As Passed by the House

126th General Assembly Regular Session 2005-2006

Sub. H. B. No. 197

Representatives Raussen, Gibbs, McGregor, J., Carmichael, Evans, C., Flowers, Evans, D., Faber, Ujvagi, Koziura, Schaffer, Blasdel, Martin, Beatty, Blessing, Cassell, Collier, DeBose, Distel, Dolan, Domenick, Fessler, Hagan, Hughes, Key, Law, Mason, Miller, Patton, S., Smith, S., Stewart, D., Sykes, Wagoner, White, Williams, Woodard, Yuko 

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A BILL

To amend sections 3727.11, 3727.12, 3727.14, and

1

3727.16, to amend for the purpose of adopting new

2

section numbers as indicated in parentheses

3

sections 3727.11 (3727.34), 3727.12 (3727.42),

4

3727.121 (3727.43), 3727.14 (3727.36), and 3727.16

5

(3727.45), to enact sections 3727.30, 3727.301,

6

3727.302, 3727.303, 3727.304, 3727.305, 3727.31,

7

3727.32, 3727.33, 3727.331, 3727.332, 3727.35,

8

3727.37, 3727.38, 3727.39, 3727.40, 3727.41, and

9

3727.44, and to repeal sections 3727.13 and

10

3727.15 of the Revised Code concerning hospitals

11

submitting information about performance measures

12

and disclosing price data.

13

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 3727.11, 3727.12, 3727.14, and	14
3727.16 be amended, sections 3727.11 (3727.34), 3727.12 (3727.42),	15
3727.121 (3727.43), 3727.14 (3727.36), and 3727.16 (3727.45) be	16
amended for the purpose of adopting new section numbers as	17
indicated in parentheses, and sections 3727.30, 3727.301,	18
3727.302, 3727.303, 3727.304, 3727.305, 3727.31, 3727.32, 3727.33,	19
3727.331, 3727.332, 3727.35, 3727.37, 3727.38, 3727.39, 3727.40,	20
3727.41, and 3727.44 of the Revised Code be enacted to read as	21
follows:	22

Sec. 3727.30.  There is hereby created the hospital	23
performance measures advisory council. The council shall consist	24
of the following members:	25

(A) The director of health;

26

(B) The superintendent of insurance;

27

(C) Two members of the house of representatives, from	28
different political parties, appointed by the speaker of the house	29
of representatives;	30

(D) Two members of the senate, from different political	31
parties, appointed by the president of the senate;	32

(E) One representative of each of the following appointed by	33
the speaker of the house of representatives:	34

(1) Health insurers;

35

(2) Small employers;

36

(3) Organized labor;

37

(4) Physicians in general practice;

38

(5) Childrens' hospitals.

39

(F) One representative of each of the following appointed by	40
the president of the senate:	41

(1) Physicians specializing in public health;

42

(2) Hospitals;

43

(3) Health services researchers;

44

(4) Health care consumers;

45

(5) Large employers.

46

Sec. 3727.301.  All of the following shall apply to members	47
of the hospital performance measures advisory council:	48

(A) They shall serve at the pleasure of their appointing	49
authority.	50

(B) They shall serve without remuneration, except to the	51
extent that serving on the council is considered a part of their	52
regular employment duties.	53

(C) They shall not be reimbursed for expenses incurred in the	54
performance of their duties on the council.	55

Sec. 3727.302.  The director of health shall serve as chair	56
of the hospital performance measures advisory council.	57

Sec. 3727.303.  The department of health shall provide	58
meeting space and staff and other administrative support for the	59
hospital performance measures advisory council.	60

Sec. 3727.304.  The hospital performance measures advisory	61
council shall do all of the following:	62

(A) Study the issue of hospitals reporting information	63
regarding performance measures for hospital inpatient and	64
outpatient services, including how such reports are made in other	65
states;	66

(B) Not later than one year after the date the last of the	67
initial members of the council is appointed to the council, issue	68
a report to the director of health with recommendations for all of	69
the following:	70

(1) Collecting information from hospitals that shows the	71
hospitals' records in meeting the performance measures;	72

(2) The audits performed under section 3727.332 of the	73
Revised Code;	74

(3) Disseminating hospitals' records in meeting the	75
performance measures, including effective means of displaying	76
information on the internet web site established under section	77
3727.39 of the Revised Code;	78

