Legislature(2021 - 2022)BELTZ 105 (TSBldg)
04/19/2021 01:30 PM Senate LABOR & COMMERCE
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| Audio | Topic |
|---|---|
| Start | |
| SB93 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 93 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
ALASKA STATE LEGISLATURE
SENATE LABOR AND COMMERCE STANDING COMMITTEE
April 19, 2021
2:13 p.m.
MEMBERS PRESENT
Senator Mia Costello, Chair
Senator Joshua Revak, Vice Chair
Senator Gary Stevens
Senator Elvi Gray-Jackson
MEMBERS ABSENT
Senator Peter Micciche
COMMITTEE CALENDAR
SENATE BILL NO. 93
"An Act relating to the establishment of an all-payer health
claims database; and providing for an effective date."
- MOVED CSSB 93(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: SB 93
SHORT TITLE: HEALTH INS. ALL-PAYER CLAIMS DATABASE
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
02/24/21 (S) READ THE FIRST TIME - REFERRALS
02/24/21 (S) HSS, L&C, FIN
03/11/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/11/21 (S) <Bill Hearing Rescheduled to 3/16/21>
03/16/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/16/21 (S) <Bill Hearing Canceled>
03/23/21 (S) HSS AT 1:30 PM BUTROVICH 205
03/23/21 (S) Heard & Held
03/23/21 (S) MINUTE(HSS)
04/07/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
04/07/21 (S) Scheduled but Not Heard
04/13/21 (S) HSS AT 1:30 PM BUTROVICH 205
04/13/21 (S) Moved CSSB 93(HSS) Out of Committee
04/13/21 (S) MINUTE(HSS)
04/14/21 (S) HSS RPT CS 2DP 1DNP 2NR SAME TITLE
04/14/21 (S) DP: WILSON, BEGICH
04/14/21 (S) DNP: REINBOLD
04/14/21 (S) NR: COSTELLO, HUGHES
04/19/21 (S) L&C AT 1:30 PM BELTZ 105 (TSBldg)
WITNESS REGISTER
LORI WING-HEIER, Director
Division of Insurance
Department of Commerce, Community and Economic Development
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint to introduce SB 66 on
behalf of the Senate Rules Committee by request of the Governor.
ACTION NARRATIVE
2:13:29 PM
CHAIR MIA COSTELLO called the Senate Labor and Commerce Standing
Committee meeting to order at 2:13 p.m. Present at the call to
order were Senators Gray-Jackson, Revak, and Chair Costello.
Senator Stevens joined the committee during the course of the
meeting.
SB 93-HEALTH INS. ALL-PAYER CLAIMS DATABASE
2:14:12 PM
CHAIR COSTELLO announced the consideration of SENATE BILL NO. 93
"An Act relating to the establishment of an all-payer health
claims database; and providing for an effective date."
[CSSB 93(HSS), work order 32-GS1530\B, was before the
committee.]
She stated her intention to hear the PowerPoint introduction
from Lori Wing-Heier, take questions, hear public testimony, and
look to the will of the committee. She listed the individuals
available to answer questions.
2:15:19 PM
LORI WING-HEIER, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED) delivered a
PowerPoint to introduced SB 93.
MS. WING-HEIER stated that since she became the director of the
Division of Insurance in 2014, the cost of and access to
healthcare has been one of the top conversations every
legislative session. While there has not always been agreement
on the direction of healthcare, there is agreement that
healthcare insurance is difficult to find in Alaska and the
premiums are high.
MS. WING-HEIER reported that Providence Health adopted the
triple aim in health care two years ago. That has changed to the
quadruple aim the goal of which is to improve the patient
experience, improve the provider experience, achieve better
health outcomes with a quality metric, and lower the cost of
healthcare. She admitted that she did not know whether SB 93
would lower the cost of healthcare but it might stabilize the
cost and help to understand the reason for the costs. She
highlighted the transparency piece to the all payer claims
database that she believes will help all Alaskans.
CHAIR COSTELLO handed the gavel to Senator Revak.
MS. WING-HEIER advised that the discussion about the cost of
healthcare and an all-payer claims database (APCD) has included
the administration, the legislature, the Congressional
delegation, tribal partners, the Alaska Chamber of Commerce,
Commonwealth North and other organizations, but what is missing
is data. There are many reports from Alaska Care, Medicare,
Medicaid, insurance companies, third-party administrators, and
others but the data is not centralized. It resides within each
of those entities.
