Legislature(2021 - 2022)BUTROVICH 205
03/23/2021 01:30 PM Senate HEALTH & SOCIAL SERVICES
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| Audio | Topic |
|---|---|
| Start | |
| SJR4 | |
| SB93 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | SB 93 | TELECONFERENCED | |
| *+ | SB 92 | TELECONFERENCED | |
| += | SJR 4 | TELECONFERENCED | |
SB 93-HEALTH INS. ALL-PAYER CLAIMS DATABASE
1:37:31 PM
CHAIR WILSON reconvened the meeting and 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." Chair Wilson asked Director
Wing-Heir to present the bill.
LORI WING-HEIR, Director, Division of Insurance, Department of
Commerce, Community and Economic Development (DCCED), Anchorage,
Alaska, said that an all-payer claims database has been
discussed before in the state. This year the governor has
introduced SB 93. She has been the director since 2014 and there
has not been a year that she has not discussed the cost of
healthcare or healthcare insurance with a member of the
legislature. It really started with the ACA (Affordable Care
Act), which is about the time she took the position, when the
state saw the individual market increase. The employer's market
increased. It didn't matter if it was a large employer with a
self-insured plan or a small employer. Alaska had the highest
cost in the nation, if not in the world. This has had an impact
on employers as they strive to put together an affordable
healthcare plan for their employees and continue to grow their
businesses.
1:40:00 PM
MS. WING-HEIR said that physicians and other providers have
worked hard with payers, be it with employers directly or
insurance companies, for stronger and stricter network
agreements. About two years ago, she first heard of the triple
aim. Providence put on a seminar to talk about how to transform
healthcare. At that time it was the triple aim. Now it is the
quadruple aim. The goals are to improve the patient experience,
improve the provider experience, have better health outcomes,
and, importantly, lower the cost of healthcare.
MS. WING-HEIR said quadruple aim and conversations around the
cost of healthcare have had broad community involvement. The
administration and the legislature, the Congressional
delegation, tribal partners, several groups from the Alaska
Policy Forum to the Mat-Su Health Foundation, insurance
companies, and providers have met many times in many different
forums to discuss the cost of healthcare or to transform the
healthcare system in Alaska. This ties back to the quadruple aim
that people are trying to achieve. The Mat-Su Health Foundation,
along with the Alaska State Medical Association and AARP, have
submitted letters of support for this bill.
MS. WING-HEIR asked what is missing. People talk about the cost
of healthcare, but the state has not had succinct, organized
data. She can pull data from insurance companies and data can be
gotten for AlaskaCare and Medicaid. Others could choose to
provide information. The problem is that all have different
systems. They come from different databases and there is no way
to merge data to look at an aggregate cost of healthcare. Alaska
has many reports on healthcare but no data. The reports show
that healthcare costs a great deal, but they offer no solutions
because there is not enough data. The state has had over 10
years of reports, not to mention those from ISER (Institute of
Social and Economic Research) with the University of Alaska
Anchorage. This is data needed to transform healthcare and take
a step forward to the quadruple aim.
MS. WING-HEIR said that many of these reports concluded that an
all-payer claims database was needed. She noted again that this
is not a new concept. Reports back to 2013 to the state of
Alaska urged the state to consider an all-payer claims database.
An all-payer claims database is either hosted directly in the
state or through a contract, where the state would do an
independent procurement bid to hire a contractor to collect the
data for the state in an organized format. Particular attention
is given to privacy, in the transfer to the database and who can
access it and under what conditions. The state proposal is to
hire a contractor. The Division of Insurance and its partners at
Retirement and Benefits and the Department of Health and Social
Services (DHSS) would contract out for a database manager. There
would be a lead organization to help the state through the
process and then the state would have the data management
vendor. Medicaid and private payers, insurance companies and
third-party adjusters, would submit the data in a predetermined
standard format. Particular attention will be paid to privacy.
The data will be deidentified, meaning the cost of claims and
procedures will be seen, but who had the procedure done will not
be known.
1:45:01 PM
SENATOR HUGHES said that privacy is very important to her and
her district. She clarified that nothing would be included that
could be traced back to a patient, including social security
numbers.
