HOUSE BILL NO. 2670 103RD GENERAL ASSEMBLY
INTRODUCED BY REPRESENTATIVE PETERS.
6304H.01I JOSEPH ENGLER, Chief Clerk
AN ACT To repeal sections 192.131, 192.665, 192.667, 192.700, 192.703, 192.707, 192.710, 192.712, 192.714, 192.716, 192.718, 192.723, 192.725, 197.165, 197.293, 197.294, 643.263, and 643.265, RSMo, and to enact in lieu thereof nine new sections relating to public health.
Be it enacted by the General Assembly of the state of Missouri, as follows:
Section A. Sections 192.131, 192.665, 192.667, 192.700, 192.703, 192.707, 192.710, 2 192.712, 192.714, 192.716, 192.718, 192.723, 192.725, 197.165, 197.293, 197.294, 643.263, 3 and 643.265, RSMo, are repealed and nine new sections enacted in lieu thereof, to be known 4 as sections 192.131, 192.665, 192.667, 192.700, 192.703, 192.714, 197.293, 197.294, and 5 643.263, to read as follows: 192.131. 1. As used in this section, the following terms shall mean: 2 (1) ["Advisory panel", the infection control advisory panel created by section 3 197.165; 4 (2)] "Antibiogram", a record of the resistance of microbes to various antibiotics; 5 [(3)] (2) "Antimicrobial", the ability of an agent to destroy or prevent the 6 development of pathogenic action of a microorganism; 7 [(4)] (3) "Department", the department of health and senior services. 8 2. Every laboratory performing culture and sensitivity testing on humans in Missouri 9 shall submit data on health care associated infections to the department in accordance with 10 this section. The data to be reported shall be defined by regulation of the department [after 11 considering the recommendations of the advisory panel]. Such data may include 12 antibiograms and, not later than July 1, 2005, shall include but not be limited to the
EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law. Matter in bold-face type in the above bill is proposed language. HB 2670 2
13 number of patients or isolates by hospital, ambulatory surgical center, and other facility or 14 practice setting with methicillin-resistant staphylococcus aureus (MRSA) or vancomycin- 15 resistant enterococcus (VRE). 16 3. Information on infections collected pursuant to this section shall be subject to the 17 confidentiality protections of this chapter but shall be available in provider-specific form to 18 appropriate facility and professional licensure authorities. 19 4. The [advisory panel] department shall [develop a recommended plan to] use 20 laboratory and health care provider data provided pursuant to this chapter to create a system 21 to: 22 (1) Enhance the ability of health care providers and the department to track the 23 incidence and distribution of preventable infections, with emphasis on those infections that 24 are most susceptible to interventions and that pose the greatest risk of harm to Missouri 25 residents; and 26 (2) Monitor trends in the development of antibiotic-resistant microbes, including but 27 not limited to methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant 28 enterococcus (VRE) infections. 29 5. In implementing this section, [the advisory panel and] the department shall 30 conform to guidelines and standards adopted by the federal Centers for Disease Control and 31 Prevention. [The advisory panel's plan may provide for demonstration projects to assess the 32 viability of the recommended initiatives.] 192.665. As used in this section, section 192.667, and sections 197.150 to [197.165] 2 197.162, the following terms mean: 3 (1) "Charge data", information submitted by health care providers on current charges 4 for leading procedures and diagnoses; 5 (2) "Charges by payer", information submitted by hospitals on amount billed to 6 Medicare, Medicaid, other government sources and all nongovernment sources combined as 7 one data element; 8 (3) "Department", the department of health and senior services; 9 (4) "Financial data", information submitted by hospitals drawn from financial 10 statements which includes the balance sheet, income statement, charity care and bad debt and 11 charges by payer, prepared in accordance with generally accepted accounting principles; 12 (5) "Health care provider", hospitals as defined in section 197.020 and ambulatory 13 surgical centers and abortion facilities as defined in section 197.200; 14 (6) "Nosocomial infection", as defined by the federal Centers for Disease Control and 15 Prevention and applied to infections within hospitals, ambulatory surgical centers, abortion 16 facilities, and other facilities; HB 2670 3
17 (7) "Nosocomial infection incidence rate", a risk-adjusted measurement of new cases 18 of nosocomial infections by procedure or device within a population over a given period of 19 time, with such measurements defined by rule of the department pursuant to subsection 3 of 20 section 192.667 for use by all hospitals, ambulatory surgical centers, abortion facilities, and 21 other facilities in complying with the requirements of the Missouri nosocomial infection 22 control act of 2004; 23 (8) "Other facility", a type of facility determined to be a source of infections and 24 designated by rule of the department pursuant to subsection 11 of section 192.667; 25 (9) "Patient abstract data", data submitted by hospitals which includes but is not 26 limited to date of birth, sex, race, zip code, county of residence, admission date, discharge 27 date, principal and other diagnoses, including external causes, principal and other procedures, 28 procedure dates, total billed charges, disposition of the patient and expected source of 29 payment with sources categorized according to Medicare, Medicaid, other government, 30 workers' compensation, all commercial payors coded with a common code, self-pay, no 31 charge and other. 192.667. 1. All health care providers shall at least annually provide to the department 2 charge data as required by the department. All hospitals shall at least annually provide patient 3 abstract data and financial data as required by the department. Hospitals as defined in section 4 197.020 shall report patient abstract data for outpatients and inpatients. Ambulatory surgical 5 centers and abortion facilities as defined in section 197.200 shall provide patient abstract data 6 to the department. The department shall specify by rule the types of information which shall 7 be submitted and the method of submission. 