Source: https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201920200AB2830
Timestamp: 2020-04-08 07:08:20
Document Index: 596714121

Matched Legal Cases: ['art 1', 'art 5', 'art 2', 'art 5', 'art 2', 'art 4', 'art 4']

Bill Text - AB-2830 Health care cost transparency database.
AB-2830 Health care cost transparency database.(2019-2020)
AB2830:v99#DOCUMENT
An act to amend Sections 127671, 127672, and 127673 of, to add Sections 127671.1, 127672.8, 127672.9, 127673.1, 127673.2, 127673.3, 127673.4, 127673.5, 127673.6, 127673.8, 127673.9, and 127674.1 to, to repeal Section 127671.5 of, and to repeal and add Section 127674 of, the Health and Safety Code, relating to health care.
AB 2830, as introduced, Wood. Health care cost transparency database.
Existing law states the intent of the Legislature to establish a Health Care Cost Transparency Database to collect information on the cost of health care, and requires the Office of Statewide Health Planning and Development to convene a review committee to advise the office on the establishment and implementation of the database. Existing law requires, subject to appropriation, the office to establish, implement, and administer the database by January 1, 2023. Existing law exempts contracts entered into by the office from provisions of the Public Contract Code. Existing law requires certain health care entities, including a health care service plan, to provide specified information to the office for collection in the database. Existing law provides that a violation of these provisions is not a crime.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime.
This bill would state the intent of the Legislature to establish a system to collect health information related to health care cost, quality, and efficiency by January 1, 2022. The bill would direct the office to take a number of actions with respect to developing and implementing the Health Care Cost Transparency Database, including, among other things, ensuring the database can map to other databases, contracting with a data collection vendor, as necessary, collecting and incorporating data from other state and federal agencies, developing and maintaining a master person index, a master provider index, and a master payer index, developing data quality and improvement processes, and developing an information security program to ensure the privacy of individuals and the security of the data collected. The bill would authorize the office to impose a user fee on eligible users of the database in an amount that does not exceed the office’s administrative costs in providing eligible users access to the database.
The bill would define the types of entities that are mandatory submitters that are required to submit specified health care cost data to the office. The bill would direct the office to use moneys appropriated for these purposes in the 2019–20 Budget Act, and would require, once those moneys are exhausted, additional funding be provided from the Managed Care Fund and the Insurance Fund, upon appropriation by the Legislature. The bill would make failure to comply with these provisions a violation of the licensing law governing the noncompliant mandatory submitter, which includes the Knox-Keene Health Care Service Plan Act of 1975. Because a violation of the licensing provisions governing health care service plans is a crime, the bill would impose a state-mandated local program.
(a) It is the intent of the Legislature in enacting this chapter to establish a system to collect information regarding the cost of health care. health care costs, quality, and equity. Health care data is reported and collected through many disparate systems. Creating a process to aggregate this data will provide greater transparency regarding health care costs, quality, and equity, and the information may be used to inform policy decisions regarding the provision of quality health care, reduce disparities, and reduce health care costs. costs while preserving consumer privacy.
(c) It is the intent of the Legislature in enacting this chapter to encourage health care service plans, health insurers, and providers to use such this data to develop innovative approaches, services, and programs that may have the potential to deliver health care that is both cost effective and responsive to the needs of enrollees, including recognizing the diversity of California and the impact of social determinants of health.
(d) It is the intent of the Legislature that the development of a Health Care Cost Transparency Database be substantially completed no later than July 1, 2023, 2022, pursuant to this chapter.
(a) The office shall establish, implement, and administer the Health Care Cost Transparency Database in accordance with this chapter.
(b) The database shall collect data on all California residents to the extent feasible and permissible under state and federal law.
(a) (1) The Office of Statewide Health Planning and Development shall convene a review health care data policy advisory committee, composed of health care stakeholders and experts, including, but not limited to, all of the following:
(2) The review advisory committee shall consist of no fewer than nine and no more than 11 persons.
