RULES AND REGULATIONS
Title 28--HEALTH AND SAFETY
HEALTH CARE COST CONTAINMENT COUNCIL
[28 PA. CODE CH. 912]
Severity Methodology
[29 Pa.B. 5093] The Health Care Cost Containment Council (Council), under the authority of section 5(b) of the Pennsylvania Health Care Cost Containment Act (35 P. S. § 449.5(b)), is submitting final-form regulations to amend §§ 912.1, 912.3 and 912.31 (relating to legal base and purpose; definitions; and principle). The amendments remove specific reference to a particular methodology currently used by the Council to afford the Council flexibility in selecting an alternative methodology for measuring provider quality and provider service effectiveness.
Purpose
The purpose is to give the Council greater flexibility in responding to the marketplace than the present regulations allow. The amendments will enable the Council to change its vendor if the vendor fails to meet its contractual requirements.
Summary of Amendments
The amendments remove specific reference to the MedisGroups methodology to afford the Council flexibility in selecting a methodology for measuring provider quality and provider service effectiveness.
Affected Parties
All data sources in this Commonwealth currently are required to use the MedisGroups methodology.
Paperwork Requirements
The amendments will not impose additional paperwork on the private sector, the general public or the Commonwealth and its political subdivisions.
Fiscal Impact
The amendments will have no fiscal impact on the regulated community, the State or local governments.
Effective Date
The amendments will be effective upon publication in the Pennsylvania Bulletin.
Sunset Date
The Council continually monitors its regulations. Therefore, no sunset date has been assigned.
Contact Person
For further information, contact Marc P. Volavka, Executive Director, Health Care Cost Containment Council, 225 Market Street, Suite 400, Harrisburg, PA 17101, (717)232-6787.
Response to Public Comment
Written comments, suggestions or objections were requested within a 30-day period after publication of the proposed amendments at 29 Pa.B. 332 (January 16, 1999). Comments were submitted by the Hospital and Healthsystem Association of Pennsylvania and the Hospital Council of Western Pennsylvania. In addition, the Council received comments from the Pennsylvania Medical Society after the 30-day comment period ended. In preparing the final-form regulations, the Council has considered all comments received.
In general, the comments supported the intent of the proposed amendments. It was suggested by the Hospital and Healthsystem Association of Pennsylvania and the Hospital Council of Western Pennsylvania, however, that the Council should remove specific reference to ''clinical'' factors in the definition of ''patient severity.'' The Council's detailed response to these comments was submitted to the Independent Regulatory Review Commission (IRRC) with the final-form regulations. The Council's response outlines reasons why this suggestion was not incorporated into the final-form regulations, the main reason being that severity adjustment systems, whether they are ''clinical'' or ''administrative'' systems, incorporate some degree of ''clinical'' information. A copy of the complete response is available to the public upon request.
Regulatory Review
On January 5, 1999, as required by section 5(a) of the Regulatory Review Act (71 P. S. § 745.4(a)), the Council submitted copies of the proposed revisions, which were published at 29 Pa.B. 332, to IRRC, the Senate Public Health and Welfare Committee and House Health and Human Services Committee for review and comment. The Council, in accordance with section 5(b.1) of the Regulatory Review Act (71 P. S. § 745.5(b.1)), also provided IRRC and the Committees with the Regulatory Analysis Form prepared in compliance with Executive Order 1982-2 (relating to improving government regulations) and copies of comments received.
In preparing the final-form regulations, the Council has considered the comments received from the public and IRRC. No comments on the proposed amendments were received from either of the legislative committees. The text of the final-form regulations is identical to that submitted under the proposed rulemaking.
The final-form regulations were deemed approved by the Senate Public Health and Welfare Committee and the House Health and Human Services Committee on August 18, 1999. IRRC met on August 19, 1999, and approved the final-form regulations under section 5(c) of the Regulatory Review Act.
Order
(a) The regulations of the Council, 28 Pa. Code Chapter 912, are amended by amending §§ 912.1, 912.3 and 912.31 to read as set forth in Annex A, with ellipses referring to the existing text of the regulations.
(b) The Council shall submit this order and Annex A to the Office of Attorney General for approval as to form and legality as required by law.
(c) The Council shall certify this order and Annex A and deposit them with the Legislative Reference Bureau as required by law.
(d) The amendments adopted by this order shall take effect upon publication in the Pennsylvania Bulletin.
LEONARD BORESKI,
Chairperson(Editor's Note: For the text of the order of the Independent Regulatory Review Commission relating to this document, see 29 Pa. B. 4749 (September 4, 1999). For a statement of policy relating to this rulemaking, see 29 Pa.B. 5109 (October 2, 1999).)
Fiscal Note: 100-14. No fiscal impact; (8) recommends adoption.
Annex A
TITLE 28. HEALTH AND SAFETY
PART VI. HEALTH CARE COST CONTAINMENT COUNCIL
CHAPTER 912. DATA REPORTING REQUIREMENTS
Subchapter A. GENERAL PROVISIONS § 912.1. Legal base and purpose.
(a) This chapter is promulgated by the Council under section 6 of the act (35 P. S. § 449.6).
(b) This chapter establishes submission schedules and formats for the collection of data from health care facilities specified in section 6 of the act.
§ 912.3. Definitions.
The following words and terms, when used in this chapter, have the following meanings, unless the context clearly indicates otherwise:
* * * * * Major ambulatory service--Surgical or medical procedures, including diagnostic and therapeutic radiological procedures, commonly performed in hospitals or ambulatory service facilities, which are not of a type commonly performed or which cannot be safely performed in physicians' offices and which require special facilities, such as operating rooms or suites or special equipment, such as fluoroscopic equipment or computed tomographic scanners, or a postprocedure recovery room or short term convalescent room.
Pennsylvania Uniform Claims and Billing Form format--The Uniform Hospital Billing Form UB-82/HCFA-1450, and the HCFA 1500, or their successors, as developed by the National Uniform Billing Committee, with additional fields as necessary to provide the data in section 6(c) and (d) of the act (35 P. S. § 449.6(c) and (d)).
* * * * *
Subchapter B. PENNSYLVANIA UNIFORM CLAIMS AND BILLING FORM SUBMISSION SCHEDULES § 912.31. Principle.
The Council may, within its discretion and for good reason, grant exceptions to sections within this chapterwhen the policy and objectives of this chapter and the act are otherwise met.
[Pa.B. Doc. No. 99-1664. Filed for public inspection October 1, 1999, 9:00 a.m.]
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