Bill Text: CA AB2830 | 2019-2020 | Regular Session | Amended
Bill Title: Health Care Payments Data Program.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2020-07-01 - Referred to Com. on HEALTH. [AB2830 Detail]
Download: California-2019-AB2830-Amended.html
Amended
IN
Assembly
May 12, 2020 |
Introduced by Assembly Member Wood |
February 20, 2020 |
LEGISLATIVE COUNSEL'S DIGEST
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.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest.
This bill would make legislative findings to that effect.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: YESBill Text
The people of the State of California do enact as follows:
SECTION 1.
Section 1386 of the Health and Safety Code is amended to read:1386.
(a) The director may, after appropriate notice and opportunity for a hearing, by order suspend or revoke any license issued under this chapter to a health care service plan or assess administrative penalties if the director determines that the licensee has committed any of the acts or omissions constituting grounds for disciplinary action.SEC. 2.
The heading of Chapter 8.5 (commencing with Section 127671) of Part 2 of Division 107 of the Health and Safety Code is amended to read:
CHAPTER
8.5. Health Care Cost Transparency Database Payments Data Program
SECTION 1.SEC. 3.
Section 127671 of the Health and Safety Code is amended to read:127671.
(a)(b)
(c)
(d)
SEC. 2.SEC. 4.
Section 127671.1 is added to the Health and Safety Code, to read:127671.1.
(a) The office shall establish, implement, and administer the Health CareSEC. 3.SEC. 5.
Section 127671.5 of the Health and Safety Code is repealed.SEC. 4.SEC. 6.
Section 127672 of the Health and Safety Code is amended to read:127672.
(a) (1) The Office of Statewide Health Planning and Development shall convene a(3)
(4)
SEC. 5.SEC. 7.
Section 127672.8 is added to the Health and Safety Code, to read:127672.8.
The office shallSEC. 6.SEC. 8.
Section 127672.9 is added to the Health and Safety Code, to read:127672.9.
(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.SEC. 7.SEC. 9.
Section 127673 of the Health and Safety Code is amended to read:127673.
(a) 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)For the purpose of 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:
(3)An individual, organization, or entity contracted to provide health services pursuant to Section 14087.3 of the Welfare and Institutions Code.
(4)A
(5)A
(e)Entities
(f)
(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)
(i)
SEC. 8.SEC. 10.
Section 127673.1 is added to the Health and Safety Code, to read:127673.1.
(a) (1) The office shall report the information it receives pursuant to this chapter in a form that allows valid comparisons across care delivery systems.SEC. 9.SEC. 11.
Section 127673.2 is added to the Health and Safety Code, to read:127673.2.
(a) In the development of the(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)
(d)
SEC. 10.SEC. 12.
Section 127673.3 is added to the Health and Safety Code, to read:127673.3.
(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.SEC. 11.SEC. 13.
Section 127673.4 is added to the Health and Safety Code, to read:127673.4.
(a) The office shall develop data quality and improvement processes and shall make these processes publicly available.SEC. 12.SEC. 14.
Section 127673.5 is added to the Health and Safety Code, to read:127673.5.
(a) (1) The purpose of theSEC. 13.SEC. 15.
Section 127673.6 is added to the Health and Safety Code, to read:127673.6.
The office shall develop an information security program that uses existing state standards and complies with applicable state and federal laws.(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.
(b)Access to nonpublic data shall be governed by the data use, access, and release program.
(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.
SEC. 16.
Section 127673.7 is added to the Health and Safety Code, to read:127673.7.
The office shall include in an annual analysis, but shall not limit the content of that analysis to, all of the following:SEC. 17.
Section 127673.8 is added to the Health and Safety Code, to read:127673.8.
(a) The office shall use the program data to produce publicly available information, including data products, summaries, analyses, studies, and other reports, to support the goals of the program. The office shall receive input on priorities for the public information portfolio from the advisory committee. The office may establish a pricing mechanism for data products.SEC. 18.
Section 127673.81 is added to the Health and Safety Code, to read:127673.81.
(a) All personal consumer information obtained or maintained by the program shall be confidential. Only deidentified aggregate patient or other consumer data shall be included in a publicly available analysis, data product, or research.SEC. 19.
Section 127673.82 is added to the Health and Safety Code, to read:127673.82.
(a) The office shall develop a comprehensive program for data use, access, and release that includes data use agreements that require data users to comply with this chapter. The purpose of the data use, access, and release program is to ensure that only aggregated, deidentified information is publicly accessible.SEC. 20.
Section 127673.83 is added to the Health and Safety Code, to read:127673.83.
(a) In accessing or obtaining nonpublic data through the secure environment, users shall only have access to the minimum amount of potentially identifiable data necessary for an approved project or access to a dataset designed for an approved purpose. Each person who accesses or obtains nonpublic personal data shall sign a data use agreement. Violation of a data use agreement shall be considered a violation of Section 1798.56 of the Civil Code and, if applicable, Section 1798.57 of the Civil Code.SEC. 21.
Section 127673.84 is added to the Health and Safety Code, to read:127673.84.
(a) The office shall establish a data release committee with a membership of at least 7 and no more than 11 members appointed by the director. Notwithstanding any other law, a quorum shall be achieved with one fewer member than one-half of the full membership.SEC. 16.SEC. 22.
Section 127674 of the Health and Safety Code is repealed.SEC. 17.SEC. 23.
Section 127674 is added to the Health and Safety Code, to read:127674.
(a) The office shall expend the General Fund moneys appropriated in the(b)
(c)
(d)
(e)
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.
No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.
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.