SB78: (New Title) establishing the New Hampshire health care information council.

SB 78-FN - AS AMENDED BY THE SENATE

03/27/03 0820s

04/10/03 1210s

2003 SESSION

03-0608

01/09

SENATE BILL 78-FN

AN ACT establishing the New Hampshire health care information council.

SPONSORS: Sen. O'Hearn, Dist 12; Sen. Clegg, Dist 14; Sen. Flanders, Dist 7; Rep. Hunt, Ches 28; Rep. Kurk, Hills 48; Rep. Rogers Johnson, Rock 83

COMMITTEE: Public Institutions, Health and Human Services

ANALYSIS

This bill establishes the New Hampshire health care information council. Under this bill, the health care information council shall implement and maintain a statewide health care data base.

This bill is a request of the insurance department.

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

03/27/03 0820s

04/10/03 1210s

03-0608

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

AN ACT establishing the New Hampshire health care information council.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 New Chapter; New Hampshire Health Care Information Council. Amend RSA by inserting after chapter 420-J the following new chapter:

CHAPTER 420-K

NEW HAMPSHIRE HEALTH CARE INFORMATION COUNCIL

420-K:1 Statement of Purpose. The purpose of this chapter is to create a nonprofit, voluntary council to promote informed decision-making, increase accountability in the health care system, and improve health care planning through the collection and maintenance of useful, objective, reliable and comprehensive data and health care information. The council shall serve as a resource for insurers, employers, providers, and purchasers of health care, as well as state government, to continuously assess and improve the cost and quality of health care in New Hampshire and to enhance the ability of New Hampshire consumers and employers to make informed and cost effective health care choices.

420-K:2 Creation of Council. A New Hampshire health care information council is hereby created. The council shall be a nonprofit voluntary corporation under RSA 292 organized for the purpose of compiling, maintaining, and disseminating statewide health care information and data. The council shall be governed by a 17-member board of directors. The board shall administer this chapter and shall report to the governor, the legislature, New Hampshire's congressional delegation, and the public. The council shall be deemed a health oversight agency, as that term is defined by 45 CFR Part 164.501, and shall operate under the authority of the state of New Hampshire. The council shall possess all powers as provided in this chapter and as derived from its status as a nonprofit voluntary corporation, and such additional powers as are specified in its plan of operation approved by the commissioner of the department of health and human services.

420-K:3 Definitions. In this chapter:

I. "Board" means the board of directors of the New Hampshire health care information council.

II. "Commissioner" means the commissioner of the department of health and human services.

III. Council" means the New Hampshire health care information council.

IV. "Claims data" means encounter information created or received by a licensed health carrier that is used or relied upon to carry out the financial or administrative activities related to the provision of health care.

V. "Direct personal identifier" means a name, postal address information other than town or city, state and zip code, telephone and fax number, electronic mail address, social security number, or other information that identifies a particular individual.

VI. "Health carrier" means any entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the insurance commissioner, that contracts or offers to provide, deliver, arrange for, pay for or reimburse any of the costs of health services; including an insurance company, a health maintenance organization, a nonprofit health services corporation, or any other entity providing health coverage.

VII. "Health care" means care, services, or prescription drugs that are related to the health of an individual and provided by a licensed health care provider for preventive, diagnostic, therapeutic, or rehabilitative reasons.

VIII. "Health care facility" means an institution primarily providing health care services, including, but not limited to, hospitals and licensed inpatient centers, ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers, diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health settings.

IX. "Health care provider" means a hospital, pharmacy, nursing home, long-term care facility, health care facility, or licensed health care professional or group of hospitals or health care professionals that provide health care services, other than supplying medical equipment or products.

X. "Public use data set" means a data set from which all direct personal identifiers have been removed or blanked.

420-K:4 Board of Directors.

I. The council shall be governed by a 17-member board of directors. Members of the board shall serve in a volunteer capacity, and shall not receive compensation, other than reimbursement for expenses.

II. Two members shall serve in an ex-officio capacity and 15 members shall be appointed in accordance with this paragraph:

(a) The commissioner, or designee, shall serve in an ex-officio capacity.

(b) The commissioner of insurance, or designee, shall serve in an ex-officio capacity.

(c) One physician representative, appointed by the New Hampshire Medical Society.

(d) Three consumer representatives, who shall be appointed by the commissioner of the department of health and human services, by the commissioner of the insurance department, and by the governor. No consumer representative shall be an employee, officer, or director of any health care insurer, health care provider or health care facility, or otherwise have a significant financial interest in a health care facility, insurer, or provider.

(e) Three business representatives, who shall be appointed by the New Hampshire Chambers of Commerce governing board, by the Business and Industry Association of New Hampshire, and by the governor. No business representative shall be an employee, officer, or director of any health care insurer, health care provider or health care facility, or otherwise have a significant financial interest in a health care facility, insurer, or provider.

