AB 801

Under current law, the Department of Health Services and the Department of Employee Trust Funds may contract with a data organization to request health care claims information from insurers and administrators and to perform other duties specified under current law. In certain circumstances, if the data organization’s contract is terminated, DHS may instead request health claims data from insurers and administrators and perform other duties specified under current law. Currently, DHS contracts with the Wisconsin Health Information Organization (WHIO) to collect this data and perform these duties. WHIO is a partnership between the state and the private sector established to maintain a claims database and information system and provide public access to information on the state’s health care delivery system. Under current law, as a condition of the contract, WHIO is required to include on its board of directors the secretary of health services and the secretary of employee trust funds, or their designees. Current law permits, but does not require, WHIO to request health care claims information from insurers and administrators. Further, current law does not require insurers and administrators to submit requested information.

This bill both requires WHIO, as the contracted data organization, to request health care claims information from insurers and administrators and requires insurers and administrators to submit requested information. The bill provides that insurers and administrators must begin submitting required data in a format specified by the data organization under contract no later than six months following the effective date of the bill. Under the bill, as a condition of contract, the data organization under contract must ensure uniform data collection, determine a method of collection, and determine the data elements to be collected, the reporting formats for data submitted, and the use and reporting of any data submitted. The bill further directs WHIO, as the data organization under contract, to publicly report health care claims information from insurers and administrators both in a machine-readable format and in language that is understandable to laypersons.

The bill provides that, beginning on the date on which the bill becomes law, WHIO, as the data organization under contract, has the exclusive right to use and to provide for a fee a data compilation, data service, or special report based on information collected by WHIO or provided to WHIO by DHS. WHIO, as the data organization under contract, must establish reasonable and necessary user fees for the provision of a compilation, service, or report, subject to approval by the secretary of health services. WHIO may additionally establish, subject to approval by the secretary of health services, reasonable and necessary fees to be paid by insurers, administrators, and any other data contributors for any services provided by WHIO. Further, the bill provides that WHIO, as the data organization under contract, may share data for health care operations, research, public health, or publication purposes if it determines 1) that the data request is consistent with program goals; 2) that the use of data provides greater transparency in health care costs, utilization, quality, or safety; and 3) that the information will be used to inform policy decisions.

The bill repeals certain requirements under current law that are applicable to WHIO, as the data organization under contract, with respect to the management of patient-identifiable data and instead imposes general requirements on WHIO, as the data organization under contract, to manage the data collected. Under the bill, WHIO must ensure the security of the data collected, protect the privacy of the data in compliance with state and federal law, and incorporate and utilize publicly available data other than administrative claims if necessary to measure and analyze a significant health care cost, utilization, quality, or safety issue that cannot be adequately measured with administrative claims data on its own. Subject to limitations, the bill also requires WHIO, as the data organization under contract, to take certain actions, including auditing the accuracy of all data collected and, under certain circumstances, sharing data. The bill provides that the board of directors of the data organization under contract may make recommendations regarding the database, if the recommendations meet certain standards.

The bill repeals certain conditions of contract imposed on the data organization under contract under current law, including an obligation to provide matching funds and an obligation to conduct statewide consumer information campaigns to improve health literacy.

The bill allows the secretary of health services to appoint an advisory committee to advise DHS and ETF on the establishment of an all-payer claims database dashboard.