Added by Stats. 1995, Ch. 415, Sec. 9. Effective January 1, 1996.
This chapter shall be known as the Health Data and Advisory Council Consolidation Act.
Chapter 1 - Health Facility Data
California Health and Safety Code — §§ 128675-128810
Showing inline text for up to 20 sections. Open a section link to read its full text.
Sections (32)
Amended by Stats. 2011, Ch. 32, Sec. 20. (AB 106) Effective June 29, 2011. Operative January 1, 2012, by Sec. 73 of Stats. 2011, Ch. 32.
The Legislature hereby finds and declares that:
(a)Significant changes have taken place in recent years in the health care marketplace and in the manner of reimbursement to health facilities by government and private third-party payers for the services they provide.
(b)These changes have permitted the state to reevaluate the need for, and the manner of data collection from health facilities by the various state agencies and commissions.
(c)It is the intent of the Legislature that as a result of this reevaluation that the data collection function be consolidated in a single
state agency. It is the further intent of the Legislature that the single state agency only collect that data from health facilities that are essential. The data should be collected, to the extent practical on consolidated, multipurpose report forms for use by all state agencies.
(d)It is the further intent of the Legislature to eliminate the California Health Facilities Commission, the State Advisory Health Council, and the California Health Policy and Data Advisory Commission, and to consolidate data collection and planning functions within the office.
(e)It is the Legislature’s further intent that the review of the data that the state collects be an ongoing function. The office shall annually review this data for need and shall revise, add, or delete items as necessary. The office shall consult with affected state agencies and the affected industry when adding or eliminating
data items. However, the office shall neither add nor delete data items to the Hospital Discharge Abstract Data Record or the quarterly reports without prior authorizing legislation, unless specifically required by federal law or judicial decision.
(f)The Legislature recognizes that the authority for the California Health Facilities Commission is scheduled to expire January 1, 1986. It is the intent of the Legislature, by the enactment of this chapter, to continue the uniform system of accounting and reporting established by the commission and required for use by health facilities. It is also the intent of the Legislature to continue an appropriate, cost-disclosure program.
Added by Stats. 1995, Ch. 415, Sec. 9. Effective January 1, 1996.
Intermediate care facilities/developmentally disabled-habilitative, as defined in subdivision (e) of Section 1250, are not subject to this chapter.
Amended by Stats. 2021, Ch. 143, Sec. 195. (AB 133) Effective July 27, 2021.
Intermediate care facilities/developmentally disabled—nursing, as defined in subdivision (h) of Section 1250, and intermediate care facilities/developmentally disabled-continuous nursing, as defined in subdivision (m) of Section 1250, are not subject to this chapter.
Amended by Stats. 2021, Ch. 143, Sec. 196. (AB 133) Effective July 27, 2021.
As used in this chapter, the following terms mean:
(a)“Ambulatory surgery procedures” mean those procedures performed on an outpatient basis in the general operating rooms, ambulatory surgery rooms, endoscopy units, or cardiac catheterization laboratories of a hospital or a freestanding ambulatory surgery clinic.
(b)“Emergency department” means, in a hospital licensed to provide emergency medical services, the location in which those services are provided.
(c)“Encounter” means a face-to-face contact between a patient and the provider who has primary responsibility for
assessing and treating the condition of the patient at a given contact and exercises
independent judgment in the care of the patient.
(d)“Freestanding ambulatory surgery clinic” means a surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204.
(e)“Health facility” or “health facilities” means all health facilities required to be licensed pursuant to Chapter 2 (commencing with Section 1250) of Division 2.
(f)“Hospital” means all health facilities except skilled nursing, intermediate care, congregate living, and hospice health facilities.
(g)“Department” means the Department of Health Care Access and Information.
(h)“Risk-adjusted outcomes” means the clinical outcomes of patients grouped by diagnoses or procedures that have been adjusted for demographic and clinical factors.
Amended by Stats. 2021, Ch. 143, Sec. 197. (AB 133) Effective July 27, 2021.
On and after January 1, 1986, any reference in this code to the Advisory Health Council or the California Health Policy and Data Advisory Commission shall be deemed a reference to the department.
Amended by Stats. 2021, Ch. 143, Sec. 198. (AB 133) Effective July 27, 2021.
(a)Effective January 1, 1986, the department shall be the single state agency designated to collect the following health facility or clinic data for use by all state agencies:
(1)Data required by the department pursuant to Section 127285.
(2)Data required in the Medi-Cal cost reports pursuant to Section 14170 of the Welfare and Institutions Code.
(3)Data items formerly required by the California Health Facilities Commission that are listed in Sections 128735 and 128740. Information collected pursuant to subdivision (g) of Section 128735 and Sections 128736 and
128737 shall be made available to the State Department of Health Care Services, the State Department of Public Health, and the California Health Benefit Exchange. The departments and the Exchange shall ensure that the patient’s rights to confidentiality shall not be violated in any manner. The departments and the Exchange shall comply with all applicable policies and requirements involving review and oversight by the State Committee for the Protection of Human Subjects.
