AN ACT IMPLEMENTING THE GOVERNOR'S BUDGET RECOMMENDATIONS CONCERNING AN ALL-PAYER CLAIMS DATABASE PROGRAM.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. Section 19a-724 of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2012):

(a) (1) As used in this section and section 19a-725, "Affordable Care Act" means the Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the Health Care and Education Reconciliation Act, P.L. 111-152, as both may be amended from time to time, and federal regulations adopted thereunder.

(2) As used in this section and section 19a-724a, as amended by this act: (A) "All-payer claims database" means a database that receives and stores data from a reporting entity relating to medical insurance claims, dental insurance claims, pharmacy claims and information from enrollment and eligibility files; and (B) "reporting entity" means (i) an insurer, as defined in section 38a-1, licensed to do health insurance business in this state, (ii) a health care center, as defined in section 38a-175, (iii) an insurer or health care center that provides coverage under Part C or Part D of Title XVIII of the Social Security Act, as amended from time to time, to residents of this state, (iv) a third-party administrator, as defined in section 38a-720, (v) a pharmacy benefits manager, as defined in section 38a-479aaa, (vi) a hospital service corporation, as defined in section 38a-199, (vii) a medical service corporation, as defined in section 38a-214, (viii) a fraternal benefit society, as described in section 38a-595, that transacts health insurance business in this state, (ix) a dental plan organization, as defined in section 38a-577, (x) a preferred provider network, as defined in section 38a-479aa, or (xi) any other person, as defined in section 38a-1, that administers health care claims and payments pursuant to a contract or agreement or is required by statute to administer such claims and payments.

(b) There is established, in the office of the Lieutenant Governor, the Office of Health Reform and Innovation. The Special Advisor to the Governor on Healthcare Reform shall direct the activities of the Office of Health Reform and Innovation.

(c) The Office of Health Reform and Innovation shall:

(1) Coordinate and implement the state's responsibilities under state and federal health care reform;

(2) Identify (A) federal grants and other nonstate funding sources to assist with implementing the Affordable Care Act, and (B) other measures which further enhance access to health care, reduce costs and improve the quality of health care in the state;

(3) Recommend and advance executive action and legislation to effectively and efficiently implement the Affordable Care Act, and state health care reform initiatives;

(4) Design processes to maximize stakeholder and public input and ensure transparency in implementing health care reform;

(5) Ensure ongoing information sharing and coordination of efforts with the General Assembly and state agencies concerning public health and health care reform;

(6) Report on or after January 1, 2012, and annually thereafter, in accordance with section 11-4a, to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies, human services, insurance and public health on the progress of state agencies concerning implementation of the Affordable Care Act;

(7) Ensure coordination of efforts with state agencies concerning prevention and management of chronic illnesses;

(8) Ensure that the structures of state government are working in concert to effectively implement federal and state health care reform;

(9) Ensure, in consultation with the Connecticut Health Insurance Exchange and the Department of Social Services, the necessary coordination between said exchange and Medicaid enrollment planning; [and]

(10) Maximize private philanthropic support to advance health care reform initiatives;

(11) Establish and maintain an all-payer claims database program for the purpose of providing transparent and public reporting of health care information relating to safety, quality, cost-effectiveness, access and efficiency for all levels of health care;

(12) Oversee the initial planning and implementation of the all-payer claims database program; and

(13) Ensure that reporting entities report health care data for the purpose of allowing: (A) A determination of the maximum capacity and distribution of existing resources allocated to health care; (B) identification of the demands of the health care system; (C) health care policymakers to make informed choices; (D) an evaluation of the effectiveness of intervention programs to improve health outcomes; (E) a comparison of the costs and effectiveness of various treatment settings and approaches to offering treatment; (F) consumers of health care services to be informed with regard to consumer health care services; (G) improvement in the quality and affordability of health care and health care coverage in the state; and (H) an evaluation of health disparities in the state, including, but not limited to, any health disparities relating to race or ethnicity.

(d) The Office of Health Reform and Innovation, in consultation with the SustiNet Health Care Cabinet established pursuant to section 19a-725, shall [, on or before August 1, 2011,] convene a consumer advisory board that consists of not less than seven members.

(e) The Office of Health Reform and Innovation and the Office of the Healthcare Advocate shall provide staff support to the SustiNet Health Care Cabinet.

(f) The Office of Health Reform and Innovation shall maintain a central comprehensive health reform web site.

(g) State agencies shall, within available appropriations, use their best efforts to provide assistance to the Office of Health Reform and Innovation.

(h) The Office of Health Reform and Innovation, in consultation with the SustiNet Health Care Cabinet, may retain any consultants necessary to carry out the statutory responsibilities of said office, except the Office of Health Reform and Innovation may, without consulting with said cabinet, retain any consultants necessary to assist with the planning or implementation of the all-payer claims database program. Consultants may be retained by said office for purposes that include, but are not limited to, conducting feasibility and risk assessments required to implement, as may be practicable, private and public mechanisms to provide adequate health insurance products to individuals, small employers, nonstate public employers, municipal-related employers and nonprofit employers, commencing on January 1, 2014. Not later than October 1, 2012, the Office of Health Reform and Innovation and the SustiNet Health Care Cabinet shall make recommendations to the Governor based on the results of the analyses undertaken pursuant to this subsection.

