Statement of Basis and Purpose and Specific Statutory Authority for Patient Medical Record
STATEMENT OF BASIS AND PURPOSE
AND SPECIFIC STATUTORY AUTHORITY FOR
Amendments to Standards for Hospitals and Health Facilities, 6 CCR 1011-1,
Chapter II, part 5.2.3.4 re: patient medical record reproduction fees
Adopted by the State Board of Health on
January 16, 2008
Basis and Purpose
This regulation is adopted pursuant to 25-1-801 C.R.S., which recognized the need for patient records in the custody of health facilities to be available for inspection to the patient or the patient’s designated personal representative, and for copies of those records to be made available to the patient or the patient’s designated personal representative upon payment of reasonable costs. The current rate shall not change for the purpose of the patient and or the patient’s personal representative as defined by HIPAA. The proposed regulation increases the fee for the first ten pages from $14.00 to $16.50 and increases the per-page fees for the first time in six years for all entities other than the discharged patient and/or their personal representative.
Such costs would include record retrieval, processing, copying, reassembling, and invoicing, as well as such labor-intensive items as review of the patient’s authorization for appropriateness and the application of state and federal privacy statutes, including HIPAA’s comprehensive privacy rule to each request.
Designated patient representatives, such as attorneys, may bear the cost of the initial request, but usually pass the charge along to their clients. State agencies, such as the Department of Disability Determination Services and the Board of Workers Compensation set their own independent rates for what may be charged for copies of medical records for their purpose.
Most Colorado hospitals use third-party record copying services to screen requests and subpoenas for medical records, and then fulfill the request and do the billing and collection for payment on those requests. This practice relieves the hospitals of the burden of having to hire and maintain staff to handle this work and has allowed companies that provide this service on an outsource basis to become experts in the confidential handling of medical records. State regulation makes the charge for copies consistent across the state.
In 2001, AHIOS petitioned the Board to increase the rates of patient records to $14.00 for the first ten or fewer pages, $0.50 per page for pages 11-40, and $0.33 per page for every additional page. In the past six years, this rate has not been increased or adjusted.
Below is the methodology for determining the proposed increase amount:
Methodology to develop the search retrieval fee rate:
Currently, 42 States charge a base rate. We omitted the highest and lowest rates, added the current rates and then divided to obtain a national average ($661.70/40= $16.54) which was rounded down to obtain a national average of $16.50. A list of current rates charged by other states can be found on pages 10 and 11 of this packet.
Methodology to obtain number of initial free pages:
No change is requested for the number of free pages.In reviewing the other 13 regulated states that include some number of free pages in the initial fee, it was decided to keep the number of free pages (10) the same. The current average is approximately 13 pages.
Methodology to obtain the price levels:
Below are the five states closest to Colorado in population and what they charge per-page for reproduction.
Arizona $1.00, $.75
Minnesota$1.15
COLORADO$.50, $.33
Alabama$1.00, $.50
Louisiana$1.00, $.50
South Carolina$.65, $.50
After reviewing these rates, the average for the five that had tiered rates was $.83 for the first tier and $.52 for the second. We decided to round down the first tier to $.75 and round down the second tier to $.50.
The rate for microfilm reproduction was not adjusted.
Specific Statutory Authority
These rules are promulgated pursuant to the following statutes: 25-1-801, CRS, 25-1-108(1)(c), CRS and 25-1.5-103(1)(a)(l), CRS.
Benefits to Consumers
By outsourcing the release-of-information function, hospitals help patients and others in need of medical records achieve timely, secure access, and help them obtain copies that are reasonably priced, while preventing a drain on the hospitals’ staffing and workload. Without a price increase reflecting the increased cost of providing such services, customers face the consequences of companies leaving the marketplace and returning the service to hospitals to perform in-house. The original need filled by the outsourcing industry will return, resulting in a slow turnaround time and higher costs to produce records because hospitals cannot perform this function. Additionally, if competitive pressures are reduced timeliness suffers and there is no market pressure to improve. Eventually most companies would withdraw from the Colorado market due to increased costs and inadequate returns to justify doing business, caused by artificial caps on fees that can be charged for the service.