(b)The department shall consolidate any and all of the reports listed under this section or Sections 128735 and 128740, to the extent feasible, to minimize the reporting burdens on hospitals, provided, however, that the department shall neither add nor delete data items from the Hospital Discharge Abstract Data Record or the quarterly reports without prior authorizing
legislation, unless specifically required by federal law or regulation or judicial decision.
(c)The Exchange shall report to the Governor and the Legislature on or before August 1, 2023, on the impacts to the Exchange associated with paragraph (3) of subdivision (a), including the impacts on premium rates for health plans offered through the Exchange. The report shall be submitted in compliance with Section 9795 of the Government Code.
Amended by Stats. 2021, Ch. 143, Sec. 199. (AB 133) Effective July 27, 2021.
(a)Each organization that operates, conducts, owns, or maintains a skilled nursing facility licensed pursuant to subdivision (c) of Section 1250 shall file with the department as part of the information required in subdivisions (a) to (e), inclusive, of Section 128735, whether the licensee, or a general partner, director, or officer of the licensee, has an ownership or control interest of 5 percent or more in a related party that provides any service to the skilled nursing facility. If the licensee, or the general partner, director, or officer of the licensee has such an interest, the licensee shall disclose all services provided to the skilled nursing facility, the number of individuals who provide that service at the skilled nursing
facility, and any other information requested by the department. If goods, fees, and services collectively worth ten thousand dollars ($10,000) or more per year are delivered to the skilled nursing facility, the disclosure required pursuant to this subdivision shall include the related party’s profit and loss statement, and the Payroll-Based Journal public use data of the previous quarter for the skilled nursing facility’s direct caregivers.
(b)For purposes of this section, all of the following definitions shall apply:
(1)“Direct caregiver” shall have the same meaning as that term is defined in Section 1276.65.
(2)“Profit and loss statement” means the most recent annual statement on profits and losses finalized by a
related party for the most recent year available.
(3)“Related party” means an organization related to the licensee provider or that is under common ownership or control, as defined in Section 413.17(b) of Title 42 of the Code of Federal Regulations.
(c)Current licensees shall provide the information required by this section to the department in a manner prescribed by the
department.
(d)The provisions of this section shall become effective on January 1, 2020.
Amended by Stats. 2022, Ch. 28, Sec. 108. (SB 1380) Effective January 1, 2023.
(a)(1) Commencing with fiscal years ending December 31, 2023, an organization that operates, conducts, owns, manages, or maintains a skilled nursing facility or facilities licensed pursuant to subdivision (c) of Section 1250 shall prepare and file with the office, at the times as the office shall require, an annual consolidated financial report.
(2)The annual consolidated financial report required to be prepared pursuant to paragraph (1) shall be reviewed by a certified public accountant in accordance with generally accepted accounting principles and with the Financial Accounting Standards Board’s financial reporting requirements, with financial statements
prepared using the accrual basis. If the organization has prepared an audit by a certified public accountant of its annual consolidated financial report for any reason, that audit shall be filed with the office, and, in that instance, no review of the consolidated financial report shall be necessary. The reviewed or audited report, as applicable, shall, in addition to the requirements set forth in Section 128735, include, but not be limited to, the following statements:
(A)A balance sheet detailing the assets, liabilities, and net worth at the end of its fiscal year.
(B)A statement of income, expenses, and operating surplus or deficit for the annual fiscal period, and a statement of ancillary utilization and patient census.
(C)A statement detailing patient revenue by payer, including, but not limited to, Medicare, Medi-Cal, and other payers, and revenue center.
(D)A statement of cashflows, including, but not limited to, ongoing and new capital expenditures and depreciation.
(E)A combined financial statement that includes all entities reported in the consolidated financial report, unless the organization is prohibited from including a combined financial statement in a consolidated financial report pursuant to a state or federal law or regulation or a national accounting standard. When applicable, the organization must disclose to the office the applicable state or federal law or regulation or national accounting standard.
(3)In
addition to the consolidated financial report, the following information shall be provided to the office as an attachment to the consolidated financial report:
(A)The financial information required by paragraph (2) of subdivision (a) from all operating entities, licenseholders, and related parties in which the organization has an ownership or control interest of 5 percent or more and that provides any service, facility, or supply to the skilled nursing facility.
(B)A detailed document outlining a visual representation of the organization’s structure that includes both of the following:
(i)All related parties in which the organization has an ownership or control interest of 5 percent or more and that provides any service,
facility, or supply to the skilled nursing facility.
(ii) Unrelated parties that provide services, facilities, or supplies to the skilled nursing facility or facilities that are operated, conducted, owned, managed, or maintained by the organization, including, but not limited to, management companies and property companies, and that are paid more than two hundred thousand dollars ($200,000) by the skilled nursing facility.