2:18:12 PM
MS. WING-HEIER said slide 6 highlights the many reports by
various organizations that have tried to talk about solutions to
the high cost of healthcare, but have gone nowhere. However, a
common suggestion in the reports is to start with an all-payer
claims database. She paraphrased the following definition:
An All-Payer Claims Data Base (APCD) is a large
database that includes medical, pharmaceutical, and
dental claims. These databases are hosted, directly or
through a contract, by states. Public (i.e., Medicaid)
and private payers (i.e., insurance companies and
third-party adjusters) submit the data, in a pre-
determined standard format, to the state.
MS. WING-HEIER advised that, should SB 93 pass, the Division of
Insurance intends to issue a request for proposal (RFP) and hire
a qualified contractor to organize and maintain the database.
Public payers such as Medicaid and other private payers would
submit their data through the contractor directly to the
database in a format predetermined by the United States
Department of Labor. This directive came from the No Surprises
Act that passed in December 2020. She said the division expects
the USDOL to post the format and take comments very soon.
2:20:06 PM
SENATOR GRAY-JACKSON asked how the information from her dentist
appointment tomorrow would be put into the database.
MS. WING-HEIER replied the division expects monthly updates to
the database, but the information will be deidentified. Nobody
would ever see that Senator Eli Gray-Jackson visited the dentist
on 4/20/21. What will appear is the code for the service and the
cost.
SENATOR GRAY-JACKSON asked if somebody would be required to put
this information in the database.
MS. WING-HEIER answered yes; the insurance company or
administrator of claims will be required to enter the
information into the database.
Continuing the presentation on slide 8, she reported that about
22 other states have operating all-payer claims databases. She
noted that the legislature has talked about an APCD before, most
recently last year. SB 93 has the same pretext and will have an
all-payer claims database.
MS. WING-HEIER said the answer to the question why would the
Governor do this now is "If not now, when? If not us, who?" To
continue towards the quadruple aim of health care, it is
important to take the first step. There is no more important
time to look at the cost of healthcare and healthcare insurance
than now when the state is coming out of the recession and
people are returning to work and have insurance through their
employer. The No Surprises Act provided a nudge. It said there
will be an all-payer claims database and it provides a grant of
$2.5 million to the state to develop the database.
2:22:34 PM
MS. WING-HEIER paraphrased the following points that the No
Surprises Act provides:
• Provides a structure to protect consumers against
surprise medical bills and determining out-of-
network provider payments including air
ambulances
• Notice and consent provisions for balance billing
of non-emergency services by nonparticipating
providers at participating facilities
• Establishes requirements for provider directories
• Establishes a dispute resolution process for
uninsured
• Provides guidance for continuity of care
• Requires insurers and other plans to have a price
comparison tool
• Modifies requirement on insurance cards
• Requires plans to provide an advance explanation
of benefits
• Encourages All-Payer Claims Databases and
provides grants up to $2.5 million to each state
2:23:29 PM
MS. WING-HEIER said 15 pages in the No Surprises Act address the
all-payers claims database. Much of what SB 93 does is to comply
with the federal law. This includes standard formatting, that
the grants would come from the Department of Treasury, billing
at cost for customized reports, and what data will be free to
authorized users or constituents. There will be a public front
so consumers can look at costs throughout the state. She said
one of the fiscal notes addresses the division's application for
the $2.5 million APCD grant.
She reviewed the authorized users that the No Surprises Act
defines. The slide read as follows:
An entity wanting access to the APCD, that has
received a grant, shall submit to the State APCD an
application for such access which shall include:
• In the case of an entity requesting access for
research purposes a description of the uses and
methodologies for evaluating health system
performance using the APCD; and
• Documentation of approval of the research by an
institutional review board, if applicable for a
particular plan or research
• The entity shall enter into a data use and
confidentiality agreement with the state the
agreement shall include a prohibition on attempts
to reidentify and disclose individually
identifiable health information and proprietary
financial information
• If the entity is an employer, health insurance
company, third-party administrator, or health
care provider requesting access for the purpose
of quality improvement or cost-containment, a
description of the intended use of the data.
• Employers and employer organizations may request
customized reports, at cost, subject to the
requirements of privacy, security, and
proprietary financial information.
• The state shall make available, to all eligible
users, aggregate data sets free of charge.
2:25:27 PM
SENATOR REVAK asked if the federal law or SB 93 addresses the
penalties for breaking that trust.
