HB 102: Community Health, Department of; Georgia Quality Reporting Project; establish

Georgia currently collects insurance claims data through the All-Payer Claims Database, but not detailed clinical data from electronic health records. This bill directs the Department of Community Health to set up the Georgia Quality Reporting Project (GQRP) to gauge the quality of opioid use disorder treatment and healthcare generally, improve care, lower costs, and support clinical research. Starting January 1, 2028, Medicaid care management organizations (called submitting entities) would have to send monthly clinical data in a standardized federal format, either directly or through certified health information networks. Starting January 1, 2029, the department would combine that clinical data with claims data monthly to calculate statewide quality measures. Direct personal identifiers in the data would be exempt from Georgia's open records law, and all data handling would follow federal HIPAA privacy rules. Entities that fail to submit data face fines of up to $1,000 per day, and insurance-regulated entities could also face penalties under Georgia's unfair trade practices law.

• Creates the Georgia Quality Reporting Project within the Department of Community Health to track opioid treatment and overall healthcare quality statewide.
• Requires Medicaid care management organizations to submit monthly clinical data from electronic health records to the department starting January 1, 2028.
• Directs the department to combine that clinical data with claims data starting January 1, 2029 to calculate statewide opioid and quality statistics.
• Exempts direct personal identifiers in the submitted clinical data from Georgia's open records law (O.C.G.A. Article 4 of Chapter 18 of Title 50).
• Allows the department to fine noncompliant submitting entities up to $1,000 per day, with proceeds going to the state treasury.
• Amends Georgia's unfair trade practices law (O.C.G.A. § 33-6-4) so failing to submit clinical data is also a violation enforceable by the Commissioner of Insurance.

Medicaid care management organizations that contract with the state, the Department of Community Health, healthcare providers who treat Medicaid patients for substance use disorder, the Georgia Commissioner of Insurance, and Medicaid patients whose clinical data would be collected and analyzed.

The bill would give the state a new pipeline of detailed clinical data, beyond insurance claims, to measure how well Georgia is treating opioid use disorder and other health conditions. It creates real financial penalties for insurers who don't comply, while shielding identifying patient details from public records requests.

• Section 1 adds a new Code section, O.C.G.A. § 31-2-20, defining terms like 'submitting entity' (Medicaid care management organizations) and 'QHIN' (certified health data networks).
• Subsection (b) states the GQRP's purposes: gauging opioid treatment and overall care quality, improving care, cutting costs, and fostering clinical research.
• Subsection (c) creates a GQRP use case working group to build a framework and implementation plan.
• Subsection (d) requires monthly clinical data submissions starting January 1, 2028, covering opioid care and other state-level quality measures.
• Subsection (e) requires the department to combine clinical and claims data starting January 1, 2029 using a nationally accredited HEDIS calculation process.
• Subsection (f) exempts direct personal identifiers in the data from Georgia's open records law, and subsection (g) requires compliance with federal HIPAA privacy rules.
• Subsection (h) sets penalties of up to $1,000 per day for noncompliant submitting entities, deposited into the state treasury; subsection (i) extends enforcement to the Commissioner of Insurance.
• Section 2 amends O.C.G.A. § 33-6-4 to add failure to submit clinical data as an unfair trade practice violation.

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

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

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