Bill Text: CA SB1159 | 2015-2016 | Regular Session | Amended

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

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Bill Title: California Health Care Cost, Quality, and Equity Data

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2016-09-27 - Chaptered by Secretary of State. Chapter 727, Statutes of 2016. [SB1159 Detail]

Download: California-2015-SB1159-Amended.html

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BILL NUMBER: SB 1159	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MARCH 28, 2016

INTRODUCED BY   Senator Hernandez

                        FEBRUARY 18, 2016

    An act to amend Section 136000 of the Health and Safety
Code, relating to health care.   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 1159, as amended, Hernandez.  Health Care: Office of
Patient Advocate.   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 require certain health care entities, including
health care service plans, to provide specified information to the
Secretary of California Health and Human Services. The bill would
authorize the secretary 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.  
   This bill would also require the secretary to convene an advisory
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 a 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 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. 

   Existing law establishes the Office of Patient Advocate within the
California Health and Human Services Agency, to provide assistance
to, and advocate on behalf of, health care consumers. The duties of
the office, include, among other things, compiling an annual
publication, to be made available on the office's Internet Web site,
of specified information relating to certain publicly operated
consumer assistance centers.  
   This bill would require the office to log, and include in the
annual publication, a call center's record of answering calls within
30 seconds, the number of abandoned calls, and the number of busy
messages sent to consumers. 
   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.
 
      CHAPTER 8.  CALIFORNIA HEALTH CARE QUALITY IMPROVEMENT AND COST
CONTAINMENT COMMISSION


   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, including recognizing the diversity of California and the
impact of social determinants of health.
   127671.  (a) (1) Solely for the purpose of developing information
for inclusion in a 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 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 self-insured employer, 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 all of the following to the Secretary
of California Health and Human Services:
   (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 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 secretary 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) is not a crime.
   (b) (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 of 1977 (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 pursuant to this
section shall ensure that the privacy, security, and confidentiality
of individually identifiable health information is protected. The
secretary 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.
   127672.  (a) The Secretary of California Health and Human Services
shall convene an advisory 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 (a) 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
a health care cost and quality database, including a business plan
for sustainability without using moneys appropriated from the General
Fund, and to identify the type of data, purpose of use, and entities
and individuals that are required to report to, or that may have
access to, a health care cost and quality database. The advisory
committee shall hold public meetings with stakeholders, solicit
input, and set its own meeting agendas. Meetings of the advisory
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 advisory 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.
   (5) Increasing the transparency of health care costs and the
relative efficiency with which care is delivered.
   (6) Use of disease management, wellness, prevention, and other
innovative programs to keep people healthy, reduce disparities and
costs, and improve health outcomes for all populations.
   (7) Efficient utilization of prescription drugs and technology.
   (8) Reducing unnecessary, inappropriate, and wasteful health care.

   (9) Educating consumers in the use of health care information.
   (10) Using existing data sources to build a health care cost and
quality database.
   (c) Notwithstanding any other law, the members of the advisory
committee shall not receive 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 Secretary of California Health and Human Services,
it is necessary for that information to remain confidential. 

  SECTION 1.    Section 136000 of the Health and
Safety Code is amended to read:
   136000.  (a) (1) The Office of Patient Advocate is hereby
established within the California Health and Human Services Agency,
to provide assistance to, and advocate on behalf of, health care
consumers. The goal of the office shall be to coordinate amongst,
provide assistance to, and collect data from, all of the state agency
consumer assistance or patient assistance programs and call centers,
to better enable health care consumers to access the health care
services to which they are eligible under the law, including, but not
limited to, commercial and Exchange coverage, Medi-Cal, Medicare,
and federal veterans health benefits. Notwithstanding any provision
of this division, each regulator and health coverage program shall
retain its respective authority, including its authority to resolve
complaints, grievances, and appeals.
   (2) The office shall be headed by a patient advocate appointed by
the Governor. The patient advocate shall serve at the pleasure of the
Governor.
   (b) (1) The duties of the office shall include, but not be limited
to, all of the following:
   (A) Coordinate and work in consultation with state agency and
local, nongovernment health care consumer or patient assistance
programs and health care ombudsperson programs.
   (B) Produce a baseline review and annual report to be made
publically available on the office's Internet Web site by July 1,
2015, and annually thereafter, of health care consumer or patient
assistance help centers, call centers, ombudsperson, or other
assistance centers operated by the Department of Managed Health Care,
the Department of Health Care Services, the Department of Insurance,
and the Exchange, that includes, at a minimum, all of the following:

