H. B. 2625

(By Delegates Walters, Pulliam, Sorah, Petersen
and Huntwork)
[Introduced March 17, 1993; referred to the
Select Committee on Health Care Policies.]

A BILL to amend chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, by adding thereto a new article, designated article two-a, relating to insurance; office of consumer advocacy; health care services quality and cost data control; providing definitions; duties and functions of consumer advocate, and criminal penalties.

Be it enacted by the Legislature of West Virginia:
That chapter thirty-three of the code of West Virginia, one thousand nine hundred thirty-one, as amended, be amended by adding thereto a new article, designated article two-a, to read as follows:

ARTICLE 2A. HEALTH CARE SERVICES; QUALITY AND COST DATA.

§33-2A-1. Purpose.

It is the purpose of this legislation to promote the public interest by encouraging the development of competitive health care services in which health care costs are contained and toassure that all citizens have reasonable access to quality health care.
It is further the intent of this article to facilitate the continuing provision of quality, cost-effective health services throughout West Virginia by providing data and information to the purchasers and consumers of health care on both cost and quality of health care services, and to assure access to health care services.
§33-2A-2. Definitions.
The following words and phrases when used in this article have the meanings given to them in this section unless the context clearly indicates otherwise:
"Ambulatory service facility" means a facility licensed in West Virginia, not part of a hospital, which provides medical, diagnostic or surgical treatment to patients not requiring hospitalization, including ambulatory surgical facilities, ambulatory imaging or diagnostic centers, birthing centers, freestanding emergency rooms and any other facilities providing ambulatory care which charge a separate facility charge. This term does not include the offices of private physicians or dentists, whether for individual or group practices.
"Charge" or "rate" means the amount billed by a provider for specific goods or services provided to a patient, prior to any adjustments for contractual allowances.
"Covered services" means any health care services or procedures connected with episodes of illness that require eitherinpatient hospital care or major ambulatory service such as surgical, medical or major radiological procedures, including any initial and followup outpatient services associated with the episode of illness before, during or after inpatient hospital care or major ambulatory service. The term does not include routine outpatient services connected with episodes of illness that do not require hospitalization or major ambulatory service.
"Data source" means a hospital, ambulatory service facility, physician health, maintenance organization, hospital, medical or health service plan with a certificate of authority issued by the insurance department, including, but not limited to, hospital plan corporations, and professional health services plan corporations, commercial insurer with a certificate of authority issued by the insurance department providing health or accident insurance self-insured employer providing health or accident coverage or benefits for employees employed in West Virginia, administrator of a self-insured or partially self-insured health or accident plan providing health or accident coverage or benefits for employees employed in West Virginia, administrator of a self-insured or partially self-insured health or accident plan providing covered services in West Virginia, any health and welfare fund that provides health or accident benefits or insurance pertaining to covered service in West Virginia, the department of health and human services for those covered services it purchases or provides through the medical assistance program and any other payor for covered services in West Virginiaother than an individual.
"Health care insurer" means any person, corporation or other entity that offers administrative, indemnity or payment services for health care in exchange for a premium or service charge under a program of health care benefits, including, but not limited to, an insurance company, association, hospital plan corporation, professional health services plan corporation, health maintenance organization, preferred provider organization fraternal benefit societies, beneficial societies, and third-party administrators, but excluding employers, labor unions or health and welfare funds jointly or separately administered by employers or labor unions that purchase or self-fund a program of health care benefits for their employees or members and their dependents.
"Health maintenance organization" means an organized system which combines the delivery and financing of health care and which provides basic health services to voluntarily enrolled subscribers for a fixed prepaid fee.
"Hospital" means an institution, licensed in West Virginia, which is a general, tuberculosis, mental, chronic disease or other type of hospital, or kidney disease treatment center, whether profit or nonprofit and including those operated by an agency of state or local government.
"Indigent care" means the actual costs for the provision of appropriate health care on an inpatient or outpatient basis, given to individuals who cannot pay for their care because they are above the medical assistance eligibility levels and have nohealth insurance or other financial resources which can cover their health care.
