BILL NUMBER: SB 1196	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  JUNE 28, 2012
	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 related to health care services provided to
specified individuals, to a qualified entity, as defined. The bill
would further 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.  (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 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.
  hospital, a skilled nursing facility, a comprehensive
outpatient rehabilitation facility, a home health agency, a hospice,
a clinic, or a rehabilitation agency. 
   (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.
  physician and surgeon or other health care
practitioner, or an entity that furnishes health care services other
than a provider. 
  SEC. 2.  Section 10117.52 is added to the Insurance Code, to read:
   10117.52.  (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 or a supplier shall prohibit,
condition, or in any way restrict the disclosure of claims data
related to health care services provided to  insureds
  a policyholder or insured of the insurer  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.
  hospital, a skilled nursing facility, a comprehensive
outpatient rehabilitation facility, a home health agency, a hospice,
a clinic, or a rehabilitation agency. 
   (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.
  physician and surgeon or other health care
practitioner, or an entity that furnishes health care services other
than a provider. 
  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.