   (i) The types of calls received and the number of calls.
   (ii) The call center's role with regard to each type of call,
question, complaint, or grievance.
   (iii) The call center's protocol for responding to requests for
assistance from health care consumers, including any performance
standards.
   (iv) The protocol for referring or transferring calls outside the
jurisdiction of the call center.
   (v) The call center's methodology of tracking calls, complaints,
grievances, or inquiries.
   (vi) The call center's record of answering calls within 30
seconds, the number of abandoned calls, and the number of busy
messages sent to consumers.
   (C) (i) Collect, track, and analyze data on problems and
complaints by, and questions from, consumers about health care
coverage for the purpose of providing public information about
problems faced and information needed by consumers in obtaining
coverage and care. The data collected shall include demographic data,
source of coverage, regulator, type of problem or issue or
comparable types of problems or issues, and resolution of complaints,
including timeliness of resolution. Notwithstanding Section 10231.5
of the Government Code, the office shall submit a report by July 1,
2015, and annually thereafter to the Legislature. The report shall be
submitted in compliance with Section 9795 of the Government Code.
The format may be modified annually as needed based upon comments
from the Legislature and stakeholders.
   (ii) For the purpose of publically reporting information as
required in subparagraph (B) and this subparagraph about the problems
faced by consumers in obtaining care and coverage, the office shall
analyze data on consumer complaints and grievances resolved by the
agencies listed in subdivision (c), including demographic data,
source of coverage, insurer or plan, resolution of complaints, and
other information intended to improve health care and coverage for
consumers.
   (D) Make recommendations, in consultation with stakeholders, for
improvement or standardization of the health consumer assistance
functions, referral process, and data collection and analysis.
   (E) Develop model protocols, in consultation with consumer
assistance call centers and stakeholders, that may be used by call
centers for responding to and referring calls that are outside the
jurisdiction of the call center, program, or regulator.
   (F) Compile an annual publication, to be made publically available
on the office's Internet Web site, of a quality of care report card,
including, but not limited, to health care service plans, preferred
provider organizations, and medical groups.
   (G) Make referrals to the appropriate state agency, whether
further or additional actions may be appropriate, to protect the
interests of consumers or patients.
   (H) Assist in the development of educational and informational
guides for consumers and patients describing their rights and
responsibilities and informing them on effective ways to exercise
their rights to secure and access health care coverage, produced by
the Department of Managed Health Care, the Department of Health Care
Services, the Exchange, and the California Department of Insurance,
and to endeavor to make those materials easy to read and understand
and available in all threshold languages, using an appropriate
literacy level and in a culturally competent manner.
   (I) Coordinate with other state and federal agencies engaged in
outreach and education regarding the implementation of federal health
care reform, and to assist in these duties, may provide or assist in
the provision of grants to community-based consumer assistance
organizations for these purposes.
   (J) If appropriate, refer consumers to the appropriate regulator
of their health coverage programs for filing complaints or
grievances.
   (2) The office shall employ necessary staff. The office may employ
or contract with experts when necessary to carry out the functions
of the office. The patient advocate shall make an annual budget
request for the office that shall be identified in the annual Budget
Act.
   (3) The patient advocate shall annually issue a public report on
the activities of the office, and shall appear before the appropriate
policy and fiscal committees of the Senate and Assembly, if
requested, to report and make recommendations on the activities of
the office.
   (4) The office shall adopt standards for the organizations with
which it contracts pursuant to this section to ensure compliance with
the privacy and confidentiality laws of this state, including, but
not limited to, the Information Practices Act of 1977 (Chapter 1
(commencing with Section 1798) of Title 1.8 of Part 4 of Division 3
of the Civil Code). The office shall conduct privacy trainings as
necessary, and regularly verify that the organizations have measures
in place to ensure compliance with this provision.
   (c) The Department of Managed Health Care, the Department of
Health Care Services, the Department of Insurance, the Exchange, and
any other public health coverage programs shall provide to the office
data concerning call centers to meet the reporting requirements in
subparagraph (B) of paragraph (1) of subdivision (b) and consumer
complaints and grievances to meet the reporting requirements in
clause (i) of subparagraph (C) of paragraph (1) of subdivision (b).
   (d) For purposes of this section, the following definitions apply:

   (1) "Consumer" or "individual" includes the individual or his or
her parent, guardian, conservator, or authorized representative.
   (2) "Exchange" means the California Health Benefit Exchange
established pursuant to Title 22 (commencing with Section 100500) of
the Government Code.
   (3) "Health care" includes services provided by any of the health
care coverage programs.
   (4) "Health care service plan" has the same meaning as that set
forth in subdivision (f) of Section 1345. Health care service plan
includes "specialized health care service plans," including
behavioral health plans.
   (5) "Health coverage program" includes the Medi-Cal program,
Healthy Families Program, tax subsidies and premium credits under the
Exchange, the Basic Health Program, if enacted, county health
coverage programs, and the Access for Infants and Mothers Program.
   (6) "Health insurance" has the same meaning as set forth in
Section 106 of the Insurance Code.
   (7) "Health insurer" means an insurer that issues policies of
health insurance.
   (8) "Office" means the Office of Patient Advocate.
   (9) "Threshold languages" has the same meaning as for Medi-Cal
managed care.