HOUSE OF REPRESENTATIVES

H.B. NO.

728

TWENTY-EIGHTH LEGISLATURE, 2015

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

relating to insurance.

 

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 


SECTION 1. Article 2 of chapter 431, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"431:2- De-identified claims data; disclosure. (a) The commissioner shall annually provide claims data collected pursuant to sections 432:1- , 432:2- , and 432D-    to a large group purchaser at no charge if the large group purchaser requests the data and is:

(1) Able to demonstrate its ability to comply with state and federal laws; and

(2) Is either:

(A) An employer with an enrollment of greater than one thousand covered lives and at least five hundred covered lives enrolled with the health organization providing the information; or

(B) A multiemployer trust with an enrollment of greater than five hundred covered lives and at least two hundred and fifty covered lives enrolled with the health organization providing the information.

(b) Nothing in this section shall be construed to prohibit a health organization and large group purchaser from negotiating the release of additional information not described in this section.

(c) All disclosures of data to the large group purchaser made pursuant to this section shall comply with the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191) and the federal Health Information Technology for Economic and Clinical Health Act, Title XIII of the federal American Recovery and Reinvestment Act of 2009 (Public Law 111-5), and implementing regulations.

(d) All disclosures of data to the large group purchaser made pursuant to this section shall comply with the confidentiality requirements of section 432D-21.

(e) De-identified claims data provided to the commissioner shall be deemed confidential information that shall not be made public by the commissioner and shall be exempt from disclosure under chapter 92F except as provided in this section.

(f) For purposes of this section, "health organization" means a mutual benefit society governed by article 1 of chapter 432, fraternal benefit society governed by article 2 of chapter 432, or health care service plan or health maintenance organization governed by chapter 432D."

SECTION 2. Article 1 of chapter 432, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432:1- De-identified claims data; disclosure. (a) Each society shall annually provide to the commissioner at no charge claims data that a qualified statistician has determined are de-identified so that the claims data does not identify or does not provide a reasonable basis from which to identify an individual; provided that if the statistician is unable to determine that the data has been de-identified, then the data that cannot be de-identified shall not be provided by the society to the commissioner; provided further that a society may provide the claims data in an aggregated form as necessary to comply with section 431:2- .

(b) As an alternative to providing claims data required pursuant to subsection (a), the society shall provide, at no charge to the commissioner, all of the following:

(1) De-identified data sufficient for a large group purchaser to calculate the cost of obtaining similar services from other health providers and evaluate cost-effectiveness by service and disease category;

(2) De-identified aggregated patient-level data on demographics, prescribing, encounters, inpatient services, outpatient services, and any other data that is comparable to what is required of the society to comply with risk adjustment, reinsurance, or risk corridors pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder; and

(3) De-identified aggregated patient-level data used to experience rate the large group, including diagnostic and procedure coding and costs assigned to each service that that society has available.

(b) The society shall obtain a formal determination from a qualified statistician that the data provided pursuant to subsection (a) has been de-identified so that the data does not identify or does not provide a reasonable basis from which to identify an individual. If the statistician is unable to determine that the data has been de-identified, the society shall not provide to the commissioner the data that cannot be de-identified. The statistician shall document the formal determination in writing and shall, upon request, provide the protocol used for de-identification to the commissioner."

SECTION 3. Article 2 of chapter 432, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432:2- De-identified claims data; disclosure. (a) Each society shall annually provide to the commissioner at no charge claims data that a qualified statistician has determined are de-identified so that the claims data does not identify or does not provide a reasonable basis from which to identify an individual; provided that if the statistician is unable to determine that the data has been de-identified, then the data that cannot be de-identified shall not be provided by the society to the commissioner; provided further that a society may provide the claims data in an aggregated form as necessary to comply with section 431:2- .

(b) As an alternative to providing claims data required pursuant to subsection (a), the society shall provide, at no charge to the commissioner, all of the following:

(1) De-identified data sufficient for a large group purchaser to calculate the cost of obtaining similar services from other health providers and evaluate cost-effectiveness by service and disease category;

(2) De-identified aggregated patient-level data on demographics, prescribing, encounters, inpatient services, outpatient services, and any other data that is comparable to what is required of the society to comply with risk adjustment, reinsurance, or risk corridors pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder; and

(3) De-identified aggregated patient-level data used to experience rate the large group, including diagnostic and procedure coding and costs assigned to each service that that society has available.

