BILL NUMBER: AB 2967	AMENDED
	BILL TEXT

	AMENDED IN SENATE  AUGUST 4, 2008
	AMENDED IN SENATE  JUNE 25, 2008
	AMENDED IN SENATE  JUNE 11, 2008
	AMENDED IN ASSEMBLY  APRIL 15, 2008
	AMENDED IN ASSEMBLY  MARCH 13, 2008

INTRODUCED BY   Assembly Member Lieber

                        FEBRUARY 22, 2008

   An act to amend and repeal Section 128725 of, and to amend,
repeal, and add Section 128695 of, and to add Chapter 4 (commencing
with Section 128850) to Part 5 of Division 107 of, the Health and
Safety Code, relating to health care.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2967, as amended, Lieber. Health care cost and quality
transparency.
   Existing law creates the California Health and Human Services
Agency.
   This bill would create the California Health Care Cost and Quality
Transparency Committee in the California Health and Human Services
Agency, with specified powers and duties, including the development
of a health care cost and quality transparency plan, which would
include various strategies to improve medical data collection and
reporting practices. The bill would require the Secretary of
California Health and Human Services and the committee to undertake
duties specified in the bill, including implementing various
strategies to improve health care quality, and related performance
measures. This bill would require the secretary, or the Office of
Statewide Health Planning and Development, to adopt regulations as
necessary to carry out the bill's requirements.
   The bill would provide for the confidentiality of information
obtained in the course of the data collection activities implemented
under the bill. The bill would establish the Health Care Cost and
Quality Transparency Fund, consisting of specified fees authorized
under the bill that shall not exceed the cost of implementing the
above provisions. The fund would be used, upon appropriation, to
support implementation of the activities required under the bill.
   Existing law, the Health Data and Advisory Council Consolidation
Act, makes provision for the collection of data from health
facilities. The act creates the California Health Policy and Data
Advisory Commission, which is charged with certain functions and
duties regarding data collection.
   This bill would, commencing July 1, 2009, repeal the provisions
creating and establishing the functions and duties of the California
Health Policy and Data Advisory Commission and provide that any
reference in the Health and Safety Code to the commission shall be
deemed a reference to the Health Care Cost and Quality Transparency
Committee.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 128695 of the Health and Safety Code is amended
to read:
   128695.  (a) There is hereby created the California Health Policy
and Data Advisory Commission to be composed of 13 members.
   The Governor shall appoint nine members, one of whom shall be a
hospital chief executive officer, one of whom shall be a chief
executive officer of a hospital serving a disproportionate share of
low-income patients, one of whom shall be a long-term care facility
chief executive officer, one of whom shall be a freestanding
ambulatory surgery clinic chief executive officer, one of whom shall
be a representative of the health insurance industry involved in
establishing premiums or underwriting, one of whom shall be a
representative of a group prepayment health care service plan, one of
whom shall be a representative of a business coalition concerned
with health, and two of whom shall be general members. The Speaker of
the Assembly shall appoint two members, one of whom shall be a
physician and surgeon and one of whom shall be a general member. The
Senate Committee on Rules shall appoint two members, one of whom
shall be a representative of a labor coalition concerned with health,
and one of whom shall be a general member.
   The Governor shall designate a member to serve as chairperson for
a two-year term. No member may serve more than two, two-year terms as
chairperson. All appointments shall be for four-year terms. No
individual shall serve more than two, four-year terms.
   (b) This section shall remain in effect only until July 1, 2009,
and as of that date is repealed, unless a later enacted statute, that
is enacted before July 1, 2009, deletes or extends that date.
  SEC. 2.  Section 128695 is added to the Health and Safety Code, to
read:
   128695.  (a) On and after July 1, 2009, any reference in this code
to the California Health Policy and Data Advisory Commission shall
be deemed a reference to the Health Care Cost and Quality
Transparency Committee created pursuant to Section 128855.
   (b) This section shall become operative on July 1, 2009.
  SEC. 3.  Section 128725 of the Health and Safety Code is amended to
read:
   128725.  The functions and duties of the commission shall include
the following:
   (a) Advise the office on the implementation of the new,
consolidated data system.
   (b) Advise the office regarding the ongoing need to collect and
report health facility data and other provider data.
   (c) Annually develop a report to the director of the office
regarding changes that should be made to existing data collection
systems and forms. Copies of the report shall be provided to the
Senate Committees on Health and Human Services and to the Assembly
Committee on Health.
   (d) Advise the office regarding changes to the uniform accounting
and reporting systems for health facilities.
   (e) Conduct public meetings for the purposes of obtaining input
from health facilities, other providers, data users, and the general
public regarding this chapter and Chapter 1 (commencing with Section
127125) of Part 2 of Division 107.
   (f) Advise the Secretary of Health and Welfare on the formulation
of general policies which shall advance the purposes of this part.
   (g) Advise the office on the adoption, amendment, or repeal of
regulations it proposes prior to their submittal to the Office of
Administrative Law.
   (h) Advise the office on the format of individual health facility
