C.R.S.
Section 25.5-1-204
Advisory committee to oversee the all-payer health claims database
- creation
- members
- duties
- legislative declaration
- rules
- report
(1)
The general assembly hereby finds and declares that an advisory committee for the all-payer health claims database would support the database in its established mission of facilitating the reporting of health-care and health quality data that results in transparent and public reporting of safety, quality, cost, and efficiency information; and analysis of health-care spending and utilization patterns for purposes that improve the population’s health, improve the care experience, and control costs.(2)
Intentionally left blank —Ed.(a)
No later than August 1, 2013, the executive director shall appoint an advisory committee to oversee the Colorado all-payer health claims database. The advisory committee shall include the following members:(I)
A member of academia with experience in health-care data and cost efficiency research;(II)
A representative of:(A)
A statewide association of hospitals;(B)
An integrated multi-specialty organization;(C)
Physicians and surgeons;(D)
An organization that processes insurance claims or certain aspects of employee benefit plans for a separate entity;(E)
A nonprofit organization that demonstrates experience working with employers to enhance value and affordability in health insurance;(F)
Dental insurers;(G)
Pharmacists or an affiliate society;(H)
Pharmacy benefit managers;(I)
A statewide association of ambulatory surgical centers;(III)
A representative, who is not a supplier or broker of health insurance, of:(A)
Small employers that purchase group health insurance for employees;(B)
Large employers that purchase health insurance for employees;(C)
Self-insured employers;(IV)
[Editor’s note:(IV)
[Editor’s note:(V)
Three representatives with a demonstrated record of advocating health-care issues on behalf of consumers;(VI)
Two representatives of health insurers, one who represents nonprofit insurers and one who represents for-profit insurers;(VII)
Two representatives of nonprofit organizations that facilitate health information exchange to improve health care for all Coloradans;(VIII)
The executive director or his or her designee, serving as an ex officio member;(IX)
The commissioner of insurance or his or her designee, serving as an ex officio member;(X)
A representative of the department of personnel, serving as an ex officio member;(XI)
The director of the office of information and technology or his or her designee, serving as an ex officio member; and(XII)
Two members of the general assembly, one appointed by the majority leader of the senate and one appointed by the majority leader of the house of representatives; except that, if the majority leaders are from the same political party, the minority leader of the house of representatives shall appoint the second member. The two members of the general assembly shall serve as ex officio members.(b)
The advisory committee shall make recommendations to the executive director and the Colorado all-payer health claims database administrator related to the Colorado all-payer health claims database. The recommendations include the following:(I)
Procedures for the collection, retention, use, and disclosure of data from the Colorado all-payer health claims database, including procedures and safeguards to protect the privacy, integrity, confidentiality, and availability of any data;(II)
Guidelines for charging for custom reports from the Colorado all-payer health claims database;(III)
Procedures to ensure compliance with the “Health Insurance Portability and Accountability Act of 1996”, Pub.L. 104-191, as amended, and implementing federal regulations;(IV)
Procedures to ensure compliance with other state and federal privacy laws; and(V)
Procedures for data confidentiality and data disposal if the Colorado all-payer health claims database ceases to exist.(c)
The members of the advisory committee appointed pursuant to subparagraph (XII) of paragraph (a) of this subsection (2) are entitled to receive compensation and reimbursement of expenses as provided in section 2-2-326, C.R.S.(3)
Intentionally left blank —Ed.(a)
The administrator shall prepare and file annual reports to the legislature by March 1 of each year. The annual report must contain:(I)
The uses of the data in the all-payer health claims database;(II)
Public studies produced by the administrator;(III)
The cost of administering the Colorado all-payer health claims database, the sources of the funding, and the total revenue taken in by the database;(IV)
The recipients of the data, the purposes for the data requests, and whether a fee was charged for the data;(V)
A fee schedule displaying the fees for providing custom data reports from the Colorado all-payer health claims database.(b)
The executive director shall require an evaluation of the Colorado all-payer health claims database initiative every five years beginning in 2018, to ensure that the database accomplishes the goals of this section. The report must contain metrics that document and demonstrate the achievements or challenges of the program goals.(c)
Intentionally left blank —Ed.(I)
By November 15, 2022, and by each November 15 thereafter, subject to available appropriations, the administrator shall provide a primary care spending report to the commissioner of insurance for use by the primary care payment reform collaborative established in section 10-16-150 regarding primary care spending:(A)
By carriers, as defined in sections 10-16-102 (8) and 24-50-603 (2);(B)
Under the “Colorado Medical Assistance Act”, articles 4, 5, and 6 of this title 25.5; and(C)
Under the “Children’s Basic Health Plan Act”, article 8 of this title 25.5.(II)
The report prepared in accordance with this subsection (3)(c) must include:(A)
The percentage of the medical expenses allocated to primary care;(B)
The share of payments that are made through nationally recognized alternative payment models and the share of payments that are not paid on a fee-for-service or per-claim basis; and(C)
Data related to the aligned quality measure set determined by the division of insurance in accordance with section 10-16-157 (3).(4)
Intentionally left blank —Ed.(a)
