HF926 Summary

• Requires health plan companies and third-party administrators to submit monthly encounter data and contracted pricing data to the state, including data on contractual value-based payments and supplemental value-based payments, effective retroactively from January 1, 2023.

• Allows self-insurers governed by the federal Employee Retirement Income Security Act (ERISA) to voluntarily elect whether third-party administrators submit their encounter and pricing data, with annual notification and reporting requirements to the commissioner.

• Creates new requirements beginning January 1, 2025, for submission of nonclaims-based payments (alternative payment models, infrastructure and workforce investments) to the state for analysis and inclusion in health care spending data.

• Establishes expanded access to all-payer claims data for researchers and organizations working on health care outcomes, quality, disparities, and spending, subject to data use agreements, oversight processes, and fee schedules that do not create barriers for those affected by disparities.

• Requires the commissioner of health to report to the legislature by February 15, 2024, on the volume and distribution of health care spending across payment models, with particular focus on value-based care and primary care spending.