All payers claims databases (APCDs) can be a valuable tool for health care consumers and policymakers and can be used to track the cost and quality of care, identify areas of waste and inefficiency and monitor the impact of new policies. However, there is a major limitation to APCDs: They cannot include data from self-insured Employee Retirement Income Security Act of 1974 (ERISA) plans.
ERISA is a federal law that governs private employer self-sponsored health plans and it includes a provision that prohibits states from imposing any “fiduciary requirements” on ERISA plans. This means that states cannot require ERISA plans to submit their claims data to APCDs.
The U.S. Supreme Court has upheld the provision that prohibits states from imposing fiduciary requirements on ERISA plans. In the 2016 case Gobeille v. Liberty Mutual Insurance Co., the court ruled that Vermont could not require self-insured ERISA plans to submit their claims data to the state’s APCD.
However, during the 2023 legislative session, the Indiana General Assembly mandated self-insured ERISA plans must provide their data to the Indiana APCD in SEA 400. This legislation is in direct conflict with the Gobeille decision. The Indiana Chamber believes self-insured ERISA plan sponsors and their third-party administrators are not legally obligated to comply with this legislation or any rules promulgated by the Indiana Department of Insurance (IDOI) regarding data submission to the APCD.
The Indiana Chamber strongly recommends any demands for claims data from the IDOI to self-insured ERISA plan sponsors or their third-party administrators be scrutinized by your legal counsel before submission. Any action to not comply with or challenge the request in court could be backed up by the Gobeille decision. We recognize the precarious position this puts self-insured ERISA plan sponsors in. The Indiana Chamber worked diligently to try and remove this provision from SEA 400 but unfortunately it was left in the final version. We believe this issue is ripe for judicial challenge in Indiana and hope self-insured ERISA plan sponsors will consider all legal avenues before unnecessarily submitting this data.
NOTE: Ashton Eller is not an attorney, and nothing here should be interpreted or construed as legal advice. This is a summary of legislation passed during the 2023 Indiana legislative session. Please consult your attorney for legal guidance.