(b)The office shall post reports and related documents submitted pursuant to this section to its internet website.
(c)Any report, document, statement, writing or any other type of record received, owned, used, or retained by the office in connection with this section is a public record within the meaning of
Section 7922.505 of the Government Code and is subject to disclosure pursuant to the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(d)The office shall develop policies and procedures to outline the format of information to be submitted pursuant to this section. The office shall determine if the information submitted pursuant to subdivision (a) is complete, but shall not be required to determine its accuracy.
(e)For the purposes of this section, “related party” has the same meaning as in Section 128734, and may include, but is not limited to, home offices; management organizations; owners of real estate; entities that provide staffing, therapy, pharmaceutical, marketing, administrative management, consulting,
and insurance services; providers of supplies and equipment; financial advisors and consultants; banking and financial entities; any and all parent companies, holding companies, and sister organizations; and any entity in which an immediate family member of an owner of those organizations has an ownership interest of 5 percent or more. “Immediate family member” includes spouse, natural parent, child, sibling, adopted child, adoptive parent, stepparent, stepchild, stepsister, stepbrother, father-in-law, mother-in-law, sister-in-law, brother-in-law, son-in-law, daughter-in-law, grandparent, and grandchild.
(f)This section shall not apply to a facility operated by a health care district organized and governed pursuant to the Local Healthcare District Law (Division 23 (commencing with Section 32000)).
(g)This section shall not apply to an organization that has no related parties as defined in subdivision (e), except that the organization is required to submit a detailed document outlining a visual representation of the organization’s structure as set forth
in subparagraph (B) of paragraph (3) of subdivision (a). This section shall not be construed to require a government entity licenseholder, that is not a related party, to file a consolidated financial report for a nursing home management company that operates under its license.
(h)Consistent with the reports and requirements required for subdivisions (a) to (e), inclusive, of Section 128735 and Section 128740, all information submitted pursuant to this section shall be accompanied by a report certification signed by a duly authorized official of the health facility or of the health facility’s home office that certifies that, to the best of the official’s knowledge and information, each statement and amount in the accompanying report is believed to be true and correct.
Amended by Stats. 2022, Ch. 28, Sec. 109. (SB 1380) Effective January 1, 2023.
An organization that operates, conducts, owns, or maintains a health facility, and the officers thereof, shall make and file with the department, at the times as the department shall require, all of the following reports on forms specified by the department that are in accord, if applicable, with the systems of accounting and uniform reporting required by this part, except that the reports required pursuant to subdivision (g) shall be limited to hospitals:
(a)A balance sheet detailing the assets, liabilities, and net worth of the health facility at the end of its fiscal year.
(b)A statement of income, expenses, and operating surplus or deficit
for the annual fiscal period, and a statement of ancillary utilization and patient census.
(c)A statement detailing patient revenue by payer, including, but not limited to, Medicare, Medi-Cal, and other payers, and revenue center.
(d)A statement of cashflows, including, but not limited to, ongoing and new capital expenditures and depreciation.
(e)(1) A statement reporting the information required in subdivisions (a), (b), (c), and (d) for each separately licensed health facility operated, conducted, or maintained by the reporting organization.
(2)Notwithstanding paragraph (1), a health facility that receives a preponderance of its
revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under
common management may report the information required pursuant to subdivisions (a) and (d) for the group and not for each separately licensed health facility.
(f)Data reporting requirements established by the department shall be consistent with national standards, as applicable.
(g)A Hospital Discharge Abstract Data Record that includes all of the following:
(1)Date of birth.
(2)Sex.
(3)Race.
(4)ZIP Code.
(5)Preferred language spoken.
(6)Patient social security number, if it is contained in the patient’s medical record.
(7)Prehospital care and resuscitation, if any, including all of the following:
(A)“Do not resuscitate” (DNR) order on admission.
(B)“Do not resuscitate” (DNR) order after admission.
(8)Admission date.
(9)Source of admission.
(10)Type of admission.
(11)Discharge date.
(12)Principal diagnosis and whether the condition was present on admission.
(13)Other diagnoses and whether the conditions were present on admission.
(14)External causes of morbidity and whether present on admission.
(15)Principal procedure and date.
(16)Other procedures and dates.
(17)Total charges.
(18)Disposition of patient.
(19)Expected source of payment.
(20)Elements added pursuant to
Section 128738.
(h)It is the intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(i)A person reporting data pursuant to this section shall not be liable for damages in an action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the department pursuant to the requirements of subdivision (g).
(j)A hospital shall use coding from the International Classification of Diseases in reporting diagnoses and procedures.
(k)On or before July 1, 2021, the department shall promulgate regulations as necessary to implement subdivision (e). A health facility that receives a preponderance of its revenue from associated comprehensive group practice prepayment health care service plans and that is operated as a unit of a coordinated group of health facilities under common management shall comply with the reporting requirements of subdivisions (b), (c), and (e) once the department finalizes related regulations.