(i) The Governor may, in consultation with the All-Payer Claims Database Advisory Group, described in section 19a-724a, as amended by this act, transfer responsibility for the implementation or administration of the all-payer claims database program from the Office of Health Reform and Innovation to any other person or entity designated by the Governor to act as the claims database administrator. The responsibilities of the claims database administrator may include the adoption of rules, policies and procedures for implementation or administration of the all-payer claims database program. The claims database administrator may retain any consultants necessary to assist with the implementation or administration of the all-payer claims database program.

(j) The Special Advisor to the Governor on Healthcare Reform or the claims database administrator, in consultation with the All-Payer Claims Database Advisory Group, described in section 19a-724a, as amended by this act, shall prescribe rules for the all-payer claims database program that are consistent with standards adopted by the Accredited Standards Committee X12 of the American National Standards Institute, the National Council for Prescription Drug Programs, the All-Payer Claims Database Council, the Center for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology. Such rules shall (1) establish the time, place, form and manner for a reporting entity to report data, including, but not limited to, (A) requiring the use of unique patient and provider identifiers; (B) implementing the use of a uniform coding system that reflects health care utilization and costs for health care services; and (C) establishing an exemption to reporting requirements based on a minimum enrollment level, (2) establish reporting requirements based on data type that includes, but is not limited to, (A) data relating to health care claims; (B) information contained in enrollment and eligibility files; and (C) reports, schedules, statistics and other data relating to health care costs, prices, quality, utilization or resources, (3) establish protocols for auditing the accuracy of reported data, and (4) establish protocols for the disclosure of data contained in the all-payer claims database that protects the confidentiality of health information, as defined in 45 CFR 160.103, and other information, as required by state and federal law.

(k) The Special Advisor to the Governor on Healthcare Reform or the claims database administrator may (1) enter into a contract or take any other action that is necessary to obtain fee-for-service health claims data under the state medical assistance program or Medicare Part A or Part B; or (2) enter into a contract for the collection, management or analysis of data. Any such contract for the collection, management or analysis of data shall expressly prohibit the disclosure of such data for purposes other than the collection, management or analysis of such data pursuant to the terms of the contract.

(l) The Special Advisor to the Governor on Healthcare Reform or the claims database administrator shall: (1) Utilize data in the all-payer claims database to provide health care consumers in the state with information concerning the cost and quality of health care services that will allow such consumers to make economically sound and medically appropriate health care decisions; and (2) make data in the all-payer claims database available to any state agency, insurer, employer, health care provider, consumer of health care services, researcher or the Connecticut Health Insurance Exchange for the purpose of allowing such person or entity to review such data as it relates to health care utilization, costs or quality of health care services. Such disclosure shall be made in a manner to protect the confidentiality of health information, as defined in 45 CFR 160.103, and other information, as required by state and federal law, and in accordance with the protocols for the disclosure of data established by the Special Advisor to the Governor on Healthcare Reform or the claims database administrator.

(m) The Special Advisor to the Governor on Healthcare Reform or the claims database administrator may set a fee to be charged to each person to access data stored in the all-payer claims database.

(n) The Office of Health Reform and Innovation and the claims database administrator may accept grants from the federal government, a municipality or any other source for the purpose of planning, implementing or administering the all-payer claims database program.

(o) Any reporting entity that fails to report in accordance with the provisions of this section or rules established under this section shall be assessed a civil penalty in an amount not to exceed one thousand dollars per day. A civil penalty assessed under this section is not allowable as a cost for the purpose of rate determination or reimbursement by a third-party payer.

Sec. 2. Section 19a-724a of the 2012 supplement to the general statutes is repealed and the following is substituted in lieu thereof (Effective October 1, 2012):

(a) The Office of Health Reform and Innovation established under subsection (b) of section 19a-724 shall convene a working group to be known as the All-Payer Claims Database Advisory Group. Said group shall (1) develop a plan to implement a state-wide multipayer data initiative to enhance the state's use of health care data from multiple sources to increase efficiency, enhance outcomes and improve the understanding of health care expenditures in the public and private sectors; and (2) advise the Special Advisor to the Governor on Healthcare Reform or the claims database administrator on matters relating to the planning, implementation and administration of the all-payer claims database program, including, but not limited to, the establishment of protocols for the disclosure of data in the all-payer claims database, as required by section 19a-724, as amended by this act. [Such] Said group shall include, but not be limited to, the Secretary of the Office of Policy and Management, the Comptroller, the Commissioners of Public Health, [and] Social Services, and Mental Health and Addiction Services, the Insurance Commissioner, the Health Care Advocate, representatives of health insurance companies, health insurance purchasers, hospitals, consumer advocates and health care providers. The Special Advisor to the Governor on Healthcare Reform or the claims database administrator may appoint additional members to said group.

(b) The Office of Health Reform and Innovation shall submit, in accordance with section 11-4a, a report on such plan to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations, insurance and public health.

Statement of Purpose:

To implement the Governor's budget recommendations.

[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not underlined.]