All payers claim database

AN ACT Relating to modernizing the all payers claims database by 1
updating reporting requirements, data disclosure standards, and lead 2
organization requirements; and amending RCW 43.371.010, 43.371.020, 3
43.371.050, 43.371.060, 43.371.070, and 43.371.090.4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
Sec. 1. RCW 43.371.010 and 2019 c 319 s 2 are each amended to 6
read as follows: 7
The definitions in this section apply throughout this chapter 8
unless the context clearly requires otherwise. 9
(1) "Authority" means the health care authority.10
(2) "Carrier" and "health carrier" have the same meaning as in 11
RCW 48.43.005. 12
(3) "Claims data" means the data required by RCW 43.371.030 to be 13
submitted to the database, including billed, allowed and paid 14
amounts, and such additional information as defined by the director 15
in rule. 16
(4) "Data supplier" means: (a) A carrier, third-party 17
administrator, or a public program identified in RCW 43.371.030 that 18
provides claims data; and (b) a carrier or any other entity that 19
provides claims data to the database at the request of an employer-20
Z-0192.1
HOUSE BILL 1382
State of Washington 69th Legislature 2025 Regular Session
By Representatives Tharinger, Macri, Stonier, Thai, Parshley, Obras,
Lekanoff, Davis, Simmons, Hill, and Ormsby; by request of Health Care
Authority
Read first time 01/17/25. Referred to Committee on Health Care &
Wellness.
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sponsored self-funded health plan or Taft-Hartley trust health plan 1
pursuant to RCW 43.371.030(1). 2
(5) "Data vendor" means an entity contracted to perform data 3
collection, processing, aggregation, extracts, analytics, and 4
reporting. 5
(6) "Database" means the statewide all-payer health care claims 6
database established in RCW 43.371.020. 7
(7) "Direct patient identifier" means a data variable that 8
directly identifies an individual, including: Names; telephone 9
numbers; fax numbers; social security number; medical record numbers; 10
health plan beneficiary numbers; account numbers; certificate or 11
license numbers; vehicle identifiers and serial numbers, including 12
license plate numbers; device identifiers and serial numbers; web 13
universal resource locators; internet protocol address numbers; 14
biometric identifiers, including finger and voice prints; and full 15
face photographic images and any comparable images.16
(8) "Director" means the director of the authority.17
(9) "Indirect patient identifier" means a data variable that may 18
identify an individual when combined with other information.19
(10) "Lead organization" means the organization selected under 20
RCW 43.371.020. 21
(11) "Office" means the office of financial management.22
(12) (("Proprietary financial information" means claims data or 23
reports that disclose or would allow the determination of specific 24
terms of contracts, discounts, or fixed reimbursement arrangements or 25
other specific reimbursement arrangements between an individual 26
health care facility or health care provider, as those terms are 27
defined in RCW 48.43.005, and a specific payer, or internal fee 28
schedule or other internal pricing mechanism of integrated delivery 29
systems owned by a carrier.30
(13))) "Unique identifier" means an obfuscated identifier 31
assigned to an individual represented in the database to establish a 32
basis for following the individual longitudinally throughout 33
different payers and encounters in the data without revealing the 34
individual's identity. 35
Sec. 2. RCW 43.371.020 and 2024 c 54 s 54 are each amended to 36
read as follows: 37
(1) The office shall establish a statewide all-payer health care 38
claims database. On January 1, 2020, the office must transfer 39
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authority and oversight for the database to the authority. The office 1
and authority must develop a transition plan that sustains operations 2
by July 1, 2019. The database shall support transparent public 3
reporting of health care information. The database must improve 4
transparency to: Assist patients, providers, and hospitals to make 5
informed choices about care; enable providers, hospitals, and 6
communities to improve by benchmarking their performance against that 7
of others by focusing on best practices; enable purchasers to 8
identify value, build expectations into their purchasing strategy, 9
and reward improvements over time; and promote competition based on 10
quality and cost. The database must systematically collect all 11
medical claims and pharmacy claims from private and public payers, 12
with data from all settings of care that permit the systematic 13
analysis of health care delivery. 14
(2) The authority ((shall use)) may act as the lead organization, 15
or select a lead organization from among the best potential bidders 16
