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

25 LC 57 0172 House Bill 102 By: Representatives Cooper of the 45th, Newton of the 127th, Silcox of the 53rd, Hawkins of the 27th, and Au of the 50th A BILL TO BE ENTITLED AN ACT To amend Chapter 2 of Title 31 of the Official Code of Georgia Annotated, relating to the1 Department of Community Health, so as to provide for the establ ishment of the Georgia2 Quality Reporting Project; to provide for definitions; to provi de for the purposes of the3 project; to provide for a working group; to provide for submission of clinical data; to provide4 for processing of clinical data with claims data; to provide fo r penalties; to amend Code5 Section 33-6-4 of the Official Code of Georgia Annotated, relating to enumeration of unfair6 methods of competition and unfair or deceptive acts or practices and penalty, so as to provide7 for conforming changes; to provide for related matters; to repe al conflicting laws; and for8 other purposes.9 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:10 SECTION 1.11 Chapter 2 of Title 31 of the Official Code of Georgia Annotated, relating to the Department12 of Community Health, is amended by adding a new Code section to read as follows:13 "31-2-20.14 (a) As used in this Code section, the term:15 H. B. 102 - 1 - 25 LC 57 0172 (1) 'Direct personal identifiers' means information relating to a covered individual that16 contains primary or obvious identifiers, such as the individual 's name, street address,17 email address, telephone number, and social security number, bu t shall not include18 geographic or demographic information that would prohibit the i dentification of a19 covered individual.20 (2) 'GQRP' means the Georgia Quality Reporting Project establi shed pursuant to this21 Code section.22 (3) 'HEDIS' means the Healthcare Effectiveness Data and Information Set.23 (4) 'Qualified Health Information Network' or 'QHIN' means a network certified by the24 secretary of the United States Department of Health and Human S ervices and the25 assistant secretary for technology policy/office of the Nationa l Coordinator for Health26 Information Technology that meets all of the Trusted Exchange Framework and Common27 Agreement requirements established by the federal 21st Century Cures Act, P.L. 114-255,28 and utilizes a quality measure calculation product certified by the National Committee29 for Quality Assurance for HEDIS reporting.30 (5) 'Submitting entity' means a Medicaid care management organization that contracts31 with the department to arrange healthcare services for Medicaid recipients.32 (b)(1) The department shall facilitate the establishment of the Georgia Quality Reporting33 Project. The purpose of the GQRP shall be to:34 (A) Gauge the quality of treatment for opioid use disorder and healthcare overall;35 (B) Improve the quality of care to Georgia residents;36 (C) Reduce the overall cost of medical treatment and care in this state; and37 (D) Foster clinical research in this state.38 (2) The department may enter into agreements with the administ rator of the Georgia39 All-Payer Claims Database established pursuant to Article 3 of Chapter 53 of this title40 and the Georgia Data Analytic Center established pursuant to Pa rt 3 of Article 4 of41 H. B. 102 - 2 - 25 LC 57 0172 Chapter 12 of Title 45 for purposes of establishing the GQRP an d accomplishing its42 purposes.43 (c) The department shall facilitate the establishment of a GQRP use case working group44 for the purpose of creating a framework and implementation plan for the GQRP.45 (d) Beginning January 1, 2028, and every month thereafter, all submitting entities shall be46 required to transmit clinical data collected through the methods and formats established by47 the federal Department of Health and Human Services' Electronic Clinical Quality48 Measures Fast Health Information Resources standards to the department. Such data shall49 be transmitted either directly or through QHIN connections impl emented by such50 submitting entities. Such data shall include:51 (1) Clinical data from electronic health records for all Georgia healthcare organizations52 who provide substance use disorder care to Medicaid patients to evaluate opioid care in53 this state; and54 (2) Clinical data from electronic health records to report rel evant state level quality55 measures to evaluate the quality of care and improve clinical o utcomes for in-state56 patients.57 (e) Beginning January 1, 2029, and every month thereafter, the clinical data collected58 pursuant to subsection (d) of this Code section shall be converted and combined with all59 claims data to calculate state level opioid statistics and relevant state level quality measures60 available in the HEDIS data sets. A nationally recognized and standardized National61 Committee for Quality Assurance accredited process shall be use d for the calculation of62 relevant HEDIS quality measures.63 (f) Direct personal identifiers contained in clinical data transmitted pursuant to this Code64 section shall not be considered a public record and shall not b e subject to Article 4 of65 Chapter 18 of Title 50, relating to open records.66 H. B. 102 - 3 - 25 LC 57 0172 (g) The collection, storage, and release of healthcare data and other information pursuant67 to this Code section shall be subject to the federal Health Ins urance Portability and68 Accountability Act (HIPAA) of 1996, P.L. 104-191.69 (h) Except as otherwise provided in this Code section, any submitting entity that fails to70 submit clinical data in accordance with this Code section shall be subject to penalty. The71 department shall adopt a schedule of penalties not to exceed $1,000.00 per day of violation,72 determined by the severity of the violation. A penalty imposed under this subsection may73 be remitted or mitigated upon such terms and conditions as the department considers proper74 and consistent with t he public health and sa fety. Any fines co llected pursuant to this75 subsection shall be deposited into the state treasury.76 (i) Any submitting entity that is subject to the jurisdiction of the Commissioner of77 Insurance that fails to submit clinical data in accordance with this Code section shall be78 subject to violation of paragraph (14.2) of subsection (b) of Code Section 33-6-4, and any79 other penalties that may be imposed by the Commissioner of Insurance. The department80 may refer violations by such submitting entities to the Commiss ioner of Insurance for81 enforcement action for each instance in which such submitting entity fails to submit clinical82 data to the department in accordance with this Code section and in accordance with any83 rules and regulations established for such purpose.84 (j) No healthcare provider contracting with a submitting entit y to provide healthcare85 services to Medicaid recipients shall be required to incur any direct or indirect expense86 related to the compliance by a submitting entity with the requirements of this Code section."87 SECTION 2.88 Code Section 33-6-4 of the Official Code of Georgia Annotated, relating to enumeration of89 unfair methods of competition and unfair or deceptive acts or p ractices and penalty, is90 amended by revising paragraph (14.2) of subsection (b) as follows:91 H. B. 102 - 4 - 25 LC 57 0172 "(14.2) Failing to submit all claims data to the Georgia All-Pa yer Claims Database as92 required in Article 3 of Chapter 53 of Title 31 or failing to submit all clinical data to the93 department as required in Code Section 31-2-20;"94 SECTION 3.95 All laws and parts of laws in conflict with this Act are repealed.96 H. B. 102 - 5 -