MS. WING-HEIR replied that the data will not be personally
identifiable. It will be aggregate data that cannot be traced
back to an Alaskan. Small communities will have to be merged
into a geographic region so that no one can be identified in a
rural village where it would be easy to identify someone with a
high-cost condition.
SENATOR COSTELLO asked if the data will show, for example, the
cost of treating a broken arm by different providers or will it
be averaged. An average won't be as helpful as looking at the
disparity.
MS. WING-HEIR answered that data will be shown by provider but
only to a degree. Federal law says that proprietary financial
information must remain private, such as rates negotiated with
an insurance company. The provider will be seen but not the
rates negotiated with different insurance companies.
MS. WING-HEIR said that all-payer claims databases (APCD) are
becoming more popular in the lower 48. More than 20 states have
an APCD, in some states for more than 10 years. Alaska can learn
from the mistakes made in the past to avoid those as it puts its
database together.
MS. WING-HEIR asked, "Why now? If not now, when. And if not us,
who?" To achieve the quadruple aim, the state must take the
first step at some point if it is dedicated to transforming
healthcare. The No Surprise Bill Act was passed in 2021. It was
funded through the Consolidated Appropriation Act of 2021. It
gave the state a gentle nudge to look at an APCD as it provides
guidance on how to establish an APCD with grants of $2.5 million
to each state to improve current databases or to adopt a
database. That is a big reason why she is there today; $2.5
million is a good head start for the APCD.
SENATOR HUGHES asked that since other states are doing it, will
Alaska be able to do comparisons to other states. Everyone has
heard that Alaska has the highest healthcare costs, but will the
APCD be part of the conversation once it is up and running.
MS. WING-HEIR answered yes. A researcher, an insurance company,
or an employer will be able to pull data for another state to
compare it to Alaska. The Secretary of Labor is in charge of
designing a standard format that states have to agree to as part
of the $2.5 million grant, so that comparisons can be made to
other states with databases.
1:50:10 PM
SENATOR REINBOLD noted that on page 3 the fiscal note is $3.9
million.
MS. WING-HEIR replied that is DHSS fiscal note and DHSS can
explain that.
CHAIR WILSON said that after the sectional the committee can ask
questions about the bill.
1:51:28 PM
MS. WING-HEIR said that the Consolidated Appropriations Act is
5,500 pages and the No Surprise Bill Act starts on page 1,628
and page 1,956 starts to talk about the APCD, which is about 15
pages of the act. It says it will provide a structure to protect
consumers against surprise medical bills. That gives an idea of
why the APCD is important now. This does not mean that anyone
who goes to a doctor will not get a billing. This means that if
someone goes to an in-network ER facility but the provider is
out of network, the patient will not get a surprise bill in that
case. Variations include the facility being out of network but
the provider is in. In an emergency situation the patient will
not get a surprise bill. This includes air ambulances. Other
times, when people go to a doctor, they will still have a cost
sharing, a copayment, a deductible. That is the basis for the No
Surprise Bill, but it also states that providers need to work
with patients on consent for nonemergency procedures. Providers
have to establish a directory of providers and a dispute
resolution process about what the provider should be reimbursed
by the payer. The bill provides guidance for continuity of care
and requires insurers and other plans to have a price comparison
tool. This gets into issues of transparency. Senator Hughes has
a bill on the right to shop and this is a tool that would help
with that. Consumers could see what the costs are. The No
Surprise Bill modifies the requirement for the data on insurance
cards, requires plans to provide an advance explanation of
benefits, and encourages all-payer claims databases and provides
grants up to $2.5 million to each state.
SENATOR HUGHES asked what the effective date is in the No
Surprise Bill.
MS. WING-HEIR said she thought it was January 2022. Some of the
dates differ.
SENATOR HUGHES said that the presentation noted that the act
requires insurers and other plans to have a price comparison
tool. Slide 4 of Ms. Wing-Heir's PowerPoint lists sources of
data and it is called an all-payer claims database, but her
understanding is that union providers are not in the database.
