Amended in Assembly August 19, 2016

Amended in Assembly August 15, 2016

Amended in Assembly June 30, 2016

Amended in Senate May 31, 2016

Amended in Senate March 28, 2016

Senate Bill No. 1159

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, Quality, and Equity begin delete Transparency Database. end delete begin insert Data Atlas. end insert

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 the California Health and Human Services Agency to research the options for developing a cost, quality, and equity begin delete transparency database. end delete begin insert data atlas. end insert The bill would require the research to include certain topics, including, among others, identification of key data submitters and a comparative analysis of potential models used in other states. The bill would authorize the agency to enter into contracts or agreements to conduct the research and would require the agency to make the results of the research available to the public no later than March 1, 2017, by submitting a report to the Assembly and Senate Committees on Health.

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.  

(a) It is the intent of the Legislature in enacting
this act that begin delete cost and quality end delete begin insert cost, quality, and equity end insert data be made
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 begin insert all end insert
enrollees, including recognizing the diversity of California and
the impact of social determinants of health.

(b) It is further the intent of the Legislature that a cost, quality,
and equity begin delete transparency database end delete begin insert data atlas end insert be utilized in California
to inform efforts to:

(1) Assess California health care needs and available resources.

(2) Contain the cost of health care services and coverage.

(3) Improve the quality and medical appropriateness of health
care.

(4) Eliminate or reduce health disparities and address the social
determinants of health.

(5) Increase the transparency of health care costs and the relative
efficiency with which care is delivered.

(6) Promote the use of disease management, wellness,
prevention, and other innovative programs to keep people healthy,
reduce disparities and costs, begin insert increase competition, end insert and improve
health outcomes for all populations.

(7) Assess the value and encourage the efficient utilization of
prescription drugs and technology.

(8) Reduce unnecessary, inappropriate, and wasteful health care.

(9) Educate consumers in the use of health care information.

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. 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, Quality, and
Equity begin delete Transparency Database end delete begin insert Data Atlas end insert

 

127670.  

(a) The California Health and Human Services Agency
shall research the options for developing a cost, quality, and equity
begin delete transparency database end delete begin insert data atlas end insert that is consistent with paragraph
(9) of subdivision (b) of Section 56.10 of the Civil Code. This
research shall include all of the following:

(1) Identification of key data submitters, including health care
service plans, specialized health care service plans, insurers
licensed to provide health insurance, as defined in Section 106 of
the Insurance Code, suppliers, as defined in paragraph (3) of
subdivision (b) of Section 1367.50, providers, as defined in
paragraph (2) of subdivision (b) of Section 1367.50, self-insured
employers, multiemployer self-insured plans that are responsible
for paying for health care services provided to beneficiaries, and
trust administrators for multiemployer self-insured plans.

(2) A comparative analysis of potential models used in other
states and an assessment of the extent to which information in
addition to the following should be included in the cost, quality,
and equity begin delete transparency database: end delete begin insert data atlas: end insert

(A)  begin delete Utilization data end delete begin insert Data end insert 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
All-Payer Claims Database 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.

begin insert

(D) Clinical data from health care service plans, integrated
delivery systems, hospitals, and clinics, or any combination thereof,
that is not included in the core set of data elements for data
submission proposed by the All-Payer Claims Database Council
and the National Association of Health Data Organizations.

end insert

(3) An assessment of types of governance structures that
incorporate representatives of health care stakeholders and experts,
including, but not limited to, representatives of data submitters
and representatives of purchasers, such as businesses, organized
labor, and consumers.

(4) Recommendations on potential funding approaches to
support the activities of the cost, quality, and equity begin delete transparency
database end delete begin insert data atlas end insert that recognize federal and state confidentiality
of medical information laws.

(5) An assessment on the extent to which the cost, quality, and
equity begin delete transparency database end delete begin insert data atlas end insert could be developed in
conjunction with existing public or private activities, including an
assessment of the trade-offs associated with housing the begin delete database end delete
begin insert atlas end insert inside or outside of state government.

(6) Consultation with a broad spectrum of health care
stakeholders and experts, including, but not limited to,
representatives of purchasers, such as organized labor, consumers,
and businesses.

(b) The agency may enter into contracts or agreements to
conduct the research described in subdivision (a).

(c) (1) The agency shall make the results of the research
described in subdivision (a) available to the public no later than
March 1, 2017, by submitting a report to the Assembly and Senate
Committees on Health.

(2) Pursuant to Section 10231.5 of the Government Code, this
subdivision shall become inoperative on January 1, 2021.

(d) The agency may use federal funds for the purpose of this
section.