Source: http://www.wvlegislature.gov/bill_status/bills_text.cfm?billdoc=SB350%20SUB1.htm&yr=2011&sesstype=RS&i=350
Timestamp: 2019-04-25 05:04:05+00:00

Document:
A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new article, designated §33-16G-1, §33-16G-2, §33-16G-3, §33-16G-4, §33-16G-5, §33-16G-6, §33-16G-7, §33-16G-8 and §33-16G-9, all relating to an all-payer claims database; declaring purpose; defining terms; developing the database by the Insurance Commissioner, Secretary of Health and Human Resources and Chairperson of the Health Care Authority; authorizing joint emergency and legislative rules; providing for compliance with privacy laws; permitting fees and assessments to be assessed; authorizing penalties to be set by rule; authorizing injunctive relief; establishing special revenue account; and allowing other sanctions.
ARTICLE 16G. ALL-PAYER CLAIMS DATABASE.
This article may be cited as the West Virginia All-Payer Claims Database Act.
(a) "All-payer claims database" or "APCD" means the program authorized by this article that collects, retains, uses and discloses information concerning the claims and administrative expenses of health care payers.
(b) "Chair" means the chairperson of the West Virginia Health Care Authority.
(c) "Commissioner" means the West Virginia Insurance Commissioner.
(d) "Data" mean the data elements from enrollment and eligibility files, specified types of claims, and reference files for date elements not maintained in formats consistent with national coding standards.
(2) Any of the following if provided under a separate policy, certificate, or contract of insurance: Limited scope dental or vision benefits: benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; coverage for only a specified disease or illness; or hospital indemnity or other fixed indemnity insurance.
Provided, however, That “health insurance claims” shall only include information from Medicare supplemental policies if the same information is obtained with respect to Medicare.
Provided, further, That the commissioner may, in his or her sole discretion, exempt a payer or class of payers from the requirements of this article for cause.
(f) "Personal identifiers" means information relating to an individual member or insured that identifies, or can be used to identify, locate or contact a particular individual member or insured, including but not limited to the individual's name, street address, social security number, e-mail address and telephone number.
(g) "Secretary" means the Secretary of the West Virginia Department of Health and Human Services.
(h) “Third party administrator” has the same meaning ascribed to it in section two, article forty-six of this chapter.
§33-16G-3. Establishment and development of an all-payer claims database.
(a) The secretary, commissioner and chair, collectively referred to herein as the "MOU parties," shall enter into a memorandum of understanding to develop an all-payer claims database program.
(4) Provide for the use of the hospital discharge data collected by the West Virginia Health Care Authority as a tool in the validation of APCD reports.
(6) Enter into voluntary agreements to obtain data from payers not subject to mandatory reporting under this article.
(b) Contracts for professional services for the development and operation of the APCD are not subject to the provisions of article three, chapter five-a of this code relating to the Purchasing Division of the Department of Administration: Provided, That the award of such contracts shall be subject to a competitive process established by the MOU parties.
(c) The MOU parties shall make an annual report to the Governor, which shall also be filed with the Joint Committee on Government and Finance, summarizing the activities of the APCD in the preceding calendar year.
§33-16G-5. Data subject to this article.
(a) All health care payers shall submit data to the commissioner or an entity designated by the commissioner at such times and in a form and manner specified in rule: Provided, That any health care payer that the commissioner determines paid or administered the payment of health insurance claims in this state for policies on fewer than 500 covered lives in the previous calendar year is exempt from the requirements of this article.
(b) Data submitted in accordance with this article shall be considered confidential by law and privileged, are exempt from disclosure pursuant to chapter twenty-nine-b of this code, are not open to public inspection, are not subject to subpoena, are not subject to discovery or admissible in evidence in any criminal, private civil or administrative action, are not subject to production pursuant to court order, and shall only be used and disclosed pursuant to law and rules promulgated pursuant to this article.
(c)(1) Data submitted to and retained by the APCD shall be available as a resource for the MOU parties to continuously review health care utilization, expenditures and performance in West Virginia and to enhance the ability of consumers to make informed and cost-effective health care decisions.
(2) Data submitted to and retained by the APCD may, in accordance with this article and the rules adopted hereunder, also be available as a resource for insurers, researchers, employers, providers, purchasers of health care, consumers, and state agencies.
(d) Notwithstanding any other provision of law, the APCD shall not disclose any data that contain personal identifiers: Provided, That the MOU parties, in accordance with procedures and standards set forth in rule, may approve access to other data elements not prohibited from disclosure by the APCD, as well as synthetic or created unique identifiers, for use by researchers, including government agencies, with established protocols for safeguarding confidential or privileged information: Provided, however, That the MOU parties' use of the data shall not constitute a disclosure.
Reasonable user fees may be collected, in amounts and in the manner established in rule, for the right to access and use the data available from the APCD: Provided, That the chair may reduce or waive the fee if he or she determines that the user is unable to pay the scheduled fees and that the user has a viable plan to use the data or information in research of general value to the public health.
In the event of any violation of this article or any rule adopted thereunder, the commissioner, secretary or chair may seek to enjoin a further violation in the circuit court of Kanawha County: Provided, That injunctive relief ordered pursuant to this section may be in addition to any other remedies and enforcement actions available to the commissioner under this chapter.
§33-16G-8. Special revenue account created.
(a) There is hereby created a special revenue account in the State Treasury, designated the "West Virginia All-Payer Claims Database Fund," which shall be an interest-bearing account and may be invested in the manner permitted by article six, chapter twelve of this code, with the interest income a proper credit to the fund, unless otherwise designated in law. The fund shall be overseen by the commissioner, secretary and chair, shall be administered by the commissioner, and shall be used to pay all proper costs incurred in implementing the provisions of this article.
(4) All other payments, gifts, grants, bequests or income from any source.
(g) Establishment of advisory boards to provide advice to the MOU parties with respect to the various functions of the APCD.
NOTE: The purpose of this bill is to establish an all-payer claims database. The bill sets forth its purpose and defines terms. The bill requires the database to be developed by the Insurance Commissioner, Secretary of Health and Human Resources and chairperson of the Health Care Authority. The bill authorizes joint emergency and legislative rules. The bill provides for compliance with privacy laws. The bill also permits fees and assessments to be assessed. The bill authorizes penalties, injunctive relief and other sanctions. The bill further establishing a special revenue account.
§33-16G-1, §33-16G-2, §33-16G-3, §33-16G-4, §33-16G-5, §33- 16G-6, §33-16G-7, §33-16G-8 and §33-16G-9 are new; therefore, strike-throughs and underscoring have been omitted.

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