She was talking to a healthcare association that said it should
be called some-payers claims database. She asked who is being
left out.
MS. WING-HEIR said that self-insured employers/union trusts are
voluntary. The bill is structured so that insured plans, third
party administrators that are not unions or trusts, Medicaid,
and AlaskaCare will put their data in. It will be voluntary for
other large employers. The division has talked to some that may
provide data, and as it grows, there may be more participants.
There is some fear of the unknown and what the data will be used
for, but all will still have access to the data.
SENATOR HUGHES asked what the rough percentage is of those who
are required to report in Alaska.
MS. WING-HEIR replied that between 35 and 40 percent will be in
it.
1:57:19 PM
SENATOR BEGICH said he and Ms. Wing-Heir had had a conversation
about this issue. Looking at page 2, line 25, to page 3, line 1,
he asked where it says that. He read, "The director [except as
prohibited under federal law,] may require a healthcare insurer
operating in the state to submit healthcare data." He asked if
the federal law protects the voluntary plans or trusts. He wants
to draw attention to this to put a stake through that belief
that exists out there that this will somehow force a trust or
voluntary plan to have to provide data.
MS. WING-HEIR said there is not a state entity that has control
over ERISA (Employee Retirement Income Security Act) plans,
which is what the trusts are. They are regulated by the federal
Department of Labor. "Except as prohibited by federal law" is
key. There was a big court case where Maine tried to do an APCD
and was slapped hard for trying to make the trusts comply. If
the trusts want to volunteer, the division will gladly include
them but does not have the authority to mandate that the trusts
submit their data to the APCD.
SENATOR BEGICH said he wanted to explicitly place on the record
that a part of the bill directly addresses what the state can
and cannot do in terms of mandating reporting.
SENATOR REINBOLD asked if this has anything, including the
grant, to do with COVID money.
MS. WING-HEIR answered no.
SENATOR REINBOLD said that she pulled up the State of Reform
[Virtual health Policy Conference] on September 30 that all
legislators were invited to. That was in regard to an APCD as
well. She asked if there is any link or relationship to the
State of Reform.
MS. WING-HEIR replied that off the top of her head she cannot
remember what happened at the State of Reform. They are not a
part of this bill nor would they be a viable entity to bid on
it. Her answer at this point is that there is no link.
SENATOR REINBOLD said that a lot of the same people, such as
Heather Carpenter, were involved and one of the key features was
an APCD. It was put on by Senator von Imhof and Representative
Spohnholz.
MS. WING-HEIR said that last year Representative Spohnholz and
Senator von Imhof introduced an APCD bill. Ms. Wing-Heir did not
attend the State of Reform last year. The bill did not move far
last year. It was a different bill but the goal was the same, to
get an APCD.
2:01:38 PM
CHAIR WILSON referred to what was the Alaska Healthcare
Blueprint and is now the Healthcare Transformation Project. It
has about 90 stakeholders. The representative and senator are on
the executive committee. He and Representative Claman serve as
members. It looks at healthcare costs around the state to find
solutions. That was one of the action items from the work of
that group.
MS. WING-HEIR replied that it was a big group. Senator von
Imhoff and Representative Spohnholz are part of the executive
committee of that organization. Funding is from Rusmuson
Foundation and Mat-Su Health Foundation.
CHAIR WILSON added the state of Alaska also.
SENATOR REINBOLD noted many legislators were involved with the
State of Reform conference, which did involve COVID. One of the
goals was an APCD. Ms. Wing-Heir in her presentation noted
improving the patient experience, producing better outcomes,
lowering the cost of healthcare, and improving staff experience.
She asked how the Division of Insurance will do that.
MS. WING-HEIR replied that the Division of Insurance is not
going to do that, but it will be part of it. Part of that is
getting the data. This data will not only be about cost but will
have a quality metric, which will help improve patient
experience and outcomes. In the end better outcomes should lower
healthcare costs and improve the provider experience because,
frankly, providers have been beat up about the cost of
healthcare. Some of it has been subjective and objective. The
state knows it is high but has never had the aggregate data to
really delve into why costs are so high or where.
