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All Payer Claims Database Supreme Court Decision

Published by HCPF on March 18, 2016
Media Contact: Marc Williams
303-866-3144

DENVER, CO – Earlier this month, the U.S. Supreme Court issued a ruling regarding a Vermont law requiring health insurance plans to provide certain claims information to state agencies for the purpose of compiling a database that consumers use to compare health care prices. The Court ruled that Employee Retirement Income Security Act (ERISA) plans were exempt from the Vermont law and insurance companies are not required to provide claims information from ERISA plans to the state.

Colorado is one of at least 17 states that compiles health care pricing information into an All Payers Claim Database (APCD). The Colorado APCD is administered by the non-profit Center for Improving Value in Health Care (CIVHC) and is governed by the Department of Health Care Policy and Financing (HCPF).

As a result of the Court’s ruling, Colorado cannot require self-insured ERISA plans to provide claims data to the Colorado APCD.

Prior to the Court’s ruling, self-insured health plans that had 100 or more covered lives in Colorado were going to be required to submit eligibility data, de-identified medical and pharmacy claims data, and provider files to Colorado APCD on a monthly basis. CIVHC, HCPF and the Attorney General’s office are working on a minor revision to the Colorado APCD regulations to bring Colorado law into compliance with the Supreme Court decision.

“We appreciate the guidance the Supreme Court decision has given us so that we can modify our regulations. Providing Coloradans access to transparent health care pricing information remains an important goal for this administration,” said Susan E. Birch, MBA, BSN, RN, Executive Director. “Informed consumers make better decisions and pricing transparency is one way to achieve this. We urge ERISA plans in Colorado to continue supporting transparency by voluntarily submitting claims data to the Colorado APCD. Colorado has one of the most innovative and collaborative public and private health care plan markets in the country. National organizations recognize CIVHC and the Colorado APCD as pioneers in the health care transparency movement.”

The Court’s decision does not affect the obligation under Colorado law for non-ERISA self-insured health plans or other current payers to submit claims data to the Colorado APCD, nor does it prevent CIVHC from accepting claims data voluntarily submitted by ERISA plans. By participating in the Colorado APCD, ERISA plans join the majority of other payers, including Medicare and Medicaid, to inform local and national health care improvement initiatives, help bend the cost curve for health care services, and offer transparency in evaluating health plans service costs.

Created by legislation in 2010, The Colorado APCD is Colorado’s most comprehensive source of health care claims information. It provides insights into health care costs, utilization, quality, and health status of Coloradans. By aggregating, analyzing and reporting these claims data, the APCD helps consumers, providers, state agencies, researchers, health plans and other organizations query and analyze health care service costs. It is the only claims repository in the state that represents the majority of insured lives in Colorado, offering a more complete picture of our health care system and making it unlike any other source of claims information available.

For more information, CIVHC has posted a summary and FAQs of the Court’s decision.

About the Colorado Department of Health Care Policy and Financing:

The Department administers the Medicaid and Child Health Plan Plus programs as well as a variety of other programs for low-income Coloradans who qualify. For more information about the department, please visit Colorado.gov/hcpf.
 

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