(a) (1) If the board requires, or has previously required in its contracts with qualified health plans, a qualified health plan to report on cost reduction efforts, quality improvements, or disparity reductions, the board shall make public on the internet website of the Exchange plan-specific data on cost reduction efforts, quality improvements, and disparity reductions.
(2) Data and information posted on the internet website of the Exchange pursuant to paragraph (1) shall be posted in a way that demonstrates the compliance and performance of a qualified health plan with respect to cost reduction efforts, quality improvement, or disparity reduction reporting, but protects the personal information of an enrollee. Comparison among qualified health plans shall contribute to the understanding of the data and progress in achieving goals established by the Exchange through qualified health plan contracts.
(3) The board shall post information on the internet website of the Exchange pursuant to paragraphs (1) and (2) no less than annually.
(b) (1) A qualified health plan shall provide data on enrollees to the Exchange in a form, manner, and frequency specified by the Exchange.
(2) Data and information made public by the Exchange shall be disclosed in a manner that protects the personal information of an enrollee, pursuant to state and federal privacy laws, including the Confidentiality of Medical Information Act (Part 2.6 (commencing with Section 56) of Division 1 of the Civil Code) and the federal Health Insurance Portability and Accountability Act of 1996 (Public Law 104-191).
(3) Records that reveal contracted rates paid by qualified health plans to providers and enrollee coinsurance that can be used to determine contracted rates paid by plans to providers shall not be subject to public disclosure.
(c) (1) A qualified health plan shall provide to the Exchange information that the board identifies as necessary to conduct its duties or exercise its oversight powers.
(2) The information shall be furnished in the form, manner, and frequency specified by the Exchange.
(d) (1) A qualified health plan shall provide enrollee data and other information on quality measures, including contract compliance with measures that affect individual and population health, as well as improvements in care coordination and patient safety, in a manner that allows for an analysis by demographic subpopulations.
(2) A qualified health plan shall provide enrollee data, encounter data, and other information on quality measures, performance improvement strategies, payment methods, and other information necessary to monitor adherence to contract provisions designed to improve health equity and reduce health disparities on an individual and population health basis.
(3) A qualified health plan shall also provide financial data and information, including cost detail, claims data, encounter data, and payment methods to evaluate cost and utilization experience for enrollees. Enrollment data and information shall include demographic, coverage, premium, product, network, and benefit design detail for each enrollee.
(e) A health care service plan or health insurer contracted with the Exchange to offer a qualified health plan shall disclose to the board the following information:
(1) Nongrandfathered individual market products, whether offered through the Exchange or otherwise.
(2) Nongrandfathered small group products, whether offered through the Exchange or otherwise.
(f) A health care service plan or health insurer contracted with the Exchange to offer a qualified health plan shall also disclose to the board, at the request of the board, quality and disparity data and information for all of the enrollees and insureds of the carrier in the individual and small group markets, but not including large group, Medi-Cal, or Medicare.
(g) In order to permit the Exchange to implement the provisions of subdivision (c) of Section 100503 and Section 2 of Chapter 655 of the Statutes of 2010, a health care service plan or health insurer contracted with the Exchange to offer a qualified health plan shall also disclose to the board data and information required by this section for each of the plan years in which the qualified health plan is or has been contracted with the Exchange, including prior years.
(h) For purposes of this section:
(1) “Disparity reduction” means a reduction in variation in disease occurrence, including communicable diseases and chronic conditions, as well as health outcomes between population groups by age, geographic area, primary language, race, ethnicity, sex, gender identity, sexual orientation, and disability status.
(2) “Financial data and information” means cost detail, including enrollee cost sharing, allowed amounts, fee schedules, and fee-for-service equivalent amounts.
(3) “Personal information” has the same meaning as set forth in Section 1798.3 of the Civil Code.
(Added by Stats. 2019, Ch. 812, Sec. 2. (AB 929) Effective January 1, 2020.)