SB 1272 - Under this act, a contract between a health carrier and a health care provider shall not require the provider to submit quality of care data to the health carrier as a condition of payment for medical services rendered, unless such data is included in the set of quality of care indicators selected by the federal Centers for Medicare and Medicaid Services for disclosure in comparative format to the public. The provisions of this section shall not be construed to limit the health carrier's ability to: (1) Abstract quality of care data from billing data submitted by the provider; or
(2) Collect data necessary to comply with federal or state law or regulation or accreditation standards; or
(3) Collect data from health care providers for whom the Centers for Medicare and Medicaid Services has not implemented quality of care indicators for disclosure in comparative format.
Under this act, any person who sells or distributes to the public quality of care data shall include a disclaimer on the information distributed stating that the data includes quality of care indicators other than those used by the federal Centers for Medicare and Medicaid Services and as such may be based on research methodologies that deviate from the those used by that agency. The act also requires those who sell quality of care data to identify what peer review process was used to confirm the validity of the data and its analysis as an objective indicator of health care quality. In addition, the sellers of quality of care date must indicate whether health care providers identified in the information were consulted regarding its development and data analysis standards. The sellers or distributer of such date shall give such health care providers the opportunity to comment on data made available to the public.
Under this act, programs of health carriers to assess and compare the performance and efficiency of health care providers shall meet certain disclosure requirements. Providers must be notified at least 45 days prior to the implementation of a quality of performance or cost-efficiency measure. The notification shall include a description of the process for using the quality of performance or cost-efficiency measure or measures. Quality of performance or cost efficiency data shall reflect appropriate risk adjustment to account for the characteristics of the patients treated by the provider. When multiple providers are involved in a patient's treatment, quality of performance indicators shall disclose the methodology for determining which provider will be held accountable for a patient's care. When disclosing comparative data, carriers shall prominently state that performance rankings are only a guide in choosing a provider and that such rankings are based on statistical analysis and have a risk of error. Health care providers shall have the right to review quality of performance and cost-efficiency data prior to their disclosure. If a provider files a timely appeal following such review, the health carrier shall not post the quality of performance or cost-efficiency data until the appeal is completed. Quality of performance and cost-efficiency data shall be designed to compare like types of health care providers within the appropriate geographic market.
Violations of the act by health carriers shall be investigated and enforced by the Department of Insurance, Professional Registration and Financial Institutions. Violations committed by persons or entities that are not health carriers shall be investigated and enforced by the department of health and senior services. A civil fine not to exceed $1,000 may be levied for a violation by the department of health and senior services.
ADRIANE CROUSE