BILL NUMBER: SB 1196	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 19, 2012
	AMENDED IN SENATE  APRIL 10, 2012
	AMENDED IN SENATE  MARCH 26, 2012

INTRODUCED BY   Senator Hernandez
   (Coauthor: Senator Gaines)

                        FEBRUARY 22, 2012

   An act to add Section 1367.50 to the Health and Safety Code, and
to add Section 10117.52 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 1196, as amended, Hernandez. Claims data disclosure.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensing and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law provides for the
regulation of health insurers by the Insurance Commissioner. Except
as specified, existing law prohibits a provider of health care, a
health care service plan, or contractor from disclosing medical
information regarding a patient of the provider of health care or an
enrollee or subscriber of a health care service plan without first
obtaining an authorization.
   Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), requires the Secretary of Health and Human Services to
make available to qualified entities, as defined, specified claims
data relating to Medicare in order to evaluate the performance of
providers and suppliers.
   This bill would provide that no contract in existence or issued,
amended, or renewed on or after January 1, 2013, between a health
care service plan or a health insurer and a provider  or supplier
 , as specified, shall prohibit, condition, or in any way
restrict the disclosure of claims  data,   data
 related to health care services provided to specified
individuals, to a qualified entity, as defined.  The bill would
furthe   r require a qualified entity to comply with the
requirements established by PPACA, as well as with any rules, 
 regulations, and guidelines adopted pursuant to that law, as
specified, relative to data obtained pursuant to these provisions.

   Because a willful violation of the act by a health care service
plan would constitute 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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


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

  SECTION 1.  Section 1367.50 is added to the Health and Safety Code,
to read:
   1367.50.   Notwithstanding Section 56.10 of the Civil
Code, no  (a)     No  contract in
existence or issued, amended, or renewed on or after January 1,
2013, between a health care service plan and a provider  ,
including a provider of supplies,   or a supplier 
shall prohibit, condition, or in any way restrict the disclosure of
claims data related to health care services provided to an enrollee
or subscriber of the health care service plan or beneficiaries of any
self-funded health coverage arrangement administered by the health
care service plan, to a qualified entity, as defined in Section
1395kk of Title 42 of the United States Code.  A qualified entity
shall comply with all requirements established pursuant to Section
1395kk of Title 42 of the United States Code, and with any rules,
regulations, and guidelines adopted pursuant to PPACA, to ensure the
privacy and security of the data obtained under this section. A
qualified entity shall also comply with all rules, regulations, and
guidelines adopted pursuant to PPACA governing provider and supplier
requests for error correction for data obtained under this section.
 
   (b) For purposes of this section, the following definitions apply:
 
   (1) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152). 

   (2) "Provider" means a "provider" as defined in Section 400.202 of
Title 42 of the Code of Federal Regulations, but does not include a
provider to the extent that it participates in Medicare.  
   (3) "Supplier" means a "supplier" as defined in Section 400.202 of
Title 42 of the Code of Federal Regulations, but does not include a
supplier to the extent that it participates in Medicare. 
  SEC. 2.  Section 10117.52 is added to the Insurance Code, to read:
   10117.52.   Notwithstanding any other provision of law, no
  (a)    No  health insurance
contract in existence or issued, amended, or renewed on or after
January 1, 2013, between a health insurer and a provider  ,
including a provider of supplies,   or a supplier 
shall prohibit, condition, or in any way restrict the disclosure of
claims data related to health care services provided to insureds or
beneficiaries of any self-insured health coverage arrangement
administered by the insurer, to a qualified entity, as defined in
Section 1395kk of Title 42 of the United States Code.  A
qualified entity shall comply with all requirements established
pursuant to that section, and with any rules, regulations, and
guidelines adopted pursuant to PPACA, to ensure the privacy and
security of the data obtained under this section. A qualified entity
shall also comply with all rules, regulations, and guidelines adopted
pursuant to PPACA governing provider and supplier requests for error
correction for data obtained under this section.  
   (b) For purposes of this section, the following definitions apply:
 
   (1) "PPACA" means the federal Patient Protection and Affordable
Care Act (PPACA, Public Law 111-148), as amended by the federal
Health Care and Education Reconciliation Act of 2010 (Public Law
111-152).  
   (2) "Provider" means a "provider" as defined in Section 400.202 of
Title 42 of the Code of Federal Regulations, but does not include a
provider to the extent that it participates in Medicare.  
   (3) "Supplier" means a "supplier" as defined in Section 400.202 of
Title 42 of the Code of Federal Regulations, but does not include a
supplier to the extent that it participates in Medicare. 
  SEC. 3.  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.