Amended by Stats. 2023, Ch. 131, Sec. 132. (AB 1754) Effective January 1, 2024.
(a)Each hospital shall file an Emergency Care Data Record for each patient encounter in a hospital emergency department. The Emergency Care Data Record shall include all of the following:
(1)Date of birth.
(2)Sex.
(3)Race.
(4)Ethnicity.
(5)Preferred language spoken.
(6)ZIP Code.
(7)Patient social security number, if it is contained in the patient’s medical
record.
(8)Service date.
(9)Principal diagnosis.
(10)Other diagnoses.
(11)External causes of morbidity.
(12)Principal procedure.
(13)Other procedures.
(14)Disposition of patient.
(15)Expected source of payment.
(16)Elements added pursuant to Section 128738.
(b)It is the expressed intent of the Legislature that the patient’s rights of confidentiality shall
not be violated in any manner. Patient social security numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(c)No person reporting data pursuant to this section shall be liable for damages in any action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the department pursuant to the requirements of subdivision (a).
(d)Data reporting requirements established by the department shall be consistent with national standards as applicable.
(e)This section shall become operative on January 1,
2004.
Amended by Stats. 2022, Ch. 28, Sec. 111. (SB 1380) Effective January 1, 2023.
(a)Each general acute care hospital and freestanding ambulatory surgery clinic shall file an Ambulatory Surgery Data Record for each patient encounter during which at least one ambulatory surgery procedure is performed. The Ambulatory Surgery Data Record shall include all of the following:
(1)Date of birth.
(2)Sex.
(3)Race.
(4)Ethnicity.
(5)Preferred language spoken.
(6)ZIP Code.
(7)Patient social security number, if it is contained in the patient’s medical record.
(8)Service date.
(9)Principal diagnosis.
(10)Other diagnoses.
(11)Principal procedure.
(12)Other procedures.
(13)External causes of morbidity.
(14)Disposition of patient.
(15)Expected source of payment.
(16)Elements added pursuant to Section 128738.
(b)It is the expressed intent of the Legislature that the patient’s rights of confidentiality shall not be violated in any manner. Patient social security numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(c)No person reporting data pursuant to this section shall be liable for damages in any action based on the use or misuse of patient-identifiable data that has been mailed or otherwise transmitted to the office pursuant to
the requirements of subdivision (a).
(d)Data reporting requirements established by the department shall be consistent with national standards as applicable.
(e)This section shall become operative on January 1, 2004.
Amended by Stats. 2021, Ch. 143, Sec. 203. (AB 133) Effective July 27, 2021.
(a)The department shall allow and provide for, in accordance with appropriate regulations, additions or deletions to the patient level data elements listed in subdivision (g) of Section 128735, Section 128736, and Section 128737, to meet the purposes of this chapter.
(b)Prior to any additions or deletions, all of the following shall be considered:
(1)Utilization of sampling to the maximum extent possible.
(2)Feasibility of collecting data elements.
(3)Costs and benefits of collection and submission
of data.
(4)Exchange of data elements as opposed to addition of data elements.
(c)The department shall add no more than a net of 15 elements to each data set over any five-year period. Elements contained in the uniform claims transaction set or uniform billing form required by the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. Sec. 300gg) shall be exempt from the 15-element limit.
(d)The department, in order to minimize costs and administrative burdens, shall consider the total number of data elements required from hospitals and freestanding ambulatory surgery clinics, and optimize the use of common data elements.
Amended by Stats. 2023, Ch. 6, Sec. 2. (AB 112) Effective May 15, 2023.
(a)The following summary financial and utilization data shall be reported to the department by a hospital within 45 days of the end of a calendar quarter. Adjusted reports reflecting changes as a result of audited financial statements may be filed within four months of the close of the hospital’s fiscal or calendar year. The quarterly summary financial and utilization data shall conform to the uniform description of accounts as contained in the Accounting and Reporting Manual for California Hospitals and shall include all of the following:
(1)Number of licensed beds.
(2)Average number of available beds.
(3)Average number of
staffed beds.
(4)Number of discharges.
(5)Number of inpatient days.
(6)Number of outpatient visits.
(7)Total operating expenses.
(8)Total inpatient gross revenues by payer, including, but not limited to, Medicare, Medi-Cal, county indigent programs, commercial coverage, other third parties, and other payers.
(9)Total outpatient gross revenues by payer, including, but not limited to, Medicare, Medi-Cal, county indigent programs,
commercial coverage, other third parties, and other payers.
(10)Deductions from revenue in total and by component, including the following: Medicare contractual adjustments, Medi-Cal contractual adjustments, and county indigent program contractual adjustments, other contractual adjustments, bad debts, charity care, restricted donations and subsidies for indigents, support for clinical teaching, teaching allowances, and other deductions.
