957 CMR, § 4.04 - Reporting Requirements

(1) Use of Existing Data. Whenever feasible, the Center shall use currently reported data to calculate Provider performance on SQMS measures in a uniform manner. The Center may request additional data from Providers, including data derived from electronic health records and patient registries, to calculate the SQMS quality measures.

(2) Data Submission Manual. The Center will prepare a draft Data Submission Manual prior to requiring data submissions from Providers. Providers will be given 30 days to submit written comments on the draft Data Submission Manual. The Center will issue a final Data Submission Manual following the deadline for written comments and will notify Providers of its availability.

(3) Data Submission Process. Each Provider shall submit data directly to the Center or the Betsy Lehman Center in the format specified by the Data Submission Manual. Data submissions must conform to specifications set forth in the Data Submission Manual by the Center. The Center will notify a Provider whether the submission has been accepted or rejected. Providers must correct and resubmit rejected data until notified that the submission has been accepted.

(4) Reporting Requirement Changes. Providers will be notified of changes to the Data Submission Manual and corresponding changes in reporting requirements by administrative bulletin. Providers will be given 30 days to submit written comments on the proposed revisions to the Data Submission Manual. The Center will finalize revisions to the Data Submission Manual no fewer than 15 days after the deadline to submit written comments.

(5) Audits. Data submissions are subject to audit through whatever mechanisms the Center deems necessary, including but not limited to matching and validating data in the All Payer Claims Database and the Hospital Discharge Database, or through medical record review.

(6) Data Verification Process.

(a) The Center will provide each Provider with a summary report of the data submitted for review and verification. These reports will provide aggregate results (aggregated to the reporting Provider level as defined in 957 CMR 4.02) of the SQMS measures based on the data submitted by the Provider or collected through alternative mechanisms as specified in the Data Submission Manual.

(b) Prior to the Center's public release of Provider performance data on the SQMS, the Provider will have an opportunity to correct and resubmit data or to provide comments. A Provider may request the Center's approval to amend the Provider's data submission. Regardless of whether the Center grants approval for data resubmission or amendment, Provider comments shall be included in the public data release.

(c) Providers will be notified by the Center at least 15 days in advance of the publication or release of Provider-specific data.

Notes

957 CMR, § 4.04