26B-8-504.  Health care cost and reimbursement data.

(1)  The committee shall, as funding is available:

Terms Used In Utah Code 26B-8-504

  • Committee: means the Health Data Committee created in Section 26B-1-413. See Utah Code 26B-8-501
  • Data supplier: means a health care facility, health care provider, self-funded employer, third-party payor, health maintenance organization, or government department which could reasonably be expected to provide health data under this part. See Utah Code 26B-8-501
  • Health care provider: means the same as that term is defined in Section 78B-3-403. See Utah Code 26B-8-501
  • Health data: means information relating to the health status of individuals, health services delivered, the availability of health manpower and facilities, and the use and costs of resources and services to the consumer, except vital records as defined in Section 26B-8-101 shall be excluded. See Utah Code 26B-8-501
  • Plan: means the plan developed and adopted by the Health Data Committee under Section 26B-1-413. See Utah Code 26B-8-501
  • State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
  • United States: includes each state, district, and territory of the United States of America. See Utah Code 68-3-12.5
(a)  establish a plan for collecting data from data suppliers to determine measurements of cost and reimbursements for risk-adjusted episodes of health care;

(b)  share data regarding insurance claims and an individual’s and small employer group’s health risk factor and characteristics of insurance arrangements that affect claims and usage with the Insurance Department, only to the extent necessary for:

(i)  risk adjusting; and

(ii)  the review and analysis of health insurers’ premiums and rate filings; and

(c)  assist the Legislature and the public with awareness of, and the promotion of, transparency in the health care market by reporting on:

(i)  geographic variances in medical care and costs as demonstrated by data available to the committee; and

(ii)  rate and price increases by health care providers:

(A)  that exceed the Consumer Price Index – Medical as provided by the United States Bureau of Labor Statistics;

(B)  as calculated yearly from June to June; and

(C)  as demonstrated by data available to the committee;

(d)  provide on at least a monthly basis, enrollment data collected by the committee to a not-for-profit, broad-based coalition of state health care insurers and health care providers that are involved in the standardized electronic exchange of health data as described in Section 31A-22-614.5, to the extent necessary:

(i)  for the department or the Medicaid Office of the Inspector General to determine insurance enrollment of an individual for the purpose of determining Medicaid third party liability;

(ii)  for an insurer that is a data supplier, to determine insurance enrollment of an individual for the purpose of coordination of health care benefits; and

(iii)  for a health care provider, to determine insurance enrollment for a patient for the purpose of claims submission by the health care provider;

(e)  coordinate with the State Emergency Medical Services Committee to publish data regarding air ambulance charges under Section 26B-4-106;

(f)  share data collected under this part with the state auditor for use in the health care price transparency tool described in Section 67-3-11; and

(g)  publish annually a report on primary care spending within Utah.

(2)  A data supplier is not liable for a breach of or unlawful disclosure of the data caused by an entity that obtains data in accordance with Subsection (1).

(3)  The plan adopted under Subsection (1) shall include:

(a)  the type of data that will be collected;

(b)  how the data will be evaluated;

(c)  how the data will be used;

(d)  the extent to which, and how the data will be protected; and

(e)  who will have access to the data.

Renumbered and Amended by Chapter 306, 2023 General Session

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