BILL NUMBER: SB 1322 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY JUNE 17, 2014
AMENDED IN SENATE APRIL 1, 2014
INTRODUCED BY Senator Hernandez
FEBRUARY 21, 2014
An act to add Sections 127670 and 127671 to
Chapter 8 (commencing with Section 127670) to Part 2 of Division
107 of, and to repeal the heading of Chapter 8 ( formerly
commencing with Section 127670) of Part 2 of Division 107 of,
the Health and Safety Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 1322, as amended, Hernandez. California Health Care
Quality Improvement and Cost Containment Commission.
Cost and Quality Database.
Existing law establishes health care coverage programs to provide
health care to segments of the population meeting specified criteria
who are otherwise unable to afford health care coverage and provides
for the licensure and regulation of health insurers and health care
service plans.
This bill would state the intent of the Legislature to
make available establish a system to provide
valid health care performance information to
encourage health care providers and facilities that is
publicly available and can be used to improve the safety,
appropriateness, and medical effectiveness of health care, and
to provide care that is safe, medically effective, patient-centered,
timely, efficient, affordable, and
equitable. The bill would require the Secretary of California
Health and Human Services to, no later than January 1, 2016, enter
into a contract with one or more private, independent, nonprofit
organizations to establish and administer the California Health Care
Cost and Quality Database. The bill would require the secretary to
include specified terms in that contract or contracts,
including, among others, that the nonprofit organization or
organizations establishing and administering the California Health
Care Cost and Quality Database develop methodologies relating to the
submission of health care data by health care entities. The bill
would require certain health care entities, including health care
service plans, to provide specified information to the nonprofit
organization or organizations establishing and administering the
California Health Care Cost and Quality Database. The bill would
require all data disclosures made pursuant to these provisions to
comply with all applicable state and federal laws for the protection
of the privacy and security of the data and would prohibit the public
disclose of any unaggregated, individually identifiable health
information. The bill would require the nonprofit organization or
organizations establishing and administering the California Health
Care Cost and Quality Database to collect, process, maintain, and
analyze information from specified data sources including,
among others, electronic health record systems and disease and
chronic condition registries. The bill would require, no later than
January 1, 2018, the nonprofit organization or organizations
establishing and administering the California Health Care Cost and
Quality Database to publicly make available a web-based, searchable
database and would require that database to be updated
regu larly.
This bill would also require the
Governor secretary to convene the
California Health Care Quality Improvement and Cost Containment
Commission and would specify the composition of the commission. The
bill would require the commission to examine and address specified
health care issues. an advisory committee
composed of a broad spectrum of health care stakeholders and experts
to research and recommend strategies for promoting high-quality
health care and containing health care costs, and to make
recommendations regarding the California Health Care Cost and Quality
Database. The bill would require the commission
committee to issue a report to the Legislature
and the Governor, on or before July 1, 2015, or within 6
months of the commission being convened, whichever occurs later,
making recommendations for health care quality improvement and cost
containment. Governor that examines and addresses
specified issues, including, among others, containing the cost of
health care services and coverage. The bill would provide that
the commission not be convened until the Director of Finance has
determine d that sufficient private or federal
funds have been received and appropriated for that purpose.
purpose, and that members of the committee not receive
a per diem or travel expense reimbursement, or any other expense
reimbursement.
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. The heading of Chapter 8 (formerly
commencing with Section 127670) of Part 2 of Division 107 of the
Health and Safety Code , as amended by Section
230 of Chapter 183 of the Statutes of 2004, is repealed.
CHAPTER 8. CALIFORNIA HEALTH CARE QUALITY IMPROVEMENT AND COST
CONTAINMENT COMMISSION
SEC. 2. Chapter 8 (commencing with Section 127670)
is added to Part 2 of Division 107 of the Health and
Safety Code , to read:
CHAPTER 8. CALIFORNIA HEALTH CARE COST AND QUALITY DATABASE
127670. (a) It is the intent of the Legislature to establish a
system to provide valid health care performance information that is
publicly available and can be used to improve the safety,
appropriateness, and medical effectiveness of health care, and to
provide care that is patient-centered, timely, affordable, and
equitable. It is also the intent of the Legislature to grant access
to provider performance information to consumers and purchasers in
order for them to understand the potential financial consequences and
liabilities and obtain maximum quality and value in health care
services.
