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§ 449.10. Right-to-Know Law and access to council data

Purdon's Pennsylvania Statutes and Consolidated StatutesTitle 35 P.S. Health and SafetyEffective: June 29, 2008

Purdon's Pennsylvania Statutes and Consolidated Statutes
Title 35 P.S. Health and Safety (Refs & Annos)
Chapter 1D. Health Care Cost Containment Act (Refs & Annos)
Effective: June 29, 2008
35 P.S. § 449.10
§ 449.10. Right-to-Know Law and access to council data
(a) Public access.--The information and data received by the council shall be utilized by the council for the benefit of the public and public officials. Subject to the specific limitations set forth in this section and section 3101.1 of the act of February 14, 2008 (P.L. 6, No. 3), known as the Right-to-Know Law,1 the council shall make determinations on requests for information in favor of access. Payor discounts and allowances are considered confidential proprietary information and, as such, are not records subject to the requirements for public access established under the Right-to-Know Law.
(a.1) Outreach programs.--The council shall develop and implement outreach programs designed to make its information understandable and usable to purchasers, providers, other Commonwealth agencies and the general public. The programs shall include efforts to educate through pamphlets, booklets, seminars and other appropriate measures and to facilitate making more informed health care choices.
(b) Limitations on access.--Unless specifically provided for in this act, neither the council nor any contracting system vendor shall release and no data source, person, member of the public or other user of any data of the council shall gain access to:
(1) Any raw data of the council that does not simultaneously disclose payment, as well as provider quality and provider service effectiveness pursuant to sections 5(d)(4) and 6(d) or 7(a)(1)(iii).2
(2) Any raw data of the council which could reasonably be expected to reveal the identity of an individual patient.
(3) Any raw data of the council which could reasonably be expected to reveal the identity of any purchaser, as defined in section 3,3 other than a purchaser requesting data on its own group or an entity entitled to said purchaser's data pursuant to subsection (f).
(4) Any raw data of the council relating to actual payments to any identified provider made by any purchaser, except that this provision shall not apply to access by a purchaser requesting data on the group for which it purchases or otherwise provides covered services or to access to that same data by an entity entitled to the purchaser's data pursuant to subsection (f).
(5) Any raw data disclosing discounts or allowances between identified payors and providers unless the data is released in a Statewide, aggregate format that does not identify any individual payor or class of payors, directly or indirectly through the use of a market share, and unless the council assures that the release of such information is not prejudicial or inequitable to any individual payor or provider or group thereof. Payor data shall be released to individual providers for purposes of verification and validation prior to inclusion in a public report. An individual provider shall verify and validate the payor data within 30 days of its release to that specific individual provider.
(c) Unauthorized use of data.--Any person who knowingly releases council data violating the patient confidentiality, actual payments, discount data or raw data safeguards set forth in this section to an unauthorized person commits a misdemeanor of the first degree and shall, upon conviction, be sentenced to pay a fine of $10,000 or to imprisonment for not more than five years, or both. An unauthorized person who knowingly receives or possesses such data commits a misdemeanor of the first degree.
(d) Unauthorized access to data.--Should any person inadvertently or by council error gain access to data that violates the safeguards set forth in this section, the data must immediately be returned, without duplication, to the council with proper notification.
(e) Public access to records.--All public reports prepared by the council shall be public records and shall be available to the public for a reasonable fee, and copies shall be provided, upon request of the chair, to the Public Health and Welfare Committee of the Senate and the Health and Welfare Committee of the House of Representatives.
(f) Access to raw council data by purchasers.--Pursuant to sections 5(d)(5) and 7(b) and subject to the limitations on access set forth in subsection (b), the council shall provide access to its raw data to purchasers in accordance with the following procedure:
(1) Special reports derived from raw data of the council shall be provided by the council to any purchaser requesting such reports.
(2) A means to enable computer-to-computer access by any purchaser to raw data of the council as defined in section 3 shall be developed, adopted and implemented by the council, and the council shall provide such access to its raw data to any purchaser upon request.
(3) In the event that any employer obtains from the council, pursuant to paragraph (1) or (2), data pertaining to its employees and their dependents for whom said employer purchases or otherwise provides covered services as defined in section 3 and who are represented by a certified collective bargaining representative, said collective bargaining representative shall be entitled to that same data, after payment of fees as specified in paragraph (4). Likewise, should a certified collective bargaining representative obtain from the council, pursuant to paragraph (1) or (2), data pertaining to its members and their dependents who are employed by and for whom covered services are purchased or otherwise provided by any employer, said employer shall be entitled to that same data, after payment of fees as specified in paragraph (4).
(4) In providing for access to its raw data, the council shall charge the purchasers which originally obtained such access a fee sufficient to cover its costs to prepare and provide special reports requested pursuant to paragraph (1) or to provide computer-to-computer access to its raw data requested pursuant to paragraph (2). Should a second or subsequent party or parties request this same information pursuant to paragraph (3), the council shall charge said party a reasonable fee.
(g) Access to raw council data by other parties.--Subject to the limitations on access to raw council data set forth in subsection (b), the council may, at its discretion, provide special reports derived from its raw data or computer-to-computer access to parties other than purchasers. The council shall publish regulations that set forth the criteria and the procedure it shall use in making determinations on such access, pursuant to the powers vested in the council in section 4.4 In providing such access, the council shall charge the party requesting the access a reasonable fee.

