HD22 - Virginia All-Payer Claims Database - Progress Report from the Virginia Department of Health (HB 343, 2012/SB 135, 2012)

Executive Summary:
During the 2012 General Assembly session, legislation (HB343/SB135) was enacted to establish an All-Payer Claims Database (APCD) for Virginia. Participation in the APCD is voluntary. The purpose of the APCD is to “facilitate data-driven, evidence-based improvements in access, quality, and cost of health care and to promote and improve the public health through the understanding of health care expenditure patterns and operation and performance of the health care system.”

The legislation directed that all activities associated with development and implementation of the APCD would be conducted under the leadership, and subject to the ultimate approval, of the State Health Commissioner and the Virginia Department of Health (VDH). The Commissioner is required to appoint an APCD Advisory Committee, in order to provide assistance with the formation and operation of the APCD.

The legislation provides that the State Health Commissioner, in cooperation with the Bureau of Insurance, may collect paid claims data for covered benefits, pursuant to data submission and use agreements from entities electing to participate as data suppliers. Such entities may include issuers of individual or group accident and sickness insurance policies; corporations providing individual or group accident and sickness subscription contracts; health maintenance organizations providing a health care plan for health care services; and third-party administrators and any other entities that receive or collect charges, contributions, or premiums for, or adjust or settle health care claims for Virginia residents.

The legislation directed VDH to enter into a contract with a non-profit vendor to create the APCD. VDH has an existing contract with Virginia Health Information (VHI); changes were made to the existing contract to include the creation of the APCD. Other key stakeholders included in this project are the Virginia Association of Health Plans (VAHP) and the Virginia Hospital and Healthcare Association (VHHA).

A key discussion point during the 2012 Session was the funding of the APCD. VAHP, VHHA and VHI agreed as participation in the APCD is voluntary, they would contribute the initial funding for development and implementation of the APCD. The entities agreed the VAHP will contribute 40%, VHHA will contribute 40% and VHI will contribute 20% of the funding for the initial start-up costs.

Additional requirements from the legislation include the creation of standard data submission and use agreements with each entity that submits claims data to the APCD and with each entity that subscribes to data products and reports. Finally, HB343/SB135 requires that the “Commissioner of Health report to the Governor and the General Assembly on whether the entities named in the code have executed agreements to submit claims data representing at least 75 percent of privately insured individuals and individuals covered under self-funded group health plans in the Commonwealth”.