Bill Text: CA SB26 | 2015-2016 | Regular Session | Amended
Bill Title: California Health Care Cost and Quality Database.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2016-02-01 - Returned to Secretary of Senate pursuant to Joint Rule 56. [SB26 Detail]
Download: California-2015-SB26-Amended.html
BILL NUMBER: SB 26 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 5, 2015
INTRODUCED BY Senator Hernandez
DECEMBER 1, 2014
An act to add Chapter 8 (commencing with Section 127670) to Part 2
of Division 107 of, and to repeal the heading of Chapter 8 (formerly
commencing with Section 127670) of Part 2 of Division 107 of, the
Health and Safety Code, relating to health care.
LEGISLATIVE COUNSEL'S DIGEST
SB 26, as amended, Hernandez. California Health Care Cost and
Quality Database.
Existing law establishes health care coverage programs to provide
health care to segments of the population meeting specified criteria
who are otherwise unable to afford health care coverage and provides
for the licensure and regulation of health insurers and health care
service plans.
This bill would state the intent of the Legislature to establish a
system to provide valid, timely, and comprehensive health care
performance information that is publicly available and can be used to
improve the safety, appropriateness, and medical effectiveness of
health care, and to provide care that is safe, medically effective,
patient-centered, timely, affordable, and equitable. The bill would
require the Secretary of California Health and Human Services to, no
later than January 1, 2017, enter into a contract with one or more
independent, nonprofit organizations to administer the California
Health Care Cost and Quality Database. The bill would require the
secretary to include specified terms in that contract or contracts,
including, among others, that the nonprofit organization or
organizations administering the California Health Care Cost and
Quality Database develop methodologies relating to the submission of
health care data by health care entities. The bill would require
certain health care entities, including health care service plans, to
provide specified information to the nonprofit organization or
organizations administering the California Health Care Cost and
Quality Database. The bill would authorize the nonprofit organization
or organizations to report a health care entity that fails to comply
with that requirement to the health care entity's regulating agency,
and would authorize the regulating agency to enforce that
requirement using its existing enforcement procedures.
The bill would require all data disclosures made pursuant to these
provisions to comply with all applicable state and federal laws for
the protection of the privacy and security of data and would prohibit
the public disclosure of any unaggregated, individually identifiable
health information. The bill would require that certain
confidentially negotiated contract terms be protected in data
disclosures made pursuant to these provisions and would prohibit
certain individually identifiable proprietary contract information
from being disclosed in an unaggregated format. The bill would
require the nonprofit organization or organizations administering the
California Health Care Cost and Quality Database to receive,
process, maintain, and analyze information from specified data
sources, including, among others, disease and chronic condition
registries. The bill would require, no later than January 1, 2019,
the nonprofit organization or organizations administering the
California Health Care Cost and Quality Database to publicly make
available a web-based, searchable database and would require that
database to be updated regularly. The bill would prohibit
implementation and ongoing administration costs of the California
Health Care Cost and Quality Database from being paid using General
Fund moneys.
This bill would also require the secretary to convene a review
committee composed of a broad spectrum of health care stakeholders
and experts, as specified, to, among other things, develop the
parameters for establishing, implementing, and administering the
California Health Care Cost and Quality Database. The bill would
require the secretary to arrange for the preparation of an annual
report to the Legislature and the Governor that examines and
addresses specified issues, including, among others, containing the
cost of health care services and coverage. The bill would provide
that the commission not be convened until the Director of Finance has
determined that sufficient private or federal funds have been
received and appropriated for that purpose, and that members of the
committee not receive a per diem or travel expense reimbursement, or
any other expense reimbursement.
Existing constitutional provisions require that a statute that
limits the right of access to the meetings of public bodies or the
writings of public officials and agencies be adopted with findings
demonstrating the interest protected by the limitation and the need
for protecting that interest.
This bill would make legislative findings to that effect.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The heading of Chapter 8 (formerly commencing with
Section 127670) of Part 2 of Division 107 of the Health and Safety
Code, as amended by Section 230 of Chapter 183 of the Statutes of
2004, is repealed.