using a competitive procurement process, in accordance with chapter 17
39.26 RCW, ((to select a lead organization from among the best 18
potential bidders)) to coordinate and manage the database.19
(a)(i) In conducting the competitive procurement, the authority 20
must ensure that no state officer or state employee participating in 21
the procurement process: 22
(A) Has a current relationship or had a relationship within the 23
last three years with any organization that bids on the procurement 24
that would constitute a conflict with the proper discharge of 25
official duties under chapter 42.52 RCW; or 26
(B) Is a compensated or uncompensated member of a bidding 27
organization's board of directors, advisory committee, or has held 28
such a position in the past three years. 29
(ii) If any relationship or interest described in (a)(i) of this 30
subsection is discovered during the procurement process, the officer 31
or employee with the prohibited relationship must withdraw from 32
involvement in the procurement process. 33
(b) Due to the complexities of the all-payer claims database and 34
the unique privacy, quality, and financial objectives, the authority 35
must give strong consideration to the following elements in 36
determining the appropriate lead organization contractor: (i) The 37
organization's degree of experience in health care data collection, 38
analysis, analytics, and security; (ii) whether the organization has 39
a long-term self-sustainable financial model; (iii) the 40
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organization's experience in convening and effectively engaging 1
stakeholders to develop reports, especially among groups of health 2
providers, carriers, and self-insured purchasers; (iv) the 3
organization's experience in meeting budget and timelines for report 4
generations; and (v) the organization's ability to combine cost and 5
quality data to assess total cost of care. 6
(c) The successful lead organization must apply to be certified 7
as a qualified entity pursuant to 42 C.F.R. Sec. 401.703 (a) by the 8
centers for medicare and medicaid services. 9
(d) The authority may not select a lead organization that:10
(i) Is a health plan as defined by and consistent with the 11
definitions in RCW 48.43.005; 12
(ii) Is a hospital as defined in RCW 70.41.020;13
(iii) Is a provider regulated under Title 18 RCW;14
(iv) Is a third-party administrator as defined in RCW 70.290.010; 15
or 16
(v) Is an entity with a controlling interest in any entity 17
covered in (d)(i) through (iv) of this subsection.18
(3) As part of the competitive procurement process referenced in 19
subsection (2) of this section, the lead organization shall enter 20
into a contract with a data vendor or multiple data vendors to 21
perform data collection, processing, aggregation, extracts, and 22
analytics. A data vendor must: 23
(a) Establish a secure data submission process with data 24
suppliers; 25
(b) Review data submitters' files according to standards 26
established by the authority; 27
(c) Assess each record's alignment with established format, 28
frequency, and consistency criteria; 29
(d) Maintain responsibility for quality assurance, including, but 30
not limited to: (i) The accuracy and validity of data suppliers' 31
data; (ii) accuracy of dates of service spans; (iii) maintaining 32
consistency of record layout and counts; and (iv) identifying 33
duplicate records; 34
(e) Assign unique identifiers, as defined in RCW 43.371.010, to 35
individuals represented in the database; 36
(f) Ensure that direct patient identifiers ((,)) and indirect 37
patient identifiers ((, and proprietary financial information )) are 38
released only in compliance with the terms of this chapter;39
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(g) Demonstrate internal controls and affiliations with separate 1
organizations as appropriate to ensure safe data collection, security 2
of the data with state of the art encryption methods, actuarial 3
support, and data review for accuracy and quality assurance;4
(h) Store data on secure servers that are compliant with the 5
federal health insurance portability and accountability act and 6
regulations, with access to the data strictly controlled and limited 7
to staff with appropriate training, clearance, and background checks; 8
and 9
(i) Maintain state of the art security standards for transferring 10
data to approved data requestors. 11
(4) The lead organization and data vendor must submit detailed 12
descriptions to Washington technology solutions to ensure robust 13
security methods are in place. Washington technology solutions must 14
report its findings to the authority and the appropriate committees 15
of the legislature. 16
(5) The lead organization is responsible for internal governance, 17
management, funding, and operations of the database. At the direction 18