8 2. The department shall collect data on the incidence of health care-associated 9 infections from hospitals, ambulatory surgical centers, abortion facilities, and other facilities 10 as necessary to generate the reports required by this section. Hospitals, ambulatory surgical 11 centers, abortion facilities, and other facilities shall provide such data in compliance with this 12 section. In order to streamline government and to eliminate duplicative reporting 13 requirements, if the Centers for Medicare and Medicaid Services, or its successor entity, 14 requires hospitals to submit health care-associated infection data, then hospitals and the 15 department shall not be required to comply with the health care-associated infection data 16 reporting requirements of subsections 2 to [17] 16 of this section applicable to hospitals, 17 except that the department shall post a link on its website to publicly reported data by 18 hospitals on the Centers for Medicare and Medicaid Services' Hospital Compare website, or 19 its successor. 20 3. The department shall promulgate rules specifying the standards and procedures for 21 the collection, analysis, risk adjustment, and reporting of the incidence of health care- HB 2670 4
22 associated infections and the types of infections and procedures to be monitored pursuant to 23 subsection [13] 12 of this section. In promulgating such rules, the department shall[: 24 (1)] use methodologies and systems for data collection established by the federal 25 Centers for Disease Control and Prevention's National Healthcare Safety Network, or its 26 successor[; and 27 (2) Consider the findings and recommendations of the infection control advisory 28 panel established pursuant to section 197.165]. 29 4. [By January 1, 2017, the infection control advisory panel created by section 30 197.165 shall make recommendations to] The department [regarding] will continue to assess 31 the Centers for Medicare and Medicaid Services' health care-associated infection data 32 collection, analysis, and public reporting requirements for hospitals, ambulatory surgical 33 centers, and other facilities in the federal Centers for Disease Control and Prevention's 34 National Healthcare Safety Network, or its successor, in lieu of all or part of the data 35 collection, analysis, and public reporting requirements of this section. The [advisory panel 36 recommendations] department shall address which hospitals shall be required as a condition 37 of licensure to use the National Healthcare Safety Network for data collection; the use of the 38 National Healthcare Safety Network for risk adjustment and analysis of hospital submitted 39 data; and the use of the Centers for Medicare and Medicaid Services' Hospital Compare 40 website, or its successor, for public reporting of the incidence of health care-associated 41 infection metrics. [The advisory panel shall consider the following factors in developing its 42 recommendation: 43 (1) Whether the public is afforded the same or greater access to facility-specific 44 infection control indicators and metrics; 45 (2) Whether the data provided to the public is subject to the same or greater accuracy 46 of risk adjustment; 47 (3) Whether the public is provided with the same or greater specificity of reporting of 48 infections by type of facility infections and procedures; 49 (4) Whether the data is subject to the same or greater level of confidentiality of the 50 identity of an individual patient; 51 (5) Whether the National Healthcare Safety Network, or its successor, has the 52 capacity to receive, analyze, and report the required data for all facilities; 53 (6) Whether the cost to implement the National Healthcare Safety Network infection 54 data collection and reporting system is the same or less.] 55 5. [After considering the recommendations of the infection control advisory panel, 56 and provided that the requirements of subsection 13 of this section can be met,] The 57 department shall implement guidelines from the federal Centers for Disease Control and 58 Prevention's National Healthcare Safety Network, or its successor. It shall be a condition of HB 2670 5
59 licensure for hospitals that meet the minimum public reporting requirements of the National 60 Healthcare Safety Network and the Centers for Medicare and Medicaid Services to participate 61 in the National Healthcare Safety Network, or its successor. Such hospitals shall permit the 62 National Healthcare Safety Network, or its successor, to disclose facility-specific infection 63 data to the department as required under this section, and as necessary to provide the public 64 reports required by the department. It shall be a condition of licensure for any ambulatory 65 surgical center or abortion facility which does not voluntarily participate in the National 66 Healthcare Safety Network, or its successor, to submit facility-specific data to the department 67 as required under this section, and as necessary to provide the public reports required by the 68 department. 