900 KAR 7:040. Release of public data sets for health care discharge data.

 

      RELATES TO: KRS 216.2920-216.2929

      STATUTORY AUTHORITY KRS: 194A.050(1), 216.2923(2)(c), 216.2925(1), (2)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 216.2923 requires the Cabinet for Health and Family Services to publish and make available information relating to the health care delivery and finance system that is in the public interest. KRS 216.2927 mandates that personally identifying data collected by the Cabinet for Health and Family Services from health care providers not be released to the general public nor be allowed public inspection under KRS 61.870 to 61.884. This administrative regulation establishes the guidelines for distribution and publication of data collected by the cabinet pursuant to 900 KAR 7:030, while maintaining patient confidentiality and further protecting personally identifying information.

 

      Section 1. Definitions. (1) "Cabinet" is defined by KRS 216.2920(2).

      (2) "Data" means the information collected pursuant to 900 KAR 7:030.

      (3) "Encounter-level" means the data record of a single instance of hospitalization, outpatient service, ambulatory surgery, emergency department, or observation stay billing record contained in a data file.(4) "Health care provider" is defined by KRS 216.2920(5).

      (5) "Public" means a person or group not directly responsible for the collection, maintenance, custody, or dissemination of data for purposes of this administrative regulation.

      (6) "Report" means a summary or compilation of data disseminated to the public.

 

      Section 2. Encounter-Level Data. Encounter-level data shall be released in the following standard file format described in the table below:

Encounter-Level Standard File Format -

Data Element Contained in the File if information is available

File Type

Provider ID

Quarter & Year of Discharge

Patient Gender

Patient Age Group

Patient Race/Ethnicity

Patient Resident County

Type of Admission

Source of Admission

Diagnosis 1 (Primary)

Diagnosis 2

Diagnosis 3

Diagnosis 4

Diagnosis 5

Diagnosis 6

Diagnosis 7

Diagnosis 8

Diagnosis 9

Diagnosis 10

Diagnosis 11

Diagnosis 12

Diagnosis 13

Diagnosis 14

Diagnosis 15

Diagnosis 16

Diagnosis 17

Diagnosis 18

Diagnosis 19

Diagnosis 20

Diagnosis 21

Diagnosis 22

Diagnosis 23

Diagnosis 24

Diagnosis 25

Procedure 1

Procedure 2

Procedure 3

Procedure 4

Procedure 5

Procedure 6

Procedure 7

Procedure 8

Procedure 9

Procedure 10

Procedure 11

Procedure 12

Procedure 13

Procedure 14

Procedure 15

Procedure 16

Procedure 17

Procedure 18

Procedure 19

Procedure 20

Procedure 21

Procedure 22

Procedure 23

Procedure 24

Procedure 25

Length of Stay

Total Charges

Discharge Status

Payer 1 (Primary)

Payer 2

Payer 3

Diagnostic related group

Medicare Severity - Diagnostic related group

Major Diagnostic Category

Diagnosis Version Qualifier

Event Code 1

Event Code 2

Do not resuscitate indicator

Diagnosis present on admission indicator

 

      Section 3. Summary Data. (1) The cabinet shall not release data if KRS 216.2927 prohibits its release.

      (2) The cabinet may include the following data elements, in any combination thereof, for encounter-level, aggregate, and summary report formats:

      (a) Diagnoses and procedures, primary, and any other level;

      (b) Diagnosis and procedure groupings, including diagnostic related groups, major diagnostic categories, and agency for health care policy and research clinical classification system;

      (c) Patient gender;

      (d) Age or age grouping;

      (e) Discharge status;

      (f) Payor category, all levels;

      (g) Charge information, total and ancillary;

      (h) County of patient residence;

      (i) County of provider;

      (j) Ancillary department information;

      (k) Length of stay, total, and average;

      (l) External cause of injury;

      (m) Race or ethnicity; or

      (n) Mortality rate. Reports including mortality rates shall be adjusted by severity of illness by reputable grouping software, either on a contract basis or by the cabinet.

      (3) Data shall not be withheld from the public or another interested party based solely on an unfavorable profile of a provider or group of providers, if the data is deemed reliable, accurate, and sufficiently free of error, as determined by the cabinet and pursuant to 900 KAR 7:030.

 

      Section 4. Release of Data. (1) A person or agency shall, as a condition for receiving data from the cabinet, sign an "Agreement for Use of Kentucky Health Claims Data". A person or agency receiving data shall agree to adhere to the confidentiality requirements established in subsection (2) of this section and KRS 216.2927.

      (2) To protect patient confidentiality:

      (a) A report or summary of data that consists of five (5) or fewer records shall not be released or made public;

      (b) A person or agency receiving data shall not redistribute or sell data in the original format;

      (c) Distribution of data received by the cabinet shall be approved by the custodial agency prior to receipt of the data;

      (d) The data collected pursuant to 900 KAR 7:030 shall be used only for the purpose of health statistical reporting and analysis or as specified in the user's written request for the data; and

      (e) A user shall not attempt to link the public use data set with an individually identifiable record from another data set.

 

      Section 5. Fees. (1) The cabinet shall charge $1,500 for the purchase of a single copy of an annual, public-use data set.

      (2) A public-use data set shall be available for purchase no later than sixty (60) days after the end of the facility reporting period as established in 900 KAR 7:030. Special requests for data shall be prioritized and completed at the discretion of the custodial agency.

 

      Section 6. Incorporation by Reference. (1) "Agreement for Use of Kentucky Health Claims Data", September 2008, is incorporated by reference.

      (2) This material may be inspected, copied, or obtained, subject to applicable copyright law, at the Cabinet for Health and Family Services, Office of Health Policy, 275 East Main Street 4WE, Frankfort, Kentucky 40621, Monday through Friday, 8 a.m. to 4:30 p.m. (27 Ky.R. 886; Am. 1263; eff. 11-17-2000; Recodified from 902 KAR 17:050, 6-7-2004; 35 Ky.R. 1319; 1802; eff. 2-6-2009; Recodified from 902 KAR 19:030, 4-2-2009; 38 Ky.R. 618; eff. 9-13-11.)