Download RegulatoryAnalysisAttachment2007-01209

REGULATORY ANALYSIS
Proposed amendments to Standards for Hospitals and Health Facilities, 6 CCR 1011-1,
Chapter II, part 5.2.3.4
Adopted by the State Board of Health on
January 16, 2008
Classes of Persons Affected
The proposed regulation increases the fee for all entities other than the discharged patient
and/or their personal representative as defined by HIPAA.
Licensed health care facilities would be relieved of reasonable costs that they may now
incur to meet patient record requests for which they are not permitted to charge certain patients,
or whom they are required to undercharge.
Implementation and Enforcement Costs
Implementation of the new regulations requires its distribution to all licensed health care
facilities. At minimum, this requires a single mailing or emailing to all facilities, which may be
combined with other mailings.
Enforcement costs would not exceed current costs of monitoring compliance with the
present regulations, which is done primarily on a complaint basis. Enforcement costs could
increase if the Department has to take action against some facilities. Currently, a letter is sent to
those facilities that charge higher fees than regulations allow.
Effect of Inaction
Since the current fee understates the cost of record processing, taking no action would
further burden hospitals and physicians for which record requests are an increasing financial
drain.
Alternatives Considered
There are various approaches to this problem: no action, seeking legislative change, or
raising the fee cap and/or eliminating the ceiling if the provider charges all requestors equally.
The first alternative- no action- was rejected, as noted above, because the current fee cap is
inadequate to meet the statutory standard of reasonable costs. Seeking a legislative change this
year to the statute, to eliminate the need for regulation on reasonable costs, was not seen as a
feasible option.
Eliminating the ceiling would be least intrusive on hospitals, but it poses two problems.
First, since a health care provider has a monopoly on the patient’s record, it has no economic
incentive to set reasonable fees (or to shop for a copy service that sets low prices). One reason
that the statute was originally enacted in 1976 was to eliminate instances of unreasonably high
hospital record prices.
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Secondly, there is difficulty with eliminating the ceiling in that the Department is the
ultimate arbiter of hospital patient grievances as the final appeal body from the statutory patient
grievance process (25-1-121, C.R.S.). The Department already processes appeals through this
procedure, most of which involve the appropriateness of hospital bills. It can thus be assumed
that patient disputes over record fees would come to the Department for resolution and the
Department would need guidelines as to what fees are reasonable. Therefore, in order to resolve
these appeals, the Department would need some general standards for reasonable record fees. It
would have to adopt a policy on fee based upon reasonableness, which would in effect establish
a fee ceiling whenever patients appeal.
A formula for establishing fees was also considered, wherein hospitals could enter their
own charges into the formula. However, with each facility charging its own set of fees, it would
be virtually impossible to enforce a standard of reasonableness. Patients would not know when
they were being overcharged for records, and monitoring compliance with the statutory
requirements would be very difficult.
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ATTORNEY/INSURER RATE SUMMARY AS OF 11-1-07
(some are statutory and some are decided by the health care provider or its
copy service in the absence of regulation-the ones with odd numbers are the
result of CPI percentage increases)
STATE
BASE
PER-PAGE
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
DC
Florida
Georgia
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
$5
$17.50
$15
varies
$14 (pages 1-10)
--$22
$20.92
$1
$24.86
$20
$22.84
$20 (pages 1-10)
$20
$16.81
--$15
$15
$20.92
$16.39
$21.20
$15.05
$20 (pages 1-20)
$18.49
$15
$20
--$15 (p. 1-30)
$10
$20
$17 (pages 1-5)
$35 (pages 6-25)
--$20 (pages 1-25)
$16.38
$1.00 page 1
$25 (pages 1-10)
$18.54
$1.00, then $.50
$1.00, then $.75, then $.50
$.50, then $.25
$.35 (average)
$.50, then $.33
$.65
$1.10
$.69
$1, then $.25
93¢, then $.80, then $.63, plus cert fee
$1.10
$.86, then $.57, then $.29
$.50, then $.25
$1.10
$.56, then $.39
$1.00, second request only
$1.00 p. 1-25, then $.50
$.35
$.69
$.55
$1.06 p. 1-20, then $.53, then $.22
$1.15
$1.00 p. 21-100
$.44
75¢
$.50
$.60
$.50
$1.00, then $.25
$1.00
from hospitals
--from clinics
$1.00
from clinics
$.75
to “qualified persons”
$.75
$1.08, then $.55, then $.22
$.50
$.25
$1.25, then $.93, then $.31
New York
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
$15
$1.00
$15
$.65, then $.50
no fees established by law or regulation
$15 (pp. 1-5)
75¢ p. 6-50, then $.50
$40.06 (pp. 1-10)
$1.35, then $.67 from hospitals
$25 (pp. 1-20)
$.50 from clinics
$15.50
63¢
from hospitals
$17 (pp. 1-5)
--from clinics
$35 (pp. 6-25)
$1.00
from clinics
$5 (pp. 1-10)
$.50
$10
$.50
$22
$.96, then $.73
$10
$.75
$15
$.31
$18
$1.00
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The Steps Involved in Retrieving and Reproducing Medical Records
The processing of a medical record request, whether it involves a single page
or many pages, is an involved process. The processing of a request may involve
more than 30 different steps. To begin with, medical records may not be removed
from a medical facility. The original must be kept on-site and available to health
care providers at all times.
To summarize the process, the request must be appropriately logged and
validated as authorized by the patient or the patient’s legal guardian or
representative. The record must then be located and retrieved, which may involve
retrieving parts of the record from various locations, including data stored on a
computer, microfilm or from an offsite storage facility. It must be batched for
processing and matched with a particular request to make sure that it is accurate.
Each page must be reviewed for confidential or legally protected information. For
example, there are statues in many states that prohibit the release of records
containing any mention of HIV testing, AIDS or AIDs related conditions without
special consent. Federal law protects the confidentiality of alcohol or drug abuse
treatment records and contains a very detailed procedure for disclosure.
After records are reviewed, the pertinent information for copying must be
designated, the record disassembled, and copied by placing each page on the
machine’s glass. Automatic document feeders cannot be used. Thereafter, the
document must be collated with the request and the original records reassembled
and restored. Final review of the copies is made against a request to determine the
adequacy of the response, and then the copies are prepared for mailing or other
distribution. In addition, an invoice for services must be created, and the records
must be mailed or delivered to the requestor. This is not going to a copy machine
to make a copy. After the fact, customer service and support, accounting, and
billing and other “back office” functions must occur.
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