SB 201: "An Act establishing the Alaska Health Care Transformation Corporation; relating to an all-payer claims database; and providing for an effective date."
00 SENATE BILL NO. 201 01 "An Act establishing the Alaska Health Care Transformation Corporation; relating to 02 an all-payer claims database; and providing for an effective date." 03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA: 04 * Section 1. The uncodified law of the State of Alaska is amended by adding a new section 05 to read: 06 LEGISLATIVE FINDINGS AND INTENT. (a) The legislature finds that 07 (1) the cost of health care for residents of the state is high, and the current 08 increase in health care costs has reached a critical point; from 1991 to 2014, the state's health 09 care cost growth rate has averaged 7.9 percent, while the United States average was 5.9 10 percent during this period; 11 (2) reasonable access to health care is important not only to the health and 12 vitality of the state's residents but also as an economic driver essential to the state's economy; 13 (3) to enact effective health care policy and reform, policy makers should 14 (A) understand cost drivers and health care market pressures;
01 (B) encourage the use of efficient and evidence-based practices, with 02 sound decision making rooted in accurate and comprehensive information; and 03 (C) have access to information about health care utilization, quality, 04 and pricing necessary to evaluate health programs and monitor the success and 05 efficiency of efforts to enhance access, reduce health care costs, and improve both 06 health care quality and population health; 07 (4) the percentage of the state's residents with a usual source of primary care 08 has remained around 68 percent for the last decade, leaving the state ranked as one of the 09 lowest states in this category; 10 (5) the state has struggled with implementing durable health care policy, 11 which requires a multi-year effort that exceeds the terms of elected government officials; 12 (6) health care consumers in the state face a challenge finding reliable, 13 comprehensive, consumer-friendly information on health care cost, service utilization, quality, 14 and pricing; 15 (7) despite the utility and necessity of reliable and comprehensive health care 16 data with sufficient analytic capacity for policy makers, providers, payers, patients, and 17 researchers, the state lacks a central repository and process for collecting and utilizing health 18 care cost and quality data; 19 (8) comprehensive health care data can be provided by all-payer claims 20 databases, which are large-scale databases that systematically collect health care claims data 21 from a variety of payer sources and which have been used by many other states; 22 (9) the Alaska Healthcare Transformation Project is a cooperative effort 23 involving key stakeholders from across the health care spectrum; 24 (10) the Alaska Healthcare Transformation Project concluded that 25 comprehensive and consistent health system-level data is necessary for policy makers to 26 understand and make informed decisions about the health care market in the state; 27 (11) establishing a public corporation to create an all-payer claims database to 28 continue the work of the Alaska Healthcare Transformation Project is the next step in 29 improving the state's health care system through informed health care decision making; and 30 (12) the establishment of a public corporation with a legal existence separate 31 and independent from the state should provide a foundation for ongoing policy analysis,
01 development, implementation, and support for proven strategies that will allow for innovation 02 in health care delivery. 03 (b) It is the intent of the legislature to 04 (1) encourage full participation by all parties in the corporation by exempting 05 activities undertaken, reviewed, and approved by the corporation from state antitrust laws to 06 the extent necessary to accomplish the corporation's goals; the legislature does not intend to 07 exempt agreements among competing providers or carriers or the setting of prices or specific 08 levels of reimbursement for health care services; and 09 (2) facilitate greater transparency in the health care sector by requiring and 10 encouraging all payers to submit health care data to a centralized repository that complies 11 with P.L. 104-191 (Health Insurance Portability and Accountability Act of 1996) for the 12 purposes of making data-driven health care policy that will serve the interests of citizens in 13 the state. 14 * Sec. 2. AS 18.15 is amended by adding new sections to read: 15 Article 7A. Alaska Health Care Transformation Corporation. 16 Sec. 18.15.500. Alaska Health Care Transformation Corporation 17 established. The Alaska Health Care Transformation Corporation is created as a 18 public corporation and an instrumentality of the state in the Department of Commerce, 19 Community, and Economic Development, but with a separate and independent legal 20 existence. The purpose of the corporation is to 21 (1) collect and analyze existing health care cost and quality data; 22 (2) create an objective, reliable, and comprehensive central repository 23 of health care information; 24 (3) provide researchers, policy makers, and the public timely and 25 transparent access to health care information while protecting individual privacy and 26 proprietary data; 27 (4) enable researchers, policy makers, and the public to make informed 28 health care decisions and reduce unnecessary health care costs. 29 Sec. 18.15.510. Corporation governing body; term; removal; 30 compensation. (a) The corporation shall be governed by a council consisting of 17 31 voting members appointed by the governor and four nonvoting members. A voting
