Local governments could request detailed health claims data

State health benefit programs and qualifying joint insurance funds would provide complete claims data when a participating public employer makes a written request. The data would include loss reports and large claims information for public employers that participate in the State Health Benefits Program, School Employees Health Benefits Program, or a qualifying joint insurance fund. The provider must send the information in both electronic and manual formats at no cost. The information must be handled in a way that follows federal health privacy rules. The provider would have 60 days after receiving the written request to send the information. The act would take effect 180 days after enactment.

Carriers, third-party administrators, and other health insurers covering local government employees would provide complete claims data after a written request. The rule would cover municipal, county, school, fire, and other property-tax-supported special districts, plus their joint meetings, boards, commissions, and agencies. The data must be provided in electronic and manual formats at no cost. The data must be issued in a way that follows federal health privacy rules. A violation could bring a penalty of up to $5,000 for each day of violation. The Department of Banking and Insurance would investigate and enforce the rule. The provider would have 60 days after receiving the written request to send the information. The act would take effect 180 days after enactment.

Pharmacy benefits managers covering local government employees would provide complete prescription claims data after a written request. The information would include claim-level prescription data, rebates received by the manager, and any spread-pricing practices for the local unit’s prescription drug benefits. The data must be provided in electronic and manual formats at no cost. The data must be issued in a way that follows federal health privacy rules. A violation could bring a penalty of up to $5,000 for each day of violation. The Department of Banking and Insurance would investigate and enforce the rule. The pharmacy benefits manager would have 60 days after receiving the written request to send the information. The act would take effect 180 days after enactment.