(3)The review committee shall advise the office on the establishment, implementation, and ongoing administration of the database, including a business plan for sustainability without using moneys from the General Fund.
(3) The review advisory committee shall not have decisionmaking authority related to the administration of the database and shall not have a financial interest, individually or through a family member, in the recommendations made to the office. The review advisory committee shall hold public meetings with stakeholders, solicit input, and set its own meeting agendas. Meetings of the review committee are subject to the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code).
(4) The members of the review advisory committee shall serve without compensation, but shall be reimbursed for any actual and necessary expenses incurred in connection with their duties as members of the committee.
(b)The office may consider recommendations contained within the Health Care Cost, Quality, and Equity Data Atlas Technical Feasibility Analysis dated March 1, 2017, prepared pursuant to Section 127670. In addition, the office shall review information collected by the state in various health care data systems to identify gaps between available data and recommended data. The office may utilize third-party vendors to assist with the implementation of these provisions. The vendor shall prepare a plan, for submission to the office, for completing a Health Care Cost Transparency Database and identify which elements of the system can be addressed using the appropriation included in the 2018–19 Budget Act. To the extent available funding is insufficient to address all elements identified, the plan shall prioritize the key components needed to best support health care cost transparency.
(c)The office shall develop a guidance to require data submission from the entities specified in paragraph (1) of subdivision (a). That guidance shall include a methodology for the collection, validation, refinement, analysis, comparison, review and improvement of health care data, including, but not limited to, data from fee-for-service, capitated, integrated delivery system, and other alternative, value-based, payment sources, submitted by entities specified in paragraph (1) of subdivision (a). The guidance shall also consider data elements proposed by the All-Payer Claims Database Council, the University of New Hampshire, the National Association of Health Data Organizations, Medi-Cal, and Medicare, among others.
(d)(1)No later than July 1, 2020, the office shall submit a report to the Legislature in compliance with Section 9795 of the Government Code, based on recommendations of the review committee and any third-party vendor, that does all of the following:
(A)Includes information on the types of data, including those specified in subdivision (b) of Section 127673, purpose of use, and use case definitions to assist in prioritizing areas of development.
(B)Specifies entities and individuals required to report data, including those specified in Section 127673.
(C)Defines and prioritizes data elements to collect, including the requirements for data linkages to meet specified purposes and use cases.
(D)Analyzes data aggregation and the protection of individual confidentiality to advise on privacy and security.
(E)Analyzes and provides advice regarding existing technology, existing systems, and available data that can be leveraged to ensure a streamlined system.
(2)The report shall also include recommendations including the following:
(A)Additional legislation needed to ensure the database receives appropriate data from identified data submitters including, those specified in subdivision (b) of Section 127673 and legislation regarding enforcement mechanisms necessary for these entities to comply with the requirements of the chapter.
(B)Legislation needed to protect individual privacy rights and confidentiality of the data.
(C)A plan for long-term, non-General Fund financing to support the ongoing costs of maintaining the database.
(D)The type of technology solutions required pursuant to Section 127670, including whether to build a new database or leveraging databases, or developing a network of networks to facilitate a hybrid version of the two options.
(E)Identification of governance structure, including identification of the appropriate entity to operate the database.
(F)How the database can map to other datasets, including public health datasets on morbidity and mortality, and data regarding the social determinants of health.
(e)For purposes of implementing this chapter, including, but not limited to, hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the office may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Contracts entered into or amended pursuant to this section are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and are exempt from the review or approval of any division of the Department of General Services.
(b) The office may convene other committees or workgroups as necessary to support effective operation of the database. These committees may be standing committees or time-limited workgroups, at the discretion of the director.
The office shall assure that the database can map to other datasets, including public health datasets on morbidity and mortality, and data regarding the social determinants of health.
(a) The office may contract with a data collection vendor. If the office contracts with a data collection vendor, that vendor shall have experience in health care databases, including the collection of data for all payer claims databases, and specifically experience in the collection of nonclaims based data such as encounter data.