(11)Total capital expenditures.
(12)Total net fixed assets.
(13)Total number of inpatient days, outpatient visits, and discharges by
payer, including, but not limited to, Medicare, Medi-Cal, county indigent programs,
commercial coverage, other third parties, self-pay, and other payers.
(14)Total net patient revenues by payer, including Medicare, Medi-Cal, county indigent programs, commercial coverage, other third parties, and other payers.
(15)Other operating revenue.
(16)Nonoperating revenue net of nonoperating expenses.
(17)(A) A balance sheet detailing the assets, liabilities, and net worth at the end of the quarter, as specified by the department.
(B)The department shall allow and provide for, in accordance with appropriate regulations, additions, or deletions to the summary financial and utilization data to meet the purposes of this chapter.
(b)The department may adopt regulations, including emergency regulations, necessary to implement this section.
Amended by Stats. 2022, Ch. 28, Sec. 112. (SB 1380) Effective January 1, 2023.
(a)Commencing July 1993, and annually thereafter, the department shall publish risk-adjusted outcome reports in accordance with the following schedule:
Reports for subsequent years shall include conditions and procedures and cover periods as appropriate.
(b)The procedures and conditions for risk-adjusted outcome reports pursuant to
subdivision (a) shall be divided among medical, surgical, and obstetric conditions or procedures and shall be selected by the department. The department shall publish the risk-adjusted outcome reports for selected conditions and procedures by individual hospital, individual medical group, or individual physician as selected by the department in consultation with medical specialists in the relevant area of practice. The selections, under this subdivision, shall be in accordance with all of the following criteria:
(1)The patient discharge abstract contains sufficient data to undertake a valid risk adjustment. The risk adjustment report shall ensure that public hospitals and other hospitals serving primarily low-income patients are not unfairly discriminated against.
(2)The
relative importance of the procedure and condition in terms of the cost of cases and the number of cases and the seriousness of the health consequences of the procedure or condition.
(3)Ability to measure outcome and the likelihood that care influences outcome.
(4)Reliability of the diagnostic and procedure data.
(c)(1) In addition to any other established and pending reports, on or before July 1, 2002, the department shall publish a risk-adjusted outcome report for coronary artery bypass graft surgery by hospital for all hospitals opting to participate in the report. This report shall be updated on or before July 1, 2003.
(2)The
department shall publish at least one risk-adjusted outcome report for coronary artery bypass graft surgery, transcatheter aortic valve replacement, or any type of interventional cardiovascular procedure for procedures performed in the state. For any type of interventional cardiovascular procedure other than coronary artery bypass graft surgery or transcatheter aortic valve replacement, the department shall only select from interventional cardiovascular procedures recommended by the clinical panel established by Section 128748, not to exceed one additional interventional cardiovascular procedure every three years. In each year, the reports shall compare risk-adjusted outcomes by hospital, medical group, or physician as selected by the department after consultation with the clinical panel. Upon the recommendation of the clinical panel based on statistical and technical considerations, information on
individual hospitals, individual medical groups, or individual physicians may be excluded from the reports.
(3)Each hospital shall produce and file with the department, at the times as the department shall require, reports of data the department needs to prepare risk-adjusted outcome reports under this subdivision. Unless otherwise recommended by the clinical panel established by Section 128748, the department shall continue to collect the same data used for the most recent risk-adjusted model developed for the California Coronary Artery Bypass Graft Outcomes Reporting Program. Upon recommendation of the clinical panel, the department may add any clinical data elements included in the Society of Thoracic Surgeons’ database or other relevant databases to be collected from hospitals. Prior to any additions from the Society of Thoracic
Surgeons’ database, or other relevant databases, the following factors shall be considered:
(A)Utilization of sampling to the maximum extent possible.
(B)Exchange of data elements as opposed to addition of data elements.
(4)Upon recommendation of the clinical panel, the department may add, delete, or revise clinical data elements to be collected from hospitals for outcome reports under this subdivision. Prior to any additions or deletions, all of the following factors shall be considered:
(A)Utilization of sampling to the maximum extent possible.
(B)Feasibility of collecting data elements.
(C)Costs and benefits of collection and submission of data.
(D)Exchange of data elements as opposed to addition of data elements.
(5)The department shall collect the minimum data necessary for purposes of testing or validating a risk-adjusted model for the outcome reports under this subdivision.
(6)Patient medical record numbers and any other data elements that the department believes could be used to determine the identity of an individual patient shall be exempt from the disclosure requirements of the California Public Records Act (Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code).
(d)The annual reports shall compare the risk-adjusted outcomes experienced by all patients treated for the selected conditions and procedures in each California hospital during the period covered by each report, to the outcomes expected. Outcomes shall be reported in at least the following groupings for each hospital, medical group, or physician:
(1)“Higher than average outcomes,” for hospitals with risk-adjusted outcomes higher than the norm.