SENATOR REINBOLD said that is pie in the sky. It sounds lovely.
The silver bullet is $4 million more of state bureaucracy. It
doesn't add up for her. She is skeptical because this is a
significant growth of government. She asked Ms. Wing-Heir how
deeply involved each of the health partners are in this and how.
MS. WING-HEIR said that the administration has looked at studies
and ways to cut healthcare and how to work with insurance
companies, providers, and the state's own plans for employees.
The Chamber of Commerce has been open to working with and
supporting the transformation of healthcare. It will take a
village. No one person or one organization can do this. These
groups have worked through forums, through projects, and through
papers. They have written to legislators. They are extremely
interested as employers and as a part of Alaska in seeing either
the cost of healthcare explained or at least stabilized, if not
reduced.
SENATOR REINBOLD said the state has so many databases. To make a
promise that all these things are going to be achieved,
including a reduction in healthcare, as it increases government
by about $4 million in the first year in her mind is not adding
up. She asked who the providers are. They get regulated and
regulated. She asked about the type of privacy, such as it will
be encrypted. She asked what kind of rating the state has. The
last time she checked it was an F for privacy with state data.
This is important, protected information. Article 1, Section 22,
says the legislature's responsibility is to ensure citizens'
data is protected. If the legislature authorizes this, she wants
assurances about how the information will be protected.
2:08:27 PM
MS. WING-HEIR said the division has a letter of support from the
State Medical Association, which encompasses a number of
providers. The division has talked to ASHNHA (Alaska State
Hospital and Nursing Home Association). She is sure that ASHNHA
will weigh in on the bill at some point. There has been strong
involvement with the providers. Providers were well represented
with the Healthcare Transformation Project and with Alaskans for
Sustainable Healthcare. As for privacy, she doesn't know the
rating of the state. She will see what she can find. The data
the division is looking at exists in some database, either with
a third party administrator or the Medicaid system or insurance
companies. The division would bring the deidentified data to its
database and use the strongest possible security to ensure
Alaskans' privacy is protected.
SENATOR REINBOLD said that she would like to have a hearing
about data privacy and she would like a specific list of
providers.
2:10:02 PM
SENATOR HUGHES said that she has worked with the Alaska Primary
Care Association. Over the decades the state has had task forces
on healthcare to improve the state system and the costs have
escalated. One of the reasons is because the state does not have
free market principles operating well in the healthcare system
because the costs are unknown. At most businesses, consumers
know the cost, but it is difficult with healthcare. As long as
she is assured that there is the utmost privacy with
deidentification, this is one of the first things she has seen
come out of the work over the decades that might move the
needle. She will be concerned about privacy, but this is not
gathering data for the sake of gathering data. It is to move the
needle. Alaska is the highest cost place on the planet. If this
is a way to move Alaska from that top spot, she would like to
see it. She is aware of the decades of work with providers
sitting around the table. The Alaska Medical Association, the
Alaska Dental Association, they have all been part of the
conversations. If this is what they are promoting, that might
help the state. As long it is fully deidentified, it is a step
forward. She doesn't want to grow government, but $4 million is
a drop in the bucket compared to what private citizens are
spending in a year.
MS. WING-HEIR said that most of the information about the APCD
in the act states that secretaries in D.C. are adopting
regulations about what an APCD will be, but there is a grant of
$2.5 million available to Alaska. Alaska will have to ensure
uniform data collection and privacy and security of data. The
division will do its utmost to do that.
CHAIR WILSON asked when the application period will be available
for states.
2:13:17 PM
MS. WING-HEIR said that the division is hoping by July 1, but
with all that is required in the No Surprise Bill Act, it is a
tall, tall order for the federal government, but the division is
hoping that the federal rules will be published for comment by
July 1.
MS. WING-HEIR displayed the authorized users on slide 14. The
division must guarantee who can access the data and when. She
highlighted the third bullet, "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." The state must have this
worked out to get the grant. The act addresses who can access
the data for free and who the division can charge for cost. The
standard format will be defined by the Department of Labor.
