SB 517 – This act modifies provisions relating to health care transparency. This act provides that a health carrier and any other entity in the business of offering health care coverage, to the extent allowed under federal law, shall provide data regarding quality of patient care, access to care, enrollee health status and patient satisfaction to the Department of Insurance, Financial Institutions and Professional Registration. The data submission shall be consistent with and more expansive than the requirements already required of health maintenance organizations. This raw data obtained by the department shall not be public information but may disclosed to the Department of Health and Senior Services. Reports and studies prepared by the Department of Health and Senior Services based upon such information shall be public information and may identify individual health care or coverage providers. However, the department shall not release data in a form which could be used to identify a patient. Any disclosure violation is a Class B misdemanor.
The department shall also collect and make publicly available data on such entities medical loss ratios, administrative costs as a percentage of total premium and incidence of grievances.
This act establishes guidelines for transparency in quality of health care services. A contract between a health carrier and a health care provider cannot require the provider to submit quality of care data to the health carrier as a condition of payment for medical services, unless such data is included in the set of quality of care indicators as selected by the federal Centers for Medicare and Medicaid Services for disclosure in comparative format to the public. The act prescribes what measures the health carrier may make as to data collected and disclosed. The act also prescribes what information and disclaimers shall be disseminated if any person sells or otherwise distributes to the public quality of care data.
Criteria is established for insurers to use in programs that publicly assess and compare the quality and cost efficiency of health care providers. The Department of Health and Senior Services is required to investigate complaints of alleged violations and is authorized to impose a penalty of up to $1,000. Alleged violations by health insurers will be investigated and enforced by the Department of Insurance, Financial Institutions, and Professional Registration.
This act also prescribes requirements for electronic claims transport, which is the accepting and digitizing of claims or accepting of claims already digitized and placing such claims into a format that complies with the electronic transaction standards issued by the federal Department of Health and Human Services under HIPAA law. The act outlines procedures for when such claims are electronically transmitted to the appropriate contracting entity, payer, or third-party administrator.
ADRIANE CROUSE