"Major ambulatory service" means surgical or medical procedures, including diagnostic and therapeutic radiological procedures, commonly performed in hospitals or ambulatory service facilities, which are not of a type commonly performed or which cannot be safely performed in physicians' offices and which require special facilities such as operating rooms or suites or special equipments such as fluroscopic equipment or computed tomographic scanners or a postprocedure recovery room or short- term convalescent room.
"Medical procedure incidence variations" means the variation in the incidence in the population of specific medical, surgical and radiological procedures in any given year, expressed as a deviation from the norm, as these terms are defined in the classical statistical definition of "variation," "incidence," "deviation" and "norm."
"Medically indigent" or "indigent" means the status of a person as described in the definition of indigent care.
"Payment" means the payments that providers actually accept for their services, exclusive of charity care, rather than the charges they bill.
"Payor" means any person or entity, including, but not limited to, health care insurers and purchasers, that make direct payments to providers for covered services.
"Physician" means an individual licensed under the laws ofWest Virginia to practice medicine and surgery.
"Preferred provider organization" means any arrangement between a health care insurer and providers of health care services which specifies rates of payment to such providers which differ from their usual and customary charges to the general public and which encourage enrollees to receive health services from such providers.
"Provider" means a hospital, an ambulatory service facility or a physician.
"Provider quality" means the extent to which a provider renders care that, within the capabilities of modern medicine, obtains for patients medically acceptable health outcomes and prognosis, adjusted for patient severity and treats patients compassionately and responsively.
"Provider service effectiveness" means the effectiveness of services rendered by a provider, determined by measurement of the medical outcome of patients grouped by severity receiving those services.
"Purchaser" means all corporations, labor organizations and other entities that purchase benefits which provide covered services for their employees or members, either through a health care insurer or by means of a self-funded program of benefits, and a certified bargaining representative that represents a group or groups of employees for whom employers purchase a program of benefits which provide covered services, but excluding entities defined in this section as "health care insurer."
"Raw data" or "data" means data collected by the consumer advocate under the provisions of section five of this article in the form initially received. No data may be released by the consumer advocate except as provided for in section six of this article.
"Severity" means, in any patient, the measurable degree of the potential for failure of one or more vital organs.
§33-2A-3. General duties and functions.
The consumer advocate is hereby authorized to and shall perform the following duties and functions:
(1) Develop a computerized system for the collection, analysis and dissemination of data. The consumer advocate may contract with a vendor to provide the data processing services. The consumer advocate shall assure that the system is capable of processing all data required to be collected under this article. Any vendor selected by the consumer advocate shall be selected in accordance with West Virginia law and the vendor shall relinquish all proprietary rights or claims to the data base created as a result of implementation of the data processing system.
(2) Establish a West Virginia uniform claims and billing form for all data sources and all providers which shall be utilized and maintained by all data sources and all providers for all services covered under this article.
(3) Collect and disseminate data, as specified in this article, and other information from data sources to which the consumer advocate is entitled, prepared according to formats,time frames and confidentiality provisions as specified in sections four and five of this article and by the consumer advocate.
(4) Adopt and implement a methodology and collect and disseminate data reflecting provider quality and provider service effectiveness.
(5) Subject to the restrictions on access to raw data set forth in section five of this article, issue special reports and make available raw data to any purchaser requesting it. Sale by any recipient or exchange or publication by a recipient, other than a purchaser, of raw consumer advocate data to other parties without the express written consent of, and under terms approved by, the consumer advocate is unauthorized use of data under this article.
(6) On a semiannual basis, publish in booklet form a list of all the raw data reports it has prepared and a description of the data obtained through each computer-to-computer access it has and the names of the parties to whom the consumer advocate provided the reports or the computer-to-computer access during the previous six months.
(7) Promote competition in the health care and health insurance markets.
(8) Assure that the use of consumer advocate data does not raise access barriers to care.
(9) Make annual reports to the Legislature on the rate of increase in the cost of health care in West Virginia and theeffectiveness of the consumer advocate in carrying out the legislative intent of this article. In addition, the consumer advocate may make recommendations on the need for further health care cost containment legislation. The consumer advocate shall also make annual reports to the Legislature on the quality and effectiveness of health care and access to health care for all citizens of West Virginia.