(4) Explaining to the public how to use the information about	79
the hospitals' records in meeting the performance measures,	80
including explanations about the limitations of the information.	81

(C) Provide the director of health ongoing advice on the	82
issue of hospitals reporting information regarding performance	83
measures for hospital inpatient and outpatient services,	84
disseminating the information so reported by hospitals, and making	85
improvements to the reports and dissemination of information.	86

Sec. 3727.305. The director of health may consider, but is	87
not required to follow, the recommendations and on-going advice	88
provided to the director by the hospital performance measures	89
advisory council under section 3727.304 of the Revised Code when	90
implementing sections 3727.33 to 3727.40 of the Revised Code and	91
adopting rules under section 3727.41 of the Revised Code.	92

Sec. 3727.31.  (A) The director of health shall convene a	93
group of experts in data collection and analysis or a related	94
field to do all of the following:	95

(1) Select, not later than thirty days after the date the	96
last of the initial members of the hospital performance measures	97
advisory council is appointed to the council, either the	98
refined-diagnostic related group or all patients	99
refined-diagnostic related group method by which a hospital may	100
adjust information pursuant to division (B)(4) of section 3727.33	101
of the Revised Code;	102

(2) Issue, not later than one year after the date the last of	103
the initial members of the hospital performance measures advisory	104
council is appointed to the council, a report to the director that	105
advises the director on how to provide for the internet web site	106
established under section 3727.39 of the Revised Code to include a	107
report on each hospital's overall record in meeting the	108
performance measures established by the entities specified in	109
division (A) of section 3727.33 of the Revised Code;	110

(3) Submit to the director guidelines to be used to determine	111
whether a hospital's record in meeting a specific performance	112
measure should be excluded from the web site established under	113
section 3727.39 of the Revised Code because the hospital's	114
caseload for the diagnosis or procedure that the performance	115
measure concerns is insufficient to make the hospital's record a	116
reliable indicator of its ability to treat the diagnosis or	117
provide the procedure in a quality manner;	118

(B) In addition to convening a group of experts in data	119
collection and analysis or a related field for the purposes of	120
division (A) of this section, the director of health may convene	121
such a group at other times the director determines necessary to	122
assist the hospital performance measures advisory council with its	123
duties, including assistance regarding the following:	124

(1) Determining the validity of performance measures for	125
hospital inpatient and outpatient services;	126

(2) Determining the reliability of information hospitals	127
submit to the director under section 3727.33 of the Revised Code,	128
including how the factor of caseloads affects reliability;	129

(3) Audits conducted pursuant to section 3727.332 of the	130
Revised Code.	131

(C) Each member of the hospital performance measures advisory	132
council shall appoint an individual to serve on a group convened	133
under this section. A member of the council who is an expert in	134
data collection and analysis or a related field may appoint	135
himself or herself to the group rather than appoint another	136
individual. Individuals appointed to the group shall serve without	137
remuneration, except to the extent that serving in the group is	138
considered a part of their regular employment duties, and shall	139
not be reimbursed for expenses incurred in the performance of	140
their duties in the group.	141

Sec. 3727.32.  At times the director of health determines	142
necessary, the director shall convene a group of health care	143
consumers, nurses, and experts in infection control to provide the	144
hospital performance measures advisory council information about	145
infection issues that the council needs to be able to perform its	146
duties. The director shall make the appointments to a group	147
convened under this section. Individuals appointed to the group	148
shall serve without remuneration, except to the extent that	149
serving in the group is considered a part of their regular	150
employment duties, and shall not be reimbursed for expenses	151
incurred in the performance of their duties in the group.	152

Sec. 3727.33.  (A) Beginning not later than thirty days after	153
the group convened under section 3727.31 of the Revised Code	154
completes its duty under division (A)(1) of that section, each	155
hospital shall semiannually submit information to the director of	156
health that shows the hospital's record in meeting each of the	157
performance measures for hospital inpatient and outpatient	158
services established by each of the following:	159

(1) The agency for health care research and quality;

160

(2) The national quality forum;

161

(3) The United States centers for medicare and medicaid	162
services;	163

(4) The national committee for quality assurance;

164

(5) The joint commission on accreditation of healthcare	165
organizations.	166

(B) In submitting information under division (A) of this	167
section, each hospital shall do all of the following:	168

