192.068. Quality of care, access, member satisfaction and status information provided to department--standards of measurement--rulemaking authority--data not to be made public--reports to be published - Missouri Statutes

Quality of care, access, member satisfaction and status informationprovided to department--standards of measurement--rulemakingauthority--data not to be made public--reports to be published.

192.068. 1. Any entity subject to the provisions of sections 354.400 to354.636, RSMo, shall provide data regarding quality of care, access to care,member satisfaction and member health status to the director of the departmentof health and senior services. Failure to provide such data shall be reportedto the director of the department of insurance, financial institutions andprofessional registration and shall be subject to the penalties provided insection 354.444, RSMo. Any entity subject to the provisions of sections354.400 to 354.636, RSMo, which continually or substantially fails to complywith the provisions of this section may be prohibited by the director of thedepartment of insurance, financial institutions and professional registrationfrom participating in any health program administered by the state. Thedepartment of health and senior services shall promulgate rules definingcontinual or substantial failure to comply with the provisions of thissection.

2. The department of health and senior services shall specify by rulethe types of data which shall be submitted and the methods of collection andsubmission. In defining data standards for the measurement of the quality ofcare, access to care, member satisfaction and member health status, thedirector of the department of health and senior services may:

(1) Use as the data set the Health Plan Employer Data and InformationSet (HEDIS) or an equivalent data set as determined by the department ofhealth and senior services;

(2) Consider published standards developed by nationally recognizedaccreditation organizations including, but not limited to, the NationalCommittee for Quality Assurance and the Joint Committee on Accreditation ofHealth Care Organizations;

(3) Consult with other state agencies and interested parties responsiblefor delivering, financing and purchasing health care in the state; and

(4) Use available department of health and senior services data andother agency data wherever appropriate.

3. Data or other information obtained by the department of health andsenior services pursuant to the provisions of this section shall not be publicinformation. Reports and studies prepared by the department based upon suchinformation shall be public information and may identify individual entitiesin the business of delivering or financing health care. The department ofhealth and senior services may authorize the use of the data for otherresearch pursuant to the provisions of section 192.067. The department shallnot release data in a form which could be used to identify a patient.

4. The department may choose to perform studies and shall publishinformation, including at least an annual consumer guide, based upon theinformation obtained pursuant to the provisions of this section. Thedepartment shall allow health care financing entities or health care providerswho have submitted data which will be used in any report to review and commenton the report prior to its publication or release for public use. With thepermission of the entity or the health care provider, the department mayinclude any comments of a health care financing entity or health care providerin the publication. The reports shall be made available to the public. Thedepartment may charge a reasonable fee to any entity in the business ofdelivering or financing health care for specialized reports or servicesrequested by such entity. The fees shall be credited to the public healthservices fund established in section 192.900.

(L. 1997 H.B. 335)