Bill > S1278

Introduced Session

This bill requires certain information to be included in the State Health Benefits Program (SHBP) and the School Employees' Health Benefits Program (SEHBP) claims experience data to be provided to certain public employers. Under current law, the SHBP provides upon request and not more than once in a 24-month period complete claims experience data to a public employer other than the State that participates in the SHBP. This bill changes the 24-month period to not more than once per calendar year, and adds language to allow the majority representative of the employees of that public employer to request and receive the claims experience data if the public employer requested the data. Under the bill, the same requirements would apply to the SEHBP. This bill requires certain information to be included in the claims experience data for SHBP and SEHBP. The information specified in the bill includes, but is not limited to, medical claims summary report by classification; top 50 drugs or medicines that require a doctor's prescription by total number dispensed; top 50 drugs or medicines that require a doctor's prescription by total dollars paid; number and type of ongoing maintenance prescriptions by mail order and retail; prescription utilization summary; prescription executive summary report; prescription trend performance summary for each plan design; and a prescription key performance indicator report. Current law requires the SHBP to issue claims experience data only in a manner that complies with the privacy requirements of the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) and related regulations. The bill further specifies that no information will be released in such form as to result in the identification of an individual or in such form as to adversely affect personal privacy rights. Under the bill, the same requirements would apply to the SEHBP.

AI Summary

Committee Categories

Jim Beach (D)*,  Linda Greenstein (D)*,  Tony Bucco (R),  Teresa Ruiz (D),  Paul Sarlo (D),  Bob Singer (R), 

Introduced in the Senate, Referred to Senate State Government, Wagering, Tourism & Historic Preservation Committee (on 01/09/2024)

Official Document