(2)“Average outcomes,” for hospitals with average risk-adjusted outcomes.
(3)“Lower than average outcomes,” for hospitals with risk-adjusted outcomes lower than the norm.
(e)For outcome reports under
this subdivision for which auditing is appropriate, the department shall conduct periodic auditing of data at hospitals.
(f)The department shall either include in the annual reports required under this section, or make separately available at cost to any person requesting it, risk-adjusted outcomes data assessing the statistical significance of hospital, medical group, or physician data at each of the following three levels: 99-percent confidence level (0.01 p-value), 95-percent confidence level (0.05 p-value), and 90-percent confidence level (0.10 p-value). The department shall include any other analysis or comparisons of the data in the annual reports required under this section that the department deems appropriate to further the purposes of this chapter.
Amended by Stats. 2021, Ch. 143, Sec. 206. (AB 133) Effective July 27, 2021.
Commencing July 1, 2002, and biennially thereafter, the department shall evaluate the impact of the department’s published risk-adjusted outcome reports required by Section 128745 on mortality rates in California and on any other measure of quality the department deems appropriate. The department shall also coordinate with other state agencies in promoting prevention and educational initiatives on those reported procedures and conditions.
Amended by Stats. 2021, Ch. 143, Sec. 207. (AB 133) Effective July 27, 2021.
(a)This section shall apply to any risk-adjusted outcome report under Section 128745.
(b)This subdivision applies to risk-adjusted outcome reports under subdivision (c) of Section 128745.
(1)The department shall obtain data necessary to complete a risk-adjusted outcome report from hospitals. If necessary data for an outcome report is available only from the department of a physician and not the hospital where the patient received treatment, then the hospital shall make a reasonable effort to obtain the data from the physician’s office and provide the data to the
department. In the event that the department finds any errors, omissions, discrepancies, or other problems with submitted data, the department shall contact either the hospital or physician’s office that maintains the data to resolve the problems.
(2)The department shall collect the minimum data necessary for purposes of testing or validating a risk-adjusted model. Except for data collected for purposes of testing or validating a risk-adjusted model, the department shall not collect data for an outcome report nor issue an outcome report until the clinical panel established pursuant to this section has approved the risk-adjusted model.
(c)For each risk-adjusted outcome report on a medical, surgical, or obstetric condition or procedure that includes reporting of data by
an individual physician or an individual medical group authorized by subdivision (b) of Section 128745, the department director shall appoint a clinical panel, which shall have nine members. Three members shall be appointed from a list of three or more names submitted by the physician specialty society that most represents physicians performing the medical, surgical, and obstetric procedure for which data is collected. Three members shall be appointed from a list of three or more names submitted by the California Medical Association. Three members shall be appointed from lists of names submitted by consumer organizations. At least one-half of the appointees from the lists submitted by the physician specialty society and the California Medical Association, and at least one appointee from the lists submitted by consumer organizations, shall be experts in collecting and reporting outcome measurements
for physicians, medical groups, or hospitals. The panel may include physicians from another state. The panel shall review and approve the development of the risk-adjustment model to be used in preparation of the outcome report.
(d)For risk-adjusted outcome reports authorized by subdivision (c) of Section 128745 the following shall apply:
(1)The California Coronary Artery Bypass Graft Outcomes Reporting Program Clinical Advisory Panel shall become the clinical panel for those outcome reports and this panel shall be renamed by the department.
(2)This clinical panel shall be comprised of at least 9 and no more than 13 members. The department director shall have the authority to appoint the members of the clinical
panel. Three members shall be appointed from a list of three or more names submitted by the California Chapter of the American College of
Cardiology. Three members shall be appointed from a list of three or more names submitted by the California Medical Association. Three members shall be appointed from lists of names submitted by consumer organizations. Any additional members shall be appointed at the discretion of the department director. If, at the time the department decides to report on a procedure, the panel does not have members with expertise in that procedure, the department shall seek to appoint two new members with expertise in that procedure from a list submitted by the California Chapter of the American College of Cardiology. At least one-half of the appointees from the lists submitted by the California Chapter of the American College of Cardiology, and the California Medical Association, and at least one appointee from the lists submitted by consumer organizations, shall be experts in collecting and reporting
outcome measurements. The panel may include physicians from another state.
(3)The panel shall review and approve the development of the risk-adjustment model to be used in preparation of the outcome report.
(e)Any report that includes reporting by an individual physician shall include, at a minimum, the risk-adjusted outcome data for each physician. The department may also include in the report, after consultation with the clinical panel, any explanatory material, comparisons, groupings, and other information to facilitate consumer comprehension of the data.
(f)Members of a clinical panel shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with
their duties as members of the clinical panel.
Amended by Stats. 2021, Ch. 143, Sec. 208. (AB 133) Effective July 27, 2021.