SEC. 2. Chapter 8 (commencing with Section 127670) is added to
Part 2 of Division 107 of the Health and Safety Code, to read:
CHAPTER 8. CALIFORNIA HEALTH CARE COST AND QUALITY DATABASE
127670. (a) It is the intent of the Legislature to establish a
system to provide valid, timely, and comprehensive health care
performance information that is publicly available and can be used to
improve the safety, appropriateness, and medical effectiveness of
health care, and to provide care that is patient-centered, timely,
affordable, and equitable. It is also the intent of the Legislature
to grant access to provider performance information to consumers and
purchasers in order for them to understand the potential financial
consequences and liabilities and obtain maximum quality and value
and to minimize health disparities in health care
services.
(b) It is the intent of the Legislature, by making cost and
quality data available, to encourage health care service plans,
health insurers, and providers to develop innovative approaches,
services, and programs that may have the potential to deliver health
care that is both cost effective and responsive to the needs of
enrollees. enrollees, including recognizing
the diversity of California and the impact of social determinants of
health.
127671. (a) The Secretary of California Health and Human Services
shall, no later than January 1, 2017, use a competitive process to
contract with one or more independent, nonprofit organizations in
order to administer the California Health Care Cost and Quality
Database. This competitive process and any requests for proposal
shall be publicly posted on the agency's Internet Web site for a
minimum of 30 days for public review and comment. A contract entered
into pursuant to this section is exempt from Part 2 (commencing with
Section 10100) of Division 2 of the Public Contract Code, and is
exempt from review or approval by any division of the Department of
General Services.
(b) The secretary shall include as a term in the contract or
contracts entered into pursuant to subdivision (a) all of the
following:
(1) A requirement that the nonprofit organization or organizations
administering the California Health Care Cost and Quality Database
do all of the following:
(A) Establish, implement, and administer the California Health
Care Cost and Quality Database in accordance with parameters
developed pursuant to subdivision (a) of Section 127672.
(B) Develop methodologies for the collection, validation,
refinement, analysis, comparison, review, reporting, and improvement
of health care data, including, but not limited to, data from
fee-for-service, capitated, and other alternative, value-based,
payment sources, submitted by health care entities that are
validated, recognized as reliable, and meet industry and research
standards.
(C) Receive information, as described in this section, from health
care entities and report that information in a form that allows
valid comparisons across care delivery systems.
(D) Ensure that the database has the capacity to map to other data
sets, including public health data sets on morbidity and mortality,
including data sets from the federal Centers for Disease Control, the
State Department of Public Health, and other data sets with data
regarding the social determinants of health.
(D)
( E) Comply with the requirements governing
provider and supplier requests for error correction established
pursuant to Section 401.717 of Title 42 of the Code of Federal
Regulations for all claims data received, including, but not limited
to, data from sources other than Medicare.
(2) A prohibition on the nonprofit organization or organizations
administering the California Health Care Cost and Quality Database
from doing either of the following:
(A) Using the data received during the execution of the contract
for any purpose not specified in this chapter or in the contract.
(B) Receiving funding from any other source to accomplish the same
purposes sought to be accomplished under this chapter unless funding
is received from another nonprofit or government source and is for
the purpose of research or education.
(3) A requirement that the nonprofit organization or organizations
administering the California Health Care Cost and Quality Database
identify, in accordance with this section, the type of data, purpose
of use, and entities and individuals that are required to report to,
or that may have access to, the California Health Care Cost and
Quality Database. An entity or individual shall not be required to
report to, and shall not have access to, the California Health Care
Cost and Quality Database until the review committee established
pursuant to Section 127672 has approved the nonprofit organization or
organizations determination.