MS. WING-HEIER answered that it is not in SB 93 and she would
need to look at the federal bill to see whether there are
penalties for trying to identify the deidentified data.
SENATOR REVAK said he supposes that HIPAA laws would apply.
MS. WING-HEIER agreed they would apply.
SENATOR GRAY-JACKSON asked if the individual who requests the
customized report would pay a fee.
MS. WING-HEIER said yes; Senator Begich offered that as an
amendment. She said the division sees it as similar to a public
records request that generates a cost to the department. The
charge is simply to cover the cost of the customized reports.
MS. WING-HEIER continued to say that the standardized format
would provide for medical claims, pharmaceutical claims, dental
claims, it will show eligibility, and provider files. She
highlighted that a condition of somebody accessing this data for
a customized report is that the provider files must remain
confidential.
2:27:47 PM
MS. WING-HEIER summarized the sectional analysis on slide 16
saying SB 93 gives the division the authority to contract out
and manage the all-payer claims database. She said the next
slide is a diagram of the sources and flow of APCD data
submissions. Slide 18 has a table that shows types of coverage,
the estimated number of covered lives, and the percentage of the
Alaska population that represents. She clarified that the
estimate that nearly 70 percent of Alaskans would be covered
included some of the union trusts. Without that, the coverage
estimate is 35-40 percent but that is still enough data to be
credible.
2:28:52 PM
SENATOR STEVENS joined the committee.
MS. WING-HEIER turned to slide 19 and reviewed the task and
timing expectations in years 1-3. Year 1 is foundational, year 2
is start-up, and year 3 is when data is expected to be available
for authorized users and for the state.
2:29:42 PM
MS. WING-HEIER presented the following sectional analysis for SB
93:
Section 1: Establishes a new chapter 92 in Title 21 with
the following sections:
Section 21.92.010 All-payer claims database (APCD)
is established:
(a) Defines the purpose of a statewide APCD:
1) collect and analyze existing health care
cost and quality data;
2) create a central repository that is
objective and reliable;
3) provide transparent access to health care
information while protecting individual privacy
and proprietary
data; and
4) enable researchers, policymakers, and the
public to make informed decisions regarding
health care.
(b) APCD must provide:
1) publishable analytics to improve
transparency;
2) systematic collection of data; and
3) enhanced transparency.
(c) The director may:
1) require an insurer to submit data;
2) establish penalties to ensure compliance;
3) create agreements for voluntary reporting;
MS. WING-HEIER advised that voluntary reporting primarily is
anybody that is not an insurance company, including Medicaid,
Alaska Care, and union trusts.
4) solicit, receive and administer funding from
public and private sources;
5) by regulation, establish a schedule of
reasonable fees to be charged to an authorized
requesting business entity for the use and
distribution of data; and
6) carry out other activities necessary to
fulfill the purposes of the chapter.
2:31:25 PM
CHAIR COSTELLO asked her to talk about the assurance the public
would have that the information would be deidentified and if
there would be a penalty for sharing information that is not de-
identified.
MS. WING-HEIER stated that the division's intent is to request
that the contractor use the strictest firewalls and security so
an unauthorized user cannot access the data. Importantly, the
insurance companies are to remove names, Social Security
numbers, and any personal identifiable data before it goes into
the database. In addition, the data from small villages will be
aggregated into a larger geographic area to ensure the data is
not identifiable. She reiterated that there will be a penalty
for somebody who tries to identify the deidentified data and she
understands that would be a criminal matter.
SENATOR STEVENS questioned the reason for voluntary reporting
and asked if mandatory reporting would be more valuable.
MS. WING-HEIER answered yes, but that is a large lift. The hope
is that in a year or two when the database is functioning, the
entities that were unwilling to contribute their data will see
that it has value when they are looking at their own costs of
health care.
SENATOR STEVENS summarized that in time it may prove to be
valuable but not now.
MS. WING-HEIER said that is correct.
2:34:38 PM
MS. WING-HEIER continued the sectional analysis for SB 93.
Section 21.92.020 Selection and duties of lead
organization.
(a) By competitive bid, the director shall select an
organization to manage the APCD.