or other provider data reports and on any technical and procedural
issues necessary to implement this part.
   (i) Advise the office on the formulation of general policies which
shall advance the purposes of Chapter 1 (commencing with Section
127125) of Part 2 of Division 107.
   (j) Recommend, in consultation with a 12-member technical advisory
committee appointed by the chairperson of the commission, to the
office the data elements necessary for the production of outcome
reports required by Section 128745.
   (k) (1) The technical advisory committee appointed pursuant to
subdivision (j) shall be composed of two members who shall be
hospital representatives appointed from a list of at least six
persons nominated by the California Association of Hospitals and
Health Systems, two members who shall be physicians and surgeons
appointed from a list of at least six persons nominated by the
California Medical Association, two members who shall be registered
nurses appointed from a list of at least six persons nominated by the
California Nurses Association, one medical record practitioner who
shall be appointed from a list of at least six persons nominated by
the California Health Information Association, one member who shall
be a representative of a hospital authorized to report as a group
pursuant to subdivision (d) of Section 128760, two members who shall
be representative of California research organizations experienced in
effectiveness review of medical procedures or surgical procedures,
or both procedures, one member representing the Health Access
Foundation, and one member representing the Consumers Union. Members
of the technical 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 technical
advisory committee.
   (2) The commission shall submit its recommendation to the office
regarding the first of the reports required pursuant to subdivision
(a) of Section 128745 no later than January 1, 1993. The technical
advisory committee shall submit its initial recommendations to the
commission pursuant to subdivision (d) of Section 128750 no later
than January 1, 1994. The commission, with the advice of the
technical advisory committee, may periodically make additional
recommendations under Sections 128745 and 128750 to the office, as
appropriate.
   () (1) Assess the value and usefulness of the reports required by
Sections 127285, 128735, and 128740. On or before December 1, 1997,
the commission shall submit recommendations to the office to
accomplish all of the following:
   (A) Eliminate redundant reporting.
   (B) Eliminate collection of unnecessary data.
   (C) Augment databases as deemed valuable to enhance the quality
and usefulness of data.
   (D) Standardize data elements and definitions with other health
data collection programs at both the state and national levels.
   (E) Enable linkage with, and utilization of, existing data sets.
   (F) Improve the methodology and databases used for quality
assessment analyses, including, but not limited to, risk-adjusted
outcome reports.
   (G) Improve the timeliness of reporting and public disclosure.
   (2) The commission shall establish a committee to implement the
evaluation process. The committee shall include representatives from
the health care industry, providers, consumers, payers, purchasers,
and government entities, including the Department of Managed Health
Care, the departments that comprise the Health and Welfare Agency,
and others deemed by the commission to be appropriate to the
evaluation of the databases. The committee may establish
subcommittees including technical experts.
   (3) In order to ensure the timely implementation of the provisions
of the legislation enacted in the 1997-98 Regular Session that
amended this part, the office shall present an implementation work
plan to the commission. The work plan shall clearly define goals and
significant steps within specified timeframes that must be completed
in order to accomplish the purposes of that legislation. The office
shall make periodic progress reports based on the work plan to the
commission. The commission may advise the Secretary of Health and
Welfare of any significant delays in following the work plan. If the
commission determines that the office is not making significant
progress toward achieving the goals outlined in the work plan, the
commission shall notify the office and the secretary of that
determination. The commission may request the office to submit a plan
of correction outlining specific remedial actions and timeframes for
compliance. Within 90 days of notification, the office shall submit
a plan of correction to the commission.
   (m) (1) As the office and the commission deem necessary, the
commission may establish committees and appoint persons who are not
members of the commission to these committees as are necessary to
carry out the purposes of the commission. Representatives of area
health planning agencies shall be invited, as appropriate, to serve
on committees established by the office and the commission relative
to the duties and responsibilities of area health planning agencies.
Members of the standing committees shall serve without compensation,
but shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of these
committees.
   (2) Whenever the office or the commission does not accept the
advice of the other body on proposed regulations or on major policy
issues, the office or the commission shall provide a written response
on its action to the other body within 30 days, if so requested.
   (3) The commission or the office director may appeal to the
Secretary of Health and Welfare over disagreements on policy,
procedural, or technical issues.
   (n) This section shall remain in effect only until July 1, 2009,
and as of that date is repealed, unless a later enacted statute, that
is enacted before July 1, 2009, deletes or extends that date.
  SEC. 4.  Chapter 4 (commencing with Section 128850) is added to
Part 5 of Division 107 of the Health and Safety Code, to read:
      CHAPTER 4.  HEALTH CARE COST AND QUALITY TRANSPARENCY



