{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-276.5.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-276.5.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-276.5.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-276.5.html"}],"law_id":84829,"edition_id":1,"section_id":84829,"structure_id":14841,"section_number":"32.1-276.5","catch_line":"Providers to submit data; civil penalty","history":"1996, c. 902; 2000, c. 897; 2006, c. 426; 2009, c. 175; 2013, c. 515; 2017, c. 791; 2018, c. 596; 2020, c. 1271; 2022, cc. 678, 679.","full_text":"A\n\nEvery health care provider shall submit data as required pursuant to regulations of the Board, consistent with the recommendations of the nonprofit organization in its strategic plans submitted and approved pursuant to § 32.1-276.4, and as required by this section. Such data shall include relevant data and information for any parent or subsidiary company of the health care provider that operates in the Commonwealth. Notwithstanding the provisions of Chapter 38 (§ 2.2-3800 et seq.) of Title 2.2, it shall be lawful to provide information in compliance with the provisions of this chapter.B\n\nIn addition, health maintenance organizations shall annually submit to the Commissioner, to make available to consumers who make health benefit enrollment decisions, audited data consistent with the latest version of the Health Employer Data and Information Set (HEDIS), as required by the National Committee for Quality Assurance, or any other quality of care or performance information set as approved by the Board. The Commissioner, at his discretion, may grant a waiver of the HEDIS or other approved quality of care or performance information set upon a determination by the Commissioner that the health maintenance organization has met Board-approved exemption criteria. The Board shall promulgate regulations to implement the provisions of this section.\n\t\t\tThe Commissioner shall also negotiate and contract with a nonprofit organization authorized under § 32.1-276.4 for compiling, storing, and making available to consumers the data submitted by health maintenance organizations pursuant to this section. The nonprofit organization shall assist the Board in developing a quality of care or performance information set for such health maintenance organizations and shall, at the Commissioner’s discretion, periodically review this information set for its effectiveness.C\n\nEvery medical care facility as that term is defined in § 32.1-3 that furnishes, conducts, operates, or offers any reviewable service shall report data on utilization of such service to the Commissioner, who shall contract with the nonprofit organization authorized under this chapter to collect and disseminate such data. For purposes of this section, “reviewable service” shall mean inpatient beds, operating rooms, nursing home services, cardiac catheterization, computed tomographic (CT) scanning, stereotactic radiosurgery, lithotripsy, magnetic resonance imaging (MRI), magnetic source imaging, medical rehabilitation, neonatal special care, obstetrical services, open heart surgery, positron emission tomographic (PET) scanning, psychiatric services, organ and tissue transplant services, radiation therapy, stereotactic radiotherapy, proton beam therapy, nuclear medicine imaging except for the purpose of nuclear cardiac imaging, and substance abuse treatment.\n\t\t\tEvery medical care facility for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4 is issued shall report to the Commissioner data on charity care, as that term is defined in § 32.1-102.1, provided to satisfy a condition of a certificate of public need, including (i) the total amount of such charity care the facility provided to indigent persons; (ii) the number of patients to whom such charity care was provided; (iii) the specific services delivered to patients that are reported as charity care recipients; and (iv) the portion of the total amount of such charity care provided that each service represents. The value of charity care reported shall be based on the medical care facility’s submission of applicable Diagnosis Related Group codes and Current Procedural Terminology codes aligned with methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. Notwithstanding the foregoing, every nursing home as defined in § 32.1-123 for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4 is issued shall report data on utilization and other data in accordance with regulations of the Board.