BILL NUMBER: SB 1159 CHAPTERED
BILL TEXT
CHAPTER 727
FILED WITH SECRETARY OF STATE SEPTEMBER 27, 2016
APPROVED BY GOVERNOR SEPTEMBER 27, 2016
PASSED THE SENATE AUGUST 25, 2016
PASSED THE ASSEMBLY AUGUST 23, 2016
AMENDED IN ASSEMBLY AUGUST 19, 2016
AMENDED IN ASSEMBLY AUGUST 15, 2016
AMENDED IN ASSEMBLY JUNE 30, 2016
AMENDED IN SENATE MAY 31, 2016
AMENDED IN SENATE MARCH 28, 2016
INTRODUCED BY Senator Hernandez
FEBRUARY 18, 2016
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, Hernandez. California Health Care Cost, Quality, and
Equity Data Atlas.
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 the California Health and Human Services
Agency to research the options for developing a cost, quality, and
equity data atlas. The bill would require the research to include
certain topics, including, among others, identification of key data
submitters and a comparative analysis of potential models used in
other states. The bill would authorize the agency to enter into
contracts or agreements to conduct the research and would require the
agency to make the results of the research available to the public
no later than March 1, 2017, by submitting a report to the Assembly
and Senate Committees on Health.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) It is the intent of the Legislature in enacting
this act that cost, quality, and equity data be made available and 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 all enrollees, including recognizing
the diversity of California and the impact of social determinants of
health.
(b) It is further the intent of the Legislature that a cost,
quality, and equity data atlas be utilized in California to inform
efforts to:
(1) Assess California health care needs and available resources.
(2) Contain the cost of health care services and coverage.
(3) Improve the quality and medical appropriateness of health
care.
(4) Eliminate or reduce health disparities and address the social
determinants of health.
(5) Increase the transparency of health care costs and the
relative efficiency with which care is delivered.
(6) Promote the use of disease management, wellness, prevention,
and other innovative programs to keep people healthy, reduce
disparities and costs, increase competition, and improve health
outcomes for all populations.
(7) Assess the value and encourage the efficient utilization of
prescription drugs and technology.
(8) Reduce unnecessary, inappropriate, and wasteful health care.
(9) Educate consumers in the use of health care information.
SEC. 2. 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. 3. 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, QUALITY, AND EQUITY
DATA ATLAS
127670. (a) The California Health and Human Services Agency shall
research the options for developing a cost, quality, and equity data
atlas that is consistent with paragraph (9) of subdivision (b) of
Section 56.10 of the Civil Code. This research shall include all of
the following:
(1) Identification of key data submitters, including health care
service plans, specialized health care service plans, insurers
licensed to provide health insurance, as defined in Section 106 of
the Insurance Code, suppliers, as defined in paragraph (3) of
subdivision (b) of Section 1367.50, providers, as defined in
paragraph (2) of subdivision (b) of Section 1367.50, self-insured
employers, multiemployer self-insured plans that are responsible for
paying for health care services provided to beneficiaries, and trust
administrators for multiemployer self-insured plans.
(2) A comparative analysis of potential models used in other
states and an assessment of the extent to which information in
addition to the following should be included in the cost, quality,
and equity data atlas:
(A) 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 All-Payer Claims
Database 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.
(D) Clinical data from health care service plans, integrated
delivery systems, hospitals, and clinics, or any combination thereof,
that is not included in the core set of data elements for data
submission proposed by the All-Payer Claims Database Council and the
National Association of Health Data Organizations.
(3) An assessment of types of governance structures that
incorporate representatives of health care stakeholders and experts,
including, but not limited to, representatives of data submitters and
representatives of purchasers, such as businesses, organized labor,
and consumers.
(4) Recommendations on potential funding approaches to support the
activities of the cost, quality, and equity data atlas that
recognize federal and state confidentiality of medical information
laws.
(5) An assessment on the extent to which the cost, quality, and
equity data atlas could be developed in conjunction with existing
public or private activities, including an assessment of the
tradeoffs associated with housing the atlas inside or outside of
state government.
(6) Consultation with a broad spectrum of health care stakeholders
and experts, including, but not limited to, representatives of
purchasers, such as organized labor, consumers, and businesses.
(b) The agency may enter into contracts or agreements to conduct
the research described in subdivision (a).
(c) (1) The agency shall make the results of the research
described in subdivision (a) available to the public no later than
March 1, 2017, by submitting a report to the Assembly and Senate
Committees on Health.
(2) Pursuant to Section 10231.5 of the Government Code, this
subdivision shall become inoperative on January 1, 2021.
(d) The agency may use federal funds for the purpose of this
section.