(10) Adopt, within one hundred eighty days following commencement of its operations as part of the West Virginia uniform claims and billing form for covered services a standard billing form for all providers, which shall include, any other information and explanations as the consumer advocate deems necessary and which itemizes all charges for services, equipment, supplies and medicine. Each provider is required to utilize the standard billing form for covered services within ninety days of adoption of the form by the consumer advocate. The itemized billings shall be written in language that is understandable to the average person and be presented to each patient upon discharge from a health care facility or provision of physician services or within a reasonable time thereafter.
(11) Conduct studies and publish reports thereon analyzing the effects that noninpatient, alternative health care delivery systems have on health care costs. These systems shall include, but not be limited to: HMO's; PPO's; primary health care facilities; home health care; attendant care; ambulatory service facilities; freestanding emergency centers; birthing centers; andhospice care. These reports shall be submitted to the Legislature and shall be made available to the public.
§33-2A-4. Data submission and collection.
(a) Submission of data. -- The consumer advocate is hereby authorized to collect, and data sources are hereby required to submit, upon request of the consumer advocate, all data required in this section, according to uniform submission formats, coding systems and other technical specifications necessary to render the incoming data substantially valid, consistent, compatible and manageable using electronic data processing according to data submission schedules, such schedules to avoid, to the extent possible, submission of identical data from more than one data source, established and promulgated by the consumer advocate in rules pursuant to its authority.
(b) Data elements. -- For each covered service performed in West Virginia, the consumer advocate shall collect the following data elements:
(1) Uniform patient identifier, continuous across multiple episodes and providers;
(2) Patient date of birth;
(3) Patient sex;
(4) Patient ZIP code number;
(5) Date of admission;
(6) Date of discharge;
(7) Principal and up to four secondary diagnosis by standard code;
(8) Principal procedure by consumer advocate--specified standard code and date;
(9) Up to three secondary procedures by consumer advocate-- specified standard codes and dates;
(10) Uniform health care facility identifier, continuous across episodes, patients and providers;
(11) Uniform identifier of admitting physicians by unique physician identification number established by the consumer advocate, continuous across episodes, patients and providers;
(12) Uniform identifier of consulting physicians, by unique physician identification number established by the consumer advocate, continuous across episodes, patients and providers;
(13) Total charges of health care facility, segregated into major categories, including, but not limited to, room and board, radiology, laboratory, operating room, drugs, medical supplies and other goods and services according to guidelines specified by the consumer advocate;
(14) Actual payments to health care facility segregated, if available, according to the categories specified in subdivision (13) of this section;
(15) Charges of each physician or professional rendering service relating to an incident of hospitalization or treatment in an ambulatory service facility;
(16) Actual payments to each physician or professional rendering service pursuant to subdivision (15) of this section;
(17) Uniform identifier of primary payor;
(18) ZIP code number of facility where health care service is rendered;
(19) Uniform identifier for payor group contract number;
(20) Patient discharge status; and
(21) Provider service effectiveness and provider quality.
(c) Provider quality and provider service effectiveness data elements. -- In carrying out its duty to collect data on provider quality and provider service effectiveness, the consumer advocate shall define a methodology to measure provider service effectiveness which may include additional data elements to be specified by the council sufficient to carry out its responsibilities under this article. The consumer advocate may adopt a nationally recognized methodology of quantifying and collecting data on provider quality and provider service effectiveness until such time as the consumer advocate has the capability of developing its own methodology and standard data elements. The consumer advocate shall include in the West Virginia uniform claims and billing form a field consisting of the data elements required pursuant to subdivision (21), subsection (c) of this section to provide information on each provision of covered services sufficient to permit analysis of provider quality and provider service effectiveness within one hundred eighty days of commencement of its operations pursuant to section six of this article.
(d) Reserve field utilization and addition or deletion of data elements. -- The consumer advocate shall include in the WestVirginia uniform claims and billing form a reserve field. The consumer advocate may utilize the reserve field by adding other data elements beyond those required to carry out its responsibilities under this article, and subsections (c) and (d) of this section, or the consumer advocate may delete data elements from the West Virginia uniform claims and billing form only pursuant to the following procedure:
(1) The consumer advocate shall obtain a cost-benefit analysis of the proposed addition or deletion which shall include the cost to data sources of any proposed additions.
