HB 2072 -- Health Care Quality and Cost Efficiency

Sponsor:  Ervin

This bill establishes the criteria of health carrier programs
that publicly assess and compare the quality and cost efficiency
of health care providers.  The criteria include:

(1)  Retention, at the expense of the health carrier, of a
nationally recognized independent health care quality standard-
setting organization to review the plan's program;

(2)  Program measures to provide performance data that reflects
consumers' health needs;

(3)  Performance reporting to include both quality and
cost-efficiency information;

(4)  Disclosure of measure scoring and any formula used to
develop composite scores;

(5)  Solicitation of consumers and providers for input about the
program;

(6)  Establishment of a clearly defined process for receiving and
resolving consumer complaints;

(7)  Presentation of performance information to consumers on how
to consider other factors in choosing a provider;

(8)  Notification to providers before their individual
performance information is publicly released;

(9)  Establishment of a process for providers to review their
performance results and the opportunity to present information
regarding any perceived inaccurate results;

(10)  Accessibility of and the ability of consumers and providers
to understand information about the comparative performance data
including certain cost factors;

(11)  Public disclosure of factors that might limit the
usefulness of the results;

(12)  Publication and public availability of the measures used to
assess a provider's performance and the methodology used to
calculate scores and determine rankings;

(13)  Articulation of the rationale and methodologies supporting
the unit of analysis reported;

(14)  Aggregation of data, whenever feasible, by sponsors of
provider measurement and reporting who are required to work
collaboratively for measuring and reporting purposes;

(15)  Regular evaluation of the program to assess its
effectiveness, accuracy, reliability, validity, and any
unintended consequences;

(16)  Endorsement of all quality measures by one of the specified
credible organizations;

(17)  Prohibition of certain entities from entering into new
contracts or amending existing contracts that are delivered,
issued, continued, or renewed on or after January 1, 2011, under
certain conditions; and

(18)  Compliance upon certification from the National Committee
for Quality Assurance.

A person who sells or distributes public health care quality and
cost-efficiency data for disclosure must identify the measure
source or evidence-based science used to conform the validity of
the data and its analysis.  Certain specified articles or studies
published in academic journals are exempt from the provisions of
the bill.  The Department of Health and Senior Services must
investigate possible violations by these sellers or distributors.
Upon finding that a violation has occurred, the department is
authorized to impose a penalty in an amount of up to $1,000.

Missouri House of Representatives
95th General Assembly, 2nd Regular Session
Last Updated September 14, 2010 at 3:12 pm