(b) It is the intent of the Legislature, by making cost and
quality data available, 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.
127671. (a) The Secretary of California Health and Human Services
shall, no later than January 1, 2016, use a competitive process to
contract with one or more private, independent, nonprofit
organizations in order to establish and administer the California
Health Care Cost and Quality Database. A contract entered into
pursuant to this section is exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code, and is
exempt from review or approval by any division of the Department of
General Services.
(b) The secretary shall include as a term in the contract or
contracts entered into pursuant to subdivision (a) all of the
following:
(1) A requirement that the nonprofit organization or organizations
establishing and administering the California Health Care Cost and
Quality Database do all of the following:
(A) Develop methodologies for the collection, validation,
refinement, analysis, comparison, review, reporting, and improvement
of health care data submitted by health care entities that are
validated, recognized as reliable, and meet industry and research
standards.
(B) Receive information from all types of health care entities and
report that information in a form that allows valid comparisons
across care delivery systems.
(C) 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 claims data
received, including, but not limited to, data from sources other than
Medicare.
(2) A prohibition on the nonprofit organization or organizations
establishing and administering the California Health Care Cost and
Quality Database doing either of the following:
(A) Using the data received during the execution of the contract
for any purpose not specified in this chapter or in the contract.
(B) Receiving funding from any other source to accomplish the same
purposes sought to be accomplished under this chapter.
(3) A requirement that the nonprofit organization or organizations
establishing and administering the California Health Care Cost and
Quality Database identify the type of data, purpose of use, and
entities and individuals that are required to report to, or that may
have access to, the Health Care Cost and Quality Database.
(c) For the purposes implementing the California Health Care Cost
and Quality 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, or a multiemployer self-insured plan, that is
responsible for paying for health care services provided to
beneficiaries, the trust administrator for a multiemployer
self-insured plan, 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 provide
both of the following to the nonprofit organization or organizations
establishing and administering the California Health Care Cost and
Quality Database:
(1) Utilization data from insurers' medical, dental, and pharmacy
claims and encounter data from entities that do not use claims data,
including, but not limited to, integrated delivery systems.
(2) Pricing information for health care items and services
gathered from allowed charges for covered health care items and
services or, in the case of organizations that do not use or produce
individual claims, standard price lists.
(d) (1) All disclosures 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 the data, including, but
not limited to, the federal Health Insurance Portability and
Accountability Act of 1996 (Public Law 104-191) and 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.
(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 nonprofit organization or organizations establishing
and administering the California Health Care Cost and Quality
Database 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.
(e) (1) The nonprofit organization or organizations establishing
and administering the California Health Care Cost and Quality
Database shall collect, process, maintain, and analyze information
from data sources including, but not limited to, claims from private
and public payers, electronic health record systems, disease and
chronic condition registries, third-party surveys of quality and
patient satisfaction, reviews by licensing and accrediting bodies,
and local and regional public health data. Aggregated payer and
provider performance on validated measures of clinical quality and
patient experience, such as measures from the Healthcare
Effectiveness Data and Information Set (HEDIS) and Consumer
Assessment of Healthcare Providers and Systems (CAHPS), shall be
collected from accrediting organizations, including, but not limited,
to the National Committee for Quality Assurance (NCQA), URAC, and
the Joint Commission.
(2) The nonprofit organization or organizations establishing and
administering the California Health Care Cost and Quality Database
shall include all of the following in an analysis performed pursuant
to paragraph (1):
(A) Population-level data on prevention, screening, and wellness
utilization.
(B) Population-level data on behavioral and medical risk factors,
interventions and outcomes.
(C) Population-level data on chronic conditions, management, and
outcomes.
(D) Population-level data on trends in utilization of procedures
for treatment of similar conditions to evaluate medical
appropriateness.
(E) Data that permits socioeconomic status and disparities in care
due to race, ethnicity, gender, sexual orientation, and gender
identity to be considered.
(f) No later than January 1, 2018, the nonprofit organization or
organizations establishing and administering the California Health
Care Cost and Quality Database shall make publicly available a
web-based, searchable database. The information shall be presented in
a way that facilitates comparisons of cost, quality, and
satisfaction across payers, provider organizations, and other
suppliers of health care services. This public database shall be
regularly updated to reflect new data submissions.