\n\t\t\tA medical care facility that fails to report data required by this subsection shall be subject to a civil penalty of up to $100 per day per violation, which shall be collected by the Commissioner and paid into the Literary Fund.D\n\nEvery continuing care retirement community established pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 that includes nursing home beds shall report data on utilization of such nursing home beds to the Commissioner, who shall contract with the nonprofit organization authorized under this chapter to collect and disseminate such data.E\n\nEvery hospital that receives a disproportionate share hospital adjustment pursuant to § 1886(d)(5)(F) of the Social Security Act shall report, in accordance with regulations of the Board consistent with recommendations of the nonprofit organization in its strategic plan submitted and provided pursuant to § 32.1-276.4, the number of inpatient days attributed to patients eligible for Medicaid but not Medicare Part A and the total amount of the disproportionate share hospital adjustment received.F\n\nEvery hospital shall annually report, in accordance with regulations of the Board consistent with recommendations of the nonprofit organization in its strategic plan submitted and provided pursuant to § 32.1-276.4, data and information regarding (i) the amount of charity care, discounted care, or other financial assistance provided by the hospital under its financial assistance policy pursuant to § 32.1-137.09 and (ii) the amount of uncollected bad debt, including any uncollected bad debt from payment plans entered into in accordance with subsection C of § 32.1-137.09.G\n\nThe Board shall evaluate biennially the impact and effectiveness of such data collection.","order_by":null,"text":{"0":{"id":303937,"text":"Every health care provider shall submit data as required pursuant to regulations of the Board, consistent with the recommendations of the nonprofit organization in its strategic plans submitted and approved pursuant to § 32.1-276.4, and as required by this section. Such data shall include relevant data and information for any parent or subsidiary company of the health care provider that operates in the Commonwealth. Notwithstanding the provisions of Chapter 38 (§ 2.2-3800 et seq.) of Title 2.2, it shall be lawful to provide information in compliance with the provisions of this chapter.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":303938,"text":"In addition, health maintenance organizations shall annually submit to the Commissioner, to make available to consumers who make health benefit enrollment decisions, audited data consistent with the latest version of the Health Employer Data and Information Set (HEDIS), as required by the National Committee for Quality Assurance, or any other quality of care or performance information set as approved by the Board. The Commissioner, at his discretion, may grant a waiver of the HEDIS or other approved quality of care or performance information set upon a determination by the Commissioner that the health maintenance organization has met Board-approved exemption criteria. The Board shall promulgate regulations to implement the provisions of this section.\n\t\t\tThe Commissioner shall also negotiate and contract with a nonprofit organization authorized under § 32.1-276.4 for compiling, storing, and making available to consumers the data submitted by health maintenance organizations pursuant to this section. The nonprofit organization shall assist the Board in developing a quality of care or performance information set for such health maintenance organizations and shall, at the Commissioner’s discretion, periodically review this information set for its effectiveness.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":303939,"text":"Every medical care facility as that term is defined in § 32.1-3 that furnishes, conducts, operates, or offers any reviewable service shall report data on utilization of such service to the Commissioner, who shall contract with the nonprofit organization authorized under this chapter to collect and disseminate such data. For purposes of this section, “reviewable service” shall mean inpatient beds, operating rooms, nursing home services, cardiac catheterization, computed tomographic (CT) scanning, stereotactic radiosurgery, lithotripsy, magnetic resonance imaging (MRI), magnetic source imaging, medical rehabilitation, neonatal special care, obstetrical services, open heart surgery, positron emission tomographic (PET) scanning, psychiatric services, organ and tissue transplant services, radiation therapy, stereotactic radiotherapy, proton beam therapy, nuclear medicine imaging except for the purpose of nuclear cardiac imaging, and substance abuse treatment.\n\t\t\tEvery medical care facility for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4 is issued shall report to the Commissioner data on charity care, as that term is defined in § 32.1-102.1, provided to satisfy a condition of a certificate of public need, including (i) the total amount of such charity care the facility provided to indigent persons; (ii) the number of patients to whom such charity care was provided; (iii) the specific services delivered to patients that are reported as charity care recipients; and (iv) the portion of the total amount of such charity care provided that each service represents. The value of charity care reported shall be based on the medical care facility’s submission of applicable Diagnosis Related Group codes and Current Procedural Terminology codes aligned with methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. Notwithstanding the foregoing, every nursing home as defined in § 32.1-123 for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4 is issued shall report data on utilization and other data in accordance with regulations of the Board.