      Article 1.  General Provisions


   128850.  The Legislature hereby finds and declares all of the
following:
   (a) The steady rise in health costs is eroding health access,
straining public health and finance systems, and placing an undue
burden on the state's economy.
   (b) The effective use and distribution of health care data and
meaningful analysis of that data will lead to greater transparency in
the health care system, resulting in improved health care quality
and outcomes, more cost-effective care, and improvements in life
expectancy, reduced death rates, and improved overall public health.
   (c) Hospitals, physicians, health care providers, and health
insurers that have access to systemwide performance data can use the
information to improve patient safety, efficiency of health care
delivery, and quality of care, which would lead to quality
improvement and cost savings throughout the health care system.
   (d) The State of California is uniquely positioned to collect,
analyze, and report all payer data on health care utilization,
quality, and costs in the state in order to facilitate value-based
purchasing of health care and to support and promote continuous
quality improvement among health plans and providers.
   (e) Establishing statewide data and common measurement, and
analyses of health care costs, quality, and outcomes will identify
appropriate health care utilization and ensure the highest quality of
health care services for all Californians.
   (f) Comprehensive statewide data and common measurement will allow
analysis of the provision of care, so that efforts can be undertaken
to improve health outcomes for all Californians, including those
groups with demonstrated health disparities.
   (g) It is therefore the intent of the Legislature that the State
of California assume a leadership role in measuring performance and
value in the health care system. By establishing the primary
statewide data and common measurement, and analyses of health care
costs, quality, and outcomes, and by providing sufficient revenues to
adequately analyze and report meaningful performance measures
related to health care costs, safety, and quality, the Legislature
intends to promote competition, identify appropriate health care
utilization, and ensure the highest quality of health care services
for all Californians.
   (h) The Legislature further intends to reduce duplication and
inconsistency in the collection, analysis, and dissemination of
health care performance information within state government and among
both public and private entities by coordinating health care data
development, collection, analysis, evaluation, and dissemination.
   (i) It is further the intent of the Legislature that the data
collected be used for the transparent public reporting of quality and
cost efficiency information regarding all levels of the health care
system, including health care service plans and health insurers,
hospitals and other health facilities, and medical groups,
physicians, and other licensed health professionals in independent
practice, so that health care plans and providers can improve their
performance and deliver safer, better health care more affordably; so
that purchasers can know which health care services reduce
morbidity, mortality, and other adverse health outcomes; so that
consumers can choose whether and where to have health care provided;
and so that policymakers can effectively monitor the health care
delivery system to ensure quality and value for all purchasers and
consumers.
   (j) The Legislature further intends that all existing duties,
powers, and authority relating to health care cost, quality, and
safety data collection and reporting under current state law continue
in full effect.
   128851.  As used in this chapter, the following terms have the
following meanings:
   (a) "Administrative claims data" means data that are submitted
electronically or otherwise to, or collected by, health insurers,
health care service plans, administrators, or other payers of health
