Tuesday, June 30, 2015

Supreme Court to consider who owns healthcare claims data

Modern Healthcare reports that The U.S. Supreme Court will hear a case next term on whether a self-funded insurer should have to turn over certain information to the state of Vermont.

The Court announced Monday, June 29, that it would hear Gobeille v. Liberty Mutual Insurance Co. The Supreme Court's new term will begin in October. The case will likely be heard in November or December.

FInd the article, Who controls the data? US Supreme Court agrees to hear healthcare case, by Lisa Schencker here:  http://www.modernhealthcare.com/article/20150629/NEWS/150629889?utm_source=modernhealthcare&utm_medium=email&utm_content=externalURL&utm_campaign=am

In the case, the state of Vermont argues it needs certain data from Liberty, such as claims, member eligibility and other issues, to help it improve the cost and effectiveness of healthcare.

Liberty Mutual, however, argues that the federal Employer Retirement Income Security Act, known as ERISA, protects it and its third-party administrator from having to hand over the information, which is otherwise required by the state. 

The 2nd U.S. Circuit Court of Appeals already ruled that ERISA, which regulates traditional pensions and other employer-provided benefits, takes precedence over state law, meaning Liberty Mutual's third-party administrator shouldn't have to turn over the data. 

But the US Solicitor General's office, representing the federal government, argues the case has national consequences:

“With the encouragement of the federal government, other states are establishing similar healthcare databases to help improve health outcomes for their citizens, and thus the question presented has national importance.”

“If States are unable to acquire such data from self-insured ERISA healthcare plans, their databases will be significantly less comprehensive and thus not as useful in developing health policy at both the state and national levels.”

The state of Vermont argues that it needs access to such data to to create consumer-oriented websites, conduct research on healthcare outcomes or track access to specialists.

“As healthcare costs continue to skyrocket and place enormous pressures on state budgets, the States have an urgent need to take advantage of the 'great potential' … offered by all-payer claims databases.”

Liberty Mutual argues that ERISA pre-empts state law regarding the collection of data: 

“In addition to protecting the interests of beneficiaries, Congress intended to protect plans and employers with self-funded plans (and, ultimately, employees and beneficiaries as well) from the burdens of complying with conflicting state laws by reserving the field of employee benefit plans for federal regulation.”

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