\n\t\t\tA medical care facility that fails to report data required by this subsection shall be subject to a civil penalty of up to $100 per day per violation, which shall be collected by the Commissioner and paid into the Literary Fund.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":303940,"text":"Every continuing care retirement community established pursuant to Chapter 49 (§ 38.2-4900 et seq.) of Title 38.2 that includes nursing home beds shall report data on utilization of such nursing home beds to the Commissioner, who shall contract with the nonprofit organization authorized under this chapter to collect and disseminate such data.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"4":{"id":303941,"text":"Every hospital that receives a disproportionate share hospital adjustment pursuant to § 1886(d)(5)(F) of the Social Security Act shall report, in accordance with regulations of the Board consistent with recommendations of the nonprofit organization in its strategic plan submitted and provided pursuant to § 32.1-276.4, the number of inpatient days attributed to patients eligible for Medicaid but not Medicare Part A and the total amount of the disproportionate share hospital adjustment received.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"F"},"5":{"id":303942,"text":"Every hospital shall annually report, in accordance with regulations of the Board consistent with recommendations of the nonprofit organization in its strategic plan submitted and provided pursuant to § 32.1-276.4, data and information regarding (i) the amount of charity care, discounted care, or other financial assistance provided by the hospital under its financial assistance policy pursuant to § 32.1-137.09 and (ii) the amount of uncollected bad debt, including any uncollected bad debt from payment plans entered into in accordance with subsection C of § 32.1-137.09.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E","next_prefix":"G"},"6":{"id":303943,"text":"The Board shall evaluate biennially the impact and effectiveness of such data collection.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F"}},"ancestry":[{"id":14841,"edition_id":1,"name":"Health Care Data Reporting","identifier":"7.2","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:50:19","date_modified":"2026-06-26 03:50:19","permalink":{"id":204329,"object_type":"structure","relational_id":14841,"identifier":"7.2","token":"32.1\/7.2","url":"\/32.1\/7.2\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":79337,"structure_id":14841,"section_number":"32.1-276.10","catch_line":"Chapter and actions thereunder not to be construed as approval of charges or costs","url":"\/32.1-276.10\/","token":"32.1\/7.2\/32.1-276.10","metadata":false},{"id":68729,"structure_id":14841,"section_number":"32.1-276.11","catch_line":"Violations","url":"\/32.1-276.11\/","token":"32.1\/7.2\/32.1-276.11","metadata":false},{"id":71744,"structure_id":14841,"section_number":"32.1-276.2","catch_line":"Health care data reporting; purpose","url":"\/32.1-276.2\/","token":"32.1\/7.2\/32.1-276.2","metadata":false},{"id":67276,"structure_id":14841,"section_number":"32.1-276.3","catch_line":"Definitions","url":"\/32.1-276.3\/","token":"32.1\/7.2\/32.1-276.3","metadata":false},{"id":56739,"structure_id":14841,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","url":"\/32.1-276.4\/","token":"32.1\/7.2\/32.1-276.4","metadata":false},{"id":84829,"structure_id":14841,"section_number":"32.1-276.5","catch_line":"Providers to submit data; civil penalty","url":"\/32.1-276.5\/","token":"32.1\/7.2\/32.1-276.5","metadata":false},{"id":62565,"structure_id":14841,"section_number":"32.1-276.5:1","catch_line":"Repealed","url":"\/32.1-276.5_1\/","token":"32.1\/7.2\/32.1-276.5_1","metadata":false},{"id":77566,"structure_id":14841,"section_number":"32.1-276.6","catch_line":"Patient level data system continued; reporting requirements","url":"\/32.1-276.6\/","token":"32.1\/7.2\/32.1-276.6","metadata":false},{"id":67668,"structure_id":14841,"section_number":"32.1-276.7","catch_line":"Methodology to review and measure the efficiency and productivity of health care providers","url":"\/32.1-276.7\/","token":"32.1\/7.2\/32.1-276.7","metadata":false},{"id":85887,"structure_id":14841,"section_number":"32.1-276.7:1","catch_line":"All-Payer Claims Database created; purpose; reporting requirements","url":"\/32.1-276.7_1\/","token":"32.1\/7.2\/32.1-276.7_1","metadata":false},{"id":73124,"structure_id":14841,"section_number":"32.1-276.8","catch_line":"Fees for processing, verification, and dissemination of data","url":"\/32.1-276.8\/","token":"32.1\/7.2\/32.1-276.8","metadata":false},{"id":80143,"structure_id":14841,"section_number":"32.1-276.9","catch_line":"Confidentiality, subsequent release of data and relief from liability for reporting; penalty for wrongful disclosure; individual action for damages","url":"\/32.1-276.9\/","token":"32.1\/7.2\/32.1-276.9","metadata":false},{"id":81074,"structure_id":14841,"section_number":"32.1-276.9:1","catch_line":"Health information needs related to reform; work group","url":"\/32.1-276.9_1\/","token":"32.1\/7.2\/32.1-276.9_1","metadata":false}],"previous_section":{"id":56739,"structure_id":14841,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","url":"\/32.1-276.4\/","token":"32.1\/7.2\/32.1-276.4","metadata":false},"next_section":{"id":62565,"structure_id":14841,"section_number":"32.1-276.5:1","catch_line":"Repealed","url":"\/32.1-276.5_1\/","token":"32.1\/7.2\/32.1-276.5_1","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-276.5\/","history_text":"

