sb83.html

05 LC 33 0587

Senate Bill 83

By: Senators Hamrick of the 30th and Thompson of the 5th

A BILL TO BE ENTITLED
AN ACT

To amend Title 31 of the Official Code of Georgia Annotated, relating to health, so as to change certain provisions relating to the Department of Community Health́s powers, duties, and functions; to require hospitals and medical facilities to make certain information available on their Internet websites; to require hospitals and medical facilities to provide estimates of charges to patients; to require hospital authorities to make certain information available on their Internet websites; to require hospital authorities to provide estimates of charges to patients; to provide for the collection and dissemination of certain information by the Department of Human Resources; to provide for related matters; to repeal conflicting laws; and for other purposes.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

SECTION 1.

Title 31 of the Official Code of Georgia Annotated, relating to health, is amended in Code Section 31-5A-4, relating to the Department of Community Health́s powers, duties, functions, and responsibilities, divisions, directors, the Office of Womeńs Health, and contracts for health benefits, by striking subsection (f) and inserting in its place the following:

"(f) In addition to its other powers, duties, and functions, the department:

(1) Shall be the lead agency in coordinating and purchasing health care benefit plans for state and public employees, dependents, and retirees and may also coordinate with the board of regents for the purchase and administration of such health care benefit plans for its members, employees, dependents, and retirees;

(2) Is authorized to plan and coordinate medical education and physician workforce work force issues;

(3) Is authorized to convene at least quarterly a state agency coordinating committee comprised of the commissioners, directors, chairpersons, or their designees, of the following agencies involved in health related activities: the Department of Human Resources, including the Division of Public Health, the Division of Mental Health, Developmental Disabilities, and Addictive Diseases, and the Division of Aging Services thereof, the Department of Juvenile Justice, the Department of Corrections, the Insurance Department, the State Merit System of Personnel Administration, the State Board of Workerś Compensation, and the Governoŕs Office of Planning and Budget. The board of regents may also designate a person to serve on the coordinating committee. The committee will convene for the purposes of planning and coordinating health issues that have interagency considerations. The commissioner of the department will serve as the chairperson of the state agency coordinating committee and will report to the Governor the activities, findings, and recommendations of the committee;

(4) Shall investigate the lack of availability of health insurance coverage and the issues associated with the uninsured population of this state. In particular, the department is authorized to investigate the feasibility of creating and administering insurance programs for small businesses and political subdivisions of the state and to propose cost-effective solutions to reducing the numbers of uninsured in this state;

(5) Shall study and recommend any additional functions needed to carry out the purposes of the department, including the creation of a consumer medical advocate. Such recommendations shall be made to the Governor and General Assembly by December 31, 1999;

(6) Is authorized to appoint a health care work force policy advisory committee to oversee and coordinate work force planning activities;

(7) Is authorized to solicit and accept donations, contributions, and gifts and receive, hold, and use grants, devises, and bequests of real, personal, and mixed property on behalf of the state to enable the department to carry out its functions and purposes; and

(8) Is authorized to award grants, as funds are available, to hospital authorities and hospitals for public health purposes, pursuant to Code Sections 31-7-94 and 31-7-94.1; and

(9) Shall conduct research, analyses, and studies relating to the collection of a statistically valid sample of data on the retail prices charged by pharmacies for the 50 most frequently prescribed medicines from any pharmacy licensed by this state as a special study authorized by the General Assembly to be performed by the department quarterly. If the drug is available generically, price data shall be reported for the generic drug and price data of a brand-named drug for which the generic drug is the equivalent shall be reported. The department shall make available on its Internet website for each pharmacy, no later than October 1, 2006, drug prices for a 30 day supply at a standard dose. The data collected shall be reported for each drug by pharmacy and by metropolitan statistical area or region and updated quarterly."

SECTION 2.

Said title is further amended by adding after Code Section 31-7-11, relating to written summary of hospital service charge rates, new Code sections to read as follows:

"31-7-11.1.

