Some House Republicans are questioning a proposed regulation under the federal health reform law that would require insurers to submit claims data to provide justification for extra payments for plans that cover large numbers of individuals with serious illnesses, The Hill's "Healthwatch" reports.
Details of Proposed Rule
The proposed regulation outlines three options for claims data collection:
- A centralized approach, in which insurers submit raw claims data sets to federal officials;
- An intermediate state-level approach, in which insurers submit raw claims data to the state; and
- A distributed approach, in which insurers reformat their own data and then forward self-determined risk scores and plan averages to the entity tasked with assessing risk-adjusted payments.
According to "Healthwatch," the proposed rule favors the second option but acknowledges that the approach could raise privacy concerns. The rule recommends that states "utilize specific privacy standards in [their] data collection risk adjustment procedures."
CMS is accepting comments on the proposed rule through the end of October.
Details of GOP Concerns
Rep. Tim Huelskamp (R-Kan.) and other representatives have sent a letter to HHS Secretary Kathleen Sebelius urging her to reject the proposed rule.
The letter states, "Regardless of whether the data collection would involve raw claims data or individual risk scores, the creation of such a risk adjustment database constitutes extreme government overreach, impinges on patients' rights to privacy and jeopardizes fair competition in the health care market."
Huelskamp also wrote a separate letter, co-signed by other members of Congress, to Rep. Denny Rehberg (R-Mont.) asking him to block funding for the rule in the 2012 health services spending bill. Rehberg is chair of the House Appropriations Subcommittee on Labor, HHS, Education and Related Agencies (Pecquet, "Healthwatch," The Hill, 10/13).
On Thursday, Rehberg sent a letter to Sebelius seeking information about the purpose of the database, HHS' authority to create the database and whether efforts have been made to allow for public input (Heggem, KRTV, 10/13).
Rehberg wrote, "I have been told that HHS has already procured a contractor to build a database and that this contractor has already taken steps to acquire personal health care data from a large claims database." He added that if those reports are true, "it would represent an egregious violation of the privacy rights that the American public rightfully demands" (Rehberg release, 10/13).
Rehberg said he might call for oversight hearings to discuss the government's authority to create such a database (KRTV, 10/13).
Obama Administration Responds
In a blog post, Steve Larsen -- director of the Center for Consumer Information and Insurance Oversight -- writes that the proposed rule outlines "general options for collecting information" and says the office has not begun work on the project.
Larsen said CMS is not proposing that states collect personal information such as names or Social Security numbers.
He added, "Protecting an individual's personal health information continues to be among CMS' highest priorities. That is why CMS will not require states to collect your medical record or information that identifies your doctor; nor would the federal government collect this information" ("Healthwatch," The Hill, 10/13).