HOUSE OF REPRESENTATIVES

H.B. NO.

1284

THIRTY-FIRST LEGISLATURE, 2021

H.D. 2

STATE OF HAWAII

S.D. 1

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO THE DEPARTMENT OF HUMAN SERVICES.

 

 

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

 


SECTION 1. Chapter 346, Hawaii Revised Statutes, is amended by adding a new section to part XX to be appropriately designated and to read as follows:

"346-   Access to health care, pharmacy benefits, and dental care insurance data; mandatory reporting for certain insurers. (a) Beginning November 1, 2016, providers of health insurance that provide health benefits plans funded by the Hawaii employer-union health benefits trust fund, the state medicaid agency, or both, shall provide to the health analytics program, or its designee, administrative data required by the health analytics program to determine health benefits costs, including health care services claims and payment data regarding beneficiaries of health benefits plans funded by the Hawaii employer-union health benefits trust fund, the state medicaid agency, or both.

(b) Beginning July 1, 2019, providers of health insurance that provide medicare advantage (medicare part C) health benefits plans to residents of the State shall provide to the health analytics program, or its designee, administrative data required by the health analytics program, including health care services claims and payment data.

(c) Upon request of the health analytics program, providers of health insurance doing business in the State that are not subject to subsections (a) and (b) may submit administrative data to the health analytics program, or its designee, that the health analytics program deems necessary to perform its functions.

(d) Subject to available funding, the health analytics program may contract with entities for the analysis of all‑claims, all-payer administrative data collected under this section and processed by a data center pursuant to this section to benefit medicaid and medicare recipients, public employees, and public sector retirees and for other public purposes.

(e) The health analytics program shall develop and update an annual plan for the analysis, maintenance, and publication of all-claims, all-payer administrative data collected pursuant to this section. The health analytics program shall seek approval for the annual plan from the director of health, administrator of the Med-QUEST division of the department of human services, and the chief information officer of the State.

(f) The health analytics program shall adopt rules, pursuant to chapter 91, for the schedule and frequency at which providers of health insurance shall provide all-claims, all‑payer administrative data to the health analytics program. Rules adopted pursuant to this subsection shall also include provisions relating to data governance, data submission, use and sharing, information security, privacy protection, reporting, and any other matter necessary for the health analytics program to perform its functions under this section. In adopting rules, the health analytics program shall consider the measures necessary to implement all-claims, all-payer administrative data submission requirements by providers of health insurance subject to this section, using methods that are reasonable and cost‑effective for data submitters.

(g) The health analytics program or its designee shall not disclose any individual patient's personal health information in violation of state or federal law.

(h) To minimize any risk of data breaches and re‑identification of data, the all-claims, all-payer administrative data and information submitted to the health analytics program shall include only the minimum protected health information identifiers necessary to link public and private data sources and the geographic and services data to undertake studies.

(i) The health analytics program or its designee, and any recipient of data collected pursuant to this section, shall maintain the original all-claims, all-payer protected health information identifier in a separate database that is not linked with any other data and shall use a proxy or encrypted record identifier for data analysis.

(j) No person shall attempt to re‑identify subjects of protected health information from the all-claims, all-payer administrative data submitted to the health analytics program or its designee. No person shall disclose all-claims, all-payer administrative data that contains direct personal identifiers, including but not limited to name, mailing address, electronic mail, telephone number, date of birth, or social security number.

(k) The health analytics program or its designee may acquire federal medicare data sets specific to this State and made available to states. Any public agency that possesses medicare data sets specific to this State shall share the data with the health analytics program or its designee at no additional cost to the health analytics program or its designee.

(l) No later than twenty days prior to the convening of each regular session, the health analytics program shall submit an annual report to the legislature on the submission, maintenance, and use of all-claims, all-payer administrative data submitted to the health analytics program pursuant to this section.

(m) For the purposes of this section:

"Administrative data" means:

(1) Statistical and financial reports of information;

(2) Patient invoices or similar patient encounter data;

(3) Records of services used for or resulting from administering delivery of health care, pharmacy benefits, or dental care, including records of services provided under health benefits plans as defined in section 87A-1; and

(4) Any other records as established pursuant to rules adopted pursuant to chapter 91.

"Provider of health insurance" means a group health insurance contract or service agreement that may include medical, hospital, surgical, prescription drug, vision, or dental services, in which a carrier agrees to provide, pay for, arrange for, or reimburse the cost of the services, including third party administrators."

SECTION 2. New statutory material is underscored.

SECTION 3. This Act shall take effect on January 1, 2022.


 


 

Report Title:

Med-QUEST; All-claims, All-payer Data; Health Analytics Program; Medicare Advantage; Administrative Data

 

Description:

Requires health insurance providers that provide health benefits plans funded by the Hawaii employer-union health benefits trust fund or the state medicaid agency and providers that provide medicare advantage (medicare part C) health benefits plans to provide administrative data to the health analytics program in the department of human services. Requires the health analytics program to develop an annual plan for the analysis, maintenance, and publication of collected all-claims, all-payer administrative data. Effective 1/1/22. (SD1)

 

 

 

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