Credits

1986, July 8, P.L. 408, No. 89, § 10, imd. effective. Reenacted and amended 1993, June 28, P.L. 146, No. 34, § 1, imd. effective; 2003, July 17, P.L. 31, No. 14, § 4, imd. effective; 2009, June 10, P.L. 10, No. 3, § 4, retroactive effective June 29, 2008.
EXPIRATION
<See 35 P.S. § 449.19 for expiration of this act.>
HISTORICAL AND STATUTORY NOTES
Act 1993-34 legislation
The 1993 amendment in subsec. (a) inserted “and public officials”, inserted subsec. (a.1), in subsec. (e) substituted “and copies shall be provided, upon request of the chair, to the Public Health and Welfare Committee of the Senate and the Health and Welfare Committee of the House of Representatives” for “not to exceed the cost of duplication”, in subd. (f)(4) substituted “reasonable fee” for “fee sufficient to cover only the costs of duplicating the original access”, and in subsec. (g) substituted “reasonable fee” for “fee sufficient to cover its costs of providing such access”.
Act 2003-14 legislation
Act 2003-14, § 4, rewrote subsec. (b)(5), which prior thereto read:
“(5) Any raw data disclosing discounts or differentials between payments accepted by providers for services and their billed charges obtained by identified payors from identified providers unless comparable data on all other payors is also released and the council determines that the release of such information is not prejudicial or inequitable to any individual payor or provider or group thereof. In making such determination the council shall consider that it is primarily concerned with the analysis and dissemination of payments to providers, not with discounts.”
Section 10 of 2003, July 17, P.L. 31, No. 14, imd. effective, provides that “[t]his act shall apply retroactively to June 29, 2003.”
Act 2009-3 legislation
Act 2009-3, § 10, in subsec. (a), inserted “and section 3101.1 of the act of February 14, 2008 (P.L. 6, No. 3), known as the Right-to-Know Law” and “Payor discounts and allowances are considered confidential proprietary information and, as such are not records subject to the requirements for public access established under the Right-to-Know Law.”; and rewrote subsec. (b)(5), which prior thereto read:
“(5) Any raw data disclosing discounts or differentials between payments accepted by providers for services and their billed charges obtained by identified payors from identified providers unless the data is released in a Statewide, aggregate format that does not identify any individual payor or class of payors and the council assures that the release of such information is not prejudicial or inequitable to any individual payor or provider or group thereof.”

Footnotes

65 P.S. § 67.3101.1.
35 P.S. §§ 449.5, 449.6, 449.7.
35 P.S. § 449.3.
35 P.S. § 449.4.
35 P.S. § 449.10, PA ST 35 P.S. § 449.10
Current through 2018 Regular Session Act 76
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