Bill Text: CA SB1196 | 2011-2012 | Regular Session | Chaptered
Bill Title: Claims data disclosure.
Spectrum: Bipartisan Bill
Status: (Passed) 2012-09-30 - Chaptered by Secretary of State. Chapter 869, Statutes of 2012. [SB1196 Detail]
Download: California-2011-SB1196-Chaptered.html
BILL NUMBER: SB 1196 CHAPTERED
BILL TEXT
CHAPTER 869
FILED WITH SECRETARY OF STATE SEPTEMBER 30, 2012
APPROVED BY GOVERNOR SEPTEMBER 30, 2012
PASSED THE SENATE AUGUST 29, 2012
PASSED THE ASSEMBLY AUGUST 27, 2012
AMENDED IN ASSEMBLY AUGUST 22, 2012
AMENDED IN ASSEMBLY JUNE 28, 2012
AMENDED IN ASSEMBLY JUNE 19, 2012
AMENDED IN SENATE APRIL 10, 2012
AMENDED IN SENATE MARCH 26, 2012
INTRODUCED BY Senator Hernandez
(Coauthor: Senator Gaines)
FEBRUARY 22, 2012
An act to add Part 2.7 (commencing with Section 57) to Division 1
of the Civil Code, to add Section 1367.50 to the Health and Safety
Code, and to add Section 10117.52 to the Insurance Code, relating to
health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1196, Hernandez. Claims data disclosure.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensing and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law provides for the
regulation of health insurers by the Insurance Commissioner. Except
as specified, existing law prohibits a provider of health care, a
health care service plan, or contractor from disclosing medical
information regarding a patient of the provider of health care or an
enrollee or subscriber of a health care service plan without first
obtaining an authorization.
Existing law, the federal Patient Protection and Affordable Care
Act (PPACA), requires the Secretary of Health and Human Services to
make available to qualified entities, as defined, specified claims
data relating to Medicare in order to evaluate the performance of
providers and suppliers. Existing federal regulations require a
qualified entity, as defined, to comply with specified requirements
for Medicare claims data error correction.
This bill would provide that no contract in existence or issued,
amended, or renewed on or after January 1, 2013, between a health
care service plan or a health insurer and a provider or supplier, as
specified, shall prohibit, condition, or in any way restrict the
disclosure of claims data related to health care services provided to
specified individuals, to a qualified entity, as defined. The bill
would require a health care service plan or health insurer to comply
with all state and federal laws and implementing regulations for the
protection of data privacy and security. Because a willful violation
of these requirements by a health care service plan would constitute
a crime, the bill would impose a state-mandated local program.
This bill would further require a qualified entity, as defined,
to comply with specified requirements for error correction for all
claims data received, including data received from sources other than
Medicare.
Because a willful violation of the act by a health care service
plan would constitute a crime, the bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Part 2.7 (commencing with Section 57) is added to
Division 1 of the Civil Code, to read:
PART 2.7. Medical Claims Data Error Correction
57. (a) A qualified entity, as defined in Section 1395kk(e)(2) of
Title 42 of the United States Code, that receives claims data from a
health care service plan or health insurer shall comply with the
requirements governing provider and supplier requests for error
correction established under Section 401.717 of Title 42 of the Code
of Federal Regulations for all claims data received, including data
from sources other than Medicare.
(b) For purposes of this section, the following definitions apply:
(1) "Provider" means a hospital, a skilled nursing facility, a
comprehensive outpatient rehabilitation facility, a home health
agency, a hospice, a clinic, or a rehabilitation agency.
(2) "Supplier" means a physician and surgeon or other health care
practitioner, or an entity that furnishes health care services other
than a provider.
SEC. 2. Section 1367.50 is added to the Health and Safety Code, to
read:
1367.50. (a) No contract in existence or issued, amended, or
renewed on or after January 1, 2013, between a health care service
plan and a provider or a supplier shall prohibit, condition, or in
any way restrict the disclosure of claims data related to health care
services provided to an enrollee or subscriber of the health care
service plan or beneficiaries of any self-funded health coverage
arrangement administered by the health care service plan, to a
qualified entity, as defined in Section 1395kk(e)(2) of Title 42 of
the United States Code. All disclosures of data made under this
section shall 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 (Public Law 104-191) and the federal
Health Information Technology for Economic and Clinical Health Act,
Title XIII of the federal American Recovery and Reinvestment Act of
2009 (Public Law 111-5), and implementing regulations.
(b) For purposes of this section, the following definitions apply:
(1) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152).
(2) "Provider" means a hospital, a skilled nursing facility, a
comprehensive outpatient rehabilitation facility, a home health
agency, a hospice, a clinic, or a rehabilitation agency.
(3) "Supplier" means a physician and surgeon or other health care
practitioner, or an entity that furnishes health care services other
than a provider.
SEC. 3. Section 10117.52 is added to the Insurance Code, to read:
10117.52. (a) No health insurance contract in existence or
issued, amended, or renewed on or after January 1, 2013, between a
health insurer and a provider or a supplier shall prohibit,
condition, or in any way restrict the disclosure of claims data
related to health care services provided to a policyholder or insured
of the insurer or beneficiaries of any self-insured health coverage
arrangement administered by the insurer, to a qualified entity, as
defined in Section 1395kk(e)(2) of Title 42 of the United States
Code. All disclosures of data made under this section shall 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
(Public Law 104-191) and the federal Health Information Technology
for Economic and Clinical Health Act, Title XIII of the federal
American Recovery and Reinvestment Act of 2009 (Public Law 111-5),
and implementing regulations.
(b) For purposes of this section, the following definitions apply:
(1) "PPACA" means the federal Patient Protection and Affordable
Care Act (Public Law 111-148), as amended by the federal Health Care
and Education Reconciliation Act of 2010 (Public Law 111-152).
(2) "Provider" means a hospital, a skilled nursing facility, a
comprehensive outpatient rehabilitation facility, a home health
agency, a hospice, a clinic, or a rehabilitation agency.
(3) "Supplier" means a physician and surgeon or other health care
practitioner, or an entity that furnishes health care services other
than a provider.
SEC. 4. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
