Data Submission and Use Agreement Between the Delaware
Health Information Network and name of Reporting Entity
For the Delaware Health Care Claims
Database
This Data Submission and Use Agreement between the Delaware
Health Information Network ("DHIN"), a not-for-profit statutory instrumentality
of the State of Delaware located at 107 Wolf Creek Blvd, Suite, 2, Dover, DE
19901 and [name of reporting entity] (the "Reporting Entity") sets forth the
terms and conditions for the collection and use of health care claims data for
the Delaware Health Care Claims Database.
Recitals
WHEREAS Under 16 Del.C. Ch. 103 as enacted, the
Delaware General Assembly directed the Delaware Health Information Network to
develop, maintain and administer the Delaware Health Care Claims Database
(HCCD); and
WHEREAS Effective health care data analysis and
reporting are essential to achieving the Triple Aim and helping move the
state's health care system from a fee-for-service to a valued-based system that
rewards providers for quality and efficiency of care; and
WHEREAS Claims data are an important component
of population health research and analysis and support value-based health care
purchasing and prevalence of illness or injury; and
WHEREAS provider and other health care entities
accepting financial risk for managing the health care needs of a population
should have access to claims data as necessary to effectively manage that risk;
and
WHEREAS DHIN Is authorized to create the HCCD to
facilitate data-driven, evidence-based improvements in health care and improve
public health through increased transparency of accurate health care claims
data and information; and
WHEREAS 16 Del.C. §
10313 directs that DHIN and each
reporting entity shall execute a data submission and use agreement that
includes procedures for submission, collection, aggregation and distribution of
claims data,
NOW THEREFORE THE PARTIES AGREE AS
FOLLOWS:
1. Precedence
a. DHIN shall promulgate regulations to
implement the provisions of 16 Del.C. Ch. 103, hereinafter, and as the same may
be amended from time to time, the "HCCD Regulations". The HCCD Regulations
shall take precedence over any terms and conditions represented in this
Agreement.
b. Definitions in
Section
2.0 of the HCCD
Regulations shall also pertain to this Agreement.
2. Data Submission: Privacy and Security
a. 16 Del.C. Ch. 103 establishes DHIN as a
public health authority that is responsible for public health matters pursuant
to 45 CFR
164.501.
b. The HIPAA Privacy Rule permits covered
entities to disclose PHI for general public health activities per
45 CFR
164.512(b)(1)(i).
c. Notwithstanding these provisions, DHIN
shall ensure protection of patient privacy under provisions of 16 Del.C. Ch.
103, and including HIPAA, Title XIX and XXI of the Social Security Act and the
HITECH Act and all other applicable state and federal privacy
laws.
3. Data Submission:
Collection
a. Reporting Entity shall submit
Required Claims Data to the HCCD according to the specifications set forth in
the Submission Guide. The Submission Guide is a technical guidance document,
and may be updated and replaced without replacing the entire
agreement.
b. Reporting Entity
shall submit Required Claims Data to the HCCD according to the schedule set
forth in Attachment A, Reporting Schedule, of the HCCD Regulations, or as
mutually agreed. The schedule is included herein for convenience, but in case
of conflict between this Agreement and the HCCD Regulations, the HCCD
Regulations shall take precedence.
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c.
Reporting Entity shall submit data files using protocols developed by the HCCD.
i. The Submission Guide shall reflect the
content and formats in use by similar databases in other states.
ii. The data submission specifications shall
be updated no more than once per calendar year.
iii. The parties agree to review and discuss
any such changes prior to the effective date.
iv. Reporting Entity shall provide conforming
data no later than 180 calendar days after publication of changes or by
agreement between the HCCD Administrator and the Reporting Entity.
v. The HCCD Administrator may provide
clarifications and technical corrections as needed to assist Reporting Entity
in providing data submissions that conform to
specifications.
d.
Reporting Entity shall provide corrected data files within the timelines
established in subsection 4.4.1 of the HCCD Regulations, or as mutually
agreed.
e. Upon agreement between
DHIN and the Reporting Entity, the Reporting Entity may submit additional data
to the HCCD to improve or augment established reporting.
f. DHIN will review the Submission Guide and
any subsequent annual revisions with Reporting Entity prior to the 180 day
implementation period and on an annual basis thereafter.
g. Data collection methodologies in the
Submission Guide shall facilitate uniformity among various health care claims
databases of other states and specification of data fields, consistent with
national standards.
h. Reporting
Entity may request exemptions from specific data collection requirements,
including minimum standards for reporting, subject to the approval of the HCCD
Administrator.
4. Claims
Data Uses
a. Pursuant to 16 Del.C. §
10314 (a)(1),
Claims Data shall only be provided to a requesting party when a majority of the
HCCD Committee determines that such request facilitates the statutory purposes
of the HCCD.
i. Reporting Entities shall be
given opportunity for comment prior to release of Claims Data.
ii. Determinations of the Committee shall be
provided in writing to the requesting party.
iii. Decisions of the Committee shall be
final and not subject to appeal.
b. Data Requestors may include payers,
providers and purchasers.
c. The
submitted claims data may be used for the broad purposes described in the
enabling statute, including:
i. Alternative
delivery and payment models
ii.
Population health research
iii.
Provider risk-sharing arrangements
iv. Public transparency
v. Other uses in furtherance of the "Triple
Aim" of improved health, health care quality and experience, and
affordability
d. Detailed
permitted uses include, but are not limited to, the following:
i. Population health research and reporting
on disease incidence, prevalence, and geographic distribution, costs of care
and service utilization
ii. Health
care service price variation reports and studies
iii. Design, model and evaluate payment
models and purchasing initiatives
iv. Effects of care delivery strategies
(e.g., care coordination, behavioral health integration) on utilization and
outcomes
v. Efficiency of care,
service models or procedures based on quality, value and/or outcomes
vi. Public facing provider performance
reports
vii. Augment
patient-specific records with data derived from the HCCD to improve the care of
the patient, ensure better outcomes and deliver better
value.
e. Publicly
available data and reports shall, to the fullest extent practicable, comply
with guidance in Statement 6 of the United States Department of Justice and
Federal Trade Commission Enforcement Policy on Provider Participation in
Exchanges of Price and Cost Information, August 1996, as the same may be
amended, supplemented or modified from time to time, available at
https://www.justice.gov/atr/statements-antitrust-enforcement-policy-health-care#CONTNUM_49
(last visited June 5, 2017).
f.
Standard public-facing reports may be developed which provide aggregated,
summary level views of the data in accordance with the statutory purpose of
public transparency.
Applicable Law:
This Agreement shall be governed by and construed under the
laws of the State of Delaware without regard to conflicts of law
principles.
IN WITNESS WHEREOF, and intending to be legally
bound thereby, the Parties have caused their duly authorized representatives to
execute this Agreement.
Signatories:
[Reporting Entity] Delaware Health Information Network
____________________________________
____________________________________
[Name] Janice L. Lee, MD
[Title] Chief Executive Officer
Date: Date:
