BILL ANALYSIS                                                                                                                                                                                                    �



                                                                  SB 1196
                                                                  Page  1

          Date of Hearing:   August 8, 2012

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                Felipe Fuentes, Chair

                  SB 1196 (Hern�ndez) - As Amended:  June 28, 2012 

          Policy Committee:                             HealthVote:19-0

          Urgency:     No                   State Mandated Local Program: 
          Yes    Reimbursable:              No

           SUMMARY  

          This bill prohibits contracts between a health plan or insurer, 
          and a provider or supplier, from prohibiting, conditioning, or 
          restricting the disclosure of health care claims data to a 
          qualified entity that is certified by the federal Health and 
          Human Services Secretary to use the data to evaluate performance 
          on a range of quality and efficiency measures. 

           FISCAL EFFECT  

          Negligible state fiscal effect.

           COMMENTS  

           1)Rationale  . The author indicates that key reforms in the 
            federal Patient Protection and Affordable Care Act (ACA) 
            intend to promote transparency in price and quality 
            measurements, and that reimbursement reforms and other trends 
            in the health care marketplace demand such transparency.  
            Despite this, the author contends, some providers have 
            prevented price and quality information from being disclosed.  
            The author believes this bill will help ensure successful 
            implementation of data transparency requirements in California 
            by removing barriers to data access.

          2)Background  . The ACA requires Medicare fee-for-service claims 
            data to be made available to qualified entities for the 
            evaluation of the performance of providers and suppliers. 
            Qualified entities may use the data to evaluate the 
            performance of providers and suppliers, and to generate public 
            reports regarding such performance. Qualified entities are 
            also required to combine claims data from sources other than 








                                                                  SB 1196
                                                                  Page  2

            Medicare with the Medicare data when evaluating the 
            performance of providers and suppliers.  This bill would 
            ensure that no contractual prohibitions would prevent Medicare 
            and other health care claims data from being transmitted to 
            qualified entities for purposes described above. 
           
            3)Related Legislation  . SB 751 (Gaines), Chapter 244, Statutes of 
            2011 prohibited contracts between plans or insurers, and 
            hospitals or hospital-owned facilities, from including 
            provisions that restrict the ability of the plans or insurer 
            to furnish information to enrollees or policyholders 
            concerning the cost and quality of services performed by the 
            hospital or facility.
           
          Analysis Prepared by  :    Lisa Murawski / APPR. / (916) 319-2081