(a)Prior to the public release of the annual outcome reports, the department shall furnish a preliminary report to each hospital that is included in the report. The department shall allow the hospital and chief of staff 60 days to review the outcome scores and compare the scores to other California hospitals. A hospital or its chief of staff that believes that the risk-adjusted outcomes do not accurately reflect the quality of care provided by the hospital may submit a statement to the department, within the 60 days, explaining why the outcomes do not accurately reflect the quality of care provided by the hospital. The statement shall be included in an appendix to the public report, and a notation that the hospital or its chief of staff
has submitted a statement shall be displayed wherever the report presents outcome scores for the hospital.
(b)(1) Prior to the public release of any outcome report that includes data by a physician or medical group, the department shall furnish a preliminary report to each physician or medical group that is included in the report. The department shall allow the physician or medical group 30 days from the date the department sends the report to the physician or medical group to review the outcome scores and compare the scores to other California physicians or medical groups, respectively. A physician or medical group that believes that the risk-adjusted outcome does not accurately reflect the quality of care provided by the physician or medical group may submit a statement to the department within the 30 days, explaining why
the outcomes do not accurately reflect the quality of care provided by the physician or medical group.
(2)The department shall promptly review the statement and shall respond to the physician or medical group with one of the following conclusions:
(A)The statement reveals a flaw in the accuracy of the reported data relating to the physician or medical group that materially diminishes the validity of the report. If this finding is made, the data for that physician or medical group shall not be included in the report until the flaw in the data is corrected.
(B)The statement reveals a flaw in the risk-adjustment model that materially diminishes the value of the report for all physicians or medical groups. If this finding
is made, the report using that risk-adjustment model shall not be issued until the flaw is corrected.
(C)The statement does not reveal a flaw in either the accuracy of the reported data relating to the physician or medical group, or the risk-adjustment model in which case the report shall be used, unless the physician or medical group chooses to use the procedure set forth in paragraph (3).
(3)If a physician or medical group is not satisfied with the conclusion reached by the department, the physician or medical group shall notify the department of that fact. Upon receipt of the notice, the department shall forward the statement to the appropriate clinical panel appointed pursuant to Section 128748. The department shall forward the statement with any information identifying
the physician or medical group or the hospital of the physician or medical group redacted, or shall adopt other means to ensure the physician or medical group’s identity is not revealed to the panel. The clinical panel shall promptly review the statement and the conclusion of the office and shall respond by either upholding the conclusion or reaching one of the other conclusions set forth in this subdivision. The panel decision shall be the final determination regarding the statement. The process set forth in this subdivision shall be completed within 60 days from the date the department sends the report to each physician or medical group included in the report. If a decision by either the department or the clinical panel cannot be reached within the 60-day period, then the outcome report may be issued but shall not include data for the physician or medical group submitting the statement.
(c)The department shall, in addition to public reports, provide hospitals and the chiefs of staff of the medical staffs with a report containing additional detailed information derived from data summarized in the public outcome reports as an aid to internal quality assurance.
(d)If, pursuant to the recommendations of the department, the Legislature subsequently amends Section 128735 to authorize the collection of additional discharge data elements, then the outcome reports for conditions and procedures for which sufficient data is not available from the current abstract record will be produced following the collection and analysis of the additional data elements.
(e)The recommendations of the department for the
addition of data elements to the discharge abstract should take into consideration the technical feasibility of developing reliable risk-adjustment factors for additional procedures and conditions as determined by the department with the advice of the research community, physicians and surgeons, hospitals, consumer or patient advocacy groups, and medical records personnel.
(f)The department at a minimum shall identify a limited set of core clinical data elements to be collected for all of the selected procedures and conditions and unique clinical variables necessary for risk adjustment of specific conditions and procedures selected for the outcomes report program. In addition, the department should give careful consideration to the costs associated with the additional data collection and the value of the specific information to be collected.
(g)The department shall also engage in a continuing process of data development and refinement applicable to both current and prospective outcome studies.
Amended by Stats. 2021, Ch. 143, Sec. 209. (AB 133) Effective July 27, 2021.
(a)(1) Hospitals shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the department within four months after the close of the hospital’s fiscal year except as provided in paragraph (2).
(2)If a licensee relinquishes the facility license or puts the facility license in suspense, the last day of active licensure shall be deemed a fiscal year end.
(3)The department shall make the reports filed pursuant to this subdivision available no later than three months after they were filed.
(b)(1) Skilled nursing facilities, intermediate care facilities, intermediate care facilities/developmentally disabled, hospice facilities, and congregate living facilities, including nursing facilities certified by the State Department of Health Care Services to participate in the Medi-Cal program, shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 with the department within four months after the close of the facility’s fiscal year, except as provided in paragraph (2).
(2)(A) If a licensee relinquishes the facility license or puts the facility licensure in suspense, the last day of active licensure shall be deemed a fiscal year end.
(B)If a fiscal year end is created because the facility license is relinquished or
put in suspense, the facility shall file the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 within two months after the last day of active licensure.