care services and that are submitted to, or collected for, the
purposes of payment to any licensed health professional, medical
provider group, laboratory, pharmacy, hospital, imaging center, or
any other facility or person that is requesting payment for the
provision of medical care.
   (b) "Committee" means the Health Care Cost and Quality
Transparency Committee. 
   (1) All references to the California Health Policy and Data
Advisory Commission created pursuant to Section 128695 shall be
deemed to be references to the committee.  
   (2) All references to the technical advisory committee created
pursuant to subdivisions (j) and (k) of Section 128725 shall be
deemed to be references to the clinical advisory panel or technical
committee designated by the committee for this purpose. 
   (c) "Data source" means a licensed physician or any other licensed
health professional in independent practice, medical provider group,
health facility, health care service plan licensed by the Department
of Managed Health Care, health insurer certificated by the Insurance
Commissioner to sell health insurance, any state agency providing or
paying for health care or collecting health care data or
information, or any other payer for health care services in
California.
   (d) "Encounter data" means data related to treatment or services
rendered by providers to patients that may be reimbursed on a
fee-for-service statement.
   (e) "Group" or "medical provider group" means an affiliation of
physicians and other health care professionals, whether a
partnership, corporation, or other legal form, with the primary
purpose of providing medical care.
   (f) "Health facility" or "health facilities" means health
facilities required to be licensed pursuant to Chapter 2 (commencing
with Section 1250) of Division 2.
   (g) "Licensed health professional in independent practice" means a
licensed health professional who is authorized to order or direct
health services for patients or who is eligible to bill Medi-Cal for
services. The term includes, but is not limited to, nurse
practitioners, physician assistants, dentists, chiropractors, and
pharmacists.
   (h) "Office" means the Office of Statewide Health Planning and
Development.
   (i) "Risk-adjusted outcomes" means the clinical outcomes of
patients grouped by diagnoses or procedures, that have been adjusted
for demographic and clinical factors.
   (j) "Secretary" means the Secretary of California Health and Human
Services.
   128852.   (a)    Any limitation on the addition
of data elements or public reporting pursuant to Chapter 1
(commencing with Section 128675) shall be inapplicable to the extent
determined necessary to implement the responsibilities under this
chapter. All data collected by the office shall be available 
to the committee and secretary for the purposes of carrying out
their responsibilities under this chapter. The office shall make
available to the committee any and all data files, information, and
staff resources as may be necessary to assist in and support the
responsibilities of the committee.   ,   except
that this data shall not be made available in a manner that would
permit the linking of the information disclosed to the individual to
whom it pertains, unless the entity receiving the data is entitled to
receive that data pursuant to Section 1798.24 of the Civil Code.
 
   (b) The office shall make available to the committee any
information and staff resources as may be necessary to assist in and
support the responsibilities of the committee.  
   (c) All data collected by the office shall be available to any
entity with which the secretary has contracted pursuant to
subdivision (c) of Section 128865 as necessary for the purposes of
carrying out responsibilities under this chapter. However, this data
shall be made available in a manner that would prevent linking the
information disclosed to the individual to whom it pertains, unless
the entity receiving the data is entitled to receive that data
pursuant to Section 1798.24 of the Civil Code. 

