,i #aafth ,,congress #b;d ,session ,h4 ,r4 #fjjd ,,in ,,the ,,house ,,of ,,representatives ,february #bg1 #bjbj,mr4 ,lipinski introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xxvii of the ,public ,health ,service ,act to require the ,secretary of ,health and ,human ,services to establish a grant program for purposes of facilitating ,state efforts to establish or maintain all-payer claims databases1 and for other purposes4 #a4 ,short title2 findings 7a7 ,short title ,this ,act may be cited as the ,transparency and ,accountability in ,health ,care ,costs and ,prices ,act of #bjbj4 7b7 ,findings ,congress finds the following3 7#a7 ,according to official estimates published by the ,centers for ,medicare ,medicaid ,services1 ,americans spent a total of #c4f trillion on health care in #bjah1 or #aa1agb per person4 7#b7 ,spending on hospital care services reached #a4b trillion in #bjah and rose by #d4e percent from the previous year4 ,this growth occurred even as ,americans made fewer hospital visits because of growth in hospital prices4 7#c7 ,spending on physician visits and clinical services reached #gbe4f billion in #bjah and rose by #d4a percent from the previous year4 7#d7 ,spending on prescription drugs reached #cce billion in #bjah and rose by #b4e percent from the previous year4 7#e7 ,according to a #bjai analysis of a subset of commercial insurance claims by the independent1 non-partisan ,health ,care ,cost ,institute1 prices for common medical services could vary up to #be times between different metro areas and up to #ci times for the same service within the same metro area4 7#f7 ,a #bjae analysis of a subset of commercial insurance claims by ,yale1 ,university of ,pennsylvania1 ,carnegie ,mellon1 and ,,mit researchers found that even within one hospital1 prices for certain common services like lower limb ,m,r,is1 knee replacements1 and colonoscopies could vary by #bc4e percent on average depending on which insurer covered the patient4 7#g7 ,information about contracts between providers and insurers available to researchers1 policymakers1 and the public is limited or incomplete because these contracts frequently prohibit disclosure of information about how providers are paid4 7#h7 ,all-payer claims databases 7,a,p,c,ds7 are large-scale databases increasingly adopted by ,states to collect health care claims data across different payers such as private insurers1 government employee health plans1 ,medicare1 and ,medicaid4 7#i7 ,,apcd data can be shared with vetted and authorized users to make it easier to track trends in health care prices1 create tools for consumers to check price and quality1 assist employers and health plans in making more informed decisions when developing employer-sponsored health plans1 test new ideas for holding down health care costs1 and guide policymakers in developing health care policy4 7#aj7 ,in #bjai1 the independent1 non-partisan ,,rand ,corporation published the first broad-based study reporting prices paid by private health plans to hospitals identified by name4 ,this important study tracked important disparities in price trends across the nation1 with relative prices increasing rapidly from #bjae to #bjag for hospitals in some ,states1 while falling in others4 ,this work was made possible in part through the use of data from ,a,p,c,ds in ,new ,hampshire and ,colorado4 7#aa7 ,since #bjae1 ,oregon has used data from its ,,apcd to review insurers' proposed premium rates1 including determining whether or not proposed premiums are excessive4 ,oregon has also used its ,,apcd to create an annual report on hospital reimbursement variations from different insurers4 7#ab7 ,minnesota and ,virginia have used data from their ,a,p,c,ds to shine a spotlight on spending for low-value--possibly even unnecessary--medical services4 7#ac7 ,washington ,state has used data from its ,,apcd to create the ,washington ,health,care,compare tool that helps patients learn about local prices for medical services at local doctors' offices1 hospitals1 and outpatient centers1 and puts those prices in context by highlighting what kinds of prices can be considered typical1 low1 or high4 ,additional ,states that have developed price transparency tools from their ,a,p,c,ds include ,new ,hampshire1 ,maine1 ,massachusetts1 ,colorado1 ,maryland1 and ,rhode ,island4 7#ad7 ,according to the ,,apcd ,council1 a learning collaborative of public and private organizations working on developing and establishing ,a,p,c,ds1 at least #ah ,states have enacted ,state laws establishing ,a,p,c,ds4 7#ae7 ,while many ,states have or are considering establishing ,a,p,c,ds1 current ,a,p,c,ds vary in the types of data collected1 the types of users allowed to access the data1 the types of data that can be published1 and how much authorized users are charged to access the data4 7#af7 ,a #bjaf ,supreme ,court decision1 ,gobeille v4 ,liberty ,mutual ,insurance ,co41 prohibited ,states from requiring claim submissions to ,a,p,c,ds from large employers that pay for health benefits directly instead of purchasing health coverage from insurance companies4 ,this limited the data that ,states could mandate for inclusion in an ,,apcd4 7#ag7 ,supporting the establishment of ,a,p,c,ds is an important way to promote transparency and understanding of overall health care spending4 7#ah7 ,state ,a,p,c,ds should be encouraged to collect data from more types of payers2 make it easier and more affordable for ,,apcd data to be used to assist patients and providers in making informed choices about care2 make it easier and more affordable for ,,apcd data to be used for efforts to bring health care cost growth under control and improve insurance coverage2 and permit their data to be used to report provider-level prices4 #b4 ,requiring the ,secretary of ,health and ,human ,services to establish a grant program for purposes of facilitating ,state efforts to establish or maintain all-payer claims databases ,part ,c of title ,,xxvii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia et seq47 is amended by adding at the end the following new section3 #bgie4 ,all-payer claims database grant program 7a7 ,in general ,not later than #a year after the date of the enactment of this section1 the ,secretary shall establish a grant program 7in this section referred to as the program7 for purposes of awarding grants to ,states to facilitate such ,states in establishing or maintaining an all-payer claims database4 7b7 ,use of funds ,a ,state use funds from a grant awarded under the program for any of the following3 