(3)The department shall make the reports filed pursuant to paragraph (1) available not later than three months after they are filed.
(4)(A) Effective for fiscal years ending on or after December 31, 1991, the reports required by subdivisions (a), (b), (c), and (d) of Section 128735 shall be filed with the department by electronic media, as determined by the department.
(B)Congregate living health facilities are exempt from the electronic media reporting requirements of subparagraph (A).
(c)A hospital shall file the reports required by subdivision (g) of Section 128735 as follows:
(1)For patient discharges on or after January 1, 1999, through December 31, 1999, the reports shall be filed semiannually by each hospital or its designee not later than six months after the end of each semiannual period, and shall be available from the department no later than six months after the date that the report was filed.
(2)For patient discharges on or after January 1, 2000, through December 31, 2000, the reports shall be filed semiannually by each hospital or its designee not later than three months after the end of each semiannual period. The reports shall be filed by electronic tape, diskette, or similar medium as
approved by the department. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the date that the report is approved.
(3)For patient discharges on or after January 1, 2001, the reports shall be filed by each hospital or its designee for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving
it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the date that the report is approved.
(d)The reports required by subdivision (a) of Section 128736 shall be filed by each hospital for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall
be rejected. The report shall be considered not filed as of the date the facility is notified that the report is rejected. A report shall be available from the department no later than 15 days after the report is approved.
(e)The reports required by subdivision (a) of Section 128737 shall be filed by each hospital or freestanding ambulatory surgery clinic for report periods and at times determined by the department. The reports shall be filed by online transmission in formats consistent with national standards for the exchange of electronic information. The department shall approve or reject each report within 15 days of receiving it. If a report does not meet the standards established by the department, it shall not be approved as filed and shall be rejected. The report shall be considered not filed as of the date the facility is notified that
the report is rejected. A report shall be available from the department no later than 15 days after the report is approved.
(f)Facilities shall not be required to maintain a full-time electronic connection to the office for the purposes of online transmission of reports as specified in subdivisions (c), (d), and (e). The department may grant exemptions to the online transmission of data requirements for limited periods to facilities. An exemption may be granted only to a facility that submits a written request and documents or demonstrates a specific need for an exemption. Exemptions shall be granted for no more than one year at a time, and for no more than a total of five consecutive years.
(g)The reports referred to in paragraph (2) of subdivision (a) of Section
128730 shall be filed with the department on the dates required by applicable law and shall be available from the department no later than six months after the date that the report was filed.
(h)The department shall post on its internet website and make available to any person a copy of any report referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and, in addition, shall make available in electronic formats reports referred to in subdivision (a), (b), (c), (d), or (g) of Section 128735, subdivision (a) of Section 128736, subdivision (a) of Section 128737, Section 128740, and subdivisions (a) and (c) of Section 128745, unless the department determines that an individual patient’s rights of confidentiality would be violated. The
department shall make the reports available at cost.
Amended by Stats. 2021, Ch. 143, Sec. 210. (AB 133) Effective July 27, 2021.
(a)On and after January 1, 1986, the systems of health facility accounting and auditing formerly approved by the California Health Facilities Commission shall remain in full force and effect for use by health facilities, but shall be maintained by the department.
(b)The department shall allow and provide, in accordance with appropriate regulations, for modifications in the accounting and reporting systems for use by health facilities in meeting the requirements of this chapter if the modifications are necessary to do any of the following:
(1)To correctly reflect differences in size of, provision of, or payment for,
services rendered by health facilities.
(2)To correctly reflect differences in scope, type, or method of provision of, or payment for, services rendered by health facilities.
(3)To avoid unduly burdensome costs for those health facilities in meeting the requirements of differences pursuant to paragraphs (1) and (2).
(c)The department shall allow and provide, in accordance with appropriate regulations, for modifications to discharge data reporting format and frequency requirements if these modifications will not impair the department’s ability to process the data or interfere with the purposes of this chapter. This modification authority shall not permit the department to administratively require the reporting of
discharge data items not specified pursuant to Section 128735.
(d)The department shall allow and provide, in accordance with appropriate regulations, for modifications to emergency care data reporting format and frequency requirements if these modifications will not impair the department’s ability to process the data or interfere with the purposes of this chapter. This modification authority shall not permit the department to require administratively the reporting of emergency care data items not specified in subdivision (a) of Section 128736.
(e)The department shall allow and provide, in accordance with appropriate regulations, for modifications to ambulatory surgery data reporting format and frequency requirements if these modifications will not impair the department’s
ability to process the data or interfere with the purposes of this chapter. The modification authority shall not permit the department to require administratively the reporting of ambulatory surgery data items not specified in subdivision (a) of Section 128737.
(f)The department shall adopt comparable modifications to the financial reporting requirements of this chapter for county hospital systems consistent with the purposes of this chapter.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.
Open the section link to read its full text.