      Article 2.  Health Care Cost and Quality Transparency Committee



   128855.  There is hereby created in the California Health and
Human Services Agency the Health Care Cost and Quality Transparency
Committee, composed of 16 members. The appointments shall be made as
follows:
   (a) The Governor shall appoint 10 members as follows:
   (1) One researcher with experience in health care data and cost
efficiency research.
   (2) One representative of private hospitals.
    (3) One representative of public hospitals.
    (4) One representative of an integrated multispecialty medical
group.
   (5) One representative of health insurers or health care service
plans.
   (6) One representative of licensed health professionals in
independent practice.
   (7) One representative of large employers that purchase group
health care coverage for employees and who is not also a supplier or
broker of health care coverage.
   (8) One representative of a labor union.
   (9) One representative of employers that purchase group health
care coverage for their employees or a representative of a nonprofit
organization that demonstrates experience working with employers to
enhance value and affordability of health care coverage.
   (10) One representative of pharmacists.
   (b) The Senate Committee on Rules shall appoint three members as
follows:
   (1) One representative of a labor union.
   (2) One representative of consumers with a demonstrated record of
advocating health care issues on behalf of consumers.
   (3) One representative of physicians and surgeons who is a
practicing patient-care physician licensed in the State of
California.
   (c) The Speaker of the Assembly shall appoint three members as
follows:
   (1) One representative of consumers with a demonstrated record of
advocating health care issues on behalf of consumers.
   (2) One representative of small employers that purchase group
health care coverage for employees and who is not also a supplier or
broker in health care coverage.
   (3) One representative of a nonprofit labor-management purchaser
coalition that has a demonstrated record of working with employers
and employee associations to enhance value and affordability in
health care.
   (d) The following members shall serve in an ex officio, nonvoting
capacity:
   (1) The Executive Officer of the California Public Employees
Retirement System or his or her designee.
   (2) The Director of the Department of Managed Health Care or his
or her designee.
   (3) The Insurance Commissioner or his or her designee.
   (4) The Director of the Department of Public Health or his or her
designee.
   (5) The Director of the State Department of Health Care Services
or his or her designee.
   (6) The Director of Statewide Health Planning and Development.

   (7) The executive director of the Managed Risk Medical Insurance
Board or his or her designee. 
   (e) The Governor shall designate a member to serve as chairperson
for a two-year term. No member may serve more than two, two-year
terms as chairperson. All appointments shall be for four-year terms,
as provided. However, the initial term shall be two years for members
initially filling the positions set forth in paragraphs (1), (2),
(4), and (6) of subdivision (a), paragraph (2) of subdivision (b),
and paragraph (2) of subdivision (c).
   128856.  The committee shall meet at least once every two months,
or more often, if necessary to fulfill its duties.
   128857.  The members of the committee shall receive reimbursement
for any actual and necessary expenses incurred in connection with
their duties as members of the committee.
   128858.  The secretary shall provide or contract for
administrative support for the committee.
   128859.  The committee shall do all of the following:
   (a) Develop and recommend to the secretary the health care cost
and quality transparency plan, as provided in Article 3 (commencing
with Section 128865).
   (b) Monitor the implementation of the health care cost and quality
transparency plan.
   (c) Issue an annual public report, on or before March 1, on the
status of implementing this chapter, the resources necessary to fully