of the authority, the lead organization shall work with the data 19
vendor to: 20
(a) Collect claims data from data suppliers as provided in RCW 21
43.371.030; 22
(b) Design data collection mechanisms with consideration for the 23
time and cost incurred by data suppliers and others in submission and 24
collection and the benefits that measurement would achieve, ensuring 25
the data submitted meet quality standards and are reviewed for 26
quality assurance; 27
(c) Ensure protection of collected data and store and use any 28
data in a manner that protects patient privacy and complies with this 29
section. All patient-specific information must be deidentified with 30
an up-to-date industry standard encryption algorithm;31
(d) Consistent with the requirements of this chapter, make 32
information from the database available as a resource for public and 33
private entities, including carriers, employers, providers, 34
hospitals, and purchasers of health care; 35
(e) Report performance on cost and quality pursuant to RCW 36
43.371.060 using, but not limited to, the performance measures 37
developed under RCW 41.05.690; 38
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(f) Develop protocols and policies, including prerelease peer 1
review by data suppliers, to ensure the quality of data releases and 2
reports; 3
(g) Develop a plan for the financial sustainability of the 4
database as may be reasonable and customary as compared to other 5
states' databases and charge fees for reports and data files as 6
needed to fund the database. Any fees must be approved by the 7
authority and should be comparable, accounting for relevant 8
differences across data requests and uses. The lead organization may 9
not charge providers or data suppliers fees other than fees directly 10
related to requested reports and data files; and 11
(h) Convene advisory committees with the approval and 12
participation of the authority, including: (i) A committee on data 13
policy development; and (ii) a committee to establish a data release 14
process consistent with the requirements of this chapter and to 15
provide advice regarding formal data release requests. The advisory 16
committees must include in-state representation from key provider, 17
hospital, public health, health maintenance organization, large and 18
small private purchasers, consumer organizations, and the two largest 19
carriers supplying claims data to the database. 20
(6) The lead organization governance structure and advisory 21
committees for this database must include representation of the 22
third-party administrator of the uniform medical plan. A payer, 23
health maintenance organization, or third-party administrator must be 24
a data supplier to the all-payer health care claims database to be 25
represented on the lead organization governance structure or advisory 26
committees. 27
Sec. 3. RCW 43.371.050 and 2019 c 319 s 5 are each amended to 28
read as follows: 29
(1) Except as otherwise required by law, claims or other data 30
from the database shall only be available for retrieval in processed 31
form to public and private requesters pursuant to this section and 32
shall be made available within a reasonable time after the request. 33
Each request for claims data must include, at a minimum, the 34
following information: 35
(a) The identity of any entities that will analyze the data in 36
connection with the request; 37
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(b) The stated purpose of the request and an explanation of how 1
the request supports the goals of this chapter set forth in RCW 2
43.371.020(1); 3
(c) A description of the proposed methodology; 4
(d) The specific variables requested and an explanation of how 5
the data is necessary to achieve the stated purpose described 6
pursuant to (b) of this subsection; 7
(e) How the requester will ensure all requested data is handled 8
in accordance with the privacy and confidentiality protections 9
required under this chapter and any other applicable law;10
(f) The method by which the data will be destroyed at the 11
conclusion of the data use agreement; 12
(g) The protections that will be utilized to keep the data from 13
being used for any purposes not authorized by the requester's 14
approved application; and 15
(h) Consent to the penalties associated with the inappropriate 16
disclosures or uses of direct patient identifiers ((,)) or indirect 17
patient identifiers((, or proprietary financial information )) adopted 18
under RCW 43.371.070(1). 19
(2) The lead organization may decline a request that does not 20
include the information set forth in subsection (1) of this section 21
that does not meet the criteria established by the lead 22
organization's data release advisory committee, or for reasons 23
established by rule. 24
(3) Except as otherwise required by law, the authority shall 25
