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

California Senate Bill 1196 (Prior Session Legislation)

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

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

BILL NUMBER: SB 1196	AMENDED
	BILL TEXT

	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, 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.  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  further  require a  qualified entity
  health care service plan or health insurer  to
comply with  the requirements established by PPACA, as well
as with any rules, regulations, and guidelines adopted pursuant to
that law, as specified, relative to data obtained pursuant to these
provisions   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.
   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.    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. 
   SECTION 1.   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 
 1395kk(e)(2)  of Title 42 of the United States Code.
 A qualified entity shall comply with all requirements
established pursuant to Section 1395kk of Title 42 of the United
States Code, and with any rules, regulations, and guidelines adopted
pursuant to PPACA, to ensure the privacy and security of the data
obtained under this section. A qualified entity shall also comply
with all rules, regulations, and guidelines adopted pursuant to PPACA
governing provider and supplier requests for error correction for
data obtained under this section.   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. 2.   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   1395kk(e)(2) 
of Title 42 of the United States Code.  A qualified entity
shall comply with all requirements established pursuant to that
section, and with any rules, regulations, and guidelines adopted
pursuant to PPACA, to ensure the privacy and security of the data
obtained under this section. A qualified entity shall also comply
with all rules, regulations, and guidelines adopted pursuant to PPACA
governing provider and supplier requests for error correction for
data obtained under this section.   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  (PPACA, Public   (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.   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.