HCS/HB 475 - This act establishes provisions relating to health care quality data standardization and transparency. Criteria is established for insurers to use in programs that publicly assess and compare the quality and cost efficiency of health care providers.
A health care provider shall furnish a patient without health insurance, upon request, a timely cost estimate for any elective or non-emergency health care service. The health insurer of a covered individual shall furnish, upon request, a timely cost estimate and all patient cost-sharing obligations for any elective or non-emergency service. Data regarding cost estimates may be provided to the public via the Internet.
Insurers shall retain the services of a nationally recognized independent health care quality standard-setting organization to review the plan's programs for consumers that measure, report, and tier providers based on their performance. The program measures shall provide performance information that reflects consumers' health needs.
Consumers, consumer organizations, relevant providers and provider organizations shall be solicited to provide input on the program, including methods used to determine performance strata. A clearly defined process for consumers to resolve complaints and for providers to request review of their own performance results shall be established. All quality measures shall be endorsed by the National Quality Forum (NQF) and the act lists the other national organizations that shall be used for endorsement in the event that NQF measures do not exist for a particular level of measures.
A health plan shall be deemed compliant with the provisions of this act regarding the measurement of quality if it currently offers a program that has been granted or awarded certification from the National Committee for Quality Assurance (NCQA) as of January 1, 2012. Any non-accredited health plan shall offer an accredited program upon a contract renewal with a provider on or after January 1, 2013.
A person who sells or distributes health care quality and cost efficiency data in a comparative format to the public is required to identify the source used to confirm the validity of the data and its analysis as an objective indicator of health care quality. This provision does not apply to articles or research studies that are published in peer-reviewed academic journals, nonprofit community-based organizations, or by state or local governments. The Department of Health and Senior Services shall investigate complaints of alleged violations of this provision by a person or entity other than a health carrier and shall be authorized to impose a penalty not to exceed $1,000. Alleged violations by a health insurer shall be investigated by the Department of Insurance, Financial Institutions and Professional Registration.
This act is similar to SB 917 (2010) and SB 1062 (2010).