direct the lead organization and the data vendor to maintain the 26
confidentiality of claims or other data it collects for the database 27
that include ((proprietary financial information, )) direct patient 28
identifiers, indirect patient identifiers, or any combination 29
thereof. Any entity that receives claims or other data must also 30
maintain confidentiality and may only release such claims data or any 31
part of the claims data if: 32
(a) The claims data does not contain ((proprietary financial 33
information,)) direct patient identifiers, indirect patient 34
identifiers, or any combination thereof; and 35
(b) The release is described and approved as part of the request 36
in subsection (1) of this section. 37
(4) The lead organization shall, in conjunction with the 38
authority and the data vendor, create and implement a process to 39
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govern levels of access to and use of data from the database 1
consistent with the following: 2
(a) Claims or other data that include ((proprietary financial 3
information,)) direct patient identifiers, indirect patient 4
identifiers, unique identifiers, or any combination thereof may be 5
released only to the extent such information is necessary to achieve 6
the goals of this chapter set forth in RCW 43.371.020(1) to 7
researchers with approval of an institutional review board upon 8
receipt of a signed data use and confidentiality agreement with the 9
lead organization. A researcher or research organization that obtains 10
claims data pursuant to this subsection must agree in writing not to 11
disclose such data or parts of the data set to any other party, 12
including affiliated entities, and must consent to the penalties 13
associated with the inappropriate disclosures or uses of direct 14
patient identifiers ((,)) or indirect patient identifiers ((, or 15
proprietary financial information)) adopted under RCW 43.371.070(1).16
(b) Claims or other data that do not contain direct patient 17
identifiers, but that may contain ((proprietary financial 18
information,)) indirect patient identifiers, unique identifiers, or 19
any combination thereof may be released to: 20
(i) Federal, state, tribal, and local government agencies upon 21
receipt of a signed data use agreement with the authority and the 22
lead organization ((. Federal, state, tribal, and local government 23
agencies that obtain claims data pursuant to this subsection are 24
prohibited from using such data in the purchase or procurement of 25
health benefits for their employees)); 26
(ii) Any entity when functioning as the lead organization under 27
the terms of this chapter; ((and))28
(iii) The Washington health benefit exchange established under 29
chapter 43.71 RCW, upon receipt of a signed data use agreement with 30
the authority and the lead organization as directed by rules adopted 31
under this chapter; and32
(iv) Agencies, researchers, and other entities as approved by the 33
lead organization upon receipt of a signed data use agreement with 34
the authority and the lead organization. 35
(c) ((Claims or other data that do not contain proprietary 36
financial information, direct patient identifiers, or any combination 37
thereof, but that may contain indirect patient identifiers, unique 38
identifiers, or a combination thereof may be released to agencies, 39
researchers, and other entities as approved by the lead organization 40
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upon receipt of a signed data use agreement with the lead 1
organization. 2
(d))) Claims or other data that do not contain direct patient 3
identifiers, indirect patient identifiers, ((proprietary financial 4
information,)) or any combination thereof may be released upon 5
request. 6
(5) Reports utilizing data obtained under this section may not 7
contain ((proprietary financial information, )) direct patient 8
identifiers, indirect patient identifiers, or any combination 9
thereof. Nothing in this subsection (5) may be construed to prohibit 10
the use of geographic areas with a sufficient population size or 11
aggregate gender, age, medical condition, or other characteristics in 12
the generation of reports, so long as they cannot lead to the 13
identification of an individual. 14
(6) ((Reports issued by the lead organization at the request of 15
providers, facilities, employers, health plans, and other entities as 16
approved by the lead organization may utilize proprietary financial 17
information to calculate aggregate cost data for display in such 18
reports. The authority shall approve by rule a format for the 19
calculation and display of aggregate cost data consistent with this 20
chapter that will prevent the disclosure or determination of 21
proprietary financial information. In developing the rule, the 22
authority shall solicit feedback from the stakeholders, including 23
