HB102: HB102 Community Health, Department of; Georgia Quality Reporting Project; establish

Georgia currently collects insurance claims data through the Georgia All-Payer Claims Database, but it does not systematically combine that with clinical data from patient health records. This bill directs the Department of Community Health to set up the Georgia Quality Reporting Project (GQRP), a system for gathering electronic health record data from Medicaid care management organizations (called submitting entities) and using it to measure the quality of medical care, especially treatment for opioid use disorder. Starting January 1, 2028, submitting entities must send clinical data monthly to the department using federal electronic health data standards. Starting January 1, 2029, that clinical data will be combined with claims data to calculate statewide quality measures. Personal identifiers in the data are shielded from Georgia's open records law. Entities that fail to submit data face fines of up to $1,000 per day, and the bill also updates Georgia insurance law (O.C.G.A. § 33-6-4) to make this same failure an unfair claims practice enforceable by the Commissioner of Insurance.

• Creates the Georgia Quality Reporting Project inside the Department of Community Health to measure healthcare quality and opioid use disorder treatment statewide.
• Requires Medicaid care management organizations to submit patient clinical data monthly to the department starting January 1, 2028, using federal electronic health record standards.
• Directs the department to combine that clinical data with insurance claims data starting January 1, 2029 to calculate statewide quality measures.
• Shields direct personal identifiers in the submitted clinical data from disclosure under Georgia's open records law (O.C.G.A. § 50-18-70 et seq.).
• Sets penalties of up to $1,000 per day for organizations that fail to submit required data, with fines going to the state treasury.
• Amends Georgia's insurance code (O.C.G.A. § 33-6-4) so that failing to submit this clinical data also counts as an unfair claims practice enforceable by the Commissioner of Insurance.

Medicaid care management organizations that contract with the state, healthcare providers who treat Medicaid patients (though they cannot be forced to pay compliance costs), the Department of Community Health, the Commissioner of Insurance, and ultimately Medicaid patients whose health data would be collected and analyzed.

If enacted, insurers and healthcare providers serving Medicaid patients would face new monthly data reporting duties and potential daily fines for noncompliance, while the state would gain a broader picture of care quality and opioid treatment outcomes that could inform future health policy decisions.

• New Code Section 31-2-20 establishes the GQRP within the Department of Community Health and defines terms like 'submitting entity,' 'QHIN,' and 'direct personal identifiers.'
• Subsection (b) states the project's purposes: gauging opioid treatment quality, improving care, reducing costs, and fostering clinical research in Georgia.
• Subsection (c) creates a GQRP use case working group to design a framework and implementation plan for the project.
• Subsection (d) requires monthly clinical data submissions from submitting entities beginning January 1, 2028, covering opioid care and other quality measures.
• Subsection (e) requires combining clinical data with claims data starting January 1, 2029 to calculate statewide HEDIS quality measures.
• Subsection (f) exempts direct personal identifiers in the data from Georgia's open records law, and subsection (g) subjects data handling to federal HIPAA rules.
• Subsection (h) authorizes penalties of up to $1,000 per day for noncompliance, deposited into the state treasury.
• Section 2 amends O.C.G.A. § 33-6-4 to make failure to submit this clinical data an unfair claims practice enforceable by the Commissioner of Insurance.

1. 2025-01-28House Second Readers (House)
2. 2025-01-27House First Readers (House)
3. 2025-01-17House Hopper (House)

• Sharon Cooper (R, HD-045)Primary sponsor
• Mark Newton (R, HD-127)
• Deborah Silcox (R, HD-053)
• Lee Hawkins (R, HD-027)
• Michelle Au (D, HD-050)

• Medicaid
• healthcare data reporting
• opioid treatment
• health privacy
• insurance regulation