Virginia SB 634: All-Payer Claims Database; participation by certain insurance.

Bill Text

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2018 SESSION

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18102453D

SENATE BILL NO. 634 

Offered January 10, 2018 

Prefiled January 10, 2018 

A BILL to amend and reenact � 32.1-276.7:1 of the Code of 
 Virginia, relating to the All-Payer Claims Database. 
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Patron-- Dunnavant 

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Referred to Committee on Education and Health 

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Be it enacted by the General Assembly of Virginia:

1. That � 32.1-276.7:1 of the Code of Virginia is amended and 
 reenacted as follows:

� 32.1-276.7:1. All-Payer Claims Database created; purpose; 
 reporting requirements.

A. The Virginia All-Payer Claims Database is hereby created to 
 facilitate data-driven, evidence-based improvements in access, quality, and 
 cost of health care and to promote and improve the public health through the 
 understanding of health care expenditure patterns and operation and performance 
 of the health care system.

B. The Commissioner, in cooperation with the Bureau of 
 Insurance, may shall 
 collect paid claims data for covered benefits, pursuant to data submission and 
 use agreements as specified in subsection C, to 
 the extent permitted by federal law, from entities electing to participate as data 
 suppliers, which may include:

1. Issuers of individual or group accident and sickness 
 insurance policies providing hospital, medical and surgical, or major medical 
 coverage on an expense-incurred basis; corporations providing individual or 
 group accident and sickness subscription contracts; and health maintenance 
 organizations providing a health care plan for health care services;

2. Third-party administrators and any other entities that 
 receive or collect charges, contributions, or premiums for, or adjust or settle 
 health care claims for, Virginia residents;

3. The Department of Medical Assistance Services with respect 
 to services provided under programs administered pursuant to Titles XIX and XXI 
 of the Social Security Act; and

4. Federal health insurance plans, if available, including but 
 not limited to Medicare, TRICARE, and the Federal Employees Health Benefits 
 Plan.

C. The Commissioner shall ensure that the nonprofit 
 organization executes a standard data submission and use agreement with each entity 
 listed in subsection B that submits paid claims data to the All-Payer Claims 
 Database and each entity that subscribes to data products and reports. Such 
 agreements shall include procedures for submission, collection, aggregation, 
 and distribution of specified data and shall provide for, at a minimum:

1. Protection of patient privacy and data security pursuant to 
 provisions of this chapter and state and federal privacy laws, including the 
 federal Health Insurance Portability and Accountability Act (42 U.S.C. � 1320d 
 et seq., as amended); Titles XIX and XXI of the