All hospitals and medical facilities licensed under this article shall make available on their Internet websites, no later than October 1, 2006, and in a hard copy format upon request, a description of and a link to the patient charge and performance outcome data collected from such hospitals and medical facilities pursuant to Code Section 31-7-286. Each hospital and medical facility shall place a notice in the reception area that such information is available electronically and the Internet website address where it can be accessed. The hospital or medical facility may indicate that the pricing information is based on a compilation of charges for the average patient and that each patient́s bill may vary from the average depending upon the severity of illness and individual resources consumed. The hospital or medical facility may also indicate that the price of service is negotiable for eligible patients based upon the patient́s ability to pay.

31-7-11.2.

All hospitals and medical facilities licensed under this article shall provide, prior to provision of any nonemergency medical services, a written good faith estimate of reasonably anticipated charges for the facility to treat the patient́s condition upon written request of a prospective patient. The estimate shall be provided to the prospective patient within seven business days after the receipt of the request. The estimate may be the average charges for that diagnosis related group or the average charges for that procedure. Upon request, the facility shall notify the patient of any revision to the good faith estimate. Such estimate shall not preclude the actual charges from exceeding the estimate. The facility shall place a notice in the reception area that such information is available. Failure to provide the estimate within the provisions established pursuant to this Code section shall result in a fine of $500 for each instance of the facilitýs failure to provide the requested information."

SECTION 3.

Said title is further amended in Article 4, relating to county and municipal hospital authorities, by adding to the end of such article new Code sections to read as follows:

"31-7-97.

All hospital authorities subject to this article shall make available on their Internet websites, no later than October 1, 2006, and in a hard copy format upon request, a description of and a link to the patient charge and performance outcome data collected from such hospital authorities pursuant to Code Section 31-7-286. Each hospital authority shall place a notice in the reception area that such information is available electronically and the Internet website address where it can be accessed. The hospital authority may indicate that the pricing information is based on a compilation of charges for the average patient and that each patient́s bill may vary from the average depending upon the severity of illness and individual resources consumed. The hospital authority may also indicate that the price of service is negotiable for eligible patients based upon the patient́s ability to pay.

31-7-98.

All hospital authorities subject to this article shall provide, prior to provision of any nonemergency medical services, a written good faith estimate of reasonably anticipated charges for the hospital authority to treat the patient́s condition upon written request of a prospective patient. The estimate shall be provided to the prospective patient within seven business days after the receipt of the request. The estimate may be the average charges for that diagnosis related group or the average charges for that procedure. Upon request, the hospital authority shall notify the patient of any revision to the good faith estimate. Such estimate shall not preclude the actual charges from exceeding the estimate. The hospital authority shall place a notice in the reception area that such information is available. Failure to provide the estimate within the provisions established pursuant to this Code section shall result in a fine of $500 for each instance of the hospital authoritýs failure to provide the requested information."

SECTION 4.

Said title is further amended in Article 12, relating to health care data collection, by adding to the end of such article a new Code section to read as follows:

"31-7-286.

(a) For purposes of this Code section, 'health care facility' means all hospitals and medical facilities licensed under Article 1 of this chapter and all hospital authorities subject to Article 4 of this chapter.

(b)(1) The department shall require the submission by health care facilities of data necessary to carry out the department́s duties. Specifications for data to be collected under this Code section shall be developed by the department with the assistance of technical advisory panels including representatives of affected entities, consumers, purchasers, and such other interested parties as may be determined by the department.

(2) Data submitted by health care facilities shall include, but are not limited to, case mix data, patient admission, and discharge data; hospital emergency department data, which shall include the number of patients treated in the emergency department of a licensed hospital reported by patient acuity level; data on hospital acquired infections as specified by rule; data on complications as specified by rule; data on readmissions as specified by rule, with patient and provider-specific identifiers included; actual charge data by diagnostic groups; financial data; accounting data; operating expenses; expenses incurred for rendering services to patients who cannot or do not pay; interest charges; depreciation expenses based on the expected useful life of the property and equipment involved; and demographic data. The department shall adopt nationally recognized risk adjustment methodologies or software consistent with the standards of the Agency for Healthcare Research and Quality and as selected by the department for all data submitted as required by this Code section. Data may be obtained from documents such as, but not limited to, leases, contracts, debt instruments, itemized patient bills, medical record abstracts, and related diagnostic information. Reported data elements shall be reported electronically in accordance with rules established by the department. Data submitted shall be certified by the chief executive officer or an appropriate and duly authorized representative or employee of the licensed facility that the information submitted is true and accurate.

