BILL ANALYSIS Ó
------------------------------------------------------------
|SENATE RULES COMMITTEE | SB 1196|
|Office of Senate Floor Analyses | |
|1020 N Street, Suite 524 | |
|(916) 651-1520 Fax: (916) | |
|327-4478 | |
------------------------------------------------------------
CONSENT
Bill No: SB 1196
Author: Hernandez (D), et al.
Amended: 4/10/12
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 4/18/12
AYES: Hernandez, Harman, Alquist, Anderson, Blakeslee, De
León, DeSaulnier, Rubio, Wolk
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
SUBJECT : Claims data disclosure
SOURCE : Author
DIGEST : This bill prohibits a health care services plan
(health plan) or health insurance contract between a
plan/insurer (carrier) and a provider, including a provider
of supplies, from prohibiting, conditioning, or in any way
restricting the disclosure of claims data related to health
care services provided to enrollees, insureds, or
beneficiaries of any self-funded health coverage
arrangement to an entity certified by the Centers for
Medicare & Medicaid Services to generate public reports on
the performance of health care providers.
ANALYSIS :
Existing law:
CONTINUED
SB 1196
Page
2
1. Provides for the regulation of health plans by the
Department of Managed Health Care and for the regulation
of health insurance by the Department of Insurance.
2. Prohibits contracts between carriers and hospitals or
health care facilities owned by a licensed hospital from
containing any provision that restricts the ability of
the carrier from furnishing information to subscribers,
enrollees, policyholders, or insureds concerning cost
range of procedures or the quality of services.
3. Provides hospitals at least 20 days in advance to review
the methodology and data developed and compiled by the
carriers, requires utilization of appropriate risk
adjustment factors for quality data, requires a
disclosure on the carrier's website about the data
developed and compiled by the carriers and an
opportunity for a hospital to provide a link where the
hospital's response to the data can be accessed.
This bill prohibits any health plan or health insurance
contract between a carrier and a provider, including a
provider of supplies, from prohibiting, conditioning, or in
any way restricting the disclosure of claims data related
to health care services provided to enrollees, insureds, or
beneficiaries of any self-funded health coverage
arrangement to an entity certified by the Centers for
Medicare & Medicaid Services to generate public reports on
the performance of health care providers.
Background
Managing costs . According to a February 2008 California
HealthCare Foundation (CHCF) fact sheet, consumers are
paying more attention to the cost of their health care
because they have greater responsibility for paying for it.
People with insurance are coping with higher deductibles
and copayments and some are being offered consumer-driven
health savings accounts as an alternative to traditional
insurance. Those who lack health insurance have an even
more daunting task of anticipating and managing their
health care costs. Whether insured or uninsured, consumers
need to understand their financial liability and find the
best value. Additionally, employers have an increased
CONTINUED
SB 1196
Page
3
interest in price transparency in order to improve health
care outcomes for their employees and to slow the growth
rate of health care expenditures. Despite this, consumers
often do not have the tools to make informed decisions
based on cost and quality of care because some providers
have prevented price and quality information from being
disclosed.
Usefulness of data . A March 2006 report by The
Commonwealth Fund argues knowing prices of health care
services is of little value without information on the
total cost of caring for a given condition and the quality
or outcomes of that care. Transparency and better public
information on cost and quality are essential for three
reasons: (1) To help providers improve by benchmarking
their performance against others; (2) to encourage private
insurers and public programs to reward quality and
efficiency; and (3) to help patients make informed
decisions about their care. Transparency can also play an
important role in leveling the playing field, as it can
shed light on the practice of charging patients different
prices for the same care. A March 31, 2012 Los Angeles
Times article entitled, "The bizarre calculus of emergency
room charges," highlighted a number of discrepancies in
charges for health care services that, at times, did not
seem to make sense. For example, a man with health
insurance was billed $13,000 for an MRI scan of his
shoulder that required him to pay $2,500 out of pocket
while his brother-in-law, who lacks health care coverage,
was billed $350 for the same procedure.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 4/30/12)
Blue Shield of California
California School Employees Association, AFL-CIO
Pacific Business Group on Health
San Diego Electrical Pension Trust
Small Business California
ARGUMENTS IN SUPPORT : Blue Shield of California states
that this bill advances an important provision of the ACA
CONTINUED
SB 1196
Page
4
that promotes transparency in the provision of health care
services, giving beneficiaries access to information that
will help them make more informed decisions about their
health care. The California School Employees Association,
AFL-CIO (CSEA), writes that this bill will make it possible
for consumers and purchasers to access data on cost,
quality, and health care outcomes, so they can make
informed decisions. CSEA states that it is absolutely
important to have data available so that comparisons and
important health care analyses on cost, quality, and
performance can be done. The Pacific Business Group on
Health argues public disclosure of the relative quality and
cost of
providers drives improved quality and cost transparency
more rapidly than private reporting.
CTW:mw 5/1/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
**** END ****
CONTINUED