(f) Two labor representatives who shall represent the state's largest public sector and private sector unions, appointed by the governor.

(g) One hospital representative, appointed by the New Hampshire Hospital Association.

(h) Two insurance representatives, appointed by the governor.

(i) One health insurance producer, appointed by the commissioner of insurance.

(j) One nursing home or long-term care facility representative, appointed by the commissioner of the department of health and human services.

(k) One local government representative, appointed by the New Hampshire Municipal Association.

III. The board of directors shall:

(a) Prepare a plan of operation for submission to the commissioner for approval.

(b) Fulfill the duties and responsibilities outlined in the plan of operation.

(c) Prepare an annual budget.

(d) Enter into a contract or memorandum of understanding for the compilation, storage and processing of data.

(e) Make the data available for analysis of data and the preparation of reports.

(f) Develop and disseminate health care cost and other information designed to assist businesses and consumers in purchasing health insurance, health care, and long-term care services.

(g) Prepare and make public summaries, compilations and reports based on the data.

(h) Work collaboratively with the department of health and human services to establish a standard format for the submission of claims data.

(i) Develop a fee schedule for providing technical assistance and access to the council's data and information.

(j) Design, operate, and maintain facilities for public and state researchers' use of health care data.

(k) Retain an executive director and other staff to the extent allowed by available revenues to administer the council's activities.

(l) Approve and submit an annual report of its activities to the governor, the legislative oversight committee, the commissioner of the department of health and human services, and the commissioner of the insurance department.

(m) Evaluate biennially the impact and effectiveness of the data collection, the information needs of consumers and businesses, and the relevance and usefulness of the information developed by the council.

IV. The board shall nominate a chairperson from among its members.

V. The board shall establish the directors' terms of office.

420-K:5 Plan of Operation.

I. The board of directors of the council shall adopt a plan of operation that shall require the approval of the commissioner. The plan of operation shall include the following:

(a) A proposal for the development of a comprehensive information system;

(b) A description of the data sets that the council intends to include in its comprehensive health care information system;

(c) A description of the criteria that the council intends to use to determine the data included in the public use data sets;

(d) The council's procedures for handling and accounting for funds;

(e) The council's requirements for keeping financial and other records of its activities;

(f) The procedures that the council intends to use to establish and maintain public awareness of the council and the data and information available; and

(g) The regular times and places for meetings of the board.

II. The plan of operation shall provide for continuing collaboration with the commissioner on matters including, but not limited to, the criteria to be applied in developing public use data sets, and the format for the submission of claims data.

420-K:6 Duties of the Council.

I. The council shall have the following duties:

(a) The council shall develop a comprehensive health care information system that shall include an all payor claims data set, and other data and information from insurers, third party administrators, state and federal governmental agencies, health care providers, accreditation and other organizations. The information system shall:

(1) Compile and disseminate data pertaining to the cost and utilization of health care services that will assist businesses and consumers in purchasing health care and long-term care services, assist carriers and providers in managing health care delivery and insurance products, and assist government and other policymakers in analyzing and understanding the insurance and health care markets;

(2) Use, build, improve upon and coordinate existing data sources and measurement efforts through the integration of data systems and standardization of concepts;

(3) Provide public access to data collected and used by both public and private sector information systems;

(4) Minimize the burden on those providing data to the New Hampshire health care information council; and

(5) Preserve the reliability, accuracy and integrity of data and health care information while ensuring that the data and health care information is publicly available.

II.(a) The council shall review state, federal, and other data reporting requirements, and shall consider the research and initiatives being pursued by the United States Department of Health and Human Services, the National Committee for Quality Assurance, the Joint Commission on Accreditation of Health care Organizations, and the Centers for Medicare and Medicaid Services to reduce potential duplication and inconsistencies. The council shall report its findings to the New Hampshire congressional delegation and the state's legislative oversight committee on an annual basis.

(b) The council shall collaborate with state agencies and health insurance carriers that collect health-related data while maintaining confidentiality and providing other safeguards as may be required to protect the privacy of individual patients and physicians.

(c) The council shall evaluate biennially the impact and effectiveness of its data collection and data submission requirements. The council shall endeavor to ensure that the data collected and submitted to the council is used to produce information of value to consumers, providers, insurers, employers, and government. In the event that the council determines that the data is not sufficient to allow the council to carry out its duties, the council shall prepare and submit a report to the commissioner proposing legislative changes to require additional data collection.

420-K:7 Collection of Data.