Proprietary information is defined in the act--the data that
would disclose the terms of a specific contract between an
individual healthcare provider or facility and a specific group
health plan, managed care entity, or other managed care
organization, or health insurer offering group or individual
health insurance. Those network agreements are proprietary
information.
SENATOR BEGICH clarified that the APCD is free for individual
consumers but the law allows the division to consider a fee-
based process to pay for operating costs.
MS. WING-HEIR replied yes, that it does for research, for
insurance companies, and such. The division must allow it at
cost.
SENATOR BEGICH said that he had been thinking of an amendment
related to that issue, but he asked if it is necessary if the
division has the authority to do that.
MS. WING-HEIR answered that she would be hesitant to put the
pricing in until the federal government gives the state more
guidelines with the rules.
SENATOR BEGICH asked if she has the authority to charge a fee
under the bill as it is written. He was not thinking of putting
in a pricing schedule.
MS. WING-HEIR responded that she is not an attorney, but it
couldn't hurt. The federal guidelines do provide it, but it
could be stronger.
SENATOR BEGICH said that he was going to work on an amendment
that would provide the authority for fee-based access to offset
implementation and continuing operating costs.
2:16:55 PM
SENATOR REINBOLD said this sounds like a repeat of the ACPE
(Alaska Commission on Postsecondary Education) common core
database that ended up being linked to the Permanent Fund
Dividend. No one can opt out of this information. That was for
education. Healthcare is an even bigger deal than education. She
is concerned about the breach of data, even the elections data
was breached. She does not trust the state. The state does not
have the top encrypted security. This is too much liability for
her. She asked if the APCD has to comply with HIPAA. She would
be resistant if she were a provider about entrusting the state
with data. There can be serious criminal penalties for violating
HIPAA.
MS. WING-HEIR responded that the division is not collecting data
from providers but from payers.
SENATOR REINBOLD said that private providers have to play a role
or there is no healthcare.
MS. WING-HEIR said that the data will come deidentified. The
state will use a contractor. It will not be in a state database.
It will be with data security company. All she can ask for in an
RFP (Request for Proposals) is the strictest standards to
guarantee the privacy of Alaskans and their data.
MS. WING-HEIR said that the Secretary of Labor shall establish,
and periodically update, a standardized reporting format for
voluntary reporting, by group health plans of medical claims,
pharmacy claims, and dental claims and eligibility and provider
files. This comes from insurance companies. Nothing asks the
providers to submit directly to the database.
2:19:18 PM
MS. WING-HEIR displayed a simple graph on slide 17 to show how
this would work. Payers would submit to the lead organization
and data manager and then APCD reports and data products would
be available to help with the goal of reforming healthcare.
SENATOR BEGICH said in reference to the last box representing
data products, he has another amendment concept to ensure that
the data is easily accessible to the consumer. He is only posing
this theoretically, but he is thinking of requiring developing
the database in conjunction with the Better Business Bureau or a
consumer protection group.
MS. WING-HEIR said that the federal law will require the
database to have a front-facing entity where people can
comparison shop and pull data. It will not go into real
specifics, but people would see the different data on providers
and what the cost might be.
SENATOR BEGICH offered that a better approach would be to
suggest in the RFP instead of legislation that whoever develops
the database works with a consumer group that understands how
difficult it can be. Over 100 languages are spoken in his
district. Many people may not proficient with English or have
access to the internet. That could be considered as part of the
RFP. There could be a line about an ability to consider the
consumer end product in an RFP.
MS. WING-HEIR replied that is a good idea. She had not thought
of the language barriers and will take that into consideration,
that common consumers must understand what they are pulling and
what it means to them.
SENATOR BEGICH said that he will submit that in the form of a
letter rather than an amendment.
2:22:13 PM
SENATOR COSTELLO asked if a customer goes to the database to see
the potential cost, what happens if the bill from the provider
is different from the database information.
MS. WING-HEIR answered that is part of the No Surprise Act The
provider must give an estimate up front. If it is wrong, barring
no unseen consequences, there is a reporting provision back to
the federal government. There is a dispute resolution process if
there is a difference between what someone was quoted and the
final bill. That is under the No Surprise Bill.
