Utah Code § 26B-8-504 — Utah Code / Title 26B / Chapter 26B-8 / § 26B-8-504
§ 26B-8-504. Health care cost and reimbursement data -- All Payer Claims Database.
Status: in_force

(1) The department shall, as funding is available: (a) establish a plan for collecting data from data suppliers to determine measurements of cost and reimbursements for risk-adjusted episodes of health care; (b) share data regarding insurance claims and an individual's and small employer group's health risk factor and characteristics of insurance arrangements that affect claims and usage with the Insurance Department, only to the extent necessary for: (i) risk adjusting; and (ii) the review and analysis of health insurers' premiums and rate filings; (c) assist the Legislature and the public with awareness of, and the promotion of, transparency in the health care market by reporting on: (i) geographic variances in medical care and costs as demonstrated by data available to the department; and (ii) rate and price increases by health care providers: (A) that exceed the Consumer Price Index - Medical as provided by the United States Bureau of Labor Statistics; (B) as calculated yearly from June to June; and (C) as demonstrated by data available to the department; (d) provide on at least a monthly basis, enrollment data collected by the department to a not-for-profit, broad-based coalition of state health care insurers and health care providers that are involved in the standardized electronic exchange of health data as described in Section 31A-22-614.5, to the extent necessary: (i) for the department or the Office of Inspector General of Medicaid Services to determine insurance enrollment of an individual for the purpose of determining Medicaid third party liability; (ii) for an insurer that is a data supplier, to determine insurance enrollment of an individual for the purpose of coordination of health care benefits; and (iii) for a health care provider, to determine insurance enrollment for a patient for the purpose of claims submission by the health care provider; (e) coordinate with the Trauma System and Emergency Medical Services Advisory Committee to publish data regarding air ambulance charges under Section 53-2d-105; (f) share data collected under this part with the state auditor for use in the health care price transparency tool; and (g) create a database called the All Payer Claims Database for maintaining health care cost and claim information. (2) A data supplier is not liable for a breach of or unlawful disclosure of the data caused by a person that obtains data in accordance with Subsection (1). (3) The plan adopted under Subsection (1)(a) shall include: (a) the type of data that will be collected; (b) how the data will be evaluated; (c) how the data will be used; (d) the extent to which, and how the data will be protected; and (e) who will have access to the data. (4) After a plan is adopted as provided in Subsection (1)(a), the department may require any data supplier to submit fee schedules, maximum allowable costs, area prevailing costs, terms of contracts, discounts, fixed reimbursement arrangements, capitations, or other specific arrangements for reimbursement to a health care provider to the extent allowed under federal law. (5) (a) The department may not publish any health data collected under Subsection (4) that would reveal specific terms of current contracts, discounts, or fixed reimbursement arrangements, or other specific reimbursement arrangements between an individual provider and a specific payer. (b) Nothing in Subsection (4) shall prevent the department from requiring the submission of health data on the reimbursements actually made to health care providers from any source of payment, including consumers.