BILL ANALYSIS �
SB 1196
Page 1
SENATE THIRD READING
SB 1196 (Ed Hernandez)
As Amended June 28, 2012
Majority vote
SENATE VOTE :35-0
HEALTH 19-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, | |Solorio, Wagner |
| |V. Manuel P�rez, Silva, | | |
| |Smyth, Williams | | |
| | | | |
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SUMMARY : Prohibits a contract in existence or issued, amended,
or renewed on or after January 1, 2013, between a health care
service plan (health plan), or health insurer (collectively,
carriers), and a provider or supplier, from prohibiting,
conditioning, or in any way restricting the disclosure of claims
data related to health care services provided to an enrollee or
subscriber of the health plan or carrier, or beneficiaries of
any self-funded health coverage arrangement administered by the
carrier to a qualified entity, as defined. Specifically, this
bill :
1)Requires a qualified entity to comply with all requirements
established pursuant to federal law, as specified, and any
rules, regulations, and guidelines adopted pursuant to the
federal Patient Protection and Affordable Care Act (ACA), to
ensure the privacy and security of the data.
2)Requires a qualified entity to also comply with rules,
regulations, and guidelines adopted pursuant to the ACA
governing provider and supplier requests for error correction
for data obtained under this bill.
3)Defines provider as a hospital, a skilled nursing facility, a
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comprehensive outpatient rehabilitation facility, a home
health agency, a hospice, a clinic, or a rehabilitation
agency.
4)Defines supplier as a physician and surgeon or other health
care practitioner, or an entity that furnishes health care
services other than a provider.
EXISTING LAW :
1)Makes Medicare data, under federal law, available for the
evaluation of the performance of providers of services and
suppliers, to qualified entities, defined as a public or
private entity that is qualified as determined by the
Secretary of the federal Department of Health and Human
Services (HHS), to use claims data to evaluate the performance
of providers of services and suppliers on measures of quality,
efficiency, effectiveness, and resource use, and agrees to
meet specified requirements and other requirements as the HHS
Secretary may specify, such as ensuring security of data.
2)Requires, under federal regulation, a qualified entity to
share measures, measurement methodologies, and measure results
with providers and suppliers at least 60 calendar days before
making the reports public. Requires a qualified entity to
inform providers and suppliers of the date after which the
reports will be made public, and if necessary will include
information related to the status of any data or error
correction requests, regardless of their status. If a
provider or supplier has a data or error correction request
outstanding at the time the reports become public, the
qualified entity must, if feasible, post publicly the name of
the appealing provider or supplier and the category of the
appeal request.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, negligible state costs.
COMMENTS : According to the author, under the ACA and final
implementing regulations issued in December 2011, the vast
Medicare claims database will be made available for use in
producing public reports on the performance of health care
providers. Any report issued by a qualified entity using this
data must include an understandable description of the measures
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which shall include quality measures, risk adjustment methods,
physician attribution methods, data specifications and
limitations, and sponsors so that consumers, providers,
suppliers and others can assess the reports.
The reports must be available confidentially to any provider of
services or supplier to be identified in such report, prior to
the public release of such report, and provide an opportunity to
appeal and correct errors. The reports must only include
information on a provider of services or supplier in an
aggregate form as determined appropriate by the HHS Secretary.
According to the implementing regulations, the Centers for
Medicare and Medicaid Services (CMS) believes the sharing of
Medicare data with qualified entities and the resulting reports
will be an important driver of improving quality and reducing
costs in Medicare, as well as for the health care system in
general. CMS believes this will increase the transparency of
provider and supplier performance while ensuring Medicare
beneficiary privacy.
Supporters all agree that increasing transparency and giving
consumers access to data on health care costs will help in
making more informed decisions. The Small Business Majority
(SBM) emphasizes that California's small businesses are being
hit hard with skyrocketing health care costs that impact their
ability to create jobs and grow the economy. SBM continues that
the ACA's health care reforms will improve access for small
businesses to affordable health care and ensure their health
care dollars are being spent in the most efficient way. The
Pacific Business Group on Health supports this bill because
claims data contain standardized information on sizeable patient
populations with little effort from providers. These data can
provide information preventing unnecessary hospitalizations and
an average price an insured patient would pay for knee
replacement surgery.
The California Hospital Association requests amendments to
ensure hospitals can review the data and methodology before it
is released for accuracy and risk adjustment of the data.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
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