01 member must be a resident of the state. 02 (b) The voting members consist of 03 (1) four representatives of health care providers located in the state as 04 follows: 05 (A) one member who represents a tribal health program; 06 (B) one member who represents a professional hospital 07 association; 08 (C) one member who represents a professional medical 09 association; and 10 (D) one member who represents a professional pharmacy 11 association; 12 (2) four representatives of health care payers as follows: 13 (A) one member who represents a self-insured employer or 14 group located in the state that is not engaged in the business of providing 15 health care; 16 (B) one member who represents an insurance company that 17 holds a certificate of authority issued under AS 21.09; 18 (C) one member who represents a third-party administrator 19 registered in the state under AS 21.27; and 20 (D) one member who represents the state in the administration 21 of the medical assistance program established under AS 47.07; 22 (3) four representatives in health care policy-making positions in the 23 state as follows: 24 (A) one member who represents a policy-making entity in the 25 area of behavioral health services; 26 (B) one member who represents a municipality that has health 27 care powers, ownership of and management responsibilities for a hospital, or 28 ownership of and management responsibilities for a community health center; 29 (C) the director of the division of insurance in the Department 30 of Commerce, Community, and Economic Development or the director's 31 designee; and
01 (D) the director of the division of retirement and benefits in the 02 Department of Administration or the director's designee; 03 (4) five representatives of advocates for consumers of health care in 04 the state who are located in the state as follows: 05 (A) one member who represents a children's advocacy 06 association; 07 (B) one member who represents a long-term services and 08 supports advocacy association; 09 (C) one member who represents a health insurance broker or 10 consultant for small businesses or acts as a benefits navigator; 11 (D) one member who represents a behavioral health advocacy 12 association; and 13 (E) one member who has experience managing health care 14 privacy issues on behalf of consumers. 15 (c) Notwithstanding a member's appointment under (b) of this section, the 16 member shall serve the best interests of the state and not those of the member or group 17 the member represents. 18 (d) The four nonvoting members consist of 19 (1) one ex officio member of the senate appointed by the president of 20 the senate; 21 (2) one ex officio member of the house of representatives appointed by 22 the speaker of the house of representatives; 23 (3) one ex officio member representing the Office of the Governor; 24 and 25 (4) one ex officio member representing the Veterans Health 26 Administration in the United States Department of Veterans Affairs. 27 (e) When appointing a voting member to the council, the governor shall 28 consider an individual's competence and experience or expertise in the health care 29 industry. The governor shall fill a vacancy in the voting membership of the council 30 after the governor has considered a list of nominees submitted by the council. The 31 governor may reject a list or a portion of a list submitted under this subsection and
01 request that the council submit another list. The governor shall make the appointment 02 within 45 days after the council submits the list of nominees. 03 (f) The voting members of the council shall annually elect a chair and vice- 04 chair from among the voting members. The chair and vice-chair may not be members 05 of the same group of voting members as described in (b)(1) - (4) of this section. 06 (g) Voting members of the council are appointed to staggered five-year terms, 07 may be reappointed, and may not serve more than two consecutive terms. Except as 08 provided in AS 39.05.080(4), a council member appointed to fill a vacancy holds 09 office for the balance of the unexpired term. 10 (h) The governor may remove a voting member only for good cause. A 11 removal by the governor must be in writing and must state the reason for the removal. 12 The council may suggest to the governor the removal of a voting member. In this 13 subsection, "good cause" means 14 (1) a violation of AS 39.52 (Alaska Executive Branch Ethics Act); 15 (2) a conviction of a felony in any jurisdiction; or 16 (3) a conviction of a misdemeanor in any jurisdiction if the 17 misdemeanor involves dishonesty or a breach of trust or is a crime against the state. 18 (i) Council members serve without compensation but 19 are entitled to per diem and travel allowances authorized for boards and 20 commissions under AS 39.20.180. 21 Sec. 18.15.520. Quorum. (a) A majority of the voting members of the council 22 constitutes a quorum for the transaction of business and the exercise of powers and 23 duties of the council. Action may be taken and a motion or resolution may be adopted 24 upon an affirmative vote of a majority of the voting members. 25 (b) The council may meet and transact business by electronic media. An 26 action taken at a meeting held by electronic media under this subsection has the same 27 legal effect as an action taken at a meeting held in person. 28 Sec. 18.15.530. Meetings. The council shall meet at least twice every year. A 29 meeting of the council shall occur at the call of the chair or upon the written request of 30 a majority of the voting members of the council. 31 Sec. 18.15.540. Powers of the corporation. The corporation may