those listed in RCW 43.371.020(5)(h), and must consider, at a 24
minimum, data presented as proportions, ranges, averages, and 25
medians, as well as the differences in types of data gathered and 26
submitted by data suppliers.27
(7))) Recipients of claims or other data under subsection (4) of 28
this section must agree in a data use agreement or a confidentiality 29
agreement to, at a minimum: 30
(a) Take steps to protect data containing direct patient 31
identifiers, indirect patient identifiers, ((proprietary financial 32
information,)) or any combination thereof as described in the 33
agreement; 34
(b) Not redisclose the claims data except pursuant to subsection 35
(3) of this section; 36
(c) Not attempt to determine the identity of any person whose 37
information is included in the data set or use the claims or other 38
data in any manner that identifies any individual or their family or 39
attempt to locate information associated with a specific individual;40
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(d) Destroy claims data at the conclusion of the data use 1
agreement; and 2
(e) Consent to the penalties associated with the inappropriate 3
disclosures or uses of direct patient identifiers ((,)) or indirect 4
patient identifiers((, or proprietary financial information )) adopted 5
under RCW 43.371.070(1). 6
Sec. 4. RCW 43.371.060 and 2020 c 131 s 1 are each amended to 7
read as follows: 8
(1)(a) Under the supervision of and through contract with the 9
authority, the lead organization shall prepare health care data 10
reports using the database and the statewide health performance and 11
quality measure set. Prior to the lead organization releasing any 12
health care data reports that use claims data, the lead organization 13
must submit the reports to the authority for review.14
(b) By October 31st of each year, the lead organization shall 15
submit to the director a list of reports it anticipates producing 16
during the following calendar year. The director may establish a 17
public comment period not to exceed thirty days, and shall submit the 18
list and any comment to the appropriate committees of the legislature 19
for review. 20
(2)(a) Health care data reports that use claims data prepared by 21
the lead organization for the legislature and the public should 22
promote awareness and transparency in the health care market by 23
reporting on: 24
(i) Whether providers and health systems deliver efficient, high 25
quality care; and 26
(ii) Geographic and other variations in medical care and costs as 27
demonstrated by data available to the lead organization.28
(b) Measures in the health care data reports should be stratified 29
by demography, income, language, health status, and geography when 30
feasible with available data to identify disparities in care and 31
successful efforts to reduce disparities. 32
(c) Comparisons of costs among providers and health care systems 33
must account for differences in the case mix and severity of illness 34
of patients and populations, as appropriate and feasible, and must 35
take into consideration the cost impact of subsidization for 36
uninsured and government-sponsored patients, as well as teaching 37
expenses, when feasible with available data. 38
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(3) The lead organization may not publish any data or health care 1
data reports that: 2
(a) Directly or indirectly identify individual patients;3
(b) ((Disclose a carrier's proprietary financial information;4
(c))) Compare performance in a report generated for the general 5
public that includes any provider in a practice with fewer than four 6
providers; or 7
(((d))) (c) Contain medicaid data that is in direct conflict with 8
the biannual medicaid forecast. 9
(4) The lead organization may not release a report that compares 10
and identifies providers, hospitals, or data suppliers unless:11
(a) It allows the data supplier, the hospital, or the provider to 12
verify the accuracy of the information submitted to the data vendor, 13
comment on the reasonableness of conclusions reached, and submit to 14
the lead organization and data vendor any corrections of errors with 15
supporting evidence and comments within thirty days of receipt of the 16
report; 17
(b) It corrects data found to be in error within a reasonable 18
amount of time; and 19
(c) The report otherwise complies with this chapter.20
(5) The authority and the lead organization may use claims data 21
to identify and make available information on payers, providers, and 22
facilities, but may not use claims data to recommend or incentivize 23
direct contracting between providers and employers.24
(6) The lead organization shall make information about claims 25
data related to the provision of air ambulance service available on a 26
website that is accessible to the public in a searchable format by 27
