BILL NUMBER: SB 1159 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 31, 2016
AMENDED IN SENATE MARCH 28, 2016
INTRODUCED BY Senator Hernandez
FEBRUARY 18, 2016
An act to add 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 1159, as amended, Hernandez. California Health Care 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 require certain health care entities, including
health care service plans, to provide specified information to the
Secretary of California Health and Human Services. The bill would
authorize the secretary to report a health care entity that fails to
comply with that requirement to the health care entity's regulating
agency and would authorize the regulating agency to enforce that
requirement using its existing enforcement procedures.
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 data and would prohibit
the public disclosure of any unaggregated, individually identifiable
health information. The bill would require that certain
confidentially negotiated contract terms be protected in data
disclosures made pursuant to these provisions and would prohibit
certain individually identifiable proprietary contract information
from being disclosed in an unaggregated format. The bill would
authorize the secretary to enter into contracts or agreements to
share the information collected under the bill, under prescribed
conditions.
This bill would also require the secretary to convene an advisory
committee composed of a broad spectrum of health care stakeholders
and experts, as specified, to, among other things, develop
the parameters for establishing, implementing, and administering
to identify the type of data, purpose of use, and
entities and individuals that are required to report to, or that may
have access to, a health care cost and quality database. The
bill would require the secretary to arrange for the preparation of
an annual a report to the Legislature
and the Governor Governor, to be submitted by
January 1, 2019, that examines and addresses specified issues,
including, among others, containing the cost of health care services
and coverage. The bill would provide that
prohibit members of the committee not receive
from receiving a per diem or travel expense
reimbursement, or any other expense reimbursement.
Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.
This bill would make legislative findings to that effect.
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. It is the intent of the Legislature in
enacting this act to make cost and quality data available and 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, including
recognizing the diversity of California and the impact of social
determinants of health.
SECTION 1. SEC. 2. 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.
SEC. 2. SEC. 3. 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, timely, and comprehensive 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 and
to minimize health disparities 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, including recognizing the diversity of California and the
impact of social determinants of health.
127671. 127670. (a) (1) Solely for
the purpose of developing information for inclusion in a 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
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, and a self-insured employer, a
multiemployer self-insured plan that is responsible for paying for
health care services provided to beneficiaries, and the trust
administrator for a multiemployer self-insured plan may, provide all
of the following to the Secretary of California Health and Human
Services:
(A) Utilization data from the health care service plans' and
insurers' medical, dental, and pharmacy claims or, in the case of
entities that do not use claims data, including, but not limited to,
integrated delivery systems, encounter data consistent with the core
set of data elements for data submission proposed by the APCD
Council, the University of New Hampshire, and the National
Association of Health Data Organizations.
(B) Pricing information for health care items, services, and
medical and surgical episodes of care gathered from allowed charges
for covered health care items and services or, in the case of
entities that do not use or produce individual claims, price
information that is the best possible proxy to pricing information
for health care items, services, and medical and surgical episodes of
care available in lieu of actual cost data to allow for meaningful
comparisons of provider prices and treatment costs.
(C) Information sufficient to determine the impacts of social
determinants of health, including age, gender, race, ethnicity,
limited English proficiency, sexual orientation and gender identity,
ZIP Code, and any other factors for which there is peer-reviewed
evidence.
(2) (A) The secretary may report an entity's failure to comply
with paragraph (1) to the entity's regulating agency.
(B) The regulating agency of an entity described in paragraph (1)
may enforce paragraph (1) using its existing enforcement procedures.
Notwithstanding any other law, moneys collected pursuant to this
authorization shall be subject to appropriation by the Legislature,
and the failure to comply with paragraph (1) is not a crime.
(b) (1) All uses and 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 data, including, but
not limited to, the Confidentiality of Medical Information Act (Part
2.6 (commencing with Section 56) of Division 1 of the Civil Code),
the Information Practices Act of 1977 (Chapter 1 (commencing with
Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil
Code), Title 1.81 (commencing with Section 1798.80) of Part 4 of
Division 3 of the Civil Code, and the federal Health Insurance
Portability and Accountability Act of 1996 (Public Law
104-191) 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 pursuant to this
section shall ensure that the privacy, security, and confidentiality
of individually identifiable health information is protected. The
secretary shall not publicly disclose any unaggregated, individually
identifiable health information and shall develop a protocol for
assessing the risk of reidentification stemming from public
disclosure of any health information that is aggregated, 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.
(3) Confidentially negotiated contract terms contained in a
contract between a health care service plan or insurer and a provider
or supplier shall be protected in any public disclosure of data made
pursuant to this section. Individually identifiable proprietary
contract information included in a contract between a health care
service plan or insurer and a provider or supplier shall not be
disclosed in an unaggregated format.
(c) The secretary may enter into contracts or agreements to share
the information collected under this section for the purposes of this
chapter, provided that any use of that information complies with the
requirements of this section.
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, including, but not limited to,
representatives of the entities that are required to provide
information pursuant to subdivision (a) of Section 127671
127670 and representatives of purchasers,
including, but not limited to, businesses, organized labor, and
consumers, to develop the parameters for the establishment,
implementation, and ongoing administration of a health care cost and
quality database, including a business plan for sustainability
without using moneys appropriated from the General Fund, and
to identify the type of data, purpose of use, and entities
and individuals that are required to report to, or that may have
access to, a health care cost and quality database. 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 an
annual report a report, which shall be submitted
to the Legislature and the Governor, to be submitted
in compliance with Section 9795 of the Government Code,
Governor on or before January 1, 2019, 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) Reducing health disparities and addressing the social
determinants of health.
(5) Increasing the transparency of health care costs and the
relative efficiency with which care is delivered.
(6) Use of disease management, wellness, prevention, and other
innovative programs to keep people healthy, reduce disparities and
costs, and improve health outcomes for all populations.
(7) Efficient utilization of prescription drugs and technology.
(8) Reducing unnecessary, inappropriate, and wasteful health care.
(9) Educating consumers in the use of health care information.
(10) Using existing data sources to build a health care cost and
quality database.
(c) (1) A report submitted under subdivision (b) shall be
submitted in compliance with Section 9795 of the Government Code.
(2) The requirement for submitting a report pursuant to
subdivision (b) is inoperative on July 1, 2022, pursuant to Section
10231.5 of the Government Code.
(c)
(d) Notwithstanding any other law, the members of the
advisory committee shall not receive per diem or travel expense
reimbursement, or any other expense reimbursement.
SEC. 3. SEC. 4. The Legislature
finds and declares that Section 2 3 of
this act, which adds Section 127671 127670
to the Health and Safety Code, imposes a limitation on the
public's right of access to the meetings of public bodies or the
writings of public officials and agencies within the meaning of
Section 3 of Article I of the California Constitution. Pursuant to
that constitutional provision, the Legislature makes the following
findings to demonstrate the interest protected by this limitation and
the need for protecting that interest:
In order to protect confidential and proprietary information
submitted to the Secretary of California Health and Human Services,
it is necessary for that information to remain confidential.