(2) The consumer advocate shall publish notice of the proposed addition or deletion, along with a copy or summary of the cost-benefit analysis, and such notice shall include provision for a sixty day comment period.
(3) The consumer advocate may hold additional hearings or request such other reports as it deems necessary and shall consider the comments received during the sixty day comment period and any additional information gained through hearings or other reports in making a final determination on the proposed addition or deletion.
(e) Other data required to be submitted. -- Providers are hereby required to submit and the consumer advocate shall collect, in accordance with submission dates and schedules established by the consumer advocate, the following additional data, if such data is not available to the consumer advocate from public records:
(1) Audited annual financial reports of all hospitals and ambulatory service facilities providing covered services as defined in section three of this article.
(2) The medicare cost report (OMB Form 2552 or equivalent federal form), or the AG-12 form for medical assistance or successor forms, whether completed or partially completed, and including the settled medicare cost report and the certified AG- 12 form.
(3) Additional data, including, but not limited to, data which can be used to provide at least the following information:
(i) The incidence of medical and surgical procedures in the population for individual providers;
(ii) Physicians who provide covered services and accept medical assistance patients;
(iii) Physicians who provide covered services and accept medicare assignment as full payment;
(iv) Status of licensure and accreditation of hospitals and ambulatory service facilities;
(v) Mortality rates for specified diagnoses and treatments, grouped by severity, for individual providers;
(vi) Rates of infection for specified diagnoses and treatments, grouped by severity, for individual providers;
(vii) Morbidity rates for specified diagnoses and treatments, grouped by severity, for individual providers;
(viii) Readmission rates for specified diagnoses and treatments, grouped by severity, for individual providers; and
(ix) Rate of incidence of postdischarge professional care for selected diagnoses and procedures, grouped by severity, for individual providers.
(4) Any other data the consumer advocate requires to carry out its responsibilities.
(f) Allowance for clarification or dissents. -- The consumer advocate shall maintain a file of written statements submitted by data sources who wish to provide an explanation of data that they feel might be misleading or misinterpreted. The consumer advocate shall provide access to such file to any person and shall, where practical, in its reports and data files indicate the availability of such statements. When the consumer advocate agrees with such statements, it shall correct the appropriate data and comments in its data files and subsequent reports.
(g) Availability of data. -- Nothing in this article prohibits a purchaser from obtaining from its health care insurer, nor relieves the health care insurer from the obligation of providing the purchaser, on terms consistent with past practices, data previously provided or additional data not currently provided to the purchaser by the health care insurer pursuant to any existing or future arrangement, agreement or understanding.

§33-2A-5. Data dissemination and publication.

(a) Public reports. -- Subject to the restrictions on access to consumer advocate data set forth elsewhere in this article and utilizing the data collected under section four of this article,as well as other data, records and matters of record available to it, the consumer advocate shall prepare and issue reports to the Legislature and to the general public, according to the following provisions:
(1) The consumer advocate shall, for every provider within West Virginia and within appropriate regions and subregions within West Virginia and for those inpatient and outpatient services which, when ranked by order of frequency, account for at least sixty-five percent of all covered services and which, when ranked by order of total payments, account for at least sixty- five percent of total payments, prepare and issue semiannual reports that at least provide information on the following:
(i) Comparisons among all providers of payments received, charges, population-based admission or incidence rates, and provider service effectiveness, such comparisons to be grouped according to diagnosis and severity, and to identify each provider by name and type or specialty.
(ii) Comparisons among all providers of inpatient and outpatient charges and payments for room and board, ancillary services, drugs, equipment and supplies and total services, such comparisons to be grouped according to provider quality and provider service effectiveness and according to diagnosis and severity, and to identify each health care facility by name and type.
(iii) Until a methodology to measure provider quality and provider service effectiveness is available to the consumeradvocate, comparisons among all providers shall be grouped according to diagnosis, procedure and severity, which identify facilities by name and type and physicians by name and specialty, of charges and payments received, readmission rates, mortality rates, morbidity rates and infection rates. Following adoption of the methodology specified elsewhere in this article, the consumer advocate may discontinue publications of this component of the report.