(b) For purposes of implementing this chapter, including, but not limited to, hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the office may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Contracts entered into or amended pursuant to this section are exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code, and are exempt from the review or approval of any division of the Department of General Services.
Section 127673 of the Health and Safety Code is amended to read:
(a) Subject to appropriation, after the requirements of Section 127672 are fulfilled and a long term non-General Fund financing mechanism has been implemented, the office or its designee shall establish, implement, and administer the Health Care Cost Transparency Database in accordance with this chapter. The office shall develop guidance to require data submission from the entities specified in this chapter. The guidance shall include a methodology for the collection, validation, refinement, analysis, comparison, review, and improvement of health care data to be submitted by entities specified in this chapter, including, but not limited to, data from fee-for-service, capitated, integrated delivery system, and other alternative, value-based, payment sources, and any other form of payment to health care providers by health plans, health insurers, or other entities described in this chapter.
(b) After the requirements of Section 127672 are fulfilled, for For the purpose of developing providing information for inclusion in the database, a health care service plan, including a specialized health care service plan, an insurer licensed to provide health insurance, as defined in Section 106 of the Insurance Code, a self-insured employer subject to Section 1349.2, health entities contracted pursuant to Section 14087.3 of the Welfare and Institutions Code, a supplier, as defined in paragraph (3) of subdivision (b) of Section 1367.50, or a provider, as defined in paragraph (2) of subdivision (b) of Section 1367.50, shall, and a self-insured employer not subject to Section 1349.2 and a multiemployer self-insured plan that is responsible for paying for health care services provided to beneficiaries and the trust administrator for a multiemployer self-insured plan may, provide all of the following to the office:
(2) Pricing information for health care items, services, and medical and surgical episodes of care gathered from payments for covered health care items and services. services, including contracted rates, allowed amounts, fee schedules, and other information regarding the cost of care necessary to determine the amounts paid by health plans, health insurers, and public programs to health care providers and other entities. This shall include nonclaims-based payment information such as deductibles, copayments, and coinsurance and other information as needed to determine the total cost of care.
(c)The office or its designee shall receive the information, as described in this section, and report that information in a form that allows valid comparisons across care delivery systems. Policies and procedures shall be developed to outline the format and type of data to be submitted pursuant to subdivision (b).
(d)In the development of the database, the office or its designee shall consult with state entities as necessary to implement the Health Care Cost Transparency Database. State entities shall assist and provide to the office access to such datasets to effectuate the intent of this chapter.
(e)All policies and procedures developed in the performance of this chapter shall ensure that the privacy, security, and confidentiality of individually identifiable health information is protected.
(f)The office shall develop policy regarding data aggregation and the protection of individual confidentiality, privacy, and security. Individual patient-level data shall be exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), and shall not be made available except pursuant to this chapter or the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code) until the office has developed a policy regarding the release of that data.
(g)(1)Upon operation of the database and receipt of sufficient data, the office or its designee shall receive, process, maintain, and analyze information from data sources, including, but not limited to, data received pursuant to subdivision (b) and payments from private and public payers.
(2)The office or its designee shall include in an analysis performed pursuant to paragraph (1), but shall not limit the content of that analysis to, any of the following:
(A)Population and regional level data on prevention, screening, and wellness utilization.
(B)Population and regional level data on chronic conditions, management, and outcomes.
(C)Population and regional level data on trends in utilization of procedures for treatment of similar conditions to evaluate medical appropriateness.
(D)Regional variation in payment level for the treatment of identified chronic conditions.
(E)Data regarding hospital and nonhospital payments, including inpatient, outpatient, and emergency department payments and nonhospital ambulatory service data.
(3) Personally identifiable information that the plan or insurer possesses, including detailed patient identifiers such as first and last name, address, date of birth, gender or gender identity, and Social Security Number or individual taxpayer identification number, in order to support analyses, including, but not limited to, longitudinal, public health impacts, and social determinants of health analyses. Personally identifiable information shall be subject to the privacy protections of this chapter and shall not be publicly available, except as specified in this chapter.