(c) (1) For the purpose of developing information for inclusion in
the California Health Care Cost and Quality Database, a health care
service plan, including a specialized health care service plan, an
insurer licensed to provide health insurance, as defined in Section
106 of the Insurance Code, a self-insured employer, a supplier, as
defined in paragraph (3) of subdivision (b) of Section 1367.50, or a
provider, as defined in paragraph (2) of subdivision (b) of Section
1367.50, shall, and a multiemployer self-insured plan that is
responsible for paying for health care services provided to
beneficiaries and the trust administrator for a multiemployer
self-insured plan may, provide both all
of the following to the nonprofit organization or organizations
administering the California Health Care Cost and Quality Database:
(A) Utilization data from the health care service plans' and
insurers' medical, dental, and pharmacy claims or, 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 APCD
Council, the University of New Hampshire, and the National
Association of Health Data Organizations.
(B) Pricing information for health care items, services, and
medical and surgical episodes of care gathered from allowed charges
for covered health care items and services or, 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 so to
allow for meaningful comparisons of provider prices and treatment
costs.
(C) 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 is peer-reviewed
evidence.
(2) (A) The nonprofit organization or organizations administering
the California Health Care Cost and Quality Database may report an
entity's failure to comply with paragraph (1) to the entity's
regulating agency.
(B) The regulating agency of an entity described in paragraph (1)
may enforce paragraph (1) using its existing enforcement procedures.
Notwithstanding any other law, moneys collected pursuant to this
authorization shall be subject to appropriation by the Legislature,
and the failure to comply with paragraph (1) shall not be a crime.
(d) (1) All uses and disclosures of data made pursuant to this
section shall comply with all applicable state and federal laws for
the protection of the privacy and security of data, including, but
not limited to, the Confidentiality of Medical Information Act
(Part 2.6 (commencing with Section 56)) of Division 1 of the Civil
Code), the Information Practices Act (Chapter 1 (commencing with
Section 1798) of Title 1.8 of Part 4 of Division 3 of the Civil Code,
Title 1.81 (commencing with Section 1798.80) of Part 4 of Division 3
of the Civil Code, and 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.
(2) (A) All policies and protocols developed in the performance of
the contract shall ensure that the privacy, security, and
confidentiality of individually identifiable health information is
protected. The nonprofit organization or organizations administering
the California Health Care Cost and Quality Database shall not
publicly disclose any unaggregated, individually identifiable health
information and shall develop a protocol for assessing the risk of
reidentification stemming from public disclosure of any health
information that is aggregated, individually identifiable health
information.
(B) For the purposes of this paragraph, "individually identifiable
health information" has the same meaning as in Section 160.103 of
Title 45 of the Code of Federal Regulations.
(3) Confidentially negotiated contract terms contained in a
contract between a health care service plan or insurer and a provider
or supplier shall be protected in any public disclosure of data made
pursuant to this section. Individually identifiable proprietary
contract information included in a contract between a health care
service plan or insurer and a provider or supplier shall not be
disclosed in an unaggregated format.
(e) (1) The nonprofit organization or organizations administering
the California Health Care Cost and Quality Database shall receive,
process, maintain, and analyze information from data sources,
including, but not limited to, data received pursuant to subdivision
(c), claims from private and public payers, disease and chronic
condition registries, third-party surveys of quality and patient
satisfaction, reviews by licensing and accrediting bodies, and local
and regional public health data. Aggregated payer and provider
performance on validated measures of clinical quality and patient
experience, such as measures from the Healthcare Effectiveness Data
and Information Set (HEDIS) and Consumer Assessment of Healthcare
Providers and Systems (CAHPS), shall be collected from accrediting
organizations, including, but not limited to, the National Committee
for Quality Assurance (NCQA), URAC, and the Joint Commission.
(2) The nonprofit organization or organizations administering the
California Health Care Cost and Quality Database shall include in an
analysis performed pursuant to paragraph (1), but shall not be
limited to, to including, all of the
following:
(A) Population-level data on prevention, screening, and wellness
utilization.
(B) Population-level data on behavioral and medical risk factors,
interventions, and outcomes.
(C) Population-level data on chronic conditions, management, and
outcomes.
(D) Population-level data on trends in utilization of procedures
for treatment of similar conditions to evaluate medical
appropriateness.
