BILL ANALYSIS �
SB 1196
Page 1
SENATE THIRD READING
SB 1196 (Ed Hernandez)
As Amended August 22, 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
comprehensive outpatient rehabilitation facility, a home
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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.
5)Establishes in the Civil Code a requirements on qualified
entities, as defined in federal law, that receive claims data
from a health care service plan or health insurer to comply
with the requirements governing provider and supplier requests
for error correction established under Medicare regulations,
as specified, for all claims data received, including data
from sources other than Medicare.
6)Requires all disclosures of data made under this bill to
comply with all applicable state and federal laws for the
protection of the privacy and security of the data, including,
but not limited to, the federal Health Insurance Portability
and Accountability Act of 1996 and the Health Information
Technology for Economic and Clinical Health Act, of the
federal American Recovery and Reinvestment Act of 2009, and
implementing regulations.
EXISTING LAW 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.
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
which shall include quality measures, risk adjustment methods,
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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.
Analysis Prepared by : Teri Boughton / HEALTH / (916) 319-2097
FN: 0005283