(4) Personal health information, including age, gender, gender identity, race, ethnicity, sexual orientation, health status, health condition, and any other data elements that constitute personal health information in this chapter.
(2) An insurer licensed to provide health insurance, as defined in Section 106 of the Insurance Code, or a self-insured plan subject to Section 1349.2 of this code.
(3) An individual, organization, or entity contracted to provide health services pursuant to Section 14087.3 of the Welfare and Institutions Code.
(4) A provider, as defined in paragraph (2) of subdivision (b) of Section 1367.50.
(5) A supplier, as defined in paragraph (3) of subdivision (b) of Section 1367.50.
(d) For purposes of this chapter, “voluntary submitters” include, but are not limited to:
(e) Entities subject to this section shall, to the extent permitted by state and federal law, provide information on all of the following:
(1) Commercial lines of business, including individual, small group, large group, and Medicare Advantage.
(2) Self-insured plans subject to state law, including those governed by Section 1349.2.
(3) Dental, vision, and behavioral health plans.
(4) Medi-Cal plans, to the extent that this information is not provided by the State Department of Health Care Services.
(5) Student health insurance.
(f) Excluded lines of business includes all of the following:
(1) Supplemental insurance, including Medicare supplemental coverage.
(2) Stop-loss plans.
(3) Chiropractic-only and vision-only plans that do not cover essential health benefits.
(g) (1) A plan providing comprehensive benefits with enrollment of more than 50,000 covered lives in commercial, self-insured, or Medicare Advantage products shall be a mandatory submitter.
(2) A plan providing dental-only coverage with more than 50,000 lives shall be a mandatory submitter.
(3) All qualified health plans shall submit either directly or through Covered California.
(4) The Department of Health Care Services shall submit information for those enrolled in Medi-Cal and other insurance affordability programs, whether enrolled in Medi-Cal managed care, fee-for-service Medi-Cal, or any other payment arrangement.
(h) (1) Health plans, insurers, and other mandatory submitters shall submit monthly all core data, including claims, encounters, eligibility, and provider files.
(2) Nonclaims payment data files shall be submitted, at a minimum, annually.
(i) (1) In its initial implementation, the office shall seek data for the three years prior to the effective date of this chapter.
(2) In ongoing administration of the database, the office shall provide data for no less than three years and may seek data for longer time periods to support the intent of this chapter.
(b) Mandatory submitters are responsible for submitting complete and accurate data directly to the database and facilitating data submissions from data owners, including, but not limited to, data feeds from pharmacy benefit managers, behavioral health organizations, and any subsidiaries, affiliates, or subcontractors that a mandatory submitter has contracted with for services covered by this chapter.
(a) In the development of the database, the office or its designee shall consult with state and federal entities, as necessary, to implement the Health Care Cost Transparency Database. State entities shall assist and provide to the office access to datasets needed to effectuate the intent of this chapter.
(b) The office shall collect from the State Department of Health Care Services data on Medi-Cal enrollees, including enrollees in fee-for-service Medi-Cal, Medi-Cal managed care, and other Medi-Cal programs.
(c) The office shall seek data on Medicare enrollees from the federal Centers for Medicare and Medicaid Services and shall incorporate that data, to the extent possible.
(d) The office shall accept data from voluntary submitters if it is provided in a manner and format specified by the office.
(a) The office shall develop and maintain a master person index, a master provider index, and a master payer index that will enable the matching of California residents longitudinally and across coverage sources, and will enable the matching of providers across practice arrangements, payment sources, and regulators.
(b) The office shall supplement these indices with data from other public and private sources, including, but not limited to, the following:
(5) Private sources of valid and reliable data, such as a provider directory utility if it is demonstrably accurate over time.
(a) The office shall develop data quality and improvement processes and shall make these processes publicly available.
(b) Data quality processes shall be applied to each major phase of the database life-cycle, including, but not limited to:
(4) Other data processes necessary for the database.
(3) Other impediments to the functioning of the database.
