07 LC 33
1728
Senate
Bill 78
By:
Senators Hamrick of the 30th and Hill of the 32nd
A
BILL TO BE ENTITLED
AN ACT
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
Health´s 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 Health´s
powers, duties, functions, and responsibilities, divisions, directors, the
Office of Women´s Health, and contracts for health benefits, by revising
subsection (f) as follows:
"(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
composed
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 Workers´ Compensation, and the
Governor´s 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 name 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, 2007, 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, 2007, 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 patient´s 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 patient´s 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
patient´s 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 $500.00 for
each instance of the facility´s 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, 2007, 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 patient´s 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 patient´s 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
patient´s 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 $500.00 for each instance of the hospital authority´s
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 department´s 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, 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 physician´s
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, hospitals´ 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 department´s 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 decision making 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, 2007.
(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.