PRIA, Government Policy, Made Personal

Summary

The Secretary must create rules so hospitals and other health providers paid under this law (for example, skilled nursing facilities, intermediate care facilities, home health agencies, and health maintenance organizations) report costs and service data in the same way. Each type of facility must report five kinds of information: total operating costs and service volume; costs and volume by function; patient rates by category and payer; capital assets and related costs; and discharge and billing data. Hospitals must use the accounting chart, definitions, and statistics the Secretary requires so their money and service numbers match for the required reports. The Secretary must watch how the systems work, help test and evaluate them, encourage States to use them, update them to work better and cost less, and give the collected information in a useful form to appropriate agencies and organizations (such as health systems and State health planning agencies).

Title 42, §1320a

The Public Health and Welfare, Source: USLM XML via OLRC

(a)Establishment; criteria for regulations; requirements for hospitals

For the purposes of reporting the cost of services provided by, of planning, and of measuring and comparing the efficiency of and effective use of services in, hospitals, skilled nursing facilities, intermediate care facilities, home health agencies, health maintenance organizations, and other types of health services facilities and organizations to which payment may be made under this chapter, the Secretary shall establish by regulation, for each such type of health services facility or organization, a uniform system for the reporting by a facility or organization of that type of the following information:

(1)The aggregate cost of operation and the aggregate volume of services.

(2)The costs and volume of services for various functional accounts and subaccounts.

(3)Rates, by category of patient and class of purchaser.

(4)Capital assets, as defined by the Secretary, including (as appropriate) capital funds, debt service, lease agreements used in lieu of capital funds, and the value of land, facilities, and equipment.

(5)Discharge and bill data.

The uniform reporting system for a type of health services facility or organization shall provide for appropriate variation in the application of the system to different classes of facilities or organizations within that type and shall be established, to the extent practicable, consistent with the cooperative system for producing comparable and uniform health information and statistics described in section 242k(e)(1) of this title. In reporting under such a system, hospitals shall employ such chart of accounts, definitions, principles, and statistics as the Secretary may prescribe in order to reach a uniform reconciliation of financial and statistical data for specified uniform reports to be provided to the Secretary.

(b)Monitoring, etc., of systems by Secretary

The Secretary shall—

(1)monitor the operation of the systems established under subsection (a);

(2)assist with and support demonstrations and evaluations of the effectiveness and cost of the operation of such systems and encourage State adoption of such systems; and

(3)periodically revise such systems to improve their effectiveness and diminish their cost.

(c)Availability of information to appropriate agencies and organizations

The Secretary shall provide information obtained through use of the uniform reporting systems described in subsection (a) in a useful manner and format to appropriate agencies and organizations, including health systems agencies (designated under section 300l–4 of this title) and State health planning and development agencies (designated under section 300m of this title), as may be necessary to carry out such agencies’ and organizations’ functions.

Notes & Related Subsidiaries

Editorial Notes

References in Text

section 300l–4 of this title, referred to in subsec. (c), was repealed effective Jan. 1, 1987, by Pub. L. 99–660, title VII, § 701(a), Nov. 14, 1986, 100 Stat. 3799. section 300m of this title, referred to in subsec. (c), was in the original a reference to section 1521 of act

July 1, 1944, which was repealed effective Jan. 1, 1987, by Pub. L. 99–660, title VII, § 701(a), Nov. 14, 1986, 100 Stat. 3799. Pub. L. 101–354, § 2, Aug. 10, 1990, 104 Stat. 410, enacted section 1503 of act

July 1, 1944, which is classified to section 300m of this title.

Prior Provisions

A prior section 1320a, act Aug. 14, 1935, ch. 531, title XI, § 1121, as added Jan. 2, 1968, Pub. L. 90–248, title II, § 250(a), 81 Stat. 920, provided for assistance in the form of institutional services in intermediate care facilities, the subsecs. providing as follows: subsec. (a), modification of certain plans to include such benefit; subsec. (b), eligible individuals; subsec. (c), payments and Federal medical assistance percentage; subsec. (d), conditions, limitations, rights, and obligations applicable to modified plans; and subsec. (e), definition of “intermediate care facility”, which is covered in section 1396d(c) of this title, prior to repeal by Pub. L. 92–223, § 4(c), Dec. 28, 1971, 85 Stat. 810. Section was additionally amended by Pub. L. 92–603, title II, § 278(a)(24), Oct. 30, 1972, 86 Stat. 1453, without reference to the earlier repeal of this section by Pub. L. 92–223.

Statutory Notes and Related Subsidiaries

Time Periods for Establishment of Uniform Reporting Systems; Consultations With Interested Parties Pub. L. 95–142, § 19(c)(1), Oct. 25, 1977, 91 Stat. 1205, directed Secretary of Health, Education, and Welfare to establish the systems described in subsec. (a) of this section only after consultation with interested parties and for hospitals, skilled nursing facilities, and intermediate care facilities, not later than the end of the one year period beginning on Oct. 25, 1977, and for other types of health services facilities and organizations, not later than the end of the two-year period beginning on Oct. 25, 1977.

§1320a Uniform Reporting Systems for Health Services Facilities and Organizations