-in or walk-in care center,
dialysis center, birthing center, or other entity where health care associated
with illness, injury, deformity, infirmity, or other physical disability is
provided;
(5) Residential care facilities; and
(6) Adult day care programs.
(g)
“Medicare cost report” means the annual cost report, specific to a
facility type, that Medicare requires all Medicare-certified facilities to file
with a Medicare fiscal intermediary.
(h) “Settled” means that a medicare cost report has been adjusted after review or
audit by the medicare fiscal intermediary.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.03 General Requirements for Financial Data
Submission.
(a)
All health care facilities defined in He-C 1550.02(f) shall be required
to file financial data with the department or its agent.
(b)
Financial data shall be submitted annually to the department:
(1) Within 4 months following the end of the
health care facility’s fiscal year, in accordance with He-C 1550.04(a);
(2) Within 30 days
following the request of the department, in accordance with He-C 1550.04(b),
which shall be no sooner than 4 months following the end of the health care
facility’s fiscal year; or
(3) In the case of the medicare
cost report, within 30 days of submission to the medicare
fiscal intermediary and within 30 days of receipt of a settled cost report from
the medicare fiscal intermediary, in accordance with
He-C 1550.04(i).
(c)
Financial data may be submitted in either paper format or electronic format,
provided that all electronic submissions shall be in pdf format or another
read-only format that maintains the documents’ security and integrity.
(d)
Provisions of this rule shall not void any contractual requirements for
filing financial statements by health care facilities.
(e)
Contractual requirements shall not void provisions of these rules.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.04 Required Financial Data.
(a)
Each health care facility receiving payments of $500,000 or more of
state or federal funds in the health care facility’s previous fiscal year shall
file with the department certified financial statements within 4 months
following the end of the health care facility’s fiscal year.
(b)
Each health care facility receiving payments of less than $500,000 of
state or federal funds in the health care facility’s previous fiscal year
shall, at the written request of the department, file certified financial
statements within 30 days of the request.
(c)
If a health care facility is not required by either state or federal
statute to obtain a certification of audit of its financial statements, and
elects not to obtain such certification of audit, the health care facility
shall file with the department:
(1) Uncertified financial statements according to
the timeframes described in (a) and (b) above; and
(2) A certificate of authenticity which attests
that the financial statements are correct in all material respects and is
signed by an officer of the corporation, partner, or owner under penalty of
unsworn falsification.
(d)
A health care facility which is part of a consolidated financial
statement may file the certified consolidated financial statements if it includes
the consolidating schedules as supplemental information.
(e)
A health care facility which is part of a consolidated financial
statement, but whose certified consolidated financial statements do not contain
the consolidating schedules as supplemental information, shall file with the
department uncertified financial statements for the individual health care
facility and a certificate of authenticity in accordance with (c)(1) and (2)
above.
(f)
Filings shall be accompanied by a letter from the health care facility
noting the type of ownership, the name of the owner, and the number and type of
licensed bed capacity.
(g)
Upon written request by the department, a health care facility shall
provide additional information regarding the fiscal condition of the facility
within 30 days of the request or by some other date as specified in the
request.
(h)
A health care facility shall be permitted to disclose additional
information to explain or clarify the financial data submitted.
(i) The following shall apply to health care
facilities that participate in the medicare program
and are required to file an annual medicare cost
report with a medicare fiscal intermediary:
(1) Such facilities shall submit to the
department a copy of the medicare cost report as
filed and as settled; and
(2) Any health care facility that files a medicaid cost report shall be exempt from the submission
requirement in (1) above, but shall be required to submit the medicare cost report as filed and as settled upon department
request.
(j)
The department shall make requests in (b), (g), and (i)(2)
under the following circumstances:
(1) The department is requested to conduct a
fiscal analysis by a department subdivision, a legislative committee, or the
governor’s office; and
(2) The department’s request is directed towards
an entire license class, a geographical subset of that license class, or some
other subset for which a more targeted fiscal analysis is requested.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.05 Request for Extension of Filing Deadlines.
(a)
Health care facilities shall submit a request for an extension of the
filing deadline in He-C 1550.04 (a), (b), or (g) above as follows:
(1) Requests shall be made in writing;
(2) Requests shall be sent to the commissioner;
(3) Requests shall be received no later than 20
days prior to the filing deadline; and
(4) Requests shall include the following:
a. Contact information;
b. Reason for requesting the extension; and
c. New deadline.
(b)
The commissioner shall grant an extension of the filing deadline if:
(1) The request meets the requirements in (a)
above; and
(2) It is determined by the commissioner that the
health care facility has demonstrated good cause for an extension.
(c)
Good cause in (b)(2) means any circumstance beyond the health care
facility’s control that prevents that facility from taking a required action,
including:
(1) Death of the person, or in the person’s
immediate family, who is responsible for preparing the facility’s fiscal
information;
(2) Personal injury or serious illness of the
person responsible for preparing the facility’s fiscal information, or that
person’s immediate family member; or
(3) An unforeseeable situation with the
facility’s audit firm that delays the audit beyond the 4-month period required
in He-C 1550.03(b)(1) or (2).
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.06 Penalties.
(a)
Failure of a health care facility to provide to the department the
financial data required in He-C 1550.04 above by the filing deadline, or by the
filing deadline as extended pursuant to He-C 1550.05 above, shall result in the
imposition of daily penalties in accordance with RSA 126:29.