(b) Provides organizational requirements for the
APCD managing organization
(1) apply to be certified as a qualified entity
under 42 C.F.R. 401.703(a) by the Centers for
Medicare and Medicaid Services;
(2) enter into a contract with a data vendor or
multiple data vendors to perform data
collection, processing, aggregation, extracts,
and analytics;
(3) be responsible for internal governance,
management, and operations of the database and
shall work with the data vendor to fulfill the
purpose of this chapter;
(4) engage stakeholders in the development and
maintenance of the database;
MS. WING-HEIER said she believes it is very important that
stakeholders throughout Alaska are involved through the
regulation process and as the database is set up. Comments
should be solicited from employers, individuals, union trusts,
and others. Any comments should be seriously considered. For
example, the Section 1332 Waiver requires the department to hold
a hearing at least once a year to take comments and she can see
doing something similar for this database.
(5) provide an annual report to the director
regarding the status of the database and any
recommendations for changes to the database to
fulfill the purposes of this chapter;
(6) establish a process for making claims and
other data from the database available for use
and distribution upon request to authorized
requesters, consistent with the requirements of
this chapter;
(7) engage consumer protection stakeholders and
the community in the process described in (6)
of this subsection to ensure claims and other
data from the database are available in a
format accessible to all authorized requesters;
(8) prepare a health care data report each
calendar year that aggregates and analyzes the
data submitted to the database during the
previous calendar year; and
(9) perform other duties as required by the
director to fulfill the purposes of this
chapter.
Section 21.92.030 Confidentiality.
(a) The APCD shall be secure and confidential and
shall not be subject to public records public
inspection. Aggregated information can be shared as
provided in regulations. Individually identifiable
health care information will be confidential; and
(b) Information in the database will not be subject
to subpoena in any civil, criminal, judicial, or
administrative proceeding.
Section 21.92.040 Eligibility for state grants.
(a) Health insurers required to submit data to the
APCD may not receive a state grant unless compliant.
(b) Health care payers that agree to voluntarily
report data to the APCD may not receive a state
grant unless the data has been reported as required
by the payer's agreement.
MS. WING-HEIER noted that Senator Wilson put in that amendment
in the Senate Health and Social Services Committee.
Section 21.92.050 Regulations.
Allows for the director of the Division of
Insurance to adopt regulations.
Section 2: Allows the Division of Insurance to promulgate
regulations not later than January 1st of the calendar
year following the
effective date.
Section 3: Provides for an immediate effective date
2:37:22 PM
SENATOR STEVENS mentioned the recent breach in which the
Department of Health and Social Services released data to the
Municipality of Anchorage without authorization. He asked what
assurance she could offer that the security of this database
would be better.
MS. WING-HEIER replied she cannot say a breach will never happen
because everyone has seen that it does, but the department will
do everything it can to make sure the data is protected.
CHAIR COSTELLO offered her understanding that it was not someone
hacking into DHSS data but someone who was privy to information
and leaked it. She said that is why the committee's questions
about penalties are on target. The public needs assurance that
the data will be secure but it is always important to weigh the
values. In this instance, it is about the value of information
about the cost of health care that nobody has.
2:39:14 PM
SENATOR GRAY-JACKSON asked if the all-payer claims database
exists at the federal level.
MS. WING-HEIER answered no, but the federal government is
encouraging states to establish an APCD.
SENATOR GRAY-JACKSON asked who will be a mandatory reporter and
who will have discretion.
MS. WING-HEIER answered that insurance companies are the only
mandated reporters and Medicaid and Alaska Care will voluntarily
contribute their data to the database.
2:40:26 PM
CHAIR COSTELLO opened public testimony on SB 93; finding none,
she closed public testimony.
2:40:45 PM
At ease
2:41:06 PM
CHAIR COSTELLO reconvened the meeting and solicited a motion.
2:41:13 PM
SENATOR GRAY-JACKSON moved to report the CS for SB 93, work
order 32-GS1530\B, from committee with individual
recommendations and attached fiscal note(s).
CHAIR COSTELLO found no objection and CSSB 93(HSS) was reported
from the Senate Labor and Commerce Standing Committee.
2:41:55 PM
There being no further business to come before the committee,
Chair Costello adjourned the Senate Labor and Commerce Standing
Committee meeting at 2:41 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| SB 93 Sectional Analysis (Version B).pdf |
SL&C 4/19/2021 1:30:00 PM |
SB 93 |
| SB 93 Summary of Changes (Version A to Version B).pdf |
SL&C 4/19/2021 1:30:00 PM |
SB 93 |
| SB 93 Presentation for (S)L&C (April 2021).pdf |
SL&C 4/19/2021 1:30:00 PM |
SB 93 |