Transparency and Accountability in Health Care Costs and Prices Act of 2020
This bill requires the Department of Health and Human Services (HHS) to provide grants for states to establish and maintain all-payer claims databases. All-payer claims databases collect and publish health care claims data from various payers for such services, including private insurance plans, government employee plans, Medicare, and Medicaid.
HHS must prioritize awarding grants to states that, among other things, require mandatory reporting of claims data. Further, the bill permits states to require self-insured employer plans to submit claims data to the state's all-payer claims database.
[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6004 Introduced in House (IH)]
<DOC>
116th CONGRESS
2d Session
H. R. 6004
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 databases, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
February 27, 2020
Mr. Lipinski introduced the following bill; which was referred to the
Committee on Energy and Commerce, and in addition to the Committee on
Education and Labor, for a period to be subsequently determined by the
Speaker, 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 databases, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; FINDINGS.
(a) Short Title.--This Act may be cited as the ``Transparency and
Accountability in Health Care Costs and Prices Act of 2020''.
(b) Findings.--Congress finds the following:
(1) According to official estimates published by the
Centers for Medicare & Medicaid Services, Americans spent a
total of $3.6 trillion on health care in 2018, or $11,172 per
person.
(2) Spending on hospital care services reached $1.2
trillion in 2018 and rose by 4.5 percent from the previous
year. This growth occurred even as Americans made fewer
hospital visits because of growth in hospital prices.
(3) Spending on physician visits and clinical services
reached $725.6 billion in 2018 and rose by 4.1 percent from the
previous year.
(4) Spending on prescription drugs reached $335 billion in
2018 and rose by 2.5 percent from the previous year.
(5) According to a 2019 analysis of a subset of commercial
insurance claims by the independent, non-partisan Health Care
Cost Institute, prices for common medical services could vary
up to 25 times between different metro areas and up to 39 times
for the same service within the same metro area.
(6) A 2015 analysis of a subset of commercial insurance
claims by Yale, University of Pennsylvania, Carnegie Mellon,
and MIT researchers found that even within one hospital, prices
for certain common services like lower limb MRIs, knee
replacements, and colonoscopies could vary by 23.5 percent on
average depending on which insurer covered the patient.
(7) Information about contracts between providers and
insurers available to researchers, policymakers, and the public
is limited or incomplete because these contracts frequently
prohibit disclosure of information about how providers are
paid.
(8) All-payer claims databases (APCDs) are large-scale
databases increasingly adopted by States to collect health care
claims data across different payers such as private insurers,
government employee health plans, Medicare, and Medicaid.
(9) APCD data can be shared with vetted and authorized
users to make it easier to track trends in health care prices,
create tools for consumers to check price and quality, assist
employers and health plans in making more informed decisions
when developing employer-sponsored health plans, test new ideas
for holding down health care costs, and guide policymakers in
developing health care policy.
(10) In 2019, the independent, non-partisan RAND
Corporation published the first broad-based study reporting
prices paid by private health plans to hospitals identified by
name. This important study tracked important disparities in
price trends across the nation, with relative prices increasing
rapidly from 2015 to 2017 for hospitals in some States, while
falling in others. This work was made possible in part through
the use of data from APCDs in New Hampshire and Colorado.
(11) Since 2015, Oregon has used data from its APCD to
review insurers' proposed premium rates, including determining
whether or not proposed premiums are excessive. Oregon has also
used its APCD to create an annual report on hospital
reimbursement variations from different insurers.
(12) Minnesota and Virginia have used data from their APCDs
to shine a spotlight on spending for low-value--possibly even
unnecessary--medical services.
(13) Washington State has used data from its APCD to create
the Washington HealthCareCompare tool that helps patients learn
about local prices for medical services at local doctors'
offices, hospitals, and outpatient centers, and puts those
prices in context by highlighting what kinds of prices can be
considered typical, low, or high. Additional States that have
developed price transparency tools from their APCDs include New
Hampshire, Maine, Massachusetts, Colorado, Maryland, and Rhode
Island.
(14) According to the APCD Council, a learning
collaborative of public and private organizations working on
developing and establishing APCDs, at least 18 States have
enacted State laws establishing APCDs.
(15) While many States have or are considering establishing
APCDs, current APCDs vary in the types of data collected, the
types of users allowed to access the data, the types of data
that can be published, and how much authorized users are
charged to access the data.
(16) A 2016 Supreme Court decision, Gobeille v. Liberty
Mutual Insurance Co., prohibited States from requiring claim
submissions to APCDs from large employers that pay for health
benefits directly instead of purchasing health coverage from
insurance companies. This limited the data that States could
mandate for inclusion in an APCD.
(17) Supporting the establishment of APCDs is an important
way to promote transparency and understanding of overall health
care spending.
(18) State APCDs should be encouraged to collect data from
more types of payers; make it easier and more affordable for
APCD data to be used to assist patients and providers in making
informed choices about care; 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 coverage; and permit
their data to be used to report provider-level prices.