(b)
Pursuant to RSA 126:29, any amount of penalty imposed by the department
shall not be allowed as a reimbursable cost item and shall not be recoverable
from any category of payment source or patient.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
He-C 1550.07 Release of Information.
(a)
In accordance with RSA 126:28 and He-C 1550.02(c), all financial
information required to be filed by this part shall be considered confidential
financial information and shall not be made available to the public upon
request.
(b)
The department shall use the financial information submitted by any or
all health care facilities in its analyses of the financial condition of any or
all of the health care facilities.
(c)
Except as otherwise provided by law, the department may publicly release
the results of such analyses founded in (b) above except that all confidential
financial data shall be disguised, de-identified, or aggregated in such a way
that does not allow for the identification the individual health care facility.
Source. # 9781, eff 1-1-11, EXPIRED: 1-1-19
New. #12723, INTERIM, eff 2-14-19, EXPIRES:
8-13-19
(1)
Official UB-04 Data Specifications Manual
SOURCE: National Uniform Billing Data Element
Specifications
AVAILABLE FROM:
National Uniform
Billing Committee
http://www.nubc.org/
ABSTRACT: A variety of code definitions for many of the
fields included in the health care data submission requirements.
(2) Current Procedural Terminology (CPT) Codes
(Data Element: MC055)
SOURCE: Physicians' Current Procedural Terminology
(CPT) Manual
AVAILABLE FROM:
Order Department
American Medical
Association
ABSTRACT: A listing of
descriptive terms and identifying codes for reporting medical services and
procedures performed by physicians.
(3) Health Care Common Procedural Coding
System
SOURCE: Health Care Common Procedural Coding System
AVAILABLE FROM:
www.cms.gov/medicare/hcpcs.htm
Centers for Medicare
and Medicaid Services
Center for Health
Plans and Providers
CCPP/DCPC
C5-08-27
ABSTRACT: HCPCS is the Centers for Medicare and
Medicaid Services (CMS) coding scheme to group procedures performed for payment
to providers.
(4) Centers for Medicare and Medicaid Services
National Provider Identifier
SOURCE: National Provider System
AVAILABLE FROM:
Centers for Medicare
and Medicaid Services
Office of Information
Services
Security and Standards Group
Director, Division of
Health Care Information Systems
ABSTRACT: The Centers for Medicare and Medicaid
Services is developing the National Provider Identifiers, which is proposed as
the standard unique identifier for each health care provider under the Health
Insurance Portability and Accountability Act of 1996.
(5) International Classification of Diseases
Clinical Mod (ICD-9-CM) (and when available ICD-10-CM)
SOURCE: International Classification of Diseases, 9th
Revision, Clinical Modification (ICD-9-CM) (and when available ICD10-CM)
AVAILABLE FROM:
Commission of
Professional and Hospital Activities
ABSTRACT: The International Classification of Diseases,
9th Revision, Clinical Modification, describes the classification of morbidity
and mortality information for statistical purposes and for the indexing of
hospital records by disease and operations.
(6) States and Outlying Areas of the
SOURCE: National Zip Code and Post Office Directory
AVAILABLE FROM:
ABSTRACT: Provides names, abbreviations, and codes for
the 50 states, the
(7) X12 Directories
SOURCE: X12.3 Data Element Directory; X12.22 Segment
Directory
AVAILABLE FROM:
Data Interchange
Standards Association, Inc. (DISA)
ABSTRACT: The data element directory contains the
format and descriptions of data elements used to construct X12 segments. It also contains code lists associated with
these data elements. The segment
director contains the format and definitions of the data segments used to
construct the X12 transaction sets. This
source also contains the Standards for the Classification of Federal Data on
Race and Ethnicity Code Source: ASC X12 External Code Source 859 (Health
Information and Surveillance Systems Board).
(8) ZIP Code
SOURCE: National Zip Code and Post Office Directory,
Publication 65, The USPS Domestic Mail Manual
AVAILABLE FROM:
New Orders
Superintendent of
Documents
ABSTRACT: The ZIP Code is a geographic identifier of
areas within the
APPENDIX
Rule |
Specific State Statute the Rule
Implements |
|
|
He-C 1501.01 |
RSA 126:25, RSA
126:27 |
He-C 1502.01 |
RSA 126:25 |
He-C 1503.01-
1503.13 |
RSA 126:25 |
He-C 1504.01 |
RSA 126:25; RSA
125:28; 45 CFR 46 |
He-C 1504.02 |
RSA 126:28; 45
CFR 46 |
He-C 1504.03 |
RSA 126:28; 45
CFR 46 |
He-C 1504.04 |
RSA 126:28; 45
CFR 46 |
He-C 1504.05 |
RSA 91-A:10; RSA
126:28; 45 CFR 46 |
He-C 1504.06 |
RSA 126:30 |
He-C 1504.07 |
RSA 126:30 |
He-C 1504.08 |
45 CFR 46; RSA
126:30 |
He-C 1504.09 |
45 CFR 46 |
|
|
He-C 1550.01 |
RSA
126:25 |
He-C 1550.02 |
RSA 126:25 |
He-C 1550.03 |
RSA 126:25, I(a) |
He-C 1550.04 |
RSA 126:25,
I(a)-(c) |
He-C 1550.05 |
RSA 126:25 |
He-C 1550.06 |
RSA
126:29 |
He-C 1550.07 |
RSA
126:28; RSA
151-C:2, XI |