DEFINITIONS

          44:66:01:01.  Definitions. Terms used in this article mean:

          (1)  "Case severity rating," the relative value reflecting average resource consumption by patients in a hospital for its APR DRGs over a particular period of time;

          (2)  "Charge," that amount a hospital would expect to charge for an inpatient diagnostic-related group;

          (3)  "Department," the South Dakota Department of Health;

          (4)  "All patient refined diagnosis-related group," "APR DRG," a classification assigned to an inpatient hospital service claim based on the patient's age and sex, the principal and secondary diagnoses, the procedures performed, and the discharge status;

          (5)  "CMS Uniform Bill-04," "UB-04," a standardized form from the Centers for Medicare and Medicaid Services used to electronically submit claims for health care received in an institutional setting to payers;

          (6)  "Hospital variation," any of several factors, including cross subsidization of governmental payers and uncompensated care, regional staffing costs, services specialization, and operational cost structures and capital expenses that comprise a hospital's charge structure;

          (7)  "Patient variation," any of several factors, including age, preexisting condition, comorbidity, reaction to medication or treatment, and time of recovery that influences treatment decisions and affects resource consumption; and

          (8)  "SDAHO," the South Dakota Association of Healthcare Organizations.

          Source: 32 SDR 69, effective November 7, 2005; 34 SDR 88, effective September 10, 2007; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.

          44:66:02:01.  Entities required to report. Each hospital licensed pursuant to SDCL chapter 34-12 shall report annually to SDAHO the charge information for the inpatient APR DRGs for which there are at least ten cases rendered by the hospital during the twelve months preceding the report. Any hospital that does not have charge information that can be grouped to APR DRGs is exempt from the reporting requirement.

          Source: 32 SDR 69, effective November 7, 2005; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.

          44:66:02:02.  Organization and structure. SDAHO is responsible for the collection, validation, analysis, and dissemination of data and information related to reporting required in § 44:66:02:03.

          Source: 32 SDR 69, effective November 7, 2005; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11(2).

          44:66:02:03.  Required patient data to be reported. Each hospital required to report pursuant to § 44:66:02:01 shall provide the following information from the UB-04 form:

          (1)  Record type;

          (2)  Hospital number;

          (3)  Patient control number;

          (4)  Date of birth;

          (5)  Sex;

          (6)  Admission date;

          (7)  Principal diagnosis;

          (8)  Admitting diagnosis;

          (9)  Principal procedure;

          (10)  Discharge date;

          (11)  Patient status; and

          (12)  Total charges.

          All other fields on the UB-04 form shall be submitted as entered on the form or submitted with filler data as specified by the SDAHO.

          Source: 32 SDR 69, effective November 7, 2005; 34 SDR 88, effective September 10, 2007; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11(1).

          44:66:02:03.01. Required financial data to be reported. Each hospital required to report pursuant to § 44:66:02:01 shall annually provide financial information including revenue by type, uncompensated care, and revenue by payor on a form provided by the department.

          Source: 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.

          44:66:02:04.  Timelines for reporting. Each hospital shall provide to SDAHO the patient data elements described in § 44:66:02:03 by the following dates:

          First Quarter (January-March)                                      July 1 of the same year

          Second Quarter (April-June)                                              October 1 of the same year

          Third Quarter (July-September)                                         January 1 of the following year

          Fourth Quarter (October-December)                                 April 1 of the following year

          Each hospital shall provide to SDAHO the financial data described in § 44:66:02:03.01 by May 1 of each year for the fiscal year corresponding to the annual reporting period of the patient data elements described in § 44:66:02:03.

          Source: 32 SDR 69, effective November 7, 2005; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.

          44:66:03:01.  Annual publication of data. SDAHO shall publish hospital charge information data based on a calendar year.

          Source: 32 SDR 69, effective November 7, 2005; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.1.

          44:66:03:02.  Data to be published. The data to be published in accordance with § 44:66:02:01 shall include the following:

          (1)  Volume of cases by APR DRG required to be reported by hospital;

          (2)  Case severity rating by hospital; and

          (3)  A general disclaimer statement regarding those hospital variations and patient variations that affect the actual charges to patients.

          Source: 32 SDR 69, effective November 7, 2005; 35 SDR 183, effective February 2, 2009.

          General Authority: SDCL 34-12E-11.

          Law Implemented: SDCL 34-12E-11.1.