Dental Reporting and the State HIX Advisory Opinion to Senate Health Committee

Health information exchanges are being created by states around the country, using a number of models. Among various structures, the directed exchange model can be used for sending immunization data to public health organizations, as well as to report quality measures to the Center for Medicare and Medicaid Services (CMS). A legislator in your State, Senator Grace Wood, has introduced a bill based on her reaction to the August 4, 2013 New York Times article, "In Nursing Homes an Epidemic of Poor Dental Hygiene". Dental coverage is hardly a matter of routine for long term care residents but your State does offer limited coverage through Medicaid.

Senator Wood‘s Bill (S21) requires all licensed long term care facilities in the State, submit quarterly reports to the State Health Information Exchange (HIX) on the dental health (based on a routine dental examination and treatment documentation) of each resident in their respective facility. The dental information reported to the HIX will be accessed by the State Department of Health and used by State Surveyors in their annual inspection and review of long term care facilities. Violations, based on inadequate dental care, will lead to sanctions and more extensive reporting mandates. In addition, based on data drawn from the quarterly dental reports, the State Department of Health will be required under S21 to develop a numerical quality assessment score on the status of dental health in a particular facility ranging from a 4 (excellent care) to a 1 (poor care).

The State Long Term Care Facility Association (LTCFA) testified in opposition to S21. Beyond cost concerns, LTCFA is arguing that information on individual patient dental hygiene cannot be provided to the HIX without patient or guardian consent as doing so violates HIPAA (S21 has no consent requirements). In addition, LTCFA argues that the State lacks the authority to mandate reporting requirements for patients covered by Medicaid that for those receiving Medicaid, additional reporting requirements, such as S21, must be also approved by CMS. The State Senate Committee on Health to prepare a memorandum assessing the feasibility of Senator Wood's bill, S21, has retained you. The Senate Chair has asked you to review (1) the structure and functions of the Health Insurance Exchange in the state, (2) the determination of whether the legal authority of the State's HIX is sufficient to collect public health data (is this a function in other states), (3) the role of HIPAA in HIX operations, (4) the need for patient (guardian) informed consent in mandated public health data reporting, (5) steps the state needs to take in ensuring health care data report card schemes are not vulnerable to legal challenge, and (6) the impact of Medicaid on State mandated public health reporting laws.

Additional Requirement

The question lies to Nursing and it defines about writing a report on the poor dental hygiene in nursing homes. A report to the State Senate Committee on Health has been written. The structure of the report and its contents have been discussed in detail in the solution.

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