(1) Submit the information for the hospital's inpatient and	169
outpatient services regardless of who pays the charges incurred	170
for the services;	171

(2) Use the diagnosis and procedure codes for either or both	172
of the following as appropriate:	173

(a) The version of the international classification of	174
diseases, clinical modification, that is current at the time the	175
information is submitted;	176

(b) The version of the current procedural terminology (CPT)	177
published by the American medical association that is current at	178
the time the information is submitted.	179

(3) Include data about all of the following with the	180
information:	181

(a) The hospital's caseloads for treating diagnoses and	182
providing procedures;	183

(b) Adjusted length of stays;

184

(c) Complication rates, including complications from	185
infections;	186

(d) Mortality rates.

187

(4) If the hospital determines that any of the information is	188
misleading unless adjusted to reflect patients' risk factors,	189
adjust the information to reflect the risk factors in accordance	190
with the method selected by the group convened under section	191
3727.31 of the Revised Code;	192

(5) Provide for the information to reflect the performance	193
measures in effect on the date the information is submitted;	194

(6) Beginning with the first submission of information made	195
after the initial rules governing the submission of the	196
information that are adopted under section 3727.41 of the Revised	197
Code go into effect, follow those rules.	198

Sec. 3727.331.  A hospital may provide for a third party to	199
determine whether any information to be submitted to the director	200
of health under section 3727.33 of the Revised Code should be	201
adjusted for risk pursuant to division (B)(4) of that section.	202

Sec. 3727.332.  The director of health may audit any	203
information submitted to the director under section 3727.33 of the	204
Revised Code, including information adjusted for risk pursuant to	205
division (B)(4) of that section.	206

Sec. 3727.11.        Sec. 3727.34.  (A) As used in this section,	207
"nongovernmental patient" means any patient other than a patient	208
for whom primary charges are paid under Title XVIII or XIX of the	209
"Social Security Act," 49 Stat. 620 (1935), 42 U.S.C. 301, as	210
amended, or by the bureau for children with medical handicaps	211
under sections 3701.023 to 3701.028 of the Revised Code.	212

(B) On or before the first day of May each year, every	213
hospital shall disclose to the departmentdirector of health the	214
following data for nongovernmentalall patients, regardless of who	215
pays the charges incurred, in each of the one hundredsixty	216
diagnosis related groups as defined pursuant to 42 C.F.R. 412 most	217
frequently treated on an inpatient basis in the hospital as	218
represented by inpatient discharges during the previous calendar	219
year and in each of the sixty diagnosis related groups as defined	220
pursuant to 42 C.F.R. 412 most frequently treated on an outpatient	221
basis in the hospital as represented by outpatient discharges	222
during the previous calendar year:	223

(1) The total number of patients discharged;

224

(2) The mean, median, and range of total hospital charges;

225

(3) The mean, median, and range of length of stay;

226

(4) The number of admissions from each of the following:

227

(a) Emergency room;

228

(b) Transfer from another hospital;

229

(c) Other sources of admission.

230

(5) The number of nongovernmental patients falling within	231
diagnosis related group numbers 468, 469, and 470 as defined	232
pursuant to 42 C.F.R. part 412.	233

This section does not require disclosure of data for any	234
diagnosis related group for which the hospital treated fewer than	235
ten nongovernmental patients during the year.	236

Each hospital may include with data disclosed under this	237
section commentary concerning reasons for major deviations in the	238
range of data for any diagnosis related group. All reports or	239
other releases of information by the departmentdirector	240
identifying a hospital shall include the commentary provided by	241
the hospital. The departmentdirector shall maintain the	242
information disclosed under division (B)(A) of this section as a	243
public record in accordance with section 149.43 of the Revised	244
Code.	245

(C)(B) Every hospital shall make the information it reports	246
under division (B)(A) of this section available for inspection by	247
any member of the public at any reasonable time. On request, the	248
hospital shall make copies available for a reasonable fee, and the	249
hospital shall advise the requesting person that the information	250
is available from the departmentdirector of health. If a hospital	251
has information available on the average prices of diagnosis	252
related groups or specific procedures not required to be disclosed	253
under this section, it shall make such information available at	254
the request of any member of the public.	255

