BILL ANALYSIS Ó
SB 1159
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SENATE THIRD READING
SB
1159 (Hernandez)
As Amended August 19, 2016
Majority vote
SENATE VOTE: 25-12
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Health |14-3 |Wood, Maienschein, |Lackey, Patterson, |
| | |Bonilla, Burke, |Steinorth |
| | |Campos, Chiu, Gomez, | |
| | |Roger Hernández, | |
| | |Nazarian, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Thurmond, Waldron | |
| | | | |
|----------------+-----+-----------------------+---------------------|
|Privacy |11-0 |Chau, Wilk, Baker, | |
| | |Calderon, Chang, | |
| | |Cooper, Dababneh, | |
| | |Gatto, Gordon, Low, | |
| | |Olsen | |
| | | | |
|----------------+-----+-----------------------+---------------------|
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|Appropriations |16-4 |Gonzalez, Bloom, |Bigelow, Gallagher, |
| | |Bonilla, Bonta, |Jones, Wagner |
| | |Calderon, Chang, Daly, | |
| | |Eggman, Eduardo | |
| | |Garcia, Holden, | |
| | |Obernolte, Quirk, | |
| | |Santiago, Weber, Wood, | |
| | |McCarty | |
| | | | |
| | | | |
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SUMMARY: Establishes the California Health Care Cost, Quality,
and Equity Data Atlas. Specifically, this bill:
1)Requires the California Health and Human Services Agency
(CHHSA) to research the options for developing a cost,
quality, and equity transparency database that is consistent
with the confidentiality of medical information in existing
law.
2)Requires this research to include all of the following:
a) Identification of key data submitters, including health
care service plans (health plans), health insurers,
suppliers, providers, and self-insured employers, as
defined;
b) 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 transparency database:
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i) Utilization data from health plan and health
insurers' medical, dental, and pharmacy claims. 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;
ii) Pricing information for health care items, services,
and medical and surgical episode of care gathered from
allowed charges for covered health care items and
services. 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;
iii) 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 are peer-reviewed evidence; and,
iv) Clinical data from health care service plans,
integrated delivery systems, hospitals, and/or clinics
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.
c) An assessment of types of governance structures that
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incorporate representatives of health care stakeholders and
experts, as specified;
d) Recommendations on potential funding approaches to
support the activities of the cost, quality, and equity
transparency database that recognize federal and state
confidentiality of medical information laws;
e) An assessment on the extent to which the cost, quality,
and equity transparency database could be developed in
conjunction with existing public or private activities, as
specified; and,
f) Consultation with a broad spectrum of health care
stakeholders and experts, as specified.
3)Permits CHHSA to enter into contracts or agreements to conduct
the research described above.
4)Requires CHHSA to make public the results of the research
described above no later than March 1, 2017, by submitting a
report to the Assembly and Senate Committees on Health.
5)Sunsets on January 1, 2021.
6)Permits the CHHSA to use federal funds.
FISCAL IMPACT: According to the Assembly Appropriations
Committee:
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1)The activities required here are not expected to result in
significant additional state costs, as they are largely
consistent with existing activities of CHHSA, funded by an
existing federal grant. CHHSA will incur minor costs to
submit a legislative report by March 1, 2017.
2)It should be noted this bill does not explicitly require a
database to be constructed, but it authorizes a study and
related activities. Development of a database as contemplated
here, if it were to be housed in the state, would result in
General Fund cost pressure estimated in the low millions
one-time for start-up costs and low millions ongoing, based on
an analysis by Manatt Health Solutions of a
California-specific database. Actual costs would be subject
to numerous decisions about the business requirements of such
a system, and could vary significantly depending upon existing
capabilities of bidders, assuming the database implemented
through a contract. This bill requires an analysis of
potential funding sources to support the database.
COMMENTS: According to the author, beginning in March 2014, the
Senate Committee on Health convened several health care experts
to discuss factors that contribute to the growing cost of health
care in California and efforts to make care more affordable. At
a second hearing in February of this year, the Senate Health
Committee heard testimony related to some major cost drivers in
the health care system, including pharmaceuticals, hospital
costs, and the effects of geographic location on contracting.
The third, held in March of this year, served to educate members
and the public about the effect of health care costs on
consumers. This series of hearings examined policy solutions to
control health care costs as millions of Californians obtain
coverage under the federal Patient Protection and Affordable
Care Act. The author states this bill is intended to help make
available valid performance information to promote care that is
safe, medically effective, patient-centered, timely, efficient,
affordable, and equitable.
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All-Payer claims databases. In 2007, the Regional All-Payer
Healthcare Information Counsel (Counsel) began as a convening
organization to bring together several Northeast states that
had, or were developing, All-Payer Claims Database (APCD)
systems. The Counsel's vision was to support cross-state data
harmonization and analytic activities. In 2010, the Counsel
changed its name to the APCD Council to reflect the expanded
reach. The APCD Council is a learning collaborative with a
multi-fold purpose of serving an information sharing capacity
for those states that have developed, or are developing APCD;
providing technical assistance to states; and, catalyzing states
to achieve mutual goals. Some of APCD Council's current
activities include harmonizing the data collection and data
release rules across the multiple state databases; developing a
strategy for integrating Medicare data into the all payer
databases; sharing reporting applications being developed by
states; policy analysis; and, supporting other states developing
all-payer claims databases.
By January 2016, at least 18 states had enacted APCDs while more
than a dozen others considered such a law or program. They are
designed to inform cost containment and quality improvement
efforts. The databases contain eligibility and claims data
(medical, pharmacy and dental) and are used to report cost, use
and quality information. The data consist of "service-level"
information based on valid claims processed by health payers.
Service-level information includes charges and payments, the
provider(s) receiving payment, clinical diagnosis and procedure
codes, and patient demographics. To mask the identity of
patients and ensure privacy, states usually encrypt, aggregate
and suppress patient identifiers.
Analysis Prepared by:
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Kristene Mapile / HEALTH / (916) 319-2097 FN:
0004605