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Informing Policy. Advancing Health.

Supreme Court Rules Against Requiring Some Claims Data Reporting

Supreme Court Rules Against Requiring Some Claims Data Reporting

BLOG UPDATE: The U.S. Supreme Court, in a 6-2 vote on March 1, sided with Liberty Mutual, the insurance company that objects to the Vermont law requiring all health insurers to report claims data. The case has been widely watched for its potential impact on All Payer Claims Databases, including the Colorado All Payer Claims Database (APCD) administered by the Center for Improving Value in Health Care (CIVHC).

CIVHC and the Department of Health Care Policy and Financing, the state agency that authorizes Colorado’s APCD, are reviewing the ruling to understand how it impacts Colorado. CIVHC said it is hopeful that self-insured plans will continue to voluntarily submit claims data.

But assuming the ruling stands, claims from 500,000 Coloradans could be missing from the state APCD. Even in that “worst case scenario,” however, the value of the APCD is not lost, according to Amy Downs, vice president of the Colorado Health Institute. Amy told me that it’s likely that people in self-insured plans have similar expenditures as those in fully insured plans. So the pricing information available to the public would be valuable even without the self-insured data, she said. 


"Supreme Court Case Could Halt Health Data Momentum"

With some adept online shopping, I was able to find the least expensive Vitamix blender for my mom and the best grilling book for my dad over the holidays.

But for Colorado’s health care consumers, comparison shopping for hospitals or physicians historically has been much tougher.

The Colorado legislature, recognizing that difficulty, created the All Payer Claims Database (APCD) in 2010. Since then, the state’s APCD — administered by the Center for Improving Value in Health Care (CIVHC) — has assembled Colorado’s largest collection of public and private health care claims data.

Across the nation, 18 states have claims databases and 20 others are thinking about following suit, according to the National Academy for State Health Policy.

But a Vermont case before the U.S. Supreme Court, Gobeille v. Liberty Mutual, threatens to halt this momentum, impacting all APCDs, including Colorado’s.

The case revolves around whether Employment Retirement Income Security Act (ERISA) self-insured employers must provide data on health care prices to APCDs. Liberty Mutual objects to the requirement, and if the court rules in favor of the company, the loss of claims data from self-insured plans would deprive APCDs of valuable information.

ERISA, a federal law that regulates employee benefits, including most private sector health plans, is central to the case. Non-public self-insured employers fall under this federal law rather than state law.  Public employers such as municipalities, school districts, and local and state governments, do not fall under ERISA.

Vermont requires all employers to report health care data. But Liberty Mutual protested, saying that state reporting requirements are burdensome and costly for self-insured employers operating in multiple states. And because it is already governed by federal ERISA rules, the company says it should not have to follow state requirements on reporting claims data.

Both Bridget Asay, Vermont’s Solicitor General, and the Federal Solicitor General, argue that reporting such data is not difficult, since companies or their third party administrators already collect that information and must comply with HIPAA and Hi-Tech Security requirements.  

The Supreme Court Justices “appeared skeptical” that a state could require health data reporting from a self-insured company that is following federal ERISA rules, according to the Associated Press.

Justice Stephen Breyer asked if the federal Department of Labor could set up national regulations on data reporting so that employers operating in multiple states would not have to follow different reporting requirements. 

 But other justices did not seem convinced that a federal agency could fix the problem.

Justices Elena Kagan and Ruth Bader Ginsburg were concerned about employer costs, but they also questioned how much of a financial burden really results from claims data reporting since the data are already being collected from their health plan administrators. 

The final decision is expected by the end of June.

Colorado’s APCD has just begun collecting data from self-insured plans. The data will be available this summer.

Previously, self-insured plans were not included in the state’s definition of a “private health care payer” required to report health care data. This meant that claims data from about 30 percent of insured Coloradans did not make its way to the APCD.

A decision by the Colorado Department of Health Care Policy and Financing changed the rule on June 29, 2015, to include self-insured employers.

In Colorado’s APCD self-funded rule change, three items differ from Vermont’s rule: a self-funded employer serviced by a Third Party Administrator or Administrative Services Only that represents fewer than 1,000 Colorado lives is not required to participate; a self-funded employer with fewer than 100 Colorado lives is not required to participate; and an ERISA self-funded employer can opt out for 2015 and 2016 claim submissions.