(E) Facility and physician organization risk adjusted performance
information measures on the quality,
efficiency, and outcomes of care that are aligned with national
efforts, including, but not limited to, those of the National Quality
Forum, related to defining cost and quality measures. Measures
shall be publicly reported without risk adjustment for
sociodemographic factors and shall also be risk adjusted for
sociodemographic factors if peer-reviewed literature indicates an
association between health outcomes and a sociodemographic factor or
factors.
(F) Data that permits consideration of socioeconomic status and
disparities in care due to race, ethnicity, gender, limited
English proficiency, ZIP Code, sexual orientation, and
gender identity. identity,
and other factors for which there is peer-reviewed evidence of a
relationship between a social determinant of health and health
outcomes.
(f) No later than January 1, 2019, the nonprofit organization or
organizations administering the California Health Care Cost and
Quality Database shall make publicly available a web-based,
searchable database. The database shall include the information and
analysis described in subdivision (e). The information and analysis
included in the database shall be presented in a way that facilitates
comparisons of cost, quality, and satisfaction across payers,
provider organizations, and other suppliers of health care services.
This public database shall be regularly updated to reflect new data
submissions.
(g) Implementation and ongoing administration costs of the
California Health Care Cost and Quality Database shall not be paid
using General Fund moneys.
127672. (a) The Secretary of California Health and Human Services
shall convene a review committee, composed of a broad spectrum of
health care stakeholders and experts, including, but not limited to,
representatives of the entities that are required to provide
information pursuant to subdivision (c) of Section 127671 and
representatives of purchasers, including, but not limited to,
businesses, organized labor, and consumers, to develop the parameters
for the establishment, implementation, and ongoing administration of
the California Health Care Cost and Quality Database, including a
business plan for sustainability without using moneys from the
General Fund, and to approve the determinations described in
paragraph (3) of subdivision (b) of Section 127671. The review
committee shall hold public meetings with stakeholders, solicit
input, and set its own meeting agendas. Meetings of the review
committee are subject to the Bagley-Keene Open Meeting Act (Article 9
(commencing with Section 11120) of Chapter 1 of Part 1 of Division 3
of Title 2 of the Government Code).
(b) The secretary shall arrange for the preparation of an annual
report to the Legislature and the Governor, to be submitted in
compliance with Section 9795 of the Government Code, based on the
findings of the review committee, including input from the public
meetings, that shall, at a minimum, examine and address the following
issues:
(1) Assessing California health care needs and available
resources.
(2) Containing the cost of health care services and coverage.
(3) Improving the quality and medical appropriateness of health
care.
(4) Reducing health disparities and addressing the social
determinants of health.
(4)
( 5) Increasing the transparency of health
care costs and the relative efficiency with which care is delivered.
(5)
( 6) Use of disease management, wellness,
prevention, and other innovative programs to keep people healthy and
reduce disparities and costs and improving health outcomes for all
populations.
(6)
( 7) Efficient utilization of prescription
drugs and technology.
(7)
( 8) Reducing unnecessary, inappropriate,
and wasteful health care.
(8)
( 9) Educating consumers in the use of
health care information.
(9)
(10) Using existing data sources to build the
California Health Care Cost and Quality Database.
(c) The review committee established pursuant to this section
shall not be convened until the Director of Finance has determined
that sufficient private or federal funds have been received and that
the funds have been appropriated for that purpose. The review
committee shall continue to function for as long as the Department of
Finance has determined that the California Health Care Cost and
Quality Database is established and is being administered.
(d) Notwithstanding any other law, the members of the review
committee shall receive no per diem or travel expense reimbursement,
or any other expense reimbursement.
SEC. 3. The Legislature finds and declares that Section 2 of this
act, which adds Section 127671 to the Health and Safety Code, imposes
a limitation on the public's right of access to the meetings of
public bodies or the writings of public officials and agencies within
the meaning of Section 3 of Article I of the California
Constitution. Pursuant to that constitutional provision, the
Legislature makes the following findings to demonstrate the interest
protected by this limitation and the need for protecting that
interest:
In order to protect confidential and proprietary information
submitted to the California Health Care Cost and Quality Database, it
is necessary for that information to remain confidential.
