| (a) All hospitals in operation for all or any of the
reporting periods described in §421.3 of this title (relating
to Schedule for Filing Discharge Reports) shall submit discharge claims
as specified in §421.9 of this title (relating to Discharge Reports--Records,
Data Fields and Codes) on all discharged inpatients to DSHS. To the
extent the admission, treatment, or discharge is made by a health
professional, other than a physician, data elements specified in §421.9(d)(36)
- (41) of this title shall be filled accordingly or data elements
(38) or (41) shall be marked with one of DSHS approved temporary "Physician"
or "Other health professional" code numbers and data elements (36)(A)
- (C) or (39)(A) - (C) may be left blank. Hospitals owned by the federal
government and hospitals exempted may submit hospital discharge claim.
(b) All inpatient discharges shall be reported. Except
as noted in paragraphs (1) - (4) of this subsection, one or more discharge
claims shall be submitted for each patient for each discharge covering
all services and charges from admission through discharge.
(1) Separate discharge claims shall be submitted for
mothers and newborns.
(2) Hospitals shall either submit separate discharge
claims corresponding to each interim, revised, or final discharge
claims or submit a single consolidated final discharge claim for each
discharged patient.
(3) For all patients for which the hospital prepares
one or more bills for inpatient services, the hospital shall submit
a discharge claim corresponding to each bill containing the data elements
required by §421.9 of this title. For all patients for which
the hospital does not prepare a bill for inpatient services, the hospital
shall submit a discharge claim containing the required minimum data
set.
(4) For all patients that are covered by 42 USC §290dd-2
and 42 CFR Part 2.1, a hospital shall submit a discharge claim containing
the required data elements specified by §421.9 of this title.
The hospital shall replace the patient identifying information with
the default values specified in §421.9(f) of this title or submit
the patient identifying information if release of patient identifying
information is authorized in writing by the patient or patient's guardian.
(c) All hospitals shall file discharge reports by electronic
filing unless the hospital receives an exemption letter from DSHS.
(d) All hospitals shall submit discharge claims and
discharge reports in the format specified in §421.9 of this title.
(e) Hospitals shall submit discharge reports, data
certifications, exemption requests and other required information
to DSHS or its contractors at physical or telephonic addresses specified
by DSHS. DSHS shall notify all hospitals and submitters in writing
and by publication in the Texas Register at
least 30 calendar days before any change in the addresses.
(f) Hospitals may submit discharge reports, or may
designate an agent to submit the reports. If a hospital designates
an agent, it shall inform DSHS of the designation in writing at least
30 calendar days prior to the agent's submission of any discharge
report. The hospital shall inform DSHS in writing at least 30 calendar
days prior to changing agents or making the submissions itself. Designation
of an agent does not relieve the hospital of responsibility for compliance
with this chapter or other related law.
(g) If requested by DSHS, a hospital shall provide
DSHS access to, copies of and/or information from the hospital documents
and records underlying and documenting the discharge reports submitted,
as well as other patient related documentation deemed necessary to
audit hospital data to verify its accuracy and reliability. Each request
from DSHS shall detail the reasons for such request, provide the hospital
with at least 14 calendar days advance notice, and ensure that confidentiality
of patient records is maintained.
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| Source Note: The provisions of this §421.2 adopted to be effective August 19, 1997, 22 TexReg 7490; amended to be effective December 29, 1997, 22 TexReg 12494; amended to be effective July 26, 1998, 23 TexReg 7365; amended to be effective February 21, 1999, 24 TexReg 948; amended to be effective July 29, 2001, 26 TexReg 5408; amended to be effective July 6, 2003, 28 TexReg 4915; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective December 27, 2007, 32 TexReg 9683; amended to be effective December 18, 2014, 39 TexReg 7582; amended to beeffective January 30, 2019, 44 TexReg 429 |
