California Health Data Organization: all-payer claims database.

Existing law establishes the Office of Statewide Health Planning and Development (OSHPD) to perform various functions and duties with respect to health facilities, health professions development, and health policy and planning, including, but not limited to, consulting with the Insurance Commissioner, the Director of the Department of Managed Health Care, and others to adopt a California uniform billing form format for professional health care services and a California uniform billing form format for institutional provider services. Existing law requires organizations that operate or own a health facility to file specified reports with OSHPD containing various financial and patient data. Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires health care service plans and health insurers to provide an explanation of benefits or explanation of review that identifies the name of the network that has a written agreement signed by the provider whereby the payor is entitled, directly or indirectly, to pay a preferred rate for the services rendered. This bill would request the University of California to establish the California Health Data Organization and would request the organization to collect data from payers, as specified, and establish an all-payer claims database. The bill would require certain private payers to submit claims data to the organization on utilization, payment, and cost sharing for services delivered to beneficiaries. The bill would request the organization to establish working groups consisting of specified representatives to coordinate with existing stakeholder processes related to federal and state price transparency and payment reform and would request the organization to consider the recommendations of those working groups, as specified. The bill would request the organization to organize the data collected pursuant to the bill's provisions and to design and maintain an Internet Web site that allows consumers to compare the prices paid by payers for procedures, as specified. The bill would prohibit data made available to the public from containing sufficient information to identify an individual and would require the organization to keep confidential any proprietary information it obtains. The bill would request the University of California to seek available funding from the federal government and other private sources to cover the costs associated with these provisions and would authorize the organization to charge a fee to each person or entity requesting access to data stored in the database it creates. Existing constitutional provisions require that a statute that limits the right of access to the meetings of public bodies or the writings of public officials and agencies be adopted with findings demonstrating the interest protected by the limitation and the need for protecting that interest. This bill would make legislative findings to that effect.