implement this chapter, and any recommendations for changes to the
statutes, regulations, or the transparency plan that would advance
the purposes of this chapter.
   128860.  (a) The committee shall appoint at least one technical
committee, and may appoint additional technical committees as the
committee deems appropriate, and shall include on each technical
committee academic and professional experts with expertise related to
the activities of the committee.
   (b) (1) The committee shall appoint at least one clinical advisory
panel and may appoint additional panels specific to issues that
require additional or different clinical expertise. Each clinical
panel shall contain a majority of clinicians with expertise related
to the activities of the committee and any issue under consideration
and shall also include experts in collecting and reporting data. Each
clinical panel shall also include three members of the committee,
one of whom shall be a representative of hospitals or health
professionals, one of whom shall be a representative of health plans,
health insurers, or integrated multispeciality medical groups, and
one of whom shall be a representative of consumers, purchasers, or
labor unions.
   (2) For the initial plan, the committee shall appoint at least one
advisory clinical panel that shall do all of the following:
   (A) Issue a written report of recommendations to implement the
goals set forth by the committee, including how to measure quality
improvement, necessary data elements, and appropriate risk-adjustment
methodology. The report shall be submitted to the committee within
the time period specified by the committee. The committee shall
either adopt the recommendations of the clinical panel or, by a
two-thirds vote of the committee, reject the recommendations. If the
committee rejects the recommendations, it shall issue a written
finding and rationale for rejecting the recommendations, and shall
refer the issue back to the clinical panel and request additional or
modified recommendations in specific areas in which the committee
found the recommendations deficient.
   (B) Make recommendations to the committee concerning the specific
data to be collected and the methods of collection to implement this
chapter, assure that the results are statistically valid and
accurate, and state any limitations on the conclusions that can be
drawn from the data.
   (C) Make recommendations concerning the measures necessary to
implement the reporting requirements in a manner that is cost
effective, reasonable for data sources, and is reliable, timely, and
relevant to consumers, purchasers, and health providers.
   (c) The members of the technical committees and clinical advisory
panels shall be reimbursed for any actual and necessary expenses
incurred in connection with their duties as members of the technical
committee or clinical advisory panel.
   (d) The committee shall provide opportunities for participation
from consumers and patients as well as purchasers and providers at
all committee meetings.
   128861.  The committee, technical committee, and clinical advisory
panel members, and any contractors, shall be subject to the
conflict-of-interest policy of the California Health and Human
Services Agency.
   128862.  (a) On and after July 1, 2009, any reference in this code
to the California Health Policy and Data Advisory Commission shall
be deemed a reference to the Health Care Cost and Quality
Transparency Committee created pursuant to Section 128855.
   (b) On and after July 1, 2009, any reference in this code to the
technical advisory committee appointed by the chairperson of the
California Health Policy and Data Advisory Commission shall be deemed
a reference to the technical committee or committees or the clinical
advisory panel or panels appointed by the Health Care Cost and
Quality Transparency Committee pursuant to Section 128860. 
   (c) Effective July 1, 2009, the California Health Policy and Data
Advisory Commission created pursuant to Section 128695 and the
technical advisory committee created pursuant to subdivisions (j) and
(k) of Sections 128725 are abolished. 