(a) (1) The purpose of the database is to learn about public health, population health, social determinants of health, and the health care system, not about individual patients.
(2) All policies and procedures developed in implementing this chapter shall ensure that the privacy, security, and confidentiality of consumers’ individually identifiable health information is protected, consistent with state and federal privacy laws, including the Confidentiality of Medical Information Act and the federal Health Insurance Portability and Accountability Act (HIPAA).
(b) (1) The office shall develop policies regarding data aggregation and the protection of individual confidentiality, privacy, and security for individual consumers and patients.
(2) Individual patient-level data is exempt from the disclosure requirements of the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), and shall not be made available except pursuant to this chapter or the Information Practices Act of 1977 (Chapter 1 (commencing with Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code) until the office has developed a policy regarding the release of that data.
(a) (1) The office shall develop a comprehensive program for data use, access, and release that includes data user agreements that require data users to comply with this chapter. The purpose of the data use, access, and release program is to assure that information is publicly available and that only aggregated, deidentified information is publicly accessible.
(2) There shall be a data access committee that oversees the data request process on an ongoing basis.
(c) The health care payments database shall be exempt from the California Public Records Act (Chapter 3.5 (commencing with Section 6250) of Division 7 of Title 1 of the Government Code), but shall be subject to this chapter.
Section 127673.9 is added to the Health and Safety Code, to read:
127673.9.
The office shall include in an annual analysis, but shall not limit the content of that analysis to, all of the following:
(a) The office shall expend the General Fund moneys appropriated in the 2019–20 Budget Act (Chapter 23 of the Statutes of 2019) for the purposes of this chapter to fund the implementation and operation of the database.
(b) The office shall seek to maximize federal financial participation from the Medicaid program for the database, working through the sole state agency for Medicaid, the State Department of Health Care Services, and shall do so while relying on moneys appropriated from the General Fund in the 2019–20 Budget Act.
(c) (1) The office may impose a user fee for an eligible user that is in compliance with this chapter, including, but not limited to, provisions related to consumer privacy and data security. The user fee shall not exceed the office’s administrative costs in providing an eligible user’s access to the database.
(2) State agencies and consumer organizations certified for the consumer participation program administered by the Department of Managed Health Care pursuant to Section 1348.9 are not subject to the user fee but are required to comply with this chapter, including, but not limited to, provisions related to consumer privacy and data security.
(d) (1) Upon exhaustion of the General Fund moneys appropriated in the 2019–20 Budget Act, funding for the actual and necessary expenses of the office in implementing this chapter shall be provided, subject to appropriation by the Legislature, from transfers of moneys from the Managed Care Fund and the Insurance Fund.
(2) The share of funding from the Managed Care Fund shall be based on the number of covered lives in the state that are covered under plans regulated by the Department of Managed Health Care, including covered lives under Medi-Cal managed care, as determined by the Department of Managed Health Care, in proportion to the total number of all covered lives in the state.
(3) The share of funding to be provided from the Insurance Fund shall be based on the number of covered lives in the state that are covered under health insurance policies and benefit plans regulated by the Department of Insurance, including covered lives under Medicare supplement plans, as determined by the Department of Insurance, in proportion to the total number of all covered lives in the state.
(e) The office may accept foundation funding from foundations not affiliated or controlled by a health care entity.
For a mandatory submitter that fails to comply with this chapter, the office shall refer the mandatory submitter to the respective regulator and this shall constitute a violation of the respective licensing law or laws applicable to the mandatory submitter.
The Legislature finds and declares that Section 12 of this act, which adds Section 127673.5 of the Health and Safety Code, imposes a limitation on the public’s right of access to the meetings of public bodies or the writings of public officials and agencies within the meaning of Section 3 of Article I of the California Constitution. Pursuant to that constitutional provision, the Legislature makes the following findings to demonstrate the interest protected by this limitation and the need for protecting that interest:
In order to protect confidential and proprietary information submitted to the Health Care Costs Transparency Database, it is necessary for that information to remain confidential.