If the federal government adopts a severity of illness	256
classification system under Title XVIII of the "Social Security	257
Act," such system shall be used by all hospitals in reporting	258
their diagnosis related group prices effective with hospital	259
fiscal years beginning on or after said action, and if the federal	260
government fails to act by July 1, 1988, the public health council	261
shall adopt rules under Chapter 119. of the Revised Code requiring	262
the use of one or more severity of illness classification systems	263
effective with hospital fiscal years beginning on or after January	264
1, 1989.	265

Sec. 3727.35.  The director of health shall permit a hospital	266
to verify the accuracy of all information submitted to the	267
director under section 3727.33 and data disclosed under section	268
3727.34 of the Revised Code and provide corrections of the	269
information and data in a timely manner.	270

Sec. 3727.14.        Sec. 3727.36.  Under no circumstances shall the name	271
or social security number of a patient or, physician, or dentist	272
be included in the information submitted under section 3727.33 or	273
data disclosed under sections 3727.11 and 3727.13section 3727.34	274
of the Revised Code.	275

The health care information data base collected by the	276
department of health under section 3727.13 of the Revised Code and	277
any analysis of such information shall be maintained as a public	278
record within the meaning of section 149.43 of the Revised Code.	279
No data collected by the department pursuant to this section shall	280
be released to the public except on an aggregate basis by	281
geographic area, by institution, or by other aggregation.	282

No hospital that discloses data under section 3727.11 or	283
3727.13 of the Revised Code is liable for misuse or improper	284
release of the data by the department or by any other person.	285

Sec. 3727.37.  No hospital that submits information under	286
section 3727.33 or discloses data under section 3727.34 of the	287
Revised Code is liable for the misuse or improper release of the	288
information or data by any of the following:	289

(A) The department of health;

290

(B) A person with whom the department contracts under section	291
3727.40 of the Revised Code;	292

(C) A person whose misuse or improper release of the	293
information or data is not done on behalf of the hospital.	294

Sec. 3727.38.  Neither information submitted under section	295
3727.33 nor data disclosed under section 3727.34 of the Revised	296
Code shall be used to establish or alter any professional standard	297
of care or be admissible as evidence in any civil, criminal, or	298
administrative proceeding.	299

Sec. 3727.39.  (A) The director of health shall make the	300
information submitted to the director by hospitals under section	301
3727.33 of the Revised Code and the data disclosed by hospitals	302
under section 3727.34 of the Revised Code available on an internet	303
web site available to the public. In making the information and	304
data available on a web site, the director shall do all of the	305
following:	306

(1) Provide for the web site to be organized in a manner that	307
enables the public to use it easily;	308

(2) Exclude from the web site any information that	309
compromises patient privacy;	310

(3) Include links to hospitals' internet web sites to enable	311
the public to obtain additional information about hospitals,	312
including hospitals' programs designed to enhance quality and	313
safety;	314

(4) Allow other internet web sites to link to the web site	315
for the purposes of increasing the web site's availability and	316
encouraging ongoing improvement;	317

(5) Update the web site as hospitals submit new information	318
under section 3727.33 of the Revised Code, disclose new data under	319
section 3727.34 of the Revised Code, and as needed to correct	320
errors.	321

(B) The information submitted under section 3727.33 of the	322
Revised Code shall be presented on the web site in a manner that	323
enables the public to compare hospitals' records in meeting the	324
performance measures for hospital inpatient and outpatient	325
services established by the entities specified in division (A) of	326
section 3727.33 of the Revised Code. In making the information	327
available on a web site, the director shall do all of the	328
following:	329

(1) Enable the public to compare hospitals' records in	330
meeting the performance measures for specific diagnoses and	331
procedures;	332

(2) Enable the public to make the comparisons by different	333
geographic regions, such as by county or zip code;	334

(3) Based on the report issued to the director pursuant to	335
division (A)(2) of section 3727.31 of the Revised Code, include a	336
report of each hospital's overall record in meeting the	337
performance measures;	338

(4) To the extent possible, include state and federal	339
benchmarks for the performance measures;	340

(5) Include contextual information and explanations that the	341
public can easily understand, including contextual information	342
that explains why differences in different hospital's records in	343
meeting the performance measures may be misleading;	344

