BILL ANALYSIS                                                                                                                                                                                                    






                             SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:       AB 1382
          AUTHOR:        Assembly Committee on Health
          INTRODUCED:    February 27, 2013
          HEARING DATE:  June 5, 2013
          CONSULTANT:    Robinson-Taylor

           SUBJECT  :  Reporting.
           
          SUMMARY  :  Updates obsolete terminology in existing statute used  
          in the reporting of health data information by specified health  
          facilities to the Office of Statewide Health Planning and  
          Development (OSHPD) in order to be consistent with national  
          standards.  

          Existing law:
          1.Establishes OSHPD, and requires each organization that  
            operates, conducts, or maintains a health facility to make and  
            file with OSPHD certain specified reports, including a  
            Hospital Discharge Abstract Data Record that currently  
            includes 19 elements of data per admission.

          2.Requires hospitals, commencing January 1, 2004, to file with  
            OSHPD an Emergency Care Data Record and an Ambulatory Surgery  
            Data Record, each with 15 elements of data per patient.

          3.Required OSHPD, commencing July 2002 through July 2006, to  
            publish risk-adjusted outcome reports in accordance with a  
            schedule that required reports to be published on three  
            conditions or procedures each year for five years, for a total  
            of 15 reports by July 2006.  Required the procedures and  
            conditions to be reported to be equally divided among medical,  
            surgical, and obstetric conditions or procedures, and to be  
            selected by OSHPD in accordance with specified criteria.

          This bill:
          1.Updates obsolete terminology in existing statute used in the  
            reporting of health data information by specified health  
            facilities to the Office of Statewide Health Planning and  
            Development (OSHPD) in order to be consistent with national  
            standards.  

          2.Revises the following terms:  "principal language spoken" to  
            "preferred language spoken";  "(condition or external cause)  
                                                         Continued---



          AB 1382 | Page 2




            present at admission" to "(condition or external cause)  
            present on admission"; and, "external cause of injury" to  
            "external causes of morbidity."

           FISCAL EFFECT  :  None.

           PRIOR VOTES  :  
          Assembly Health:    18- 0
          Assembly Floor:     75- 0
           


          COMMENTS  :
          1.Author's statement.  In 1971, the Legislature passed the  
            Hospital Disclosure Act (Act).  The original Act created the  
            California Hospital Commission to collect hospital data.   
            Under the Act, hospitals were required to disclose detailed,  
            uniform data about hospital operations to the state.  Over the  
            years, additions have been made to the Act to require OSHPD to  
            collect additional data sets including patient-level encounter  
            data and discharge data from hospital emergency departments,  
            ambulatory surgery departments, and licensed freestanding  
            ambulatory surgery clinics.  This bill will replace obsolete  
            terms in existing statute with new national standards being  
            adopted by hospitals, many of which are already reflected in  
            OSHPD regulations.

          2.Background.  According to OSHPD, the terminology for three  
            health data elements currently reported to the department are  
            outdated according to national reporting standards.  OSHPD  
            maintains that aligning with national standards will  
            streamline patient-level data collection programs, make the  
            data collected more useful to data users, and reduce  
            regulatory burdens on data providers.  OSHPD maintains that  
            the Health and Safety Code should be amended to reflect the  
            following national data standards:

               a.     The data element, "Preferred language spoken" has  
                 been adopted and defined by the National Uniform Billing  
                 Committee, Accredited Standards Committee (ASC) X12, and  
                 Joint Commission;

               b.     In 1996, California adopted the data element for a  
                 condition or external cause of injury present "at"  
                 admission to describe whether a condition was present at  
                 admission to the hospital.  However, present "on"  




                                                            AB 1382 | Page  
          3


          

                 admission was later adopted as the national standard for  
                 reporting; and,
               
               c.     The national federal requirement to adopt the coding  
                 guidelines of the revised international disease  
                 classification system (also known as ICD-10), effective  
                 October 1, 2014, will replace "external cause of injury"  
                 with "external causes of morbidity". 
            
          3.Related legislation.  
               a.     AB 975 (Wieckowski and Bonta) revises California's  
                 non-profit community benefits requirements to include  
                 multispecialty clinics and narrows the activities that  
                 constitute community benefits, creates a definition of  
                 charity care, requires OSHPD to develop a standardized  
                 methodology for calculating community benefit, calculate  
                 the value of community benefit for submitting entities,  
                 and to issue civil penalties for noncompliance with  
                 filing requirements.  Provides a rebuttable presumption  
                 that hospitals are organized as for profit if operating  
                 revenue exceeds 10% of operating expenses during the  
                 immediate preceding fiscal year.

               b.     AB 1312 (Brown) authorizes the Department of Public  
                 Health to, without taking regulatory action, update the  
                 California Code of Regulations to standards of practice  
                 developed by recognized state or national associations by  
                 posting on its Internet Web site in accordance with  
                 specified notice, public comment, and hearing  
                 requirements.
               
               c.     SB 508 (Hernandez) requires OSHPD, with the support  
                 from the California Health and Human Services Agency, to  
                 use hospital inpatient discharge data to develop a health  
                 disparity report to assess the levels of measurable  
                 health disparities in the state.
               
          4.Prior legislation.  
               a.     AB 2381 (Mojonnier) Chapter 1326, Statutes of 1984,  
                 transferred the hospital data collection programs from  
                 the California Health Facilities Commission to OSHPD.

               b.     SB 680 (Figueroa) Chapter 898, Statutes of 2001,  
                 revised the schedule and expanded the number of reports  
                 OSHPD is required to publish on risk-adjusted outcomes,  




          AB 1382 | Page 4




                 added physician outcomes for those reports on surgical  
                 conditions or procedures, and permitted OSHPD to obtain  
                 all data elements reasonably necessary to complete the  
                 risk-adjusted outcome reports required.

          5.Support.  The American Federation of State, County and  
            Municipal Employees (AFSCME), AFL-CIO, writes in support that  
            by modernizing our health statute, this bill ensures that our  
            data collection terms match with current national data  
            collection standards.  AFSCME maintains that, as California  
            expands its pool of insured patients, it is critical to ensure  
            a smooth transition to compliance with the Affordable Care  
            Act.
          
           SUPPORT AND OPPOSITION  :
          Support:  American Federation of State, County and Municipal  
                    Employees, AFL-CIO

          Oppose:   None received.




                                      -- END --