29 U.S.C. § 1191d — Standardized reporting format
submitted 6 years ago by Pub. L. 93-406 to r/title-29-LABOR · 668 words · no verdicts yet
This section requires a standardized format for voluntary reporting to State All Payer Claims Databases and creates an advisory committee for that work. It authorizes funding and ends the committee provisions when the committee’s report is submitted.
(a) In general. Within 1 year after December 27, 2020, the Secretary* must establish and periodically update a standardized format for group health plans to voluntarily report to State* All Payer Claims Databases medical, pharmacy, and dental claims and eligibility and provider files collected from private and public payers. The Secretary must also guide States on collecting that data in the standardized format.
(b) Consultation. (1) Advisory Committee. Within 90 days after December 27, 2020, the Secretary must convene a 15-member Advisory Committee to advise on the format and guidance in paragraph (1). (2) Membership. (A) Appointment. In coordination with the Secretary of Health and Human Services, the Secretary, and the Comptroller General, must appoint members as specified below within 90 days after that date. Members must have distinguished themselves in health-services research, health economics, health informatics, data privacy and security, or State All Payer Claims Database governance, or represent likely data submitters or users, including patients, sponsoring employers or employee* organizations, providers, issuers, and third-party administrators. Terms are 3 years and staggered. Vacancies must be filled consistently with this paragraph within 3 months. (B) Composition. The Committee consists of: (i) the Assistant Secretary of Employee Benefits and Security Administration or a designee; (ii) the Assistant Secretary for Planning and Evaluation of Health and Human Services or a designee; (iii) Secretary-appointed members, including (I) a chair, (II) a Centers for Medicare & Medicaid Services representative, (III) an Agency for Healthcare Research and Quality representative, (IV) an Office for Civil Rights representative with data-privacy and security expertise, (V) a National Center for Health Statistics representative, (VI) an Office of the National Coordinator for Health Information Technology representative, and (VII) a State All-Payer Claims Database representative; and (iv) Comptroller General-appointed members, including (I) an employer* sponsoring a group health plan*, (II) an employee organization* sponsoring one, (III) an academic researcher in health economics or health-services research, (IV) a consumer advocate, and (V) two additional members. (3) Report. Within 180 days after December 27, 2020, the Committee must report to the Secretary and the specified Senate and House committees. The report must recommend how to establish the format and guidance in subsection (a).
(c) State All Payer Claims Database. For a State, this means a database that may contain medical, pharmacy, and dental claims and eligibility and provider files collected from private and public payers.
(d) Authorization. $5,000,000 is authorized for fiscal year 2021 to carry out this section. The money remains available until spent or, if earlier, until the date in subsection (e).
(e) Sunset. Starting when the report under subsection (b)(3) is submitted, subsection (b) has no force or effect.
Not later than 1 year after December 27, 2020, the Secretary* shall establish (and periodically update) a standardized reporting format for the voluntary reporting, by group health plans to State* All Payer Claims Databases, of medical claims, pharmacy claims, dental claims, and eligibility and provider files that are collected from private and public payers, and shall provide guidance to States on the process by which States may collect such data from such plans in the standardized reporting format.
Not later than 90 days after December 27, 2020, the Secretary shall convene an Advisory Committee (referred to in this section as the “Committee”), consisting of 15 members to advise the Secretary regarding the format and guidance described in paragraph (1).1
In accordance with subparagraph (B), not later than 90 days after December 27, 2020, the Secretary, in coordination with the Secretary of Health and Human Services, shall appoint under subparagraph (B)(iii), and the Comptroller General of the United States shall appoint under subparagraph (B)(iv), members who have distinguished themselves in the fields of health services research, health economics, health informatics, data privacy and security, or the governance of State All Payer Claims Databases, or who represent organizations likely to submit data to or use the database, including patients, employers, or employee* organizations that sponsor group health plans, health care providers, health insurance issuers, or third-party administrators of group health plans. Such members shall serve 3-year terms on a staggered basis. Vacancies on the Committee shall be filled by appointment consistent with this paragraph not later than 3 months after the vacancy arises.
The Committee shall be comprised of—
the Assistant Secretary of Employee Benefits and Security Administration of the Department of Labor, or a designee of such Assistant Secretary;
the Assistant Secretary for Planning and Evaluation of the Department of Health and Human Services, or a designee of such Assistant Secretary;
members appointed by the Secretary, in coordination with the Secretary of Health and Human Services, including—
1 member to serve as the chair of the Committee;
1 representative of the Centers for Medicare & Medicaid Services;
1 representative of the Agency for Healthcare Research and Quality;
1 representative of the Office for Civil Rights of the Department of Health and Human Services with expertise in data privacy and security;
1 representative of the National Center for Health Statistics;
1 representative of the Office of the National Coordinator for Health Information Technology; and
1 representative of a State All-Payer 2 Claims Database;
members appointed by the Comptroller General of the United States, including—
1 representative of an employer* that sponsors a group health plan*;
1 representative of an employee organization* that sponsors a group health plan*;
1 academic researcher with expertise in health economics or health services research;
1 consumer advocate; and
2 additional members.
Not later than 180 days after December 27, 2020, the Committee shall report to the Secretary, the Committee on Health, Education, Labor, and Pensions of the Senate, and the Committee on Energy and Commerce* and the Committee on Education and Labor of the House of Representatives. Such report shall include recommendations on the establishment of the format and guidance described in subsection (a).
In this section, the term “State All Payer Claims Database” means, with respect to a State, a database that may include medical claims, pharmacy claims, dental claims, and eligibility and provider files, which are collected from private and public payers.
To carry out this section, there are authorized to be appropriated $5,000,000 for fiscal year 2021, to remain available until expended or, if sooner, until the date described in subsection (e).
Beginning on the date on which the report is submitted under subsection (b)(3), subsection (b) shall have no force or effect.
Source credit: (Pub. L. 93–406, title I, § 735, as added Pub. L. 116–260, div. BB, title I, § 115(b), Dec. 27, 2020, 134 Stat. 2877.)
- 2020Enacted · Pub. L. 93-406 · 134 Stat. 2877
A history note hasn’t been published yet. The record shows enactment by Pub. L. 93-406 on 2020-12-27.
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