(b) The society shall obtain a formal determination from a qualified statistician that the data provided pursuant to this subsection have been de-identified so that the data does not identify or does not provide a reasonable basis from which to identify an individual. If the statistician is unable to determine that the data has been de-identified, the society shall not provide to the commissioner the data that cannot be de-identified. The statistician shall document the formal determination in writing and shall, upon request, provide the protocol used for de-identification to the commissioner."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"432D- De-identified claims data; disclosure. (a) Each health maintenance organization shall annually provide to the commissioner at no charge claims data that a qualified statistician has determined are de-identified so that the claims data does not identify or does not provide a reasonable basis from which to identify an individual; provided that if the statistician is unable to determine that the data has been de-identified, then the data that cannot be de-identified shall not be provided by the health maintenance organization to the commissioner; provided further that a health maintenance organization may provide the claims data in an aggregated form as necessary to comply with section 431:2- .

(b) As an alternative to providing claims data required pursuant to subsection (a), the health maintenance organization shall provide, at no charge to the commissioner, all of the following:

(1) De-identified data sufficient for a large group purchaser to calculate the cost of obtaining similar services from other health providers and evaluate cost-effectiveness by service and disease category;

(2) De-identified aggregated patient-level data on demographics, prescribing, encounters, inpatient services, outpatient services, and any other data that is comparable to what is required of the health maintenance organization to comply with risk adjustment, reinsurance, or risk corridors pursuant to the federal Patient Protection and Affordable Care Act (Public Law 111-148), as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152), and any rules, regulations, or guidance issued thereunder; and

(3) De-identified aggregated patient-level data used to experience rate the large group, including diagnostic and procedure coding and costs assigned to each service that that health maintenance organization has available.

(b) The health maintenance organization shall obtain a formal determination from a qualified statistician that the data provided pursuant to this subsection have been de-identified so that the data does not identify or does not provide a reasonable basis from which to identify an individual. If the statistician is unable to determine that the data has been de-identified, the health maintenance organization shall not provide to the commissioner the data that cannot be de-identified. The statistician shall document the formal determination in writing and shall, upon request, provide the protocol used for de-identification to the commissioner."

SECTION 5. Section 92F-13, Hawaii Revised Statutes, is amended to read as follows:

"92F-13 Government records; exceptions to general rule. This part shall not require disclosure of:

(1) Government records which, if disclosed, would constitute a clearly unwarranted invasion of personal privacy;

(2) Government records pertaining to the prosecution or defense of any judicial or quasi-judicial action to which the State or any county is or may be a party, to the extent that such records would not be discoverable;

(3) Government records that, by their nature, must be confidential in order for the government to avoid the frustration of a legitimate government function;

(4) Government records which, pursuant to state or federal law including an order of any state or federal court, are protected from disclosure; [and]

(5) Inchoate and draft working papers of legislative committees including budget worksheets and unfiled committee reports; work product; records or transcripts of an investigating committee of the legislature which are closed by rules adopted pursuant to section 21-4 and the personal files of members of the legislature[.]; and

(6) De-identified claims data provided to the insurance commissioner pursuant to articles 1 and 2 of chapter 432, and chapter 432D, except as provided in those sections."

SECTION 6. Section 432D-21, Hawaii Revised Statutes, is amended to read as follows:

"[[]432D-21[]] Confidentiality of medical information. (a) Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter, upon the express consent of the enrollee or applicant, pursuant to statute or court order for the production of evidence or the discovery thereof, or in the event of a claim or litigation between such person and the health maintenance organization wherein such data or information is pertinent. A health maintenance organization shall be entitled to claim any statutory privileges against disclosure which the provider who furnished the information to the health maintenance organization is entitled to claim.

(b) Nothing in this section shall prohibit a health maintenance organization from releasing relevant information described in this section for the purposes set forth in section 432D- ."

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect on July 1, 2015.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Insurance; Health Organizations; De-identified Claims Data; Disclosure

 

Description:

Requires a health organization to annually disclose de-identified claims data to Insurance Commissioner. Requires Insurance Commissioner to annually disclose de-identified claims data to a large group purchaser upon request. Exempts de-identified claims data from public disclosure except as provided. Makes conforming amendments.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.