(6) Exclude from the web site a hospital's record in meeting	345
a specific performance measure if the hospital's caseload for the	346
diagnosis or procedure that the performance measure concerns is	347
insufficient, as determined in accordance with the guidelines	348
submitted to the director under division (A)(3) of section 3727.31	349
of the Revised Code, to make the hospital's record for the	350
diagnosis or procedure a reliable indicator of its ability to	351
treat the diagnosis or provide the procedure in a quality manner;	352

(7) Clearly identify the sources of data used in the web site	353
and explain the analytical methods used in determining hospitals'	354
records in meeting performance measures.	355

Sec. 3727.40.  The director of health may contract with a	356
person for the person to perform the director's duties under	357
sections 3727.33 to 3727.39 of the Revised Code.	358

Sec. 3727.41.  The director of health shall adopt rules in	359
accordance with Chapter 119. of the Revised Code that govern	360
hospitals' submission of information and disclosure of data to the	361
director of health under sections 3727.33 and 3727.34 of the	362
Revised Code.	363

Sec. 3727.12.        Sec. 3727.42.  (A) Every hospital shall compile and	365
make available for inspection by the public a price information	366
list containing the following information, whichspecified in	367
division (B) of this section and shall be updated periodically	368
update the list to maintain current information. The price	369
information list shall be compiled and made available in a format	370
that complies with the electronic transaction standards and code	371
sets adopted by the United States secretary of health and human	372
services under 42 U.S.C. 1320d-2.	373

(B) Each price information list required by division (A) of	374
this section shall contain all of the following information:	375

(1) The usual and customary room and board charges for each	376
level of care within the hospital, including but not limited to	377
private rooms, semiprivate rooms, other multiple patient rooms,	378
and intensive care and other specialty units;	379

(2) Rates charged for nursing care, if the hospital charges	380
separately for nursing care;	381

(3) The usual and customary charges, stated separately for	382
inpatients and outpatients if different charges are imposed, for	383
any of the following services provided by the hospital:	384

(a) The thirty most common x-ray and radiological procedures;

385

(b) The thirty most common laboratory procedures;

386

(c) Emergency room services;

387

(d) Operating room services;

388

(e) Delivery room services;

389

(f) Physical, occupational, and pulmonary therapy services;

390

(g) Any other services designated as high volume services by	391
a rule which shall be adopted by the public health council.	392

(B) The list required by division (A) of this section shall	393
specify whether(4) The hospital's billing policies, including	394
whether the hospital charges interest on an amount not paid in	395
full by any person or government entity and the interest rate	396
charged;	397

(5) Whether or not the charges listed include fees for the	398
services of hospital-based anesthesiologists, radiologists,	399
pathologists, and emergency room physicians. If theand, if a	400
charge does not include such fees, the listing shall specify how	401
such fee information can be obtained.	402

(C) AtEvery hospital shall do all of the following with the	403
price information list required by this section:	404

(1) At the time of admission, or as soon as practical	405
thereafter, the hospital shall inform each patient of the	406
availability of the price information list required by this	407
section and on request shall provide the patient with a free copy	408
of the list. On;	409

(2) On request, a hospital shall provide a paper copy of the	410
list to any person or governmental agency, subject to payment of a	411
reasonable fee for copying and processing;	412

(3) Make the list available free of charge on the hospital's	413
web site to any person and post an announcement of the list's	414
availability in each of the hospital's billing offices and	415
admission, patient waiting, and reception areas.	416

Sec. 3727.121.        Sec. 3727.43.  Each hospital shall provide a full	417
disclosure of the provisions of section 3924.21 of the Revised	418
Code to every beneficiary who receives services at the hospital.	419

Sec. 3727.44.  The director of health may adopt rules in	420
accordance with Chapter 119. of the Revised Code to carry out the	421
purpose of sections 3727.42 and 3727.43 of the Revised Code.	422

Sec. 3727.16.        Sec. 3727.45.  The director of health may apply to	423
the court of common pleas of the county in which a hospital is	424
located for a temporary or permanent injunction restraining the	425
hospital from failure to comply with sections 3727.113727.33,	426
3727.34, and 3727.123727.42 of the Revised Code.	427

Section 2. That existing sections 3727.11, 3727.12, 3727.121,	428
3727.14, and 3727.16 and sections 3727.13 and 3727.15 of the	429
Revised Code are hereby repealed.	430