The purpose of this bulletin is to inform hospitals of newly adopted rules around patient demographic data required to be reported to the Department of Health (DOH) via the Comprehensive Hospital Abstract Reporting System (CHARS) under chapter 246-455 WAC. The new rules also establish a waiver for eligible hospitals. These rules are adopted pursuant to 2021 Engrossed Second Substitute House Bill 1272 (E2SHB 1272).
Please note, E2SHB 1272 included additional hospital reporting requirements that are not described in this bulletin. This rulemaking only concerns requirements for demographic data reporting and other changes to CHARS program administration.
For information on the other provisions of E2SHB 1272, please refer to WSHA’s Hospital Transparency and Reporting (2021 Session E2SHB 1272) Bulletin published on November 22, 2021.
The new demographic data reporting requirements apply to acute care hospitals licensed under chapter 70.41 RCW and behavioral health hospitals licensed under chapter 71.12 RCW.
Waiver and grant opportunities are only available to certain Critical Access Hospitals (CAHs), hospitals certified by the Centers for Medicare and Medicaid as a sole community hospital or hospitals that qualify as a Medicare dependent hospital.
- Review this bulletin, as well as the final rulemaking under WSR 22-13-187 and E2SHB 1272 to understand the new hospital reporting requirements. WSHA cannot offer legal advice to members and recommends hospitals engage legal, risk, compliance, and leadership as appropriate to evaluate compliance with the new law.
- Evaluate current hospital standards, policies and procedures relevant to data collection and reporting of patient demographics.
- Update your organization’s electronic health record to begin reporting required demographic information via CHARS by January 1, 2023.
- Read and refer to WSHA’s Hospital Collection and Reporting of Patient Demographic Data Implementation Toolkit (Email Abby Berube at AbigailB@wsha.org for a copy).
- Participate in WSHA’s upcoming member webinars on implementation of these rules occurring monthly from August-December of 2022.
E2SHB 1272 required DOH to adopt rules for detailed patient demographic reporting via CHARS by July 1, 2022 to give hospitals time to prepare to comply with the new rules by January 1, 2023. The final rules were adopted June 22, 2022 under WSR 22-13-187.
We acknowledge that compliance with these new rules will be administratively burdensome. WSHA advocated for substantial changes to E2SHB 1272 during the 2021 legislative session, and the version that passed was much more favorable to hospitals than originally proposed.
Similarly, WSHA worked closely with member hospitals to negotiate aspects of this rulemaking with DOH to mitigate the administrative burden placed on hospitals. Details of the major elements of this rulemaking, WSHA’s position, and the final disposition follow.
i. WAC 246-455-020 Reporting of data set information
WAC 246-455-020 provides for UB-04 data set elements of patients to be reported to DOH by hospitals.
New data elements include:
- Patient medical record number
- Patient address
- Sex assigned at birth (as opposed to “sex”)
- Admitting diagnosis code
- Patient’s ICD code (1-3) reason for visit
- Referring provider’s National Provider Identifier (NPI), as applicable
- Facility federal tax number
- Insured last name, first name, middle name, suffix
- Patient’s relationship to insured code
- Insured ID
Upon urging from WSHA, DOH removed a proposed requirement to report a patient’s full social security number, as well as the requirement to report provider identifier information such as name and county. Further, WSHA advocated for and was encouraged to see a change in the data element regarding patient’s “sex” to provide for “sex assigned at birth.”
ii. WAC 246-455-025 Reporting of Additional Patient Demographic Information
Beginning January 1, 2023, hospitals must report patient-identified race, ethnicity, gender identity, sexual orientation, preferred language and disability via CHARS according to detailed specifications. (Read the details in WSR 22-13-187.)
While reporting demographic information to DOH is mandatory for hospitals, patient participation is voluntary. Hospitals are required to notify patients that providing this information is voluntary per RCW 43.70.052(6)(a). Although not required, WSHA recommends hospitals consider including in the patient notification that the hospital is legally required to report the information to the Washington State Department of Health.
Hospitals must ask patients how they identify for race, ethnicity, gender identity, sexual orientation, preferred language, and disability. DOH recognizes there are some situations when a patient might not be able to answer the question (e.g., infants or incapacitated individuals), and the Department has offered to provide training and guidance materials to hospitals.
- Ethnicity: Hospitals must report each patient’s identified ethnicity as (a) Hispanic, Latino/a, Latinx, (b) Non-Hispanic, Latino/a, Latinx, (C) Decline to respond or (d) Unknown to patient. Note that this information cannot be reported as unknown to the hospital, only unknown to the patient.
- Race: Hospitals must report each patient’s identified race based on a list of 72 different race options, including “patient declined to respond” and “unknown to patient.” Note that this information cannot be reported as unknown to the hospital, only unknown to the patient.
Most hospitals are currently collecting seven broad race categories specified by the federal Office of Management and Budget. The current categories are American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Other Pacific Islander, White, Other and Unknown. Washington’s new regulations expand the current categories into more detailed identities. For example, the Alaska Native/American Indian race option is broken down into separate Alaska Native and American Indian options.
- Preferred Language: Hospitals must report each patient-identified preferred language, either written or spoken or both from a list of 50 language options, including “patient declined to respond” and “unknown.”
- Disability: Hospitals must report any disability that a patient has self-identified. The rules include 12 options for reporting patient experience regarding activities of daily living and 13 options for reporting self-identified disabilities or conditions.