(3) The department shall establish rules and regulations, after consulting with appropriate professional and governmental advisory bodies, holding public hearings, and considering existing and proposed systems of accounting and reporting utilized by health care facilities, for specifying a uniform system of financial reporting for each type of facility based on a uniform chart of accounts developed after considering any chart of accounts developed by the national association for such facilities and generally accepted accounting principles. Such systems shall, to the extent feasible, use existing accounting systems and shall minimize the paperwork required of facilities. This provision shall not be construed to authorize the department to require health care facilities to adopt a uniform accounting system. As a part of such uniform system of financial reporting, the department may require the filing of any information relating to the cost to the provider and the charge to the consumer of any service provided in such facility, except the cost of a physiciańs services which is billed independently of the facility.

(4) When more than one licensed facility is operated by the reporting organization, the information required by this Code section shall be reported for each facility separately.

(5) Within 120 days after the end of its fiscal year, each health care facility shall file with the department, on forms adopted by the department and based on the uniform system of financial reporting, its actual financial experience for that fiscal year, including expenditures, revenues, and statistical measures. Such data may be based on internal financial reports which are certified to be complete and accurate by the provider. However, hospitalś actual financial experience shall be their audited actual experience.

(6) Portions of patient records obtained or generated by the department containing the name, residence or business address, telephone number, social security or other identifying number, or photograph of any person or the spouse, relative, or guardian of such person, or any other identifying information which is patient specific or otherwise identifies the patient, either directly or indirectly, are confidential and exempt from the provisions of Article 4 of Chapter 18 of Title 50, relating to inspection of public records.

(7) No health care facility or other reporting entity or its employees or agents shall be held liable for civil damages or subject to criminal penalties either for the reporting of patient data to the department or for the release of such data by the department as authorized by this Code section.

(8) The department shall cooperate with local health agencies and the Department of Community Health with regard to health care data collection and dissemination and shall cooperate with state agencies in any efforts to establish an integrated health care database.

(c) The department shall make available performance outcome and patient charge data collected from health care facilities pursuant to subsection (b) of this Code section. The department shall determine which conditions and procedures, performance outcomes, and patient charge data to disclose. When determining which conditions and procedures are to be disclosed, the department shall consider variation in costs, variation in outcomes, and magnitude of variations and other relevant information. When determining which performance outcomes to disclose, the department:

(1) Shall consider such factors as volume of cases; average patient charges; average length of stay; complication rates; mortality rates; and infection rates, among others, which shall be adjusted for case mix and severity, if applicable; and

(2) May consider such additional measures that are adopted by the Centers for Medicare and Medicaid Studies, National Quality Forum, the Joint Commission on Accreditation of Healthcare Organizations, the Agency for Healthcare Research and Quality, or a similar national entity that establishes standards to measure the performance of health care providers, or by other states.

When determining which patient charge data to disclose, the department shall consider such measures as average charge, average net revenue per adjusted patient day, average cost per adjusted patient day, and average cost per admission, among others.

(d) The department shall determine the method and format for public disclosure of data reported pursuant to this Code section. At a minimum, the data shall be made available on the department́s Internet website in a manner that allows consumers to conduct an interactive search that allows them to view and compare the information for specific providers. The website must include such additional information as is determined necessary to ensure that the website enhances informed decisionmaking among consumers and health care purchasers, which shall include, at a minimum, appropriate guidance on how to use the data and an explanation of why the data may vary from provider to provider. The data specified in subsection (c) shall be available on the website no later than March 1, 2006.

(e) The department shall be authorized to establish rules and regulations to implement the provisions of this Code section."

SECTION 5.

All laws and parts of laws in conflict with this Act are repealed.