SENATOR REINBOLD said she spent many years in healthcare, such
as chief operating officer of a medical practice. People would
say they were coming in for a headache when it could actually be
a host of many other issues. Healthcare is complicated.
Healthcare is not like a grocery story. It is stressful to run a
front desk. She would prefer doing something about long-term
outcomes, which are more important than one more database. This
bill frustrates her.
MS. WING-HEIR replied that is one of the quadruple aims, better
healthcare outcomes, helping to bring costs down. Both the
patient and provider have a better experience.
CHAIR WILSON asked Ms. Wing-Heir to present the sectional.
2:25:32 PM
MS. WING-HEIR presented the sectional analysis for SB 93, which
is four pages long and, in its essence, allows the division to
establish a database:
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
healthcare cost and quality data;
2) create a central repository that is
objective and reliable; 3) provide
transparent access to healthcare
information while protecting individual
privacy and proprietary data; and
4) enable researchers, policymakers,
and the public to make informed
decisions regarding healthcare.
(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;
4) solicit, receive and administer
funding from public and private
sources; and
6) carry out other activities.
Section 21.92.020 Selection and duties of lead
organization.
(a) By competitive bid, the director can
select an organization to manage the APCD.
(b) Provides organizational requirements for
the APCD managing organization
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
healthcare 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 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.
MS. WING-HEIR said this is a simple bill in contracting out.
2:27:47 PM
SENATOR BEGICH said that for Section 1, Section 21.92.020,
selection and duties of lead organization, he could draft his
amendment ideas and put them in here. He will share his ideas
with the director to see if they are consistent and acceptable
with what the bill is trying to do. Otherwise, he will just
leave them with her as suggestions. The contractor should be
required to work with stakeholders so the contractor responds to
actual needs. Senator Reinbold has made clear that anything the
legislature passes must be responsive to the community. Senator
Hughes has focused on the privacy issue. He thinks of small
villages. The census uses a differential process to assign data
to a region but not necessarily a village.
MS. WING-HEIR said that everyone on her team agrees that this
has to be deidentified. A claim may not show up, say, as a North
Slope claim.
2:30:37 PM
SENATOR BEGICH said it is differential privacy. That is one of
the concerns he would put on the table. He supports the bill
with those little caveats.
SENATOR HUGHES asked if grouping villages is required in the
legislation or is that just the division plan. She wondered if
that needed to be in the bill.
MS. WING-HEIR said that the division has talked about it
internally. The federal bill requires it be deidentified. She
doesn't know if it specifies how regions have to be merged to
form one group, but the administration has talked about it
internally. With another program, so that no one could point out
a claim, the state had to do a more aggregate approach. The
state doesn't anyone with a scarlet letter because of a
healthcare condition.
SENATOR HUGHES suggested that maybe the committee could make
sure that is a durable feature of this. Also, because more
Alaskans are choosing to use providers outside of the state, she
asked if that data from out-of-state providers could be
collected and deidentified.
2:32:46 PM
MS. WING-HEIR answered that she would say yes because the data
is from the payer, not the provider, so the state would get that
data. The division would need to look at how to deidentify that
if, for example, someone went to the Mayo Clinic in Minnesota.
SENATOR HUGHES asked if there will be a way to track what
percentage of treatment is received outside of the state.
MS. WING-HEIR replied that she would think that the state could
see how much healthcare is going to Seattle, for example, and
not Anchorage, but, again, the division must cognizant of the
need for deidentification if, for example, someone went to New
Hampshire.
SENATOR REINBOLD said her philosophy is that to lower healthcare
costs in Alaska, increase vitamin D, encourage people to
exercise, and choose a healthier lifestyle. That is what will do
it, not another bureaucratic approach. On page 1 of the bill,
there is a central depository of healthcare information and line
13 says transparent access, so a lot of people can access this
data, while protecting individual privacy and proprietary data.
She asked what will be protected, exactly.
2:34:58 PM
MS. WING-HEIR answered personal, identifiable data information
that would identify individuals as the person who received that
healthcare and the proprietary information is between the
provider and the insurance company or third-party administrator
or the self-insured with a network agreement. That is considered
proprietary under the federal bill.