I. The council shall develop and implement data reporting and submission requirements for the filing, processing, storage and analysis of health care data. The data reporting and submission procedures shall:

(a) Use, build and improve upon existing data sources;

(b) Minimize the burden on those providing the data; and

(c) Preserve the reliability, accuracy and integrity of the data while ensuring that data is available to the public.

II. The council shall enter into a memorandum of understanding with the department of health and human services for services necessary to carry out the data collection, analysis, processing and storage activities and reporting activities required under this chapter. The memorandum of understanding shall require that the department annually collect the hospital discharge data, Medicaid, and claims data, and obtain the Medicare data set for New Hampshire. The department shall provide each of these data sets on a timely basis to the council. The data sets provided to the council shall not include patient names, street addresses, e-mail addresses, telephone numbers, or social security numbers.

III. All licensed health carriers shall be required to submit their claims data to the department of health and human services in accordance with the format and schedule established by the council in collaboration with the department of health and human services. Health carriers and providers shall not be required to submit any data element to the department of health and human services that is not collected in the ordinary course of business.

IV. All health maintenance organizations or other health care plans that collect the Health Employer Data and Information Set (HEDIS) shall annually submit the HEDIS information and data to the council.

V. Data required for submission to the council shall be provided annually or more frequently as specified by the council. The council shall work collaboratively with the department of health and human services to establish a schedule for the submission of data.

VI. The council shall examine the feasibility of merging multiple data sets to create integrated public use data sets and shall report annually to the commissioner on its progress in integrating and merging its data sets.

VII. The council may provide analysis of data upon request. The council may also provide technical assistance at the request of third parties for a reasonable fee. Reasonable technical assistance shall be provided at no charge to any person or entity that is subject to the annual assessment.

420-K:8 Dissemination of Information.

I. The council shall prepare and submit an annual report on its operations, its accomplishments, its priorities, and its current and planned activities to the commissioner, the insurance commissioner, the governor and the legislative oversight committee by January 1 of each year.

II. The council shall have the authority to prepare and issue reports on health care expenditures, health care utilization, health care statistics, health care costs, the health insurance market and trends in benefit design, and access to health care facilities and equipment. The council shall prepare public summaries and shall compile relevant and useful health care information for consumers and for businesses.

III. The council shall establish priorities to fulfill its duties, and shall identify its priorities and proposed implementation schedule in its plan of operation. The council shall set its priorities with due recognition of the complexity of its duties. The council shall prepare a proposed work plan annually to implement and meet its statutory obligations, and shall submit its proposed work plan with its annual report.

IV. The council shall maintain a website for disseminating information to the public and for responding to public inquiries.

V. The council shall pursue available funding opportunities, including grants, to fund its operations. The department of health and human services shall provide assistance to the council in obtaining grants and other funds.

420-K:9 Powers of the Council.

I. The council may retain an executive director, other staff, and professional consultants as necessary to perform its functions.

II. The council may apply, may receive, and may expend funds from any private source or governmental entity by way of grant, donation or loan or in any other manner.

III. The council may purchase, receive, hold, lease or acquire by foreclosure and operate, manage, license and sell, convey, transfer, grant or lease real and personal property together with such rights and privileges as may be incidental and appurtenant to the real and personal property and the use of the real and personal property, including, but not limited to, any real or personal property acquired by the council from time to time in the satisfaction of debts or enforcement of obligations.

IV. The council may accept and expend gifts and donations.

V. The council may enter into contracts, including contracts for services, and incur liabilities for any of the purposes authorized in the contracts.

VI. The council may coordinate with and avail itself of the services of government agencies and the University of New Hampshire System and may assist and otherwise encourage organizations, local or regional, private or public, in the various communities of the state in the collection and processing of health care data.

VII. The council shall adopt bylaws that are consistent with this chapter for the governance of its affairs and all other things necessary or convenient to carry out the lawful purposes of the council.

VIII. The council may enter into contracts and memoranda of understanding with state government for the transfer of funds or use of state government resources and facilities.

IX. The council shall have all powers necessary to provide services or such functions required to fulfill its responsibilities under this chapter.

420-K:10 Funding.

I. The council shall establish an annual budget by July 1 of each year, and all revenues from fees and other funding sources shall be used to defray the costs incurred by the council.

II. The council may charge reasonable fees for duplicating, mailing, producing, and publishing information and data.

III. If the council determines that a person or entity has failed to pay the duly imposed assessment, the council shall report that failure to the state agency having regulatory jurisdiction over that person or entity, and the state shall commence proceedings to compel compliance.

IV. The council may enter into contracts to perform analysis of data at the request of third parties. The council shall use revenues received from contracted services to reduce the amount of the assessment.

420-K:11 Public Access to Data.