69 6. The department shall not require the resubmission of data which has been 70 submitted to the department of health and senior services or the department of social services 71 under any other provision of law. The department of health and senior services shall accept 72 data submitted by associations or related organizations on behalf of health care providers by 73 entering into binding agreements negotiated with such associations or related organizations to 74 obtain data required pursuant to section 192.665 and this section. A health care provider shall 75 submit the required information to the department of health and senior services: 76 (1) If the provider does not submit the required data through such associations or 77 related organizations; 78 (2) If no binding agreement has been reached within ninety days of August 28, 1992, 79 between the department of health and senior services and such associations or related 80 organizations; or 81 (3) If a binding agreement has expired for more than ninety days. 82 7. Information obtained by the department under the provisions of section 192.665 83 and this section shall not be public information. Reports and studies prepared by the 84 department based upon such information shall be public information and may identify 85 individual health care providers. The department of health and senior services may authorize 86 the use of the data by other research organizations pursuant to the provisions of section 87 192.067. The department shall not use or release any information provided under section 88 192.665 and this section which would enable any person to determine any health care 89 provider's negotiated discounts with specific preferred provider organizations or other 90 managed care organizations. The department shall not release data in a form which could be 91 used to identify a patient. Any violation of this subsection is a class A misdemeanor. 92 8. The department shall undertake a reasonable number of studies and publish 93 information, including at least an annual consumer guide, in collaboration with health care 94 providers, business coalitions and consumers based upon the information obtained pursuant to 95 the provisions of section 192.665 and this section. The department shall allow all health care HB 2670 6
96 providers and associations and related organizations who have submitted data which will be 97 used in any publication to review and comment on the publication prior to its publication or 98 release for general use. The publication shall be made available to the public for a reasonable 99 charge. 100 9. Any health care provider which continually and substantially, as these terms are 101 defined by rule, fails to comply with the provisions of this section shall not be allowed to 102 participate in any program administered by the state or to receive any moneys from the state. 103 10. A hospital, as defined in section 197.020, aggrieved by the department's 104 determination of ineligibility for state moneys pursuant to subsection 9 of this section may 105 appeal as provided in section 197.071. An ambulatory surgical center or abortion facility as 106 defined in section 197.200 aggrieved by the department's determination of ineligibility for 107 state moneys pursuant to subsection 9 of this section may appeal as provided in section 108 197.221. 109 11. The department of health may promulgate rules providing for collection of data 110 and publication of the incidence of health care-associated infections for other types of health 111 facilities determined to be sources of infections; except that, physicians' offices shall be 112 exempt from reporting and disclosure of such infections. 113 12. [By January 1, 2017, the advisory panel shall recommend and] The department 114 shall adopt in regulation [with an effective date of no later than January 1, 2018,] the 115 requirements for the reporting of the following types of infections as specified in this 116 subsection: 117 (1) Infections associated with a minimum of four surgical procedures for hospitals 118 and a minimum of two surgical procedures for ambulatory surgical centers that meet the 119 following criteria: 120 (a) Are usually associated with an elective surgical procedure. An "elective surgical 121 procedure" is a planned, nonemergency surgical procedure that may be either medically 122 required such as a hip replacement or optional such as breast augmentation; 123 (b) Demonstrate a high priority aspect such as affecting a large number of patients, 124 having a substantial impact for a smaller population, or being associated with substantial cost, 125 morbidity, or mortality; or 126 (c) Are infections for which reports are collected by the National Healthcare Safety 127 Network or its successor; 128 (2) Central line-related bloodstream infections; 129 (3) Health care-associated infections specified for reporting by hospitals, ambulatory 130 surgical centers, and other health care facilities by the rules of the Centers for Medicare and 131 Medicaid Services to the federal Centers for Disease Control and Prevention's National 132 Healthcare Safety Network, or its successor; and HB 2670 7
133 (4) Other categories of infections that may be established by rule by the department. 134 135 The department[, in consultation with the advisory panel,] shall be authorized to collect and 136 report data on subsets of each type of infection described in this subsection. 137 13. [In consultation with the infection control advisory panel established pursuant to 138 section 197.165,] The department shall develop and disseminate to the public reports based 139 on data compiled for a period of twelve months. Such reports shall be updated [quarterly] at 140 least annually and shall show for each hospital, ambulatory surgical center, abortion facility, 141 and other facility metrics on risk-adjusted health care-associated infections under this section. 142 14. The types of infections under subsection 12 of this section to be publicly reported 143 shall be determined by the department by rule and shall be consistent with the infections 144 tracked by the National Healthcare Safety Network, or its successor. 145 15. Reports published pursuant to subsection 13 of this section shall be published and 146 readily accessible on the department's internet website. The reports shall be distributed at 147 least annually to the governor and members of the general assembly. The department shall 148 make such reports available to the public for a period of at least two years. 149 16. [The Hospital Industry Data Institute shall publish a report of Missouri hospitals', 150 ambulatory surgical centers', and abortion facilities' compliance with standardized quality of 151 care measures established by the federal Centers for Medicare and Medicaid Services for 152 pre