Group Insurance Commission
Administrative Bulletin 10-01:Guidance Regarding Municipal Requests for Utilization Data
April 13, 2010, Revised: November 29, 2010_______________________________________________________________
The purpose of this bulletin is to clarify and outline the parameters under which the Group Insurance Commission (GIC) will respond to written requests for enrollment and utilization data from political subdivisions, as defined in M.G.L. c.32B s.2 , that have undertaken to provide health insurance coverage through the GIC to its subscribers by acceptance of the Municipal Partnership Act, M.G.L. c.32B s.19 and that are considering whether to remain inside the GIC. These data requests are for the sole purpose of determining whether a participating municipal employer and its subscribers in the GIC's health coverage program will continue to participate after their coverage interval of three or six years, as specified in their Public Employee Committee, (PEC), agreement, expires. Requests for such data shall be made in the preceding or current fiscal year in which a given PEC agreement is open to negotiation, and such requests shall be limited to one request in the preceding or current fiscal year in which a political subdivision is considering withdrawing from GIC coverage.
1) Political subdivisions requesting utilization data should assess the amount of time they will need to analyze data and conduct negotiations necessary before making a decision about whether to remain in the GIC. Such entities must submit their requests to the GIC at least 60 days before the data are to be provided to them to use in their decision-making process.
The request for data must be made in writing and signed by the appropriate legal representative of the public authority, as defined in M.G.L. c.32B s.2(a). In a City, the request must be signed by the City Manager or the Mayor, in a Town by the Chairman of the Board of Selectmen, and in a regional school district, by the Chairman of the Regional School District Committee.
2) The GIC will provide the following data to each requesting municipal employer or regional school district with more than 50 subscribers:
a. A monthly claims report consisting of the following data elements:
i. the subscriber count;
ii. the covered lives count;
iii. the total paid medical claims;
iv. the total paid prescription drug claims.
A yearly large loss report, i.e., for claimants who have incurred $25,000 or more paid claims in a given year, consisting of the following elements:
- the de-identified claimant ICD-9 codes (diagnoses);
- the de-identified claimant total paid claims (medical and prescription drug).
3) The GIC will provide Protected Health Information to participating political subdivisions as the GIC's Business Associates under the HIPAA Privacy Rule after each signs the GIC's Business Associate Agreement (BAA) as most recently amended. These agreements may need to be amended and re-executed to conform to the HIPAA Privacy Rule's anticipated revisions to BAAs, based upon a model agreement that has not yet been issued.
4) Political subdivisions that have requested these data will be required to designate a single person to handle these data, and such persons will be required to sign a BAA in which they agree not to share these data with other parties, including public employee commission members and union personnel. The political subdivisions also agree to execute a BAA with the GIC in which they agree that only their single designated person shall handle the data, and that the data shall not be shared with anyone other than insurance brokers, benefits consultants, and health plans for the limited purpose of securing bids for the procurement of health insurance.
Please note: As of the date of this bulletin, Medicare HMO data are not available. Communities wanting such data should use the monthly premium as a substitute for actual cost. Administrative costs are also not included in the data provided.
This information provided by the Group Insurance Commission.