I. The council shall ensure that public use data is made available and accessible to interested persons.

II. The council shall adopt guidelines for its public use data sets that provide for the release of data in a manner consistent with state and federal law. The guidelines shall protect confidential and privileged information from release, including, but not limited to, financial information regarding specific discounts off-charges, capitation agreements, and other similar contractual arrangements. The council shall submit its public use data guidelines to the commissioner for approval.

III. Notwithstanding any other provision of law, upon request the council shall release its public use data sets for the purposes of research, analysis and aggregate statistical reporting under the following conditions:

(a) The person requesting the data must sign a data use agreement that contains the following provisions;

(1) An agreement not to use or permit others to use the data in any way except for research, analysis and aggregate statistical reporting;

(2) An agreement that all persons using the data sign the data use agreement;

(3) An agreement that the data shall be maintained in a secure environment and that only authorized persons use the data;

(4) An agreement not to release or permit others to release any information that identifies an individual either directly or indirectly;

(5) An agreement not to release or permit the release of data where the number of observations in a particular cell is less than or equal to 5;

(6) An agreement not to link or permit others to link the data to attempt to ascertain the identity of individuals;

(7) An agreement not to use or permit others to use the data to learn the identity of any person included in the data set;

(8) An agreement to indemnify, defend and hold harmless the data sources and the council from any or all claims and losses accruing to any person, organization or other legal entity as a result of violation of this agreement; and

(9) An agreement to acknowledge the source of the data in all reports or analysis published.

(b) The person requesting the data must also provide an assurance to the council that by signing the data use agreement the person understands that a violation of the agreement is subject to criminal prosecution as a violation and subject to a civil penalty of up to $10,000 per violation.

420-K:12 Collection and Use of Personally Identifiable Data. Notwithstanding any other provision of this chapter, the council shall not receive, collect or disclose, and shall have no power to receive, collect or disclose, any data that includes direct personal identifiers from any person or organization, including but not limited to the state, its agencies and political subdivisions and insurers, hospitals, nursing homes, physicians and other health care providers. For the purposes of this chapter, direct personal identifiers include information relating to an individual which contains primary or obvious identifiers, such as the individual's name, street address, e-mail address, telephone number and social security number.

420-K:13 Appointment of Subcommittees.

I. The council shall have the authority to appoint subcommittees consisting of persons who are not board members, to assist it in carrying out its duties and responsibilities. The subcommittees shall include representatives of hospitals, labor, employers, consumers, and insurance carriers, licensed physicians, experts in the area of health care, and government officials.

II. The subcommittees may assist the council in evaluating and recommending methodologies for use in a statewide health information system that allow for the quantification of variations in attributes and use among patient populations and health care providers and in developing methodologies for making useful and informative comparisons among providers with respect to cost and expenditures, utilization, structural and process measures, and outcomes on a statewide or regional basis. Subcommittees may also be formed to assist the council in developing and disseminating consumer educational materials, in developing methods for data collection, formatting and storage of data, in developing formats for preparing public reports on insurance products, health maintenance organizations, and insurance carriers, as well as health care providers, and in producing meaningful statistical reports that address the public's need for comparative information on health care quality and cost.

III. The council and the department of health and human services shall provide technical assistance to the subcommittees.

420-K:14 Rulemaking Authority. The commissioner may adopt rules as necessary to carry out the purposes of this chapter.

2 Effective Date. This act shall take effect upon its passage.

LBAO

03-0608

Amended 4/24/03

SB 78 FISCAL NOTE

AN ACT establishing the New Hampshire health information council.

FISCAL IMPACT:

The Department of Health and Human Services states this bill, as amended by the Senate (Senate Amendments #2003-0820s and #2003-1210s), will have an indeterminable fiscal impact on state expenditures in FY 2004 and FY 2005. There will be no fiscal impact on state, county, and local revenue or county and local expenditures.

METHODOLOGY:

The Department of Health and Human Services states this bill will establish a nonprofit Health Care Information Council in New Hampshire charged with developing a comprehensive health care information system that shall include an all-payors claims data set, and other data and information from insurers, third party administrators, state and federal government agencies, health care providers, accreditation and other organizations. This bill also indicates that efforts will be made to minimize the burden on those providing data. The Council must pursue available funding opportunities, including grants, to fund its operations. The Department is directed to provide assistance to the Council in obtaining grants and other funds. The Department assumes that department personnel will be utilized to write grants for the Council until such time funds might be awarded to enable the Council to hire its own staff, who could then continue to write grants in an effort to obtain sufficient multi-year funding as needed to begin operations. In the event sufficient start-up and operational funding could be obtained by the Council, the Department would enter into a memorandum of understanding with the Council to define and delineate the Department's ongoing responsibilities concerning data collection, analysis, and reporting activities.

· The Insurance Department states this bill will have no fiscal impact on the state, county, and local revenue or expenditures.