The administrator shall seek funding for the creation of the all-payer health claims database and develop a plan for the financial stability of the database. If sufficient funding is received through gifts, grants, and donations on or before January 1, 2012, as determined by the executive director, the administrator shall, in consultation with the advisory committee, create the Colorado all-payer claims database.(b)
The general assembly may annually appropriate general fund money to the state department to pay for expenses related to the all-payer health claims database.(5)
If sufficient funding is received, the executive director shall direct the administrator to create the database and the administrator shall:(a)
Determine the data to be collected from payers and the method of collection, including mandatory and voluntary reporting of health-care and health quality data;(b)
Seek to establish agreements for voluntary reporting of health-care claims data from health-care payers that are not subject to mandatory reporting requirements in order to ensure availability of the most comprehensive and systemwide data on health-care costs and quality;(c)
Seek to establish agreements or requests with the federal centers for medicare and medicaid services to obtain medicare health claims data;(d)
Determine the measures necessary to implement the reporting requirements in a manner that is cost-effective and reasonable for data sources and timely, relevant, and reliable for consumers, public and private purchasers, providers, and policymakers;(e)
Determine the reports and data to be made available to the public with recommendations from the advisory committee in order to accomplish the purposes of this section, including conducting studies and reporting the results of the studies;(f)
Collect, aggregate, distribute, and publicly report performance data on quality, health outcomes, health disparities, cost, utilization, and pricing in a manner accessible for consumers, public and private purchasers, providers, and policymakers;(g)
Protect patient privacy in compliance with state and federal medical privacy laws while preserving the ability to analyze data and share with providers and payers to ensure accuracy prior to the public release of information;(h)
Repealed.(i)
Provide leadership and coordination of public and private health-care quality and performance measurements to ensure efficiency, cost-effectiveness, transparency, and informed choice by consumers and public and private purchasers; and(j)
Subject to available appropriations and at the request of the commissioner of insurance, publish information to the public concerning dental loss ratio information collected by the division of insurance pursuant to section 10-16-165.(6)
The administrator, with input from the advisory committee:(a)
Shall incorporate and utilize publicly available data other than administrative claims data if necessary to measure and analyze a significant health-care quality, safety, or cost issue that cannot be adequately measured with administrative claims data alone;(b)
Shall require payer data sources to submit data necessary to implement the all-payer claims database;(c)
Shall determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted. Data collection shall align with national, regional, and other uniform all-payer claims databases’ standards where possible.(d)
May audit the accuracy of all data submitted;(e)
May contract with third parties to collect and process the health-care data collected pursuant to this section. The contract shall prohibit the collection of unencrypted social security numbers and the use of the data for any purpose other than those specifically authorized by the contract. The contract shall require the third party to transmit the data collected and processed under the contract to the administrator or other designated entity.(f)
May share data regionally or help develop a multistate effort if recommended by the advisory committee.(7)
The all-payer health claims database shall:(a)
Be available to the public when disclosed in a form and manner that ensures the privacy and security of personal health information as required by state and federal law, as a resource to insurers, consumers, employers, providers, purchasers of health care, and state agencies to allow for continuous review of health-care utilization, expenditures, and quality and safety performance in Colorado;(b)
Be available to state agencies and private entities in Colorado engaged in efforts to improve health care, subject to rules promulgated by the executive director;(c)
Be presented to allow for comparisons of geographic, demographic, and economic factors and institutional size;(d)
Present data in a consumer-friendly manner.(8)
The collection, storage, and release of health-care data and other information pursuant to this section is subject to the federal “Health Insurance Portability and Accountability Act of 1996”, Pub.L. 104-191, as amended.(9)
The executive director shall promulgate rules as necessary to implement this section, which rules shall include the assessment of a fine for a payer required to submit data that does not comply with this section. Any fines collected shall be deposited in the all-payer health claims database cash fund, which is hereby created in the state treasury. The moneys in the fund shall be appropriated to the department of health care policy and financing for the purpose of maintaining the all-payer health claims database. The moneys in the fund shall remain in the fund and not revert to the general fund or any other fund at the end of any fiscal year.(10)
Repealed.(11)
If at any time, there is not sufficient funding to finance the ongoing operations of the database, the database shall cease operating and the advisory committee and administrator shall no longer have the duty to carry out the functions required pursuant to this section. If the database ceases to operate, the data submitted shall be destroyed or returned to its original source.
Source:
Section 25.5-1-204 — Advisory committee to oversee the all-payer health claims database - creation - members - duties - legislative declaration - rules - report, https://leg.colorado.gov/sites/default/files/images/olls/crs2023-title-25.5.pdf (accessed Oct. 20, 2023).
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