The Florida Agency for Health Care Administration (AHCA) released ITN 003-16/17 (the “ITN”) to select a vendor to provide All Payer Claims Database (APCD) services pursuant to section 408.05(3)(c), Florida Statutes. The ITN, published on September 26, 2016, contains a tight time-frame for the submission and evaluation of responses to it. While written inquiries regarding the ITN must be submitted to AHCA by 2:00 on October 3, 2016, completed responses to the ITN must be received by AHCA by 2:00 on November 7, 2016. It is anticipated that AHCA will post its notice of intent to award the APCD vendor contract on January 17, 2017, with the anticipated term of the contract to run for five (5) years, from February 1, 2017 through January 31, 2022.
The APCD was enacted as part of a series of health-cost and transparency measures in 2016 CS/CS/HB 1175 (Chapter 2016-234, Laws of Florida). Other transparency measures in the bill include requiring hospitals to post or provide charge and quality information (section 395.301, F.S.), and requiring health insurers and certain health maintenance organizations (HMOs) to make available on their websites information to allow policyholders the ability to estimate anticipated cost-shares for health care services and procedures (sections 627.6385, F.S.). The bill stated, in part, its intent “… to promote health care price and quality transparency to enable consumers to make informed choices regarding health care treatment and improve competition in the health care market.”
It is anticipated that the APCD will help allow patients to access such information by providing a mechanism to search hospital price information based on specific services or procedures, and using service bundles that compose a whole episode of hospital care. In its post-session analysis of this bill, the Florida House of Representatives noted that health care costs in Florida have continued to rise, and that health insurance purchasers are asking consumers to take on greater shares of these increasing costs. The House also cited to studies explaining that individuals with price and quality information made cost-saving decisions regarding their health care expenditures, with lower total claims costs.
To help develop price information, each insurer and HMO participating in the State Group Insurance plan or Statewide Medicaid Managed Care and their affiliates will be required to contribute all Florida claims data (with certain exceptions) to the vendor selected by AHCA. For obvious reasons, entities that are owned by or have the ability to control health insurers or HMOs, or other entities that provide health care coverage, are not eligible to respond to the APCD ITN.
It should be noted that these types of programs have drawn scrutiny elsewhere in the country. States cannot require the submission of all claims information by insurers. In Gobeille v. Liberty Mutual Insurance Co., 136 S.Ct. 936 (2016), Vermont had adopted an APCD similar to Florida’s. Vermont law defines a health insurer to include self-insured, employer plans and the Court held that “ERISA’s express pre-emption clause requires invalidation of the Vermont reporting statute as applied to ERISA plans.” Therefore, in implementing Florida’s APCD, AHCA should be careful not to try to collect such data.
As noted above, the ITN responses are due to AHCA on November 7, 2016, with the contract anticipated to begin February 1, 2017.