                                 CODE OF VIRGINIA

PROVIDERS TO SUBMIT DATA; CIVIL PENALTY (§ 32.1-276.5)

A. 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 &#xA7;
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 (&#xA7; 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. 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.
			The Commissioner shall also negotiate and contract with a nonprofit
organization authorized under &#xA7; 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&#8217;s
discretion, periodically review this information set for its effectiveness.

C. Every medical care facility as that term is defined in &#xA7; 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, &#8220;reviewable
service&#8221; 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.
			Every medical care facility for which a certificate of public need with
conditions imposed pursuant to &#xA7; 32.1-102.4 is issued shall report to the
Commissioner data on charity care, as that term is defined in &#xA7; 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&#8217;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. &#xA7;
1395 et seq. Notwithstanding the foregoing, every nursing home as defined in
&#xA7; 32.1-123 for which a certificate of public need with conditions imposed
pursuant to &#xA7; 32.1-102.4 is issued shall report data on utilization and
other data in accordance with regulations of the Board.
			A 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. Every continuing care retirement community established pursuant to Chapter 49
(&#xA7; 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. Every hospital that receives a disproportionate share hospital adjustment
pursuant to &#xA7; 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
&#xA7; 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. 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 &#xA7; 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 &#xA7; 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 &#xA7; 32.1-137.09.

G. The Board shall evaluate biennially the impact and effectiveness of such data
collection.

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.