(iv) The incidence rate of selected medical or surgical procedures, the provider service effectiveness and the payments received for those providers, identified by the name and type or specialty, for which these elements vary significantly from the norms for all providers.
(2) In preparing its reports under subdivision (1) of this section, the consumer advocate shall ensure that factors which have the effect of either reducing provider revenue or increasing provider costs, and other factors beyond a provider's control which reduce provider competitiveness in the market place, are explained in the reports. It shall also ensure that any clarifications and dissents submitted by individual providers are noted in any reports that include release of data on that individual provider.
(3) The consumer advocate shall prepare and issue semiannual reports for all providers within West Virginia, that at least provide information on the following:
(i) The number of physicians, by speciality, on the staff ofeach hospital or ambulatory service facility and those physicians on the staff that accept medicare assignment as full payment and that accept medical assistance patients;
(ii) The status of hospitals respecting accreditation and licensure.
(4) The consumer advocate shall publish all reports required in this section, in at least one newspaper of general circulation in each region within West Virginia, reports on the providers in that region and regions adjacent to it. In addition, the consumer advocate shall advertise the availability of these reports and the charge for duplication in at least one newspaper of general circulation in each region within West Virginia at least once in each six months.
(b) Raw data reports and computer access to consumer advocate data. -- The consumer advocate shall provide special reports derived from raw data and a means for computer-to-computer access to its raw data to any purchaser. The consumer advocate shall provide such reports and computer-to-computer access, at its discretions, to other parties. The consumer advocate shall provide these special reports and computer-to-computer access in as timely a fashion as the consumer advocate's responsibilities to publish the public reports required in this section will allow. Any such provisions of special reports or computer-to-computer access by the consumer advocate may be made only subject to the restrictions on access to raw data and only after payment for costs of preparation orduplication.

§33-2A-6. Access to consumer advocate data.

(a) Public access. -- The information and data received by the consumer advocate shall be utilized by the consumer advocate for the benefit of the public. Subject to the specific limitations set forth in this section, the consumer advocate shall make determinations on requests for information in favor of access.
(b) Limitations on access. -- Unless specifically provided for in this article, neither the consumer advocate, nor any contracting system vendor, shall release and no data source, person, member of the public or other user of any data of the consumer advocate shall gain access to:
(1) Any raw data of the consumer advocate that does not simultaneously disclose payment, as well as provider quality and provider service effectiveness.
(2) Any raw data of the consumer advocate which could reasonably be expected to reveal the identity of an individual patient.
(3) Any raw data of the consumer advocate which may reasonably be expected to reveal the identity of any purchaser, as defined in section two of this article, other than a purchaser requesting data on its own group or an entity entitled to said purchaser's data pursuant to subsection (f) of this section.
(4) Any raw data of the consumer advocate relating to actual payments to any identified provider made by any purchaser, exceptthat this provision does not apply to access by a purchaser requesting data on the group for which it purchases or otherwise provides covered services or to access to that same data by an entity entitled to the purchaser's data pursuant to subsection (f) of this section.
(5) Any raw data disclosing discounts or differentials between payments accepted by providers for services and their billed charges obtained by identified payors from identified providers unless comparable data on all other is also released and the consumer advocate determined that the release of such information is not prejudicial or inequitable to any individual payor or provider or group thereof. In making such determination the consumer advocate shall consider that it is primarily concerned with the analysis and dissemination of payments to providers, not with discounts.
(c) Unauthorized use of data. -- Any person who knowingly releases consumer advocate data violating the patient confidentiality, actual payments, discount data or raw data safeguards set forth in this section to an unauthorized person is guilty of a misdemeanor, and, upon conviction thereof, shall be fined not more than ten thousand dollars or imprisoned in the county jail for one year, or both fined and imprisoned. An unauthorized person who knowingly receives or possesses such data is guilty of a misdemeanor with the same penalty.