- Gender Identity: Hospitals must report each patient’s identified gender identity from a list of 17 gender identity options. If a patient self-identifies as more than one gender, each gender must be reported. If the patient self-identifies as a gender not listed in the gender identity codes, hospitals should report the patient reported gender identity.
- Sexual Orientation: Hospitals must report each patient’s identified sexual orientation from a list of 10 different sexual orientation options. If a patient self-identifies as more than one sexual orientation, each sexual orientation must be reported. If the patient self-identifies a sexual orientation not listed in the sexual orientation codes, hospitals should report the patient reported sexual orientation.
WSHA appreciates DOH’s consideration of our comments on early proposed versions of the rules, including an overhaul of the section on disability per our comments. We were disappointed that DOH did not adopt our recommendations related to the gender identity reporting options.
iii. WAC 246-455-035 Waiver for Reporting the Additional Patient Demographic Information
Due to WSHA’s advocacy, the DOH was also required to develop a waiver process for critical access hospitals, sole community hospitals, and hospitals that qualify as a Medicare dependent hospital. WSHA advocated for this provision to allow small hospitals grappling with outdated electronic health record (EHR) systems additional time to come into compliance with the requirements of E2SHB 1272.
Eligible hospitals may apply for a waiver due to economic hardship, technological limitations that are not reasonably in the control of the hospital or other exceptional circumstances as attested to by the hospital. Hospitals that are granted a waiver shall be exempt from reporting the additional patient discharge information for a period of one calendar year, beginning on the calendar month following waiver approval. For example, if a hospital applies for the waiver in October 2022 and it is approved in November 2022, the hospital must begin to comply with the reporting rules by December 2023. Hospitals that need a waiver extension must apply before expiration of their current waiver. Hospitals seeking a waiver due to economic hardship or technological limitations that are not reasonably in control of the hospital are limited to two waiver extensions, for a total of three years.
WSHA successfully advocated for inclusion of a comprehensive definition of “economic hardship” for the purposes of waiver eligibility in the final rules.
The definition of an “economic hardship” includes:
- Hospitals with less than 30 operating days of cash as of December 31 based on audited financial statements;
- hospitals with a net loss or negative change in their assets for a consecutive 2 years based on audited financial statements;
- hospitals that have filed for bankruptcy in the previous year or submitted a waiver due to the filing of bankruptcy in the previous year;
- the opening of a new hospital after January 1, 2022;
- operating of a low-income hospital, defined as a hospital serving a minimum of 30 percent Medicaid patients; or
- the intent to discontinue operation of their hospital in the state prior to January 1, 2023.
“Technological limitation that is not reasonably in the control of the hospital” means the integration of electronic health records system changes, switching electronic health record system vendors or updating the hospital’s current electronic health record system to comply with the requirements of this section and is in progress but has not yet been completed.
“Other exceptional circumstance” means unforeseen circumstances that stress the hospital in such a way that compliance is not possible. Examples may include, but are not limited to, natural disasters, widespread health care emergencies, unforeseen barriers to integration or unforeseen events that results in a statewide emergency.
Grant vs. Waiver Opportunity
Although not addressed in the rulemaking, E2SHB also created a grant program for eligible hospitals. Grants are also available to critical access hospitals, sole community hospitals or Medicare dependent hospitals, unless the hospital is owned or operated by a system with two or more hospitals.
Due to the way the grant program is created in statute, eligible hospitals must choose to seek a waiver or a grant but not both. This is because the statute requires hospitals seeking a grant to comply with the new demographic reporting requirements “no later than July 1, 2023.” This is, essentially, a six month waiver with some grant funding. Eligible hospitals will need to decide whether it is more advantageous to apply for a grant or a waiver.
DOH recently sent a communication to eligible hospitals indicating the application form for both grants and waivers will be available on October 1, 2022 and will be due by October 15, 2022.
iv. WAC 246-455-050 Time Deadline for Submission of Data
For further clarification, WSHA negotiated the term “calendar days” to be added to the deadline for the submission of data, to provide that hospitals shall submit data to the department within 45 calendar days following the end of each calendar month.
v. WAC 246-455-070 Revisions to Submitted Data
The new rules also provide clarification related to the submission of revised data required to be corrected by the hospital. Such edits shall be returned to the department within 14 working days after the submission deadline as set forth in WAC 246-455-050 has passed.
Attend Implementation Webinars
WSHA will be hosting monthly webinars on implementation of these rules through the end of 2022. These webinars will provide information on compliance with the rules and best practices for collecting demographic data.
- August 17: Introduction to E2SHB 1272 and its implementing rules (Email Abby Berube AbigailB@wsha.org for materials)
- September 13: Best practices in collecting race, ethnicity, and language data (registration link)
- October 11: Best practices in collecting sexual orientation and gender identity data and the use of pronouns (registration link)
- November TBD: Disability data collection
- December TBD: Implementation and reporting
Update EMRs for Compliance
WSHA’s representatives have sent EMR specifications to your organizations. Each hospital or health system will need to reach out directly to your EMR vendor to make updates according to the specifications.
WSHA’s 2022 New Law Implementation Guide
Please visit WSHA’s new law implementation guide online. The Government Affairs team is hard at work preparing resources and information on the high priority bills that passed in 2022 to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
Background and References