geographic region, provider, and other relevant information.28
(7)(a) The lead organization shall distinguish in advance to the 29
authority when it is operating in its capacity as the lead 30
organization and when it is operating in its capacity as a private 31
entity. Where the lead organization acts in its capacity as a private 32
entity, it may only access data pursuant to RCW 43.371.050(4) (b)33
((,)) (iv) or (c)((, or (d))). 34
(b) Except as provided in RCW 43.371.050(4), claims or other data 35
that contain direct patient identifiers ((or proprietary financial 36
information)) must remain exclusively in the custody of the data 37
vendor and may not be accessed by the lead organization.38
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Sec. 5. RCW 43.371.070 and 2019 c 319 s 7 are each amended to 1
read as follows: 2
(1) The director shall adopt any rules necessary to implement 3
this chapter, including: 4
(a) Definitions of claim and data files that data suppliers must 5
submit to the database, including: Files for covered medical 6
services, pharmacy claims, and dental claims; member eligibility and 7
enrollment data; and provider data with necessary identifiers;8
(b) Deadlines for submission of claim files; 9
(c) Penalties for failure to submit claim files as required;10
(d) Procedures for ensuring that all data received from data 11
suppliers are securely collected and stored in compliance with state 12
and federal law; 13
(e) Procedures for ensuring compliance with state and federal 14
privacy laws; 15
(f) Procedures for establishing appropriate fees;16
(g) Procedures for data release; 17
(h) Penalties associated with the inappropriate disclosures or 18
uses of direct patient identifiers ((,)) and indirect patient 19
identifiers((, and proprietary financial information)); and20
(i) A minimum reporting threshold below which a data supplier is 21
not required to submit data. 22
(2) The director may not adopt rules, policies, or procedures 23
beyond the authority granted in this chapter. 24
Sec. 6. RCW 43.371.090 and 2024 c 54 s 50 are each amended to 25
read as follows: 26
(1) To ensure the database is meeting the needs of state agencies 27
and other data users, the authority shall convene a state agency 28
coordinating structure, consisting of state agencies with related 29
data needs and the Washington health benefit exchange to ensure 30
effectiveness of the database and the agencies' programs. The 31
coordinating structure must collaborate in a private/public manner 32
with the lead organization and other partners key to the broader 33
success of the database. The coordinating structure shall advise the 34
authority and lead organization on the development of any database 35
policies and rules relevant to agency data needs. 36
(2) The office must participate as a key part of the coordinating 37
structure and evaluate progress towards meeting the goals of the 38
database, and, as necessary, recommend strategies for maintaining and 39
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promoting the progress of the database in meeting the intent of this 1
section, and report its findings ((biennially)) every five years to 2
the governor and the legislature. The authority shall facilitate the 3
office obtaining the information needed to complete the report in a 4
manner that is efficient and not overly burdensome for the parties. 5
The authority must provide the office with access to database 6
processes, procedures, nonproprietary methodologies, and outcomes to 7
conduct the review and issue the ((biennial)) five-year report. The 8
((biennial)) five-year review shall assess, at a minimum the 9
following: 10
(a) The list of approved agency use case projects and related 11
data requirements under RCW 43.371.050(4); 12
(b) Successful and unsuccessful data requests and outcomes 13
related to agency and nonagency health researchers pursuant to RCW 14
43.371.050(4); 15
(c) Online data portal access and effectiveness related to 16
research requests and data provider review and reconsideration;17
(d) Adequacy of data security and policy consistent with the 18
policy of Washington technology solutions; and 19
(e) Timeliness, adequacy, and responsiveness of the database with 20
regard to requests made under RCW 43.371.050(4) and for potential 21
improvements in data sharing, data processing, and communication.22
(3) To promote the goal of improving health outcomes through 23
better cost and quality information, the authority, in consultation 24
with the agency coordinating structure, the office, lead 25
organization, and data vendor shall make recommendations to the 26
Washington state performance measurement coordinating committee as 27
necessary to improve the effectiveness of the state common measure 28
set as adopted under RCW 70.320.030. 29
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