Missouri § 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.

§ 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.

1.  Any entity subject to the provisions of sections 354.400 to 354.636 shall provide data regarding quality of care, access to care, member satisfaction and member health status to the director of the department of health and senior services.  Failure to provide such data shall be reported to the director of the department of commerce and insurance and shall be subject to the penalties provided in section 354.444.  Any entity subject to the provisions of sections 354.400 to 354.636 which continually or substantially fails to comply with the provisions of this section may be prohibited by the director of the department of commerce and insurance from participating in any health program administered by the state.  The department of health and senior services shall promulgate rules defining continual or substantial failure to comply with the provisions of this section.

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

(1)  Use as the data set the Health Plan Employer Data and Information Set (HEDIS) or an equivalent data set as determined by the department of health and senior services;

(2)  Consider published standards developed by nationally recognized accreditation organizations including, but not limited to, the National Committee for Quality Assurance and the Joint Committee on Accreditation of Health Care Organizations;

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

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

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

4.  The department may choose to perform studies and shall publish information, including at least an annual consumer guide, based upon the information obtained pursuant to the provisions of this section.  The department shall allow health care financing entities or health care providers who have submitted data which will be used in any report to review and comment on the report prior to its publication or release for public use.  With the permission of the entity or the health care provider, the department may include any comments of a health care financing entity or health care provider in the publication.  The reports shall be made available to the public.  The department may charge a reasonable fee to any entity in the business of delivering or financing health care for specialized reports or services requested by such entity.  The fees shall be credited to the public health services fund established in section 192.900.

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(L. 1997 H.B. 335)

---- end of effective  28 Aug 1997 ----

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