SEC. 2. 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 (42 U.S.C.
300gg-91 et seq.) is amended by adding at the end the following new
section:
``SEC. 2795. ALL-PAYER CLAIMS DATABASE GRANT PROGRAM.
``(a) In General.--Not later than 1 year after the date of the
enactment of this section, the Secretary shall establish a grant
program (in this section referred to as the `program') for purposes of
awarding grants to States to facilitate such States in establishing or
maintaining an all-payer claims database.
``(b) Use of Funds.--A State use funds from a grant awarded under
the program for any of the following:
``(1) To establish a State or regional all-payer claims
database or to maintain an existing such database.
``(2) To expand the capabilities of an existing such
database (such as through improving the collection of data
contained in such database or improving the dissemination of
such data).
``(c) Eligibility.--To be eligible to receive a grant under the
program, a State (or compact of States) shall submit to the Secretary
an application at such time, in such manner, and containing such
information as the Secretary may specify. Such information shall
include the following:
``(1) A specification of how the State (or compact of
States) will ensure uniform data collection through the all-
payer claims database.
``(2) A description of privacy and security protections for
data submitted to such database, including a specification of
how the State (or compact of States) will ensure that--
``(A) no individually identifiable health
information is disclosed to the public;
``(B) access to such information is limited to
staff with appropriate security and privacy training;
``(C) effective security standards for transferring
such data or making such data available to authorized
uses of such database are maintained;
``(D) a process for providing access to such data
for such users is secure and maintains the
confidentiality of any individually identifiable health
information is established;
``(E) such database adheres to best security
practices relating to the management and use of such
data, consistent with any applicable Federal law; and
``(F) users of such database are prohibited from
attempting to reidentify such data and penalized for
any such attempt.
``(3) A specification of whether submission of data to such
database is (or will be) mandatory or voluntary.
``(4) A specification of which type of entities (such as
group health plans, health insurance issues, nonfederal
governmental plans, and Federal health care programs) are (or
will be) submitting such data to such database.
``(5) A description of the types of claims included in such
database (such as medical claims, pharmacy claims, and dental
claims).
``(6) A description of the data release policy in effect
(or proposed to be put into effect) with respect to data
contained in such database, including a description of the type
of users who are (or will be) authorized to access such data
(such as employers, employee organizations, health care
providers, researchers, and policymakers).
``(7) Any other information determined appropriate by the
Secretary.
``(d) Award Priority.--In making grants under the program, the
Secretary shall prioritize applications submitted under subsection (c)
that demonstrate any of the following (with higher priority being given
to applications that demonstrate the greatest number of the following):
``(1) The all-payer claims database to be established,
maintained, or expanded through such grant requires mandatory
reporting of claims data to such database.
``(2) Such database will transition to require such
mandatory reporting.
``(3) Data contained in such database is (or will be)
easily accessible and affordable for users to access.
``(4) Such database permits (or will permit) such data to
be viewed in a provider-specific manner.
``(5) A history of (or planned) partnerships with users of
such database to facilitate the use of such data in--
``(A) informing individuals about the cost,
quality, and value of health care;
``(B) assisting health care providers, including
hospitals, in working with individuals to make informed
decisions regarding health care;
``(C) enabling health care providers, including
hospitals, 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 hospitals;
``(D) enabling entities that pay for items and
services, including employers, employee organizations,
group health plans, and health insurance issuers, to
develop value-based purchasing models and improve the
quality and cost of care furnished to employees or
enrollees;
``(E) enabling group health plans and health
insurance issuers to evaluate network design, network
construction, and the cost of care furnished to
enrollees;
``(F) facilitating State-led initiatives to lower
health care costs and improve health care quality; or
``(G) promoting competition based on quality and
cost.
``(e) 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
activities.
``(f) Disclosure of Data.--Any State (or compact of States)
receiving a grant under the program to establish, maintain, 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 Office, the Comptroller General of the United
States, the Executive Director of the Medicare Payment Advisory
Commission, and the Executive Director of the Medicaid and CHIP
Advisory Committee upon request, subject to any regulation described in
subsection (e) and State law. Such information may be made available in
the form of raw data, summary reports, or such other format determined
appropriate by the requesting entity and the State (or compact of
States).
``(g) Definition.--For purposes of this section, the term `all-
payer claims database' means, with respect to a State (or compact of
States), a State or regional database operated by (or under contract
with) a State (or compact of States) that may include medical claims,
pharmacy claims, dental claims, member eligibility, and provider files
which are collected from private and public payers.
``(h) Authorization of Appropriations.--There are authorized to be
appropriated $100,000,000 to carry out this section.''.
SEC. 3. ALLOWING FOR COLLECTION OF INFORMATION FROM SELF-INSURED GROUP
HEALTH PLANS.
Section 514(b) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following
new paragraph:
``(10) Subsection (a) shall not apply to any State law requiring a
group health plan (including a self-insured group health plan) to
provide claims data to an all-payer claims database (as defined in
section 2795(g) of the Public Health Service Act).''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
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