(d) Unauthorized access to data. -- If any person inadvertently or by consumer advocate error gains access to datathat violates the safeguards set forth in this section, the data must immediately be returned, without duplication, to the consumer advocate with proper notification.
(e) Public access to records. -- All public reports prepared by the consumer advocate are public records and shall be available to the public for a reasonable fee, not to exceed the cost of duplication.
(f) Access to raw consumer advocate data by purchasers. -- Subject to the limitations on access, the consumer advocate shall provide access to its raw data to purchasers in accordance with the following procedure:
(1) Special reports derived from raw data of the consumer advocate shall be provided by the consumer advocate to any purchaser requesting such reports.
(2) A means to enable computer-to-computer access by any purchaser to raw data of the consumer advocate as defined in section two of this article, shall be developed, adopted and implemented by the consumer advocate, and the consumer advocate shall provide such access to its raw data to any purchaser upon request.
(3) In the event that any employer obtains from the consumer advocate, pursuant to subdivision (1) or (2) of this subsection, data pertaining to its employees and their dependents for whom the employer purchases or otherwise provides covered services as defined in section two of this article and who are represented by a certified collective bargaining representative, the collectivebargaining representative shall be entitled to that same data, after payment of fees as specified in subdivision (4) of this subsection. Likewise, should a certified collective bargaining representative obtain from the consumer advocate, pursuant to subdivision (1) or (2) of this subsection, data pertaining to its members and their dependents who are employed by and for whom covered services are purchased or otherwise provided by any employer, the employer is entitled to that same data, after payment of fees as specified in subdivision (4) of this subsection.
(4) In providing for access to its raw data, the consumer advocate shall charge the purchasers which originally obtained such access a fee sufficient to cover its costs to prepare and provide special reports requested pursuant to subdivision (1) of this subsection or to provide computer-to-computer access to its raw data requested pursuant to subdivision (2) of this subsection. Should a second or subsequent party or parties request this same information pursuant to subdivision (3) of this subsection, the consumer advocate shall charge the party a fee sufficient to cover only the costs of duplicating the original access.
(g) Access to raw consumer advocate data by other parties.-- Subject to the limitations on access to raw consumer advocate data set forth in subsection (b) of this section the consumer advocate may, at its discretion, provided special reports derived from its raw data or computer-to-computer access to parties otherthan purchasers. The consumer advocate shall publish rules that set forth the criteria and the procedure it shall use in making determinations on such access, pursuant to the powers vested in the consumer advocate elsewhere in this article providing such access, the consumer advocate shall charge the party requesting the access a fee sufficient to cover its costs or providing such access.
§33-2A-7. Special studies and reports.
(a) Special studies. -- The department of health and human resources may publish or contract for publication of special studies. Any special study so published shall become a public document.
(b) Special reports. -- (1) The department of health and human resources may study and issue a report on the special medical needs, demographic characteristics, access or lack thereof to health care services and need for financing of health care services or:
(i) Senior citizens, particularly low-income senior citizens, senior citizens who are members of minority groups and senior citizens residing in low-income urban or rural areas;
(ii) Low-income urban or rural areas;
(iii) Minority communities;
(iv) Women;
(v) Children;
(vi) Unemployed workers;
(vii) Veterans.
(2) The department may study and report on the short-term and long-term fiscal and programmatic impact on the health care consumer of changes in ownership of hospitals from nonprofit to profit, whether through purchase, merger or the like. The department may also study and report on factors which have the effect of either reducing provider revenue or increasing provider cost, and other factors beyond a provider's control which reduce provider competitiveness in the marketplace, are explained in the reports.
§33-2A-8. Enforcement; penalty.
(a) Compliance enforcement. -- The consumer advocate has standing to bring an action in law or in equity through private counsel in any circuit court to enforce compliance with any provision of this article, except any requirement or appropriate request of the consumer advocate made pursuant to this article. In addition, the attorney general is authorized and shall bring any such enforcement action in aid of the consumer advocate in any circuit court at the request of the consumer advocate in the name of West Virginia.
(b) Penalty. -- Any person who fails to supply data pursuant to the provisions of this article is guilty of a misdemeanor, and, upon conviction thereof, shall be imprisoned in the county jail for one year, fined not more than ten thousand dollars or both fined and imprisoned.
