Today's Law As Amended

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AB-2502 Health care payments database.(2017-2018)

As Amends the Law Today


 Chapter 8.5 (commencing with Section 127671) is added to Part 2 of Division 107 of the Health and Safety Code, to read:

CHAPTER  8.5. California Health Care Payments Database
 (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 and to use the information to inform policymakers in making decisions regarding how to reduce health care costs while improving quality and reducing disparities.
(b) It is the intent of the Legislature in enacting this chapter to encourage health care service plans, health insurers, and providers 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.
 For purposes of this chapter, the following definitions apply:
(a) “Database” means the California Health Care Payments Database.
(b) “Review committee” refers to the entity established pursuant to subdivision (a) of Section 127674.
(c) “Secretary” means the Secretary of the California Health and Human Services Agency.
 (a) The secretary shall, no later than January 1, 2020, do all of the following:
(1) Establish, implement, and administer the California Health Care Payments Database in accordance with this chapter.
(2) Develop methodologies 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, and other alternative, value-based, payment sources, submitted by health care entities that are validated and recognized as reliable, and that meet industry and research standards.
(3) Receive information, as described in this section, from health care entities and report that information in a form that allows valid comparisons across care delivery systems.
(4) Ensure that the database has the capacity to map to other data sets, including public health data sets on morbidity and mortality, including data sets from the federal Centers for Disease Control, the State Department of Public Health, and other data sets with data regarding the social determinants of health.
(5) Comply with the requirements governing provider and supplier requests for error correction established pursuant to Section 401.717 of Title 42 of the Code of Federal Regulations for all data received, including, but not limited to, data from sources other than Medicare.
(b) The secretary shall identify, in accordance with this section, the type of data, purpose of use, and entities and individuals that are required to report to the database. An entity or individual shall not be required to submit information to the database until the review committee has approved the secretary’s determination.
(c) (1) For the purpose of developing 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 secretary:
(A) Utilization data from the health care service plans’ and insurers’ medical payments or, in the case of entities that do not use payments data, including, but not limited to, integrated delivery systems, encounter data consistent with the core set of data elements for data submission proposed by the All-Payer Claims Database Council, the University of New Hampshire, and the National Association of Health Data Organizations.
(B) Pricing information for health care items, services, and medical and surgical episodes of care gathered from payments for covered health care items and services.
(C) Information sufficient to determine the impacts of social determinants of health, including age, gender, income, disability, race, ethnicity, limited English proficiency, sexual orientation and gender identity, ZIP Code, and any other factors for which there is peer-reviewed evidence.
(2) (A) The secretary may report an entity’s failure to comply with paragraph (1) to the entity’s regulating agency.
(B) The regulating agency of an entity described in paragraph (1) may enforce paragraph (1) using its existing enforcement procedures. Notwithstanding any other law, moneys collected pursuant to this authorization shall be subject to appropriation by the Legislature, and the failure to comply with paragraph (1) is not a crime.
(d) (1) (A) All uses of data made pursuant to this section shall comply with all applicable state and federal laws for the protection of the privacy and security of data, including, but not limited to, the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code), 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), Title 1.81 (commencing with Section 1798.80) of Part 4 of Division 3 of the Civil Code, the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191), the federal Health Information Technology for Economic and Clinical Health Act, Title XIII of the federal American Recovery and Reinvestment Act of 2009 (Public Law 111-5), and implementing regulations.
(B) The secretary may contract with one or more public or private entities to administer the database, if necessary. The secretary may select that organization or those organizations by means of a competitive selection process.
(2) (A) All policies and protocols developed in the performance of the contract shall ensure that the privacy, security, and confidentiality of individually identifiable health information is protected. The secretary shall not publicly disclose any unaggregated, individually identifiable health information.
(B) For the purposes of this paragraph, “individually identifiable health information” has the same meaning as in Section 160.103 of Title 45 of the Code of Federal Regulations.
(3) Individually identifiable proprietary contract information included in a contract between a health care service plan or insurer and a provider or supplier shall not be disclosed in an unaggregated format.
(e) (1) The secretary shall receive, process, maintain, and analyze information from data sources, including, but not limited to, data received pursuant to subdivision (c) and payments from private and public payers.
(2) The secretary 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 level and regional level data on prevention, screening, and wellness utilization.
(B) Population level data on chronic conditions, management, and outcomes.
(C) Population 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.
 (a) The secretary shall convene a review committee, composed of a broad spectrum of health care stakeholders and experts, including, but not limited to, representatives of the entities that are required to provide information pursuant to subdivision (c) of Section 127673 and representatives of purchasers, including, but not limited to, businesses, organized labor, and organizations representing consumers, to advise the secretary on the establishment, implementation, and ongoing administration of the database, including a business plan for sustainability without using moneys from the General Fund. The review 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 secretary. The review 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).
(b) The secretary shall arrange for the preparation of an annual report to the Legislature and the Governor, to be submitted in compliance with Section 9795 of the Government Code, based on the findings of the review committee, including input from the public meetings, that shall, at a minimum, examine and address the following:
(1) Recommendations for assessing California health care needs and available resources.
(2) Recommendations for containing the cost of health care services and coverage.
(3) Recommendations for improving the quality, outcomes, and medical appropriateness of health care.
(4) Recommendations for reducing health disparities and addressing the social determinants of health.
(5) Recommendations for increasing the transparency of health care costs and the relative efficiency with which care is delivered.
(6) Recommendations regarding the use of disease management, wellness, prevention, and other innovative programs to keep people healthy and reduce disparities and costs and improving health outcomes for all populations.
(7) Recommendations for reducing unnecessary, inappropriate, and wasteful health care.
(8) A comparison of prices paid by payers and providers as well as year-to-year changes in the costs of health care services, broken out by payer and provider.
(9) The use of existing data sources to assist in building the database.
(c) Notwithstanding any other law, the members of the review committee shall not receive a per diem, travel expense reimbursement, or any other expense reimbursement.
SEC. 2.
 The Legislature finds and declares that Section 1 of this act, which adds Chapter 8.5 (commencing with Section 127671) to Part 2 of Division 107 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 California Health Care Payments Database, it is necessary for that information to remain confidential.