H.B. 246

1

HEALTH CARE COST AND QUALITY DATA
2 2006 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Michael T. Morley
5 Senate Sponsor: Beverly Ann Evans
6
7 LONG TITLE
8 General Description:
9 This bill amends the Health Data Authority Act to authorize the Health Data
10 Committee, as funding is available, to collect data on the costs of episodes of health
11 care, and, as funding is available, authorizes the department to develop a plan to
12 measure and compare costs of episodes of care.
13 Highlighted Provisions:
14 This bill:
15 . amends the powers and duties of the committee;
16 . authorizes the committee to develop and adopt a plan for the collection and use of
17 health care data related to cost of episodes of health care; and
18 . makes implementation of the plan contingent on funding.
19 Monies Appropriated in this Bill:
20 None
21 Other Special Clauses:
22 None
23 Utah Code Sections Affected:
24 AMENDS:
25 26-33a-104, as last amended by Chapter 201, Laws of Utah 1996
26 ENACTS:
27 26A-33a-106.1, Utah Code Annotated 1953

28
29 Be it enacted by the Legislature of the state of Utah:
30 Section 1. Section 26-33a-104 is amended to read:
31 26-33a-104. Purpose, powers, and duties of the committee.
32 (1) The purpose of the committee is to direct a statewide effort to collect, analyze, and
33 distribute health care data to facilitate the promotion and accessibility of quality and
34 cost-effective health care and also to facilitate interaction among those with concern for health
35 care issues.
36 (2) The committee shall:
37 (a) develop and adopt by rule, following public hearing and comment, a health data
38 plan that shall among its elements:
39 (i) identify the key health care issues, questions, and problems amenable to resolution
40 or improvement through better data, more extensive or careful analysis, or improved
41 dissemination of health data;
42 (ii) document existing health data activities in the state to collect, organize, or make
43 available types of data pertinent to the needs identified in Subsection (2)(a)(i);
44 (iii) describe and prioritize the actions suitable for the committee to take in response to
45 the needs identified in Subsection (2)(a)(i) in order to obtain or to facilitate the obtaining of
46 needed data, and to encourage improvements in existing data collection, interpretation, and
47 reporting activities, and indicate how those actions relate to the activities identified under
48 Subsection (2)(a)(ii);
49 (iv) detail the types of data needed for the committee's work, the intended data
50 suppliers, and the form in which such data are to be supplied, noting the consideration given to
51 the potential alternative sources and forms of such data and to the estimated cost to the
52 individual suppliers as well as to the department of acquiring these data in the proposed
53 manner; the plan shall reasonably demonstrate that the committee has attempted to maximize
54 cost-effectiveness in the data acquisition approaches selected;
55 (v) describe the types and methods of validation to be performed to assure data validity
56 and reliability;
57 (vi) explain the intended uses of and expected benefits to be derived from the data
58 specified in Subsection (2)(a)(iv), including the contemplated tabulation formats and analysis

59 methods; the benefits described must demonstrably relate to one or more of the following:
60 promoting quality health care, managing health care costs, or improving access to health care
61 services;
62 (vii) describe the expected processes for interpretation and analysis of the data flowing
63 to the committee; noting specifically the types of expertise and participation to be sought in
64 those processes; and
65 (viii) describe the types of reports to be made available by the committee and the
66 intended audiences and uses;
67 (b) have the authority to collect, validate, analyze, and present health data in
68 accordance with the plan while protecting individual privacy through the use of a control
69 number as the health data identifier;
70 (c) evaluate existing identification coding methods and, if necessary, require by rule
71 that health data suppliers use a uniform system for identification of patients, health care
72 facilities, and health care providers on health data they submit under this chapter;
73 (d) report biennially to the governor and the Legislature on how the committee is
74 meeting its responsibilities under this chapter; and
75 (e) advise, consult, contract, and cooperate with any corporation, association, or other
76 entity for the collection, analysis, processing, or reporting of health data identified by control
77 number only in accordance with the plan.
78 (3) The committee may adopt rules to carry out the provisions of this chapter in
79 accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act.
80 (4) Except for data collection, analysis, and validation functions described in this
81 section, nothing in this chapter shall be construed to authorize or permit the committee to
82 perform regulatory functions which are delegated by law to other agencies of the state or
83 federal governments or to perform quality assurance or medical record audit functions that
84 health care facilities, health care providers, or third-party payors are required to conduct to
85 comply with federal or state law. The committee shall not recommend or determine whether a
86 health care provider, health care facility, third-party payor, or self-funded employer is in
87 compliance with federal or state laws including but not limited to federal or state licensure,
88 insurance, reimbursement, tax, malpractice, or quality assurance statutes or common law.
89 (5) Nothing in this chapter shall be construed to require a data supplier to supply health

90 data identifying a patient by name or describing detail on a patient beyond that needed to
91 achieve the approved purposes included in the plan.
92 (6) No request for health data shall be made of health care providers and other data
93 suppliers until a plan for the use of such health data has been adopted.
94 (7) If a proposed request for health data imposes unreasonable costs on a data supplier,
95 due consideration shall be given by the committee to altering the request. If the request is not
96 altered, the committee shall pay the costs incurred by the data supplier associated with
97 satisfying the request that are demonstrated by the data supplier to be unreasonable.
98 (8) The committee [does not have the authority to] may require any data supplier to
99 submit fee schedules, maximum allowable costs, area prevailing costs, terms of contracts,
100 discounts, fixed reimbursement arrangements, capitations, or other specific arrangements for
101 reimbursement to a health care provider.
102 (9) [The] Except as permitted in Subsection (10), the committee shall not publish any
103 health data collected under Subsection (8) which would disclose [any of the information
104 described in Subsection (8)] specific terms of contracts, discounts, or fixed reimbursement
105 arrangements, or other specific reimbursement arrangements between an individual provider
106 and a specific payer.
107 (10) Nothing in Subsection (8) shall prevent the committee from requiring the
108 submission of health data on the reimbursements actually made to health care providers from
109 any source of payment, including consumers.
110 Section 2. Section 26A-33a-106.1 is enacted to read:
111 26A-33a-106.1. Health care cost and reimbursement data.
112 (1) The committee shall adopt a plan for the collection and use of health care data
113 pursuant to Subsection 26-33a-104 (6) and this section.
114 (2) (a) The committee shall establish a plan for collecting data from data suppliers, as
115 defined in Section 26-33a-102 , to determine cost measurements and reimbursements for risk
116 adjusted episodes of health care.
117 (b) The department may collect the data pursuant to the plan adopted under Subsection
118 (2)(a), and may phase in implementation of the plan as funding and data sources are available.
119 (3) The committee shall seek input from consumers, data suppliers, employers,
120 providers, and payers who purchase or provide health care insurance before developing and

121 adopting the data plan under this section.




Legislative Review Note
as of 1-11-06 12:33 PM

Based on a limited legal review, this legislation has not been determined to have a high
probability of being held unconstitutional.

Office of Legislative Research and General Counsel