A bill establishing a claims and clinical data warehouse at the Commonwealth Healthcare Corp. was signed into law yesterday by Gov. Ralph DLG Torres.
Senate Bill 19-61 amends sections of the measure introduced by Sen. Sixto K. Igisomar (R-Saipan) and is now known as Public Law 19-56.
PL 19-56 will assess the CNMI healthcare’s total costs by establishing the aforementioned claims and clinical data warehouse at CHCC and improve accountability of how health insurance premiums are spent.
The newly signed law also aims to require health insurance and health care providers to submit their reports on the claims and other clinical data to the insurance commissioner, which is under the Department of Commerce.
The Legislature, according to the law, found that the CNMI needed a medical claims and clinical data warehouse like the ones followed in several states in the mainland. This is to monitor and analyze health care costs, and improve coordination and quality of health care.
It hopes to assess population health conditions, support health information exchange, conduct utilization reviews, identify healthcare disparities, inform consumers of cost and quality of healthcare services, support planning and evaluation of healthcare operations, and care.
The law also allows conducting of waste, fraud, and abuse investigations based on establishing a baseline data for applications for funding and federal reporting.
Regulating the insurance costs and coverage are also important, according to the Legislature to make sure consumers receive value for the insurance premium they pay, health insurance and healthcare is affordable and accessible in the CNMI, and transparency exists in health insurance and health care.
“The Legislature further finds that without reporting of claims by insurers, the CNMI will not be able to review rates and ensure that consumers receive value for premium paid,” the newly signed law read.
The Legislature also found that the lack of cost transparency may “obscure price variations for medical services and health insurance premiums within the [CNMI], thus obstructing access to healthcare for residents.”
Directing the CHCC to establish a Claims and Clinical Data Warehouse is the purpose of the law where it hopes to have a yearly plan and calendar to require insurers and providers the clinical data to “report studies on the cost of quality care, population health conditions, healthcare disparities, and other health matters.”