HB 2418 -- Quality of Care Data for Health Insurance

Sponsor:  Onder

This bill establishes the standards for use of data that measures
the quality of health care services delivered by health care
providers and health insurance carriers.  In its main provisions,
the bill:

(1)  Prohibits a health insurance carrier from stipulating by
contract that a health care provider must submit quality of care
(QOC) data to the carrier in order to receive payments for
services delivered.  This provision cannot supersede any federal
QOC requirements currently in place;

(2)  Requires individuals that distribute QOC data to the public,
with the exception of the federal Centers of Medicare and
Medicaid Services quality of care data set, to include a
disclaimer, the peer review process used, and the consent and
comments of health care providers about the QOC methodology that
was used to evaluate the data;

(3)  Specifies that the Department of Health and Senior Services
will investigate and impose a penalty of up to $1,000 for any
violation of the distribution of QOC data by a person other than
a health carrier;

(4)  Requires quality of care programs established by health
insurance carriers to disclose performance and quality measures,
the weights and ratings given to each measure, and the
methodology behind the performance rankings;

(5)  Requires carriers to notify health care providers at least
45 days prior to implementing a QOC program and all quality of
performance data or cost-efficiency data to be risk-adjusted for
patient behaviors and conditions;

(6)  Specifies that quality of performance indicators will
determine which provider will be accountable for a patient's care
in cases where a patient has multiple health care providers;

(7)  Requires carriers to allow providers to review and appeal
any data prior to being disclosed to the public and the data to
be presented to reflect providers within the same geographic
market; and

(8)  Specifies that violations of improper disclosure of QOC data
by a health carrier will be investigated and enforced by the
Department of Insurance, Financial Institutions, and Professional
Registration.

Missouri House of Representatives
94th General Assembly, 2nd Regular Session
Last Updated October 15, 2008 at 3:12 pm