SENATOR REINBOLD clarified that the division will be getting the
personal data and the proprietary information and would have to
protect that.
MS. WING-HEIR said that she did not believe that the division
will be getting it. The division will have transparent access to
healthcare information while protecting individual privacy.
There would be no need for the division to get the identifiable
information. The division would only get the deidentified
information.
SENATOR REINBOLD asked if the contractor would get that.
MS. WING-HEIR replied that she does not believe so. It is
deidentified when the contractor gets it.
SENATOR HUGHES said that the bill on page 2, line 13, says that
"a systematic collection of at minimum" and on line 18
"deidentified enrollment files," so the vendor or contractor
doesn't get it.
2:36:40 PM
SENATOR REINBOLD asked then who has it. She is trying to figure
out what must be protected if nothing is identified. It is an
oxymoron.
CHAIR WILSON said it just states that as a double scrubber, just
in case. The provider gives the information to the insurer, the
insurer scrubs the information and then gives that to the state.
In the bill, the state will protect all the information it gets.
Protecting privacy is on page 2, which states the state will
collect the minimum, necessary deidentified information.
SENATOR REINBOLD said there could be criminal fines for
releasing HIPAA-protected data. She asked if there is any type
of fine if information is released.
MS. WING-HEIR responded that she struggles with that because
there must be information released, which is why it is being
collected, for researchers and policy makers to use to look at
the cost of healthcare, but it will be deidentified. The state
will, to the highest standards, working with insurers, other
payers, and contractor, make sure the information is
deidentified to protect the consumers.
CHAIR WILSON asked someone at DHSS to verify that there are
sanctions for violating federal HIPAA law.
2:38:53 PM
HEIDI LENGDORFER, Chief Data Officer, Department of Health and
Social Services (DHSS), Juneau, Alaska, said that is correct and
normally happens through the Office of Civil Rights.
CHAIR WILSON clarified that the office would also go after the
state of Alaska if the state released that information.
MS. LENGDORFER answered that is correct.
SENATOR REINBOLD stated that is helpful. She asked what type of
penalties are issued.
MS. LENGDORFER replied that they are typically monetary
penalties.
SENATOR REINBOLD asked for a range.
CHAIR WILSON asked Ms. Lengdorfer to provide that in writing to
the committee.
SENATOR REINBOLD asked if there are any criminal penalties.
MS. LENGDORFER answered that she is not aware of criminal
penalties because typically the enforcement action is taken
against organizations.
2:40:28 PM
CHAIR WILSON opened public testimony.
2:40:39 PM
PAM VENTGEM, Executive Director, Alaska State Medical
Association, Anchorage, Alaska, said the Alaska State Medical
Association (ASMA) is the largest physician association. It is
in support of SB 93. It is obvious to all that healthcare
quality and cost and delivery are on the forefront of policy
debates in Alaska and around the country. For ASMA, the
foundation for making good policy decisions rests on good data.
Many studies advocate for an APCD as the first step for
understanding healthcare costs, quality, and delivery and yet
Alaska has not taken that first step. Instead, Alaska constantly
debates anecdotal information, old information, and incomplete
information. Over the last decade, the state has built
healthcare delivery systems that the ASMA believes is as good as
what can be obtained Outside. That hasn't always been the case.
As the state continues to approach healthcare policy decisions,
ASMA does not want to see decisions that undermine the current
level of care. Having good, actionable information will be key
to making any healthcare policy decisions in the future.
2:42:22 PM
CHAIR WILSON closed public testimony.
SENATOR REINBOLD said that page 3 for the selection and duties
of the lead organization says the director "may" use a
competitive bid process. She asked why it does not say "shall"
use a competitive bid process.
MS. WING-HEIR answered that she would need to ask the drafters.
There is no way to do this without a competitive bid process.
SENATOR REINBOLD asked if she would mind an amendment to make it
"shall" and Ms. Wing-Heir answered no.
2:43:30 PM
CHAIR WILSON held SB 93 in committee.