01 (1) make, use, and alter a corporate seal; 02 (2) enter into contracts; 03 (3) establish and amend bylaws; 04 (4) procure facilities; 05 (5) employ and determine the salary of an executive director; the 06 executive director may, with the approval of the council, select and employ additional 07 staff as necessary; an employee of the council, including the executive director, may 08 not be a member of the council; the executive director and the other employees of the 09 corporation are in the exempt service under AS 39.25; 10 (6) solicit, receive, and administer funds from public and private 11 sources; 12 (7) review and make recommendations on public and private health 13 care quality and performance measurements to ensure efficiency, cost-effectiveness, 14 transparency, and informed choice by consumers and public and private purchasers; 15 (8) except as prohibited under federal law, require a health care insurer 16 operating in the state to submit health care data to the corporation by a procedure and 17 in a format established by the corporation in regulation; the regulations must require 18 that a health care insurer submit health care data in accordance with AS 45.48 and 19 federal privacy requirements for the protection of patient data; in this paragraph, 20 "health care insurer" has the meaning given in AS 21.54.500 and also includes a third- 21 party administrator of a health insurance plan offered by a self-insured employer or 22 health trust in the state and Medicare and Medicaid plans; 23 (9) establish an incentive program to facilitate the timely and accurate 24 reporting of health care data; 25 (10) establish and impose reasonable penalties necessary to ensure 26 compliance with mandatory health care data reporting requirements adopted by the 27 corporation in regulation; 28 (11) establish agreements for voluntary reporting of health care data, 29 including cost and quality metrics from health care payers that are not subject to 30 mandatory reporting requirements, to ensure availability of the most comprehensive 31 and system-wide data on health care costs and quality;
01 (12) in collaboration with regionally based stakeholders, incorporate 02 regional health care agendas and priorities through planning processes and policies 03 that are based on comprehensive health care data; 04 (13) evaluate a statewide health care cost growth rate based on total 05 health care expenditures as a per capita measure of total health care spending growth; 06 (14) analyze emerging health policy issues and regulations by working 07 with national and state experts to bring best practices and new ideas to the state; 08 (15) develop and analyze health and administrative policy on priority 09 topics, such as the key elements of health system transformation, rural health care 10 initiatives, health care financing, and others; 11 (16) request and be entitled to receive from any department, division, 12 board, bureau, commission, or agency of the state the assistance and data that will 13 enable it properly to carry out its powers and duties; and 14 (17) carry out other activities necessary to fulfill the purposes of 15 AS 18.15.500 - 18.15.595. 16 Sec. 18.15.550. Duties of the corporation. The corporation shall 17 (1) establish policies, procedures, and regulations for the 18 (A) selection of nominees to the council; 19 (B) collection, processing, storage, analysis, use, and release of 20 existing health care data in the state, including quality metrics and claims data 21 as specified in (4)(B) of this section, beginning with the establishment of an 22 all-payer claims database; 23 (2) develop strategies to steer the health care system in the state toward 24 a population-based payment and delivery system, beginning with uniform reporting of 25 a core set of health care quality measures; 26 (3) provide policy analyses and programming recommendations for 27 health policy leaders in the legislative and executive branches of state government and 28 those in the public and private sector concerned with improving the value of health 29 care in the state; 30 (4) establish a statewide all-payer claims database that provides 31 (A) publishable analytics that improve transparency so as to
01 (i) assist patients, providers, and hospitals to make 02 informed choices about care; 03 (ii) enable providers, insurers, payers, hospitals, and 04 communities to improve by benchmarking their performance against 05 that of others and focusing on established best practices; 06 (iii) enable purchasers to identify value, build 07 expectations into their purchasing strategy, and reward improvements 08 over time; and 09 (iv) promote competition based on quality and value; 10 (B) systematic collection of, at a minimum, 11 (i) payment and other data for all medical and pharmacy 12 claims that are billed, rejected, and paid; 13 (ii) payment and other data for all health care-related 14 claims that have been adjudicated; 15 (iii) de-identified enrollment files and provider files that 16 include cost and quality metrics from private and public payers, with 17 data from all settings of care that permit the systematic analysis of 18 health care delivery; 19 (C) enhanced transparency