Requires certain health care providers, SHBP, and School Employees’ Health Benefits Program to submit certain health care claims data to DOBI. This bill requires health care providers reimbursed by the State Medicaid Program, and the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), to annually submit to the Commissioner of Banking and Insurance information regarding health care claims data from all health care payers for the ten services or benefits having the highest costs within each respective program. The commissioner shall maintain this information and make it available upon request and at no cost to the public for the purposes of research or policymaking. Furthermore, the commissioner shall establish procedures to ensure privacy and confidentiality of patients and adopt a standard reporting form in paper and electronic formats for the purposes of submitting health care claims data pursuant to the bill.
The United States Supreme Court decision in Goebeille v. Liberty Mutual Insurance Co. prohibits states from collecting certain health care claims data directly from employers and third-party administrators, and hence, limits efforts to identify measures to lower health care costs. It is the sponsor’s intent to provide certain health care claims data from the State’s Medicaid Program, SHBP, and SEHBP to researchers and policymakers, in a manner permissible under federal law, as a means to assess utilization, cost, and quality in parts of the State’s health care system.