This law was first created in 1996. The record of its establishment is cataloged in chapter 902<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 8 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 2000, chapter 897<\/a>; in 2006, chapter 426<\/a>; in 2009, chapter 175<\/a>; in 2013, chapter 515<\/a>; in 2017, chapter 791<\/a>; in 2018, chapter 596<\/a>; in 2020, chapter 1271<\/a>; in 2022, chapters 678<\/a> and 679<\/a>.<\/p>","references":[{"id":58930,"section_number":"32.1-127.1:03","catch_line":"Health records privacy","order_by":null,"url":"\/32.1-127.1_03\/"},{"id":67922,"section_number":"32.1-23.5","catch_line":"Reporting of certain data regarding financial assistance","order_by":null,"url":"\/32.1-23.5\/"},{"id":56739,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","order_by":null,"url":"\/32.1-276.4\/"}],"refers_to":[{"id":69409,"section_number":"2.2-3800","catch_line":"Short title; findings; principles of information practice","order_by":null,"url":"\/2.2-3800\/"},{"id":77111,"section_number":"32.1-102.1","catch_line":"Definitions","order_by":null,"url":"\/32.1-102.1\/"},{"id":84648,"section_number":"32.1-102.4","catch_line":"Conditions of certificates; monitoring; revocation of certificates; civil penalties","order_by":null,"url":"\/32.1-102.4\/"},{"id":80727,"section_number":"32.1-123","catch_line":"(Effective January 1, 2026) Definitions","order_by":null,"url":"\/32.1-123\/"},{"id":80169,"section_number":"32.1-137.09","catch_line":"Hospital emergency department CPT code data reporting","order_by":null,"url":"\/32.1-137.09\/"},{"id":56739,"section_number":"32.1-276.4","catch_line":"Agreements for certain data services","order_by":null,"url":"\/32.1-276.4\/"},{"id":77454,"section_number":"32.1-3","catch_line":"Definitions","order_by":null,"url":"\/32.1-3\/"},{"id":83470,"section_number":"38.2-4900","catch_line":"Definitions","order_by":null,"url":"\/38.2-4900\/"}],"permalink":{"id":204351,"object_type":"law","relational_id":84829,"identifier":"32.1-276.5","token":"32.1\/7.2\/32.1-276.5","url":"\/32.1-276.5\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-276.5\/","token":"32.1\/7.2\/32.1-276.5","dublin_core":{"Title":"Providers to submit data; civil penalty","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-276.5","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Every health care provider<\/span> shall submit data as required pursuant to regulations of the Board<\/span>, consistent with the recommendations of the nonprofit organization<\/span> in its strategic plans submitted and approved pursuant to § 32.1-276.4<\/a>, and as required by this section. Such data shall include relevant data and information for any parent or subsidiary company of the health care provider<\/span> that operates in the Commonwealth. Notwithstanding the provisions of Chapter 38 (§ 2.2-3800<\/a> et seq.) of Title 2.2, it shall be lawful to provide information in compliance with the provisions of this chapter. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> In addition, health maintenance organizations<\/span> shall annually submit to the Commissioner<\/span>, to make available to consumers<\/span> who make health benefit enrollment decisions, audited data consistent with the latest version of the Health Employer Data and Information Set (HEDIS), as required by the National Committee for Quality Assurance, or any other quality of care or performance information set as approved by the Board<\/span>. The Commissioner<\/span>, at his discretion, may grant a waiver<\/span> of the HEDIS or other approved quality of care or performance information set upon a determination by the Commissioner<\/span> that the health maintenance organization<\/span> has met Board<\/span>-approved exemption criteria. The Board<\/span> shall promulgate regulations to implement the provisions of this section.\n\t\t\tThe Commissioner<\/span> shall also negotiate and contract<\/span> with a nonprofit organization<\/span> authorized under § 32.1-276.4<\/a> for compiling, storing, and making available to consumers<\/span> the data submitted by health maintenance organizations<\/span> pursuant to this section. The nonprofit organization<\/span> shall assist the Board<\/span> in developing a quality of care or performance information set for such health maintenance organizations<\/span> and shall, at the Commissioner<\/span>’s discretion, periodically review this information set for its effectiveness. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> Every medical care facility<\/span> as that term is defined in § 32.1-3<\/a> that furnishes, conducts, operates, or offers any reviewable service<\/span> shall report data on utilization of such service to the Commissioner<\/span>, who shall contract<\/span> with the nonprofit organization<\/span> authorized under this chapter to collect and disseminate such data. For purposes of this section, “reviewable service<\/span>” shall mean inpatient beds, operating rooms, nursing home services, cardiac catheterization, computed tomographic (CT) scanning, stereotactic radiosurgery, lithotripsy, magnetic resonance imaging (MRI), magnetic source imaging, medical rehabilitation, neonatal special care, obstetrical services, open heart surgery, positron emission tomographic (PET) scanning, psychiatric services, organ and tissue transplant services, radiation therapy, stereotactic radiotherapy, proton beam therapy, nuclear medicine imaging except for the purpose of nuclear cardiac imaging, and substance abuse treatment<\/span>.\n\t\t\tEvery medical care facility<\/span> for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4<\/a> is issued shall report to the Commissioner<\/span> data on charity care, as that term is defined in § 32.1-102.1<\/a>, provided to satisfy a condition of a certificate of public need, including (i) the total amount of such charity care the facility provided to indigent<\/span> persons<\/span>; (ii) the number of patients to whom such charity care was provided; (iii) the specific services delivered to patients that are reported as charity care recipients; and (iv) the portion of the total amount of such charity care provided that each service represents. The value of charity care reported shall be based on the medical care facility<\/span>’s submission of applicable Diagnosis Related Group codes and Current Procedural Terminology codes aligned with methodology utilized by the Centers for Medicare and Medicaid Services for reimbursement under Title XVIII of the Social Security Act, 42 U.S.C. § 1395 et seq. Notwithstanding the foregoing, every nursing home as defined in § 32.1-123<\/a> for which a certificate of public need with conditions imposed pursuant to § 32.1-102.4<\/a> is issued shall report data on utilization and other data in accordance with regulations of the Board<\/span>.\n\t\t\tA medical care facility<\/span> that fails to report data required by this subsection shall be subject to a civil penalty<\/span> of up to $100 per day per violation, which shall be collected by the Commissioner<\/span> and paid into the Literary Fund. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Every continuing care retirement community established pursuant to Chapter 49 (§ 38.2-4900<\/a> et seq.) of Title 38.2 that includes nursing home beds shall report data on utilization of such nursing home beds to the Commissioner<\/span>, who shall contract<\/span> with the nonprofit organization<\/span> authorized under this chapter to collect and disseminate such data. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Every hospital that receives a disproportionate share hospital adjustment pursuant to § 1886(d)(5)(F) of the Social Security Act shall report, in accordance with regulations of the Board<\/span> consistent with recommendations of the nonprofit organization<\/span> in its strategic plan submitted and provided pursuant to § 32.1-276.4<\/a>, the number of inpatient days attributed to patients eligible for Medicaid but not Medicare Part A and the total amount of the disproportionate share hospital adjustment received. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> Every hospital shall annually report, in accordance with regulations of the Board<\/span> consistent with recommendations of the nonprofit organization<\/span> in its strategic plan submitted and provided pursuant to § 32.1-276.4<\/a>, data and information regarding (i) the amount of charity care, discounted care, or other financial assistance provided by the hospital under its financial assistance policy pursuant to § 32.1-137.09<\/a> and (ii) the amount of uncollected bad debt, including any uncollected bad debt from payment plans entered into in accordance with subsection C of § 32.1-137.09<\/a>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> The Board<\/span> shall evaluate biennially the impact and effectiveness of such data collection. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nPROVIDERS TO SUBMIT DATA; CIVIL PENALTY (\u00a7 32.1-276.5)\n\nA. Every health care provider shall submit data as required pursuant to\nregulations of the Board, consistent with the recommendations of the nonprofit\norganization in its strategic plans submitted and approved pursuant to §\n32.1-276.4, and as required by this section. Such data shall include relevant\ndata and information for any parent or subsidiary company of the health care\nprovider that operates in the Commonwealth. Notwithstanding the provisions of\nChapter 38 (§ 2.2-3800 et seq.) of Title 2.2, it shall be lawful to provide\ninformation in compliance with the provisions of this chapter.