      Article 3.  Health Care Cost and Quality Transparency Plan


   128865.  (a) (1) The committee, within one year after its first
meeting, shall develop and recommend to the secretary an initial
health care cost and quality transparency plan.
   (2) The committee shall periodically review and recommend updates
to the Health Care Cost and Quality Transparency Plan. The committee
shall                                               conduct a full
review every three years, and any recommendations resulting from the
review shall be subject to Section 128866.
   (3) The initial plan and updates to the plan shall result in
public reporting of safety, quality, and cost efficiency information
on the health care system. The purpose of the plan shall be to
improve health care cost efficiency, improve health system
performance, and promote quality patient outcomes.
   (4) In developing the initial plan and updates to the plan, the
committee shall review existing data gathering and reporting,
including existing voluntary efforts.
   (5) In developing the initial plan and updates to the plan, the
committee shall obtain the recommendation of the relevant clinical
advisory panel or panels, if any, on the measures to be reported.
   (b) The plan shall include, but not be limited to, strategies to
do all of the following:
   (1) Measure and collect data related to health care safety and
quality, utilization, health outcomes, and cost of health care
services from health plans and insurers, medical groups, health
facilities, and licensed health professionals.
   (2) Measure each of the performance domains, including, but not
limited to, safety, timeliness, effectiveness, efficiency, quality,
and other domains as appropriate.
   (3) Develop a valid methodology for collecting and reporting cost
and quality information to ensure the integrity of the data and
reflect the intensity, cost, and scope of services provided, and that
the data are collected from the most appropriate data source.
   (4) Measure and collect data related to disparities in health
outcomes among various populations and communities, including racial
and ethnic groups.
   (5) Use and build on existing data collection standards, methods,
and definitions to the greatest extent possible to accomplish the
goals of this article in an efficient and effective manner including
the data collected by the state and federal governments.
   (6) Incorporate and utilize administrative claims data to the
extent it is the most efficient method of collecting valid and
reliable data.
   (7) Improve coordination, alignment, and timeliness of data
collection, state and federal reporting practices and standards, and
existing mandatory and voluntary measurement and reporting activities
by existing public and private entities, taking into account the
reporting burden on providers.
   (8) Provide public reports, analyses, and data on the health care
quality, safety, and performance measures of health plans and
insurers, medical groups, health facilities, licensed physicians, and
other licensed health professionals in independent practice, that
are accurate, statistically valid, and descriptive of how the data
were derived.
   (9) Maintain patient confidentiality consistent with  all
applicable  federal and state medical and patient privacy laws
 at all times  .
   (10) Coordinate and streamline existing related data collection
and reporting activities within state government.
   (11) Participate in the monitoring of plan implementation,
including a timeline and prioritization of the planned data
collection, analyses, and reports.
   (12) Participate in the monitoring of data collection, continuous
quality improvement, and reporting functions.
   (13) Assess compliance with data collection requirements needed to
implement this chapter.
   (14) Recommend a fee schedule sufficient to fund the
implementation of this chapter.
   (c) The secretary may contract with a qualified public or private
agency or academic institution to assist in the review of existing
data collection programs or to conduct other research or analysis
deemed necessary for the committee or secretary to complete and
implement the Health Care Cost and Quality Transparency Plan or to
meet the obligations of this chapter.
   128866.  (a) Within  60   90  days of
receipt of the Health Care Cost and Quality Transparency Plan
recommended by the committee, the secretary shall do one of the
following:
   (1) Advise the committee that the recommended plan is accepted and
implementing regulations shall be drafted and submitted to the
Office of Administrative Law pursuant to the Administrative
Procedures Act, Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code.
   (2) Refer the plan back to the committee and request additional or
modified recommendations in specific areas in which the secretary
finds the plan is deficient. If referred back to the committee, the
secretary shall respond to any modified recommendation in the manner
provided in this section.
   (b) Every six years after implementation, commencing with 2014,
the secretary shall report to the Legislature on the work of the
committee and whether the committee should be continued in the manner
described in this article or whether changes should be made to the
law.

