S.B. No. 203
AN ACT
relating to health care-associated infections and preventable
adverse events in certain health care facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subsections (a), (b), and (c), Section 98.103,
Health and Safety Code, as added by Chapter 359 (S.B. 288), Acts of
the 80th Legislature, Regular Session, 2007, are amended to read as
follows:
(a) A health care facility, other than a pediatric and
adolescent hospital, shall report to the department the incidence
of surgical site infections, including the causative pathogen if
the infection is laboratory-confirmed, occurring in the following
procedures:
(1) colon surgeries;
(2) hip arthroplasties;
(3) knee arthroplasties;
(4) abdominal hysterectomies;
(5) vaginal hysterectomies;
(6) coronary artery bypass grafts; and
(7) vascular procedures.
(b) A pediatric and adolescent hospital shall report the
incidence of surgical site infections, including the causative
pathogen if the infection is laboratory-confirmed, occurring in the
following procedures to the department:
(1) cardiac procedures, excluding thoracic cardiac
procedures;
(2) ventriculoperitoneal shunt procedures; and
(3) spinal surgery with instrumentation.
(c) A general hospital shall report the following to the
department:
(1) the incidence of laboratory-confirmed central
line-associated primary bloodstream infections, including the
causative pathogen, occurring in any special care setting in the
hospital; and
(2) the incidence of respiratory syncytial virus
occurring in any pediatric inpatient unit in the hospital.
SECTION 2. (a) The heading to Chapter 98, Health and
Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, is amended to read as follows:
CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
PREVENTABLE ADVERSE EVENTS
(b) Subdivisions (1) and (11), Section 98.001, Health and
Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, are amended to read as follows:
(1) "Advisory panel" means the Advisory Panel on
Health Care-Associated Infections and Preventable Adverse Events.
(11) "Reporting system" means the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System.
(c) Section 98.051, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.051. ESTABLISHMENT. The commissioner shall
establish the Advisory Panel on Health Care-Associated Infections
and Preventable Adverse Events within [the infectious disease
surveillance and epidemiology branch of] the department to guide
the implementation, development, maintenance, and evaluation of
the reporting system. The commissioner may establish one or more
subcommittees to assist the advisory panel in addressing health
care-associated infections and preventable adverse events relating
to hospital care provided to children or other special patient
populations.
(d) Subsection (a), Section 98.052, Health and Safety Code,
as added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, is amended to read as follows:
(a) The advisory panel is composed of 18 [16] members as
follows:
(1) two infection control professionals who:
(A) are certified by the Certification Board of
Infection Control and Epidemiology; and
(B) are practicing in hospitals in this state, at
least one of which must be a rural hospital;
(2) two infection control professionals who:
(A) are certified by the Certification Board of
Infection Control and Epidemiology; and
(B) are nurses licensed to engage in professional
nursing under Chapter 301, Occupations Code;
(3) three board-certified or board-eligible
physicians who:
(A) are licensed to practice medicine in this
state under Chapter 155, Occupations Code, at least two of whom have
active medical staff privileges at a hospital in this state and at
least one of whom is a pediatric infectious disease physician with
expertise and experience in pediatric health care epidemiology;
(B) are active members of the Society for
Healthcare Epidemiology of America; and
(C) have demonstrated expertise in quality
assessment and performance improvement or infection control in
health care facilities;
(4) four additional [two] professionals in quality
assessment and performance improvement[, one of whom is employed by
a general hospital and one of whom is employed by an ambulatory
surgical center];
(5) one officer of a general hospital;
(6) one officer of an ambulatory surgical center;
(7) three nonvoting members who are department
employees representing the department in epidemiology and the
licensing of hospitals or ambulatory surgical centers; and
(8) two members who represent the public as consumers.
(e) Subsections (a) and (c), Section 98.102, Health and
Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
Legislature, Regular Session, 2007, are amended to read as follows:
(a) The department shall establish the Texas Health
Care-Associated Infection and Preventable Adverse Events Reporting
System within the [infectious disease surveillance and
epidemiology branch of the] department. The purpose of the
reporting system is to provide for:
(1) the reporting of health care-associated
infections by health care facilities to the department;
(2) the reporting of health care-associated
preventable adverse events by health care facilities to the
department;
(3) the public reporting of information regarding the
health care-associated infections by the department;
(4) the public reporting of information regarding
health care-associated preventable adverse events by the
department; and
(5) [(3)] the education and training of health care
facility staff by the department regarding this chapter.
(c) The data reported by health care facilities to the
department must contain sufficient patient identifying information
to:
(1) avoid duplicate submission of records;
(2) allow the department to verify the accuracy and
completeness of the data reported; and
(3) for data reported under Section 98.103 or 98.104,
allow the department to risk adjust the facilities' infection
rates.
(f) Subchapter C, Chapter 98, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, is amended by adding Section 98.1045 to read
as follows:
Sec. 98.1045. REPORTING OF PREVENTABLE ADVERSE EVENTS.
(a) Each health care facility shall report to the department the
occurrence of any of the following preventable adverse events
involving the facility's patient:
(1) a health care-associated adverse condition or
event for which the Medicare program will not provide additional
payment to the facility under a policy adopted by the federal
Centers for Medicare and Medicaid Services; and
(2) subject to Subsection (b), an event included in
the list of adverse events identified by the National Quality Forum
that