2023 Pennsylvania Consolidated & Unconsolidated Statutes › Title 35 - HEALTH AND SAFETY › Chapter 33 - Health Care Cost Containment › Section 3308 - Right-to-Know Law and access to council data

§ 3308. Right-to-Know Law and access to council data.
(a) Public access.--
The information and data received by the council shall be utilized by the council for the benefit of the public and public officials. Subject to the specific limitations set forth in this section and section 3101.1 of the act of February 14, 2008 (P.L.6, No.3), known as the Right-to-Know Law, the council shall make determinations on requests for information in favor of access. Payor discounts and allowances are confidential proprietary information and, as such, are not records subject to the requirements for public access under the Right-to-Know Law.
(b) Outreach programs.--
The council shall develop and implement outreach programs designed to make the council's information understandable and usable to purchasers, providers, other Commonwealth agencies and the general public. The programs shall include efforts to educate through pamphlets, booklets, seminars and other appropriate measures and to facilitate making more informed health care choices.
(c) Limitations on access.--
Unless specifically provided for under this chapter, neither the council nor any contracting system vendor shall release and no data source, person, member of the public or other user of any data of the council shall gain access to:
(1) Any raw data of the council that does not simultaneously disclose payment, as well as provider quality and provider service effectiveness pursuant to sections 3304(d)(5) (relating to powers and duties of council) and 3305(d) (relating to data submission and collection).
(2) Any raw data of the council which could reasonably be expected to reveal the identity of an individual patient.
(3) Any raw data of the council which could reasonably be expected to reveal the identity of any purchaser, other than a purchaser requesting data on its own group or an entity entitled to said purchaser's data pursuant to subsection (g).
(4) Any raw data of the council relating to actual payments to any identified provider made by any purchaser, except that this provision shall not apply to access by a purchaser requesting data on the group for which it purchases or otherwise provides covered services or to access to that same data by an entity entitled to the purchaser's data pursuant to subsection (g).
(5) Any raw data disclosing discounts or allowances between identified payors and providers unless the data is released in a Statewide, aggregate format that does not identify any individual payor or class of payors, directly or indirectly through the use of a market share, and unless the council assures that the release of such information is not prejudicial or inequitable to any individual payor or provider or group thereof. Payor data shall be released to individual providers for purposes of verification and validation prior to inclusion in a public report. An individual provider shall verify and validate the payor data within 30 days of its release to that specific individual provider.
(d) Unauthorized use of data.--
A person who knowingly releases council data violating raw data safeguards under this section to an unauthorized person commits a misdemeanor of the first degree and shall, upon conviction, be sentenced to pay a fine of $10,000 or to imprisonment for not more than five years, or both. An unauthorized person who knowingly receives or possesses the data commits a misdemeanor of the first degree.
(e) Unauthorized access to data.--
If a person inadvertently or by council error gains access to data that violates the safeguards under this section, the data must immediately be returned, without duplication, to the council with proper notification.
(f) Public access to records.--
Each public report prepared by the council shall be a public record and shall be available to the public for a reasonable fee. Copies shall be provided, upon request of the chairperson, to the Health and Human Services Committee of the Senate and the Health Committee and Human Services Committee of the House of Representatives.
(g) Access to council raw data by purchasers.--
Pursuant to sections 3304(d)(6) and 3306(b) (relating to data dissemination and publication) and subject to the limitations on access under subsection (c), the council shall provide access to the council's raw data to purchasers, excluding purchasers that provide covered services other than through the purchase of fully funded insurance from a health care insurer but that are not elective health care payor data sources, in accordance with the following procedure:
(1) Special reports derived from raw data of the council shall be provided by the council to the purchaser requesting such reports.
(2) A means to enable computer-to-computer access by the purchaser to raw data of the council shall be developed, adopted and implemented by the council. The council shall provide the access to the council's raw data to a purchaser upon request.
(3) If an employer obtains from the council, under paragraph (1) or (2), data pertaining to the employer's employees and the employees' dependents for whom the employer purchases or otherwise provides covered services and who are represented by a certified collective bargaining representative, the collective bargaining representative shall be entitled to the data after payment of fees under paragraph (4). If a certified collective bargaining representative obtains from the council, under paragraph (1) or (2), data pertaining to the employer's members and the member's dependents who are employed by and for whom covered services are purchased or otherwise provided by an employer, the employer shall be entitled to the data after payment of fees under paragraph (4).
(4) In providing for access to its raw data, the council shall charge the purchasers which originally obtained the access a fee sufficient to cover the council's costs to prepare and provide special reports requested under paragraph (1) or to provide computer-to-computer access to its raw data requested under paragraph (2). If a second or subsequent party requests the information under paragraph (3), the council shall charge the party a reasonable fee.
(h) Access to council raw data by State agencies.--
The council shall develop and execute memoranda of understanding with any State agency upon request of that agency, including the Insurance Department, the Department of Health and the Department of Human Services, to allow the agency access to the data.
(i) Access to council raw data by other parties.--
Subject to the limitations on access to council raw data under subsection (c), the council may provide special reports derived from the council's raw data or computer-to-computer access to parties other than purchasers provided access under subsection (g). The council may publish regulations that set forth the criteria and the procedure the council shall use in making determinations on the access, pursuant to the powers vested in the council under section 3304. In providing the access, the council shall charge the party requesting the access a reasonable fee.
Cross References.
Section 3308 is referred to in sections 3304, 3306 of this title.