      Article 4.  Implementation of the Health Care Quality and
Transparency Plan


   128867.  (a) After acceptance of the plan pursuant to Section
128866, the secretary shall be responsible for timely implementation
of the approved plan. The secretary shall ensure timely
implementation by the office, which shall include, but not be limited
to, all of the following:
   (1) Provide data, information, and reports as may be required by
the committee to assist in its responsibilities under this chapter.
   (2) Determine the specific data to be collected and the methods of
collection to implement this chapter, consistent with the approved
plan, and ensure that the results are statistically valid and
accurate, as well as risk-adjusted, where appropriate.
   (3) Determine the measures necessary to implement the reporting
requirements in a manner that is cost effective and reasonable for
data sources, and is timely, relevant, and reliable for consumers,
purchasers, and providers.
   (4) Collect the data consistent with the data reporting
requirements of the approved plan, including, but not limited to,
data on quality, health outcomes, cost, and utilization.
   (5) Audit, as necessary, the accuracy of any or all data submitted
to the lead agency pursuant to this chapter.
   (6) Seek to establish agreements for voluntary reporting of health
care claims and data from any and all health care data sources that
are not subject to mandatory reporting pursuant to this chapter, in
order to ensure the most comprehensive systemwide data on heath care
costs and quality.
   (7) Fully protect patient privacy and confidentiality, in
compliance with federal and state privacy laws, while preserving the
ability to analyze data. Any individual patient information obtained
pursuant to this chapter shall be exempt from the disclosure
requirements of the Public Records Act (Chapter 3.5 (commencing with
Section 6250) of Division 7 of Title 1 of the Government Code).
   (8) Adopt the same procedures for health care providers as those
specified in Section 128750 and adopt substantially similar
procedures for other data sources to ensure that all data sources
identified in any outcome report have a reasonable opportunity to
review, comment on, and appeal any outcome report in which the data
source is identified before it is released to the public.
   (b) The secretary and office shall consult with the committee in
implementing this chapter, and shall cooperate with the committee in
fulfilling the committee's responsibility to monitor implementation
activities.
   (c) All state agencies shall cooperate with the secretary and the
office to implement the Health Care Cost and Quality Transparency
Plan approved by the secretary.
   (d) The secretary or the office shall adopt regulations as are
necessary to carry out the requirements of this chapter.
   128868.  Nothing in this chapter shall be construed to authorize
the disclosure of any confidential information concerning contracted
rates between health care providers and payers or any other data
source, but nothing in this section shall prevent the disclosure of
information on the relative or comparative cost to payers or
purchasers of health care services, consistent with the requirements
of this chapter.
   128869.  (a) Patient social security numbers and any other data
elements that the office believes may be used to determine the
identity of an individual patient 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).
   (b) No person reporting data pursuant to this section shall be
liable for damages in any action based on the use or misuse of
patient-identifiable data that has been mailed or otherwise
transmitted to the office pursuant to the requirements of this
chapter.
   (c) No communication of data or information by a data source to
the committee, the secretary, or the office shall constitute a waiver
of privileges preserved by Section 1156, 1156.1, or 1157 of the
Evidence Code or Section 1370.
   (d) Information, documents, or records from original sources
otherwise subject to discovery or introduction into evidence shall
not be immune from discovery or introduction into evidence merely
because they were also provided to the committee or office pursuant
to this chapter.
   128870.   (a) The office shall solicit input from interested
stakeholders and convene meetings to receive input on the creation of
a fee schedule to implement this section. This stakeholder process
shall occur in a manner that allows for meaningful review of the
information and fiscal projections by the interested stakeholders.
After the stakeholder process has been convened and used in the
development of a proposal, the office shall provide the secretary
with a proposal that will, to the extent possible, identify a fee
schedule and other financial resources for the implementation of this
chapter and allow for the recovery of costs of implementing
centralized data collection, and effective analysis and reporting
activities under this chapter.
   (b) The schedule of fees, including specific fees charged to each
data source and user, shall be  approved by the Legislature
and Governor in the annual Budget Act   evaluated by the
Legislature as a part of the annual Budget Act process  . The
annual budget of the committee shall be presented and justified to
the Legislature with an annual work plan including a description of
the data sources, data, elements, use of the data, and the number and
frequency of reports to be made available. Fees collected shall not
exceed the cost of implementing this chapter, including technical and
administrative support for the committee, the technical committee or
committees, and the clinical advisory panel or panels, as well as
the activities of the office arising from this article.
   (c) The total amount of fees charged by the office to a hospital
to recover the costs of implementing this chapter, and the fees
charged to that hospital pursuant to Section 127280 shall not exceed
0.06 percent of the gross operating cost of the hospital for the
provision of health care services for its last fiscal year that ended
on or before June 30 of the preceding calendar year. 
   (d) The office shall recover its costs in implementing this
chapter by assessing and collecting fees from data sources and data
users in accordance with the fee schedule approved by the secretary.
The office shall annually evaluate the fee schedule to determine
whether the fees are sufficient to fund the actual costs of
implementing this chapter. The office shall also evaluate the fees to
ensure that data sources and data users are equitably assessed and
that no one source or user is assessed in a disproportionate manner.
If the evaluation shows that the fees are excessive, or are
insufficient to fund the actual costs of implementing these programs,
the secretary shall propose an adjustment to the fees for evaluation
by the Legislature during the annual Budget Act process. 

   (d) 
    (e)  No fees shall be assessed or collected pursuant to
this section from any state department, authority, bureau,
commission, or officer, unless federal financial participation would
become available by doing so and an appropriation is included in the
annual Budget Act for that state department, authority, bureau,
commission, or officer for this purpose.
   128871.  There is hereby established in the State Treasury the
Health Care Cost and Quality Transparency Fund to support the
implementation of this chapter. All fees and contributions collected
by the office pursuant to Section 128870 shall be deposited in this
fund and used to support the implementation of this chapter.
Expenditures shall be subject to appropriation in the annual Budget
Act.