00                      CS FOR SENATE BILL NO. 93(HSS)                                                                    
01 "An Act relating to the establishment of an all-payer health claims database; and                                       
02 providing for an effective date."                                                                                       
03 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF ALASKA:                                                                
04    * Section 1. AS 21 is amended by adding a new chapter to read:                                                   
05                 Chapter 92. All-Payer Health Claims Database.                                                         
06            Sec. 21.92.010. All-payer health claims database established. (a) The                                      
07       director shall establish a statewide all-payer health claims database. The purpose of the                         
08       database is to                                                                                                    
09                 (1)  collect and analyze existing health care cost and quality data;                                    
10                 (2)  create an objective, reliable, and comprehensive central repository                                
11       of health care information;                                                                                       
12                 (3)  provide researchers, policy makers, and the public timely and                                      
13       transparent access to health care information while protecting individual privacy and                             
14       proprietary data; and                                                                                             

01                 (4)  enable researchers, policy makers, and the public to make informed                                 
02       health care decisions and reduce unnecessary health care costs.                                                   
03            (b)  The all-payer health claims database must provide for                                                   
04                 (1)  publishable analytics that improve transparency so as to                                           
05                      (A)  assist patients, providers, and health care facilities to make                                
06            informed choices about care;                                                                                 
07                      (B)  enable providers, insurers, payers, health care facilities, and                               
08            communities to improve by benchmarking their performance against that of                                     
09            others and focusing on establishing best practices;                                                          
10 (C)  enable purchasers to identify value and build expectations                                                         
11            into their purchasing strategy; and                                                                          
12                      (D)  promote competition based on quality and value;                                               
13                 (2)  systematic collection of, at a minimum,                                                            
14 (A)  payment and other data for all medical and pharmacy                                                                
15            claims that are billed, rejected, and paid;                                                                  
16 (B)  payment and other data for all health care-related claims                                                          
17            that have been adjudicated;                                                                                  
18 (C)  de-identified enrollment files and provider files that include                                                     
19 cost and quality metrics from private and public payers, with data from all                                             
20            settings of care that permit the systematic analysis of health care delivery; and                            
21 (3)  enhanced transparency and accountability and validated statewide,                                                  
22 plan, and health care entity-level data by market segment, health care setting,                                         
23       demographics, geography, diagnosis, and other variables.                                                          
24            (c)  The director may                                                                                        
25 (1)  except as prohibited under federal law, require a health care insurer                                              
26 operating in the state to submit health care data to the database by a procedure and in a                               
27 format established by the division in regulation; the regulations must require that a                                   
28 health care insurer submit health care data in accordance with AS 45.48 and federal                                     
29       privacy requirements for the protection of patient data;                                                          
30 (2)  establish and impose reasonable penalties necessary to ensure                                                      
31 compliance with mandatory health care data reporting requirements adopted by the                                        

01       division in regulation;                                                                                           
02 (3)  establish agreements for voluntary reporting of health care data,                                                  
03 including cost and quality metrics from health care payers that are not subject to                                      
04 mandatory reporting requirements, to ensure availability of the most comprehensive                                      
05       and system-wide data on health care costs and quality;                                                            
06                 (4)  solicit, receive, and administer funding for the creation of the                                   
07       database from public and private sources;                                                                         
08                 (5)  establish by regulation a schedule of reasonable fees to be charged                                
09       to an authorized requester that is a business entity for the use and distribution of data                         
10       from the database to the business entity; and                                                                     
11 (6)  carry out other activities necessary to fulfill the purposes of this                                               
12       chapter.                                                                                                          
13 Sec. 21.92.020. Selection and duties of lead organization. (a) The director                                           
14 shall use a competitive bid process under AS 36.30 (State Procurement Code) to select                                   
15       an organization to coordinate and manage the all-payer health claims database.                                    
16            (b)  The selected organization shall                                                                         
17 (1)  apply to be certified as a qualified entity under 42 C.F.R.                                                        
18       401.703(a) by the Centers for Medicare and Medicaid Services;                                                     
19 (2)  enter into a contract with a data vendor or multiple data vendors to                                               
20       perform data collection, processing, aggregation, extracts, and analytics;                                        
21 (3)  be responsible for internal governance, management, and                                                            
22 operations of the database and shall work with the data vendor to fulfill the purpose of                                
23       this chapter;                                                                                                     
24 (4)  engage stakeholders in the development and maintenance of the                                                      
25       database;                                                                                                         
26 (5)  provide an annual report to the director regarding the status of the                                               
27 database and any recommendations for changes to the database to fulfill the purposes                                    
28       of this chapter;                                                                                                  
29 (6)  establish a process for making claims and other data from the                                                      
30 database available for use and distribution upon request to authorized requesters,                                      
31       consistent with the requirements of this chapter;                                                                 

01                 (7)  engage consumer protection stakeholders and the community in the                                   
02       process described in (6) of this subsection to ensure claims and other data from the                              
03       database are available in a format accessible to all authorized requesters;                                       
04                 (8)  prepare a health care data report each calendar year that aggregates                               
05 and analyzes the data submitted to the database during the previous calendar year; and                                  
06 (9)  perform other duties as required by the director to fulfill the                                                    
07       purposes of this chapter.                                                                                         
08            Sec. 21.92.030. Confidentiality. (a) The all-payer health claims database and                              
09       the information contained in the database are confidential and are not public records                             
10 subject to public inspection or disclosure under AS 40.25.100 - 40.25.295 (Alaska                                       
11 Public Records Act). The organization selected to coordinate and manage the all-payer                                   
12 health claims database shall ensure the security and confidentiality of the database and                                
13 the information contained in the database and shall comply with applicable state and                                    
14 federal privacy laws. Aggregated health care information contained in the database                                      
15 may not be shared except as provided in regulations adopted to carry out the purpose                                    
16 of this chapter. Individually identifiable health care information contained in the                                     
17 database may be accessed only by the organization selected to coordinate and manage                                     
18       the all-payer health claims database under AS 21.92.020 and may not be shared.                                    
19 (b)  Information contained in the database is not subject to subpoena in any                                            
20 civil, criminal, judicial, or administrative proceeding, except that information                                        
21 pertaining to a party in litigation may be subject to subpoena in an action brought by                                  
22       or on behalf of that party to enforce a liability claim arising under this chapter.                               
23 Sec. 21.92.040. Eligibility for state grants. (a) A health care insurer that is                                       
24 required to submit health care data to the statewide all-payer health claims database                                   
25 may not receive a state grant unless the insurer submits the data as required by the                                    
26       director under AS 21.92.010.                                                                                      
27 (b)  A health care payer that agrees to voluntarily report health care data to the                                      
28 statewide all-payer health claims database may not receive a state grant unless the                                     
29       payer reports the data to the database as required by the payer's agreement.                                      
30 Sec. 21.92.050. Regulations. The director may adopt regulations to                                                    
31       implement, define, and enforce the provisions of this chapter.                                                    

01    * Sec. 2. The uncodified law of the State of Alaska is amended by adding a new section to                          
02 read:                                                                                                                   
03 TRANSITION: REGULATIONS. Not later than January 1 of the calendar year                                                  
04 following the effective date of sec. 1 of this Act, the director of the division of insurance shall                     
05 adopt regulations necessary to implement changes made by sec. 1 of this Act. The regulations                            
06 take effect under AS 44.62 (Administrative Procedure Act), but not before the effective date                            
07 of sec. 1 of this Act.                                                                                                  
08    * Sec. 3. Section 2 of this Act takes effect immediately under AS 01.10.070(c).