§33-2A-9. Research and demonstration projects.
The consumer advocate shall actively encourage research anddemonstrations to design and test improved methods of assessing provider quality, provider service effectiveness and efficiency. To that end, except that no data submission requirements in a mandated demonstration may exceed the current reserve field on the West Virginia uniform claims and billing form, the consumer advocate may:
(1) Authorize contractors engage in health services research selected by the consumer advocate, to have access to the consumer advocates raw data files, providing these entities assume any contractual obligations imposed by the consumer advocate to assure patient identity confidentiality.
(2) Place data sources participating in research and demonstrations on different data submission requirements from other data sources in this state.
(3) Require data source participation in research and demonstration projects when this is the only testing method the consumer advocate determines is promising.
§33-2A-10. Grievances and grievance procedures.
(a) Procedures and requirements. -- Pursuant to its powers to publish its rules under this article and with the requirements of this section, the consumer advocate is hereby authorized and directed to establish procedures and requirements for the filing, hearing and adjudication of grievances against the consumer advocate of any data source. These procedures and requirements shall be published pursuant to law.
(b) Claims; hearings. -- Grievance claims of any data sourceshall be submitted to the consumer advocate or to a third party designated by the consumer advocate, and the consumer advocate or the designated third party shall convene a hearing, if requested, and adjudicate the grievance.
§33-2A-11. Antitrust provisions.
Persons or entities required to submit data or information under this article or receiving data or information from the consumer advocate in accordance with this bill are declared to be acting pursuant to state requirements embodied in this bill and are exempt from antitrust claims or actions grounded upon submission or receipt of the data or information.
§33-2A-12. Contracts with vendors.
Any contract with any vendor for purchase of services or for purchase or lease of supplies and equipment related to the consumer advocates powers and duties shall be let only after a public bidding process and only in accordance with the following provisions, and no contract may be let by the consumer advocate that does not conform to the provisions:
(1) The consumer advocate shall prepare specifications fully describing the services to be rendered or equipment or supplies to be provided by a vendor and shall make these specifications available for inspection by any person at the consumer advocates offices during normal working hours and at such other places and such other times as the consumer advocate deems advisable.
(2) The consumer advocate shall publish notice of invitations to bid. The consumer advocate shall also publishsuch notice in at least four newspapers in general circulation in West Virginia on at least three occasions at intervals of not less than three days. The notice shall include at least the following:
(i) The deadline for submission of bids by prospective vendors, which shall be no sooner than thirty days following the latest publication of the notice as prescribed in this paragraph;
(ii) The locations, dates and times during which prospective vendors can examine the specifications required;
(iii) The date, time and place of the meeting or meetings of the consumer advocate at which bids will be opened and accepted;
(iv) A statement to the effect that any person is eligible to bid.
(3) Bids shall be accepted as follows:
(i) Bids shall be accepted and such acceptance shall be announced only at public meeting by the consumer advocate.
(ii) The consumer advocate may require that a certified check, in an amount determined by the consumer advocate, accompany every bid, and, when so required, no bid may be accepted unless so accompanied.
(4) In order to prevent any party from deliberately underbidding contracts in order to gain or prevent access to consumer advocate data, the consumer advocate may award any contract at its discretion, regardless of the amount of the bid, pursuant to the following:
(i) Any bid accepted must reasonably reflect the actual costof services provided;
(ii) Any vendor so selected by the consumer advocate shall be found by the consumer advocate to be of such character and such integrity as to assure, to the maximum extent possible, adherence to all the provisions of this bill in the provision of contracted services;
(iii) The consumer advocate may require the selected vendor to furnish, within twenty days after the contract has been awarded, a bond with suitable and reasonable requirements guaranteeing the services to be performed with sufficient surety in an amount determined by the consumer advocate, and upon failure to furnish the bond within the time specified, the previous award shall be void.

NOTE: The purpose of this bill is to use the office of Consumer Advocacy, which was created within the agency of the Insurance Commissioner, to develop a computerized system for the collection and dissemination of data relating to the cost and quality of health care services.

This article is new; therefore, strike-throughs and underscoring have been omitted.