\n\nB. In addition, health maintenance organizations shall annually submit to the\nCommissioner, to make available to consumers who make health benefit enrollment\ndecisions, audited data consistent with the latest version of the Health\nEmployer Data and Information Set (HEDIS), as required by the National Committee\nfor Quality Assurance, or any other quality of care or performance information\nset as approved by the Board. The Commissioner, at his discretion, may grant a\nwaiver of the HEDIS or other approved quality of care or performance information\nset upon a determination by the Commissioner that the health maintenance\norganization has met Board-approved exemption criteria. The Board shall\npromulgate regulations to implement the provisions of this section.\n\t\t\tThe Commissioner shall also negotiate and contract with a nonprofit\norganization authorized under § 32.1-276.4 for compiling, storing, and\nmaking available to consumers the data submitted by health maintenance\norganizations pursuant to this section. The nonprofit organization shall assist\nthe Board in developing a quality of care or performance information set for\nsuch health maintenance organizations and shall, at the Commissioner’s\ndiscretion, periodically review this information set for its effectiveness.\n\nC. Every medical care facility as that term is defined in § 32.1-3 that\nfurnishes, conducts, operates, or offers any reviewable service shall report\ndata on utilization of such service to the Commissioner, who shall contract with\nthe nonprofit organization authorized under this chapter to collect and\ndisseminate such data. For purposes of this section, “reviewable\nservice” shall mean inpatient beds, operating rooms, nursing home\nservices, cardiac catheterization, computed tomographic (CT) scanning,\nstereotactic radiosurgery, lithotripsy, magnetic resonance imaging (MRI),\nmagnetic source imaging, medical rehabilitation, neonatal special care,\nobstetrical services, open heart surgery, positron emission tomographic (PET)\nscanning, psychiatric services, organ and tissue transplant services, radiation\ntherapy, stereotactic radiotherapy, proton beam therapy, nuclear medicine\nimaging except for the purpose of nuclear cardiac imaging, and substance abuse\ntreatment.\n\t\t\tEvery medical care facility for which a certificate of public need with\nconditions imposed pursuant to § 32.1-102.4 is issued shall report to the\nCommissioner data on charity care, as that term is defined in § 32.1-102.1,\nprovided to satisfy a condition of a certificate of public need, including (i)\nthe total amount of such charity care the facility provided to indigent persons;\n(ii) the number of patients to whom such charity care was provided; (iii) the\nspecific services delivered to patients that are reported as charity care\nrecipients; and (iv) the portion of the total amount of such charity care\nprovided that each service represents. The value of charity care reported shall\nbe based on the medical care facility’s submission of applicable Diagnosis\nRelated Group codes and Current Procedural Terminology codes aligned with\nmethodology utilized by the Centers for Medicare and Medicaid Services for\nreimbursement under Title XVIII of the Social Security Act, 42 U.S.C. §\n1395 et seq. Notwithstanding the foregoing, every nursing home as defined in\n§ 32.1-123 for which a certificate of public need with conditions imposed\npursuant to § 32.1-102.4 is issued shall report data on utilization and\nother data in accordance with regulations of the Board.\n\t\t\tA medical care facility that fails to report data required by this subsection\nshall be subject to a civil penalty of up to $100 per day per violation, which\nshall be collected by the Commissioner and paid into the Literary Fund.\n\nD. Every continuing care retirement community established pursuant to Chapter 49\n(§ 38.2-4900 et seq.) of Title 38.2 that includes nursing home beds shall\nreport data on utilization of such nursing home beds to the Commissioner, who\nshall contract with the nonprofit organization authorized under this chapter to\ncollect and disseminate such data.\n\nE. Every hospital that receives a disproportionate share hospital adjustment\npursuant to § 1886(d)(5)(F) of the Social Security Act shall report, in\naccordance with regulations of the Board consistent with recommendations of the\nnonprofit organization in its strategic plan submitted and provided pursuant to\n§ 32.1-276.4, the number of inpatient days attributed to patients eligible\nfor Medicaid but not Medicare Part A and the total amount of the\ndisproportionate share hospital adjustment received.\n\nF. Every hospital shall annually report, in accordance with regulations of the\nBoard consistent with recommendations of the nonprofit organization in its\nstrategic plan submitted and provided pursuant to § 32.1-276.4, data and\ninformation regarding (i) the amount of charity care, discounted care, or other\nfinancial assistance provided by the hospital under its financial assistance\npolicy pursuant to § 32.1-137.09 and (ii) the amount of uncollected bad\ndebt, including any uncollected bad debt from payment plans entered into in\naccordance with subsection C of § 32.1-137.09.\n\nG. The Board shall evaluate biennially the impact and effectiveness of such data\ncollection.\n\nHISTORY: 1996, c. 902; 2000, c. 897; 2006, c. 426; 2009, c. 175; 2013, c. 515;\n2017, c. 791; 2018, c. 596; 2020, c. 1271; 2022, cc. 678, 679.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}