and accountability and validated 20 statewide, plan, and health care entity-level data by market segment, health 21 care setting, demographics, geography, diagnosis, and other variables; 22 (5) use a competitive bid process under AS 36.30 (State Procurement 23 Code) to select an organization to coordinate and manage the all-payer claims 24 database; 25 (6) establish a data policy advisory committee to provide input on data 26 collection, data security, data de-identification, reporting, data release policies, 27 development of data release procedures, formal data release requests, and related 28 policies; the advisory committee must include representatives of provider and 29 consumer groups, health care purchasers, health plans, health care researchers, and 30 state agencies involved in implementation of the all-payer claims database; 31 (7) develop a data submission guide with input from stakeholders and
01 design a process that will allow for stakeholder review and comment on drafts of the 02 data submission guide and all subsequent changes to the guide; the data submission 03 guide must, at a minimum, establish data submission requirements, including required 04 fields, file layouts, file components, editing specifications, instructions, and other 05 technical specifications; 06 (8) approve the data submission guide and all subsequent changes; 07 (9) establish committees to provide for stakeholder engagement, 08 including 09 (A) a proposal evaluation committee to review proposals, 10 including for data management services; 11 (B) an advisory committee on social determinants of health to 12 provide input into developing measures of social determinants of health; and 13 (C) an advisory committee on health care quality measures to 14 provide input on a core health care quality measure set; 15 (10) analyze health care data to support informed health policy and 16 health reform efforts; 17 (11) identify and explore key health care issues, questions, and 18 problems that may be addressed through more transparent, objective, reliable, and 19 comprehensive health care data; 20 (12) compare the cost and effectiveness of various treatment settings 21 and approaches; 22 (13) address emerging health care issues and topics as they arise in the 23 future; 24 (14) provide information to consumers and purchasers of health care 25 relating to the cost and quality of health care services; 26 (15) identify sustainable funding strategies for funding ongoing 27 operations from both public and private sources; and 28 (16) use a competitive bid process under AS 36.30 (State Procurement 29 Code) to select an organization to design, build, and maintain the all-payer claims 30 database website. 31 Sec. 18.15.560. Confidentiality. The all-payer claims database and the
01 information contained in the database are confidential and not public records subject 02 to public inspection or disclosure under AS 40.25.100 - 40.25.295 (Alaska Public 03 Records Act). The organization selected to coordinate and manage the all-payer claims 04 database under AS 18.15.550(5) shall ensure the security and confidentiality of the 05 database and the information contained in the database. Aggregated health care 06 information contained in the database may not be shared except as provided in 07 regulations of the corporation. Individually identifiable health care information 08 contained in the database may be accessed only by the organization selected to 09 coordinate and manage the all-payer claims database under AS 18.15.550(5) and may 10 not be shared. 11 Sec. 18.15.570. Regulations. The corporation may adopt regulations under 12 AS 44.62 (Administrative Procedure Act) to carry out its duties. 13 Sec. 18.15.580. Budget. The operating budget of the corporation is subject to 14 AS 37.07 (Executive Budget Act). 15 Sec. 18.15.595. Definitions. In AS 18.15.500 - 18.15.595, 16 (1) "corporation" means the Alaska Health Care Transformation 17 Corporation established under AS 18.15.500; 18 (2) "council" means the governing body of the corporation. 19 * Sec. 3. The uncodified law of the State of Alaska is amended by adding a new section to 20 read: 21 TRANSITION: MEMBERS OF THE COUNCIL OF THE ALASKA HEALTH 22 CARE TRANSFORMATION CORPORATION. Notwithstanding AS 39.05.055 and 23 AS 18.15.510(e) and (g), added by sec. 2 of this Act, the governor shall, not later than 90 days 24 after the effective date of this Act, appoint the initial voting members of the council of the 25 Alaska Health Care Transformation Corporation to one-year terms. The governor shall use the 26 criteria in AS 18.15.510(b) and (d), added by sec. 2 of this Act, when appointing the initial 27 members of the council. 28 * Sec. 4. The uncodified law of the State of Alaska is amended by adding a new section to 29 read: 30 TRANSITION: REGULATIONS. (a) Not later than June 30, 2021, the Alaska Health 31 Care Transformation Corporation shall adopt regulations necessary to implement
01 AS 18.15.550(1), enacted by sec. 2 of this Act. The regulations take effect under AS 44.62 02 (Administrative Procedure Act), but not before the effective date of sec. 2 of this Act. 03 (b) Not later than December 31, 2021, the Alaska Health Care Transformation 04 Corporation shall adopt regulations necessary to implement AS 18.15.550(5), enacted by sec. 05 2 of this Act. The regulations take effect under AS 44.62 (Administrative Procedure Act), but 06 not before the effective date of sec. 2 of this Act. 07 * Sec. 5. This Act takes effect immediately under AS 01.10.070(c).