7#a7 ,to establish a ,state or regional all-payer claims database or to maintain an existing such database4 7#b7 ,to expand the capabilities of an existing such database 7such as through improving the collection of data contained in such database or improving the dissemination of such data74 7c7 ,eligibility ,to be eligible to receive a grant under the program1 a ,state 7or compact of ,states7 shall submit to the ,secretary an application at such time1 in such manner1 and containing such information as the ,secretary may specify4 ,such information shall include the following3 7#a7 ,a specification of how the ,state 7or compact of ,states7 will ensure uniform data collection through the all-payer claims database4 7#b7 ,a description of privacy and security protections for data submitted to such database1 including a specification of how the ,state 7or compact of ,states7 will ensure that-- 7,a7 no individually identifiable health information is disclosed to the public2 7,b7 access to such information is limited to staff with appropriate security and privacy training2 7,c7 effective security standards for transferring such data or making such data available to authorized uses of such database are maintained2 7,d7 a process for providing access to such data for such users is secure and maintains the confidentiality of any individually identifiable health information is established2 7,e7 such database adheres to best security practices relating to the management and use of such data1 consistent with any applicable ,federal law2 and 7,f7 users of such database are prohibited from attempting to reidentify such data and penalized for any such attempt4 7#c7 ,a specification of whether submission of data to such database is 7or will be7 mandatory or voluntary4 7#d7 ,a specification of which type of entities 7such as group health plans1 health insurance issues1 nonfederal governmental plans1 and ,federal health care programs7 are 7or will be7 submitting such data to such database4 7#e7 ,a description of the types of claims included in such database 7such as medical claims1 pharmacy claims1 and dental claims74 7#f7 ,a description of the data release policy in effect 7or proposed to be put into effect7 with respect to data contained in such database1 including a description of the type of users who are 7or will be7 authorized to access such data 7such as employers1 employee organizations1 health care providers1 researchers1 and policymakers74 7#g7 ,any other information determined appropriate by the ,secretary4 7d7 ,award priority ,in making grants under the program1 the ,secretary shall prioritize applications submitted under subsection 7c7 that demonstrate any of the following 7with higher priority being given to applications that demonstrate the greatest number of the following73 7#a7 ,the all-payer claims database to be established1 maintained1 or expanded through such grant requires mandatory reporting of claims data to such database4 7#b7 ,such database will transition to require such mandatory reporting4 7#c7 ,data contained in such database is 7or will be7 easily accessible and affordable for users to access4 7#d7 ,such database permits 7or will permit7 such data to be viewed in a provider-specific manner4 7#e7 ,a history of 7or planned7 partnerships with users of such database to facilitate the use of such data in-- 7,a7 informing individuals about the cost1 quality1 and value of health care2 7,b7 assisting health care providers1 including hospitals1 in working with individuals to make informed decisions regarding health care2 7,c7 enabling health care providers1 including hospitals1 and communities to improve the furnishing of items and services and health outcomes for individuals through comparisons of such outcomes with other such providers and hospitals2 7,d7 enabling entities that pay for items and services1 including employers1 employee organizations1 group health plans1 and health insurance issuers1 to develop value-based purchasing models and improve the quality and cost of care furnished to employees or enrollees2 7,e7 enabling group health plans and health insurance issuers to evaluate network design1 network construction1 and the cost of care furnished to enrollees2 7,f7 facilitating ,state-led initiatives to lower health care costs and improve health care quality2 or 7,g7 promoting competition based on quality and cost4 7e7 ,privacy regulations ,the ,secretary shall promulgate regulations specifying the extent and manner to which any applicable ,federal law or regulation relating to privacy shall apply to activities carried out pursuant to a grant made under the program and may issue any additional regulation determined necessary by the ,secretary to ensure appropriate confidentiality of data associated with such activities4 7f7 ,disclosure of data ,any ,state 7or compact of ,states7 receiving a grant under the program to establish1 maintain1 or expand an all-payer claims database shall work to make all information contained in such database available to the ,director of the ,congressional ,budget ,office1 the ,comptroller ,general of the ,united ,states1 the ,executive ,director of the ,medicare ,payment ,advisory ,commission1 and the ,executive ,director of the ,medicaid and ,,chip ,advisory ,committee upon request1 subject to any regulation described in subsection 7e7 and ,state law4 ,such information may be made available in the form of raw data1 summary reports1 or such other format determined appropriate by the requesting entity and the ,state 7or compact of ,states74 7g7 ,definition ,for purposes of this section1 the term all-payer claims database means1 with respect to a ,state 7or compact of ,states71 a ,state or regional database operated by 7or under contract with7 a ,state 7or compact of ,states7 that may include medical claims1 pharmacy claims1 dental claims1 member eligibility1 and provider files which are collected from private and public payers4 7h7 ,authorization of appropriations ,there are authorized to be appropriated #ajj1jjj1jjj to carry out this section4 4 #c4 ,allowing for collection of information from self-insured group health plans ,section #ead7;b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aadd7;b77 is amended by adding at the end the following new paragraph3 7#aj7 ,subsection 7a7 shall not apply to any ,state law requiring a group health plan 7including a self-insured group health plan7 to provide claims data to an all-payer claims database 7as defined in section #bgie7;g7 of the ,public ,health ,service ,act74 4