127672. (a) The Secretary of California Health and Human Services
shall convene an advisory committee, composed of a broad spectrum of
health care stakeholders and experts to research and recommend
appropriate and timely strategies for promoting high-quality health
care, containing health care costs, and making recommendations
regarding the establishment, implementation, and ongoing
administration of the California Health Care Cost and Quality
Database, including a business plan for sustainability without using
moneys from the General Fund. The advisory committee shall hold
public meetings with stakeholders, solicit input, and set its own
meeting agendas. Meetings of the advisory 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 a report to
the Legislature and the Governor based on the findings of the
advisory committee, including input from the public meetings, that
shall, at a minimum, examine and address the following issues:
(1) Assessing California health care needs and available
resources.
(2) Containing the cost of health care services and coverage.
(3) Improving the quality and medical appropriateness of health
care.
(4) Increasing the transparency of health care costs and the
relative efficiency with which care is delivered.
(5) 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.
(6) Efficient utilization of prescription drugs and technology.
(7) Reducing unnecessary, inappropriate, and wasteful health care.
(8) Educating consumers in the use of health care information.
(9) Using existing data sources to build the Health Care Cost and
Quality Database.
(c) The advisory committee established pursuant to this section
shall not be convened until the Director of Finance has determined
that sufficient private or federal funds have been received and that
the funds have been appropriated for that purpose.
(d) Notwithstanding any other provision of law, the members of the
advisory committee shall receive no per diem or travel expense
reimbursement, or any other expense reimbursement.
SECTION 1. Section 127670 is added to the
Health and Safety Code, to be added to Chapter 8 (formerly commencing
with Section 127670) of Part 2 of Division 107, to read:
127670. (a) It is the intent of the Legislature to make available
valid performance information to encourage health care providers and
facilities to provide care that is safe, medically effective,
patient-centered, timely, efficient, and equitable. It is also the
intent of the Legislature to put provider performance information
into the hands of consumers and purchasers so that they are able to
understand their financial liability and find the best quality and
value.
(b) It is the intent of the Legislature 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.
SEC. 2. Section 127671 is added to the Health
and Safety Code, to be added to Chapter 8 (formerly commencing with
Section 127670) of Part 2 of Division 107, to read:
127671. (a) The Governor shall convene the California Health Care
Quality Improvement and Cost Containment Commission to research and
recommend appropriate and timely strategies for promoting
high-quality care and containing health care costs.
(b) The commission shall be composed of 13 members who are
knowledgeable about the health care system and health care spending.
(c) The Governor shall appoint five members of the commission, the
Senate Committee on Rules shall appoint three members, and the
Speaker of the Assembly shall appoint three members. The membership
shall be comprised of at least one of each of the following:
(1) A representative of California's business community.
(2) A representative from organized labor.
(3) A representative of consumers.
(4) A health care practitioner.
(5) A hospital industry representative.
(6) A representative of the health insurance industry.
(7) A representative of the legal community with expertise in
health and ethics.
(8) A representative of persons with disabilities.
(9) A health care economist.
(d) The Secretary of the California Health and Human Services
Agency and the Executive Director of Covered California shall serve
as members of the commission.
(e) The Governor shall appoint the chairperson of the commission.
(f) The commission shall, on or before July 1, 2015, or within six
months of the convening of the commission, whichever occurs later,
issue a report to the Legislature and the Governor making
recommendations for health care quality improvement and cost
containment. The commission shall, at a minimum, examine and address
the following issues:
(1) Assessing California health care needs and available
resources.
(2) Containing the cost of health care services and coverage.
(3) Improving the quality of health care.
(4) Increasing the transparency of health care costs and the
relative efficiency with which care is delivered.
(5) Use of disease management, wellness, prevention, and other
innovative programs to keep people healthy while reducing costs and
improving health outcomes.
(6) Consolidation of existing state programs to achieve
efficiencies where possible.
(7) Efficient utilization of prescription drugs and technology.
(g) The commission established pursuant to this section shall not
be convened until sufficient private or federal funds have been
received and appropriated for that purpose.