Bill Text: CA SB1196 | 2011-2012 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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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-Amended.html

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BILL NUMBER: SB 1196	AMENDED
	BILL TEXT

	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 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, as amended, 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.
   This bill would provide that no contract  or health
insurance policy   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, as
specified, shall prohibit, condition, or in any way restrict the
disclosure of claims data  ,  related to health care
services  or coverage  provided to specified
individuals  ,  to a qualified entity, as defined.
   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.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.50 is added to the Health and Safety Code,
to read:
   1367.50.  Notwithstanding Section 56.10 of the Civil Code, no
contract  in existence   or  issued, amended, or
renewed on or after January 1, 2013, between a health care service
plan and a provider, including a provider of supplies, 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 of Title 42 of the
United States Code.
  SEC. 2.  Section 10117.52 is added to the Insurance Code, to read:
   10117.52.  Notwithstanding any other provision of law, no health
insurance  policy   contract in existence or
 issued, amended, or renewed on or after January 1, 2013,
between a health insurer and a provider, including a provider of
supplies, shall prohibit, condition, or in any way restrict the
disclosure of claims data  ,  related to  coverage
  health care   services  provided to
insureds or beneficiaries of any self-insured health coverage
arrangement administered by  a carrier   the
insurer,  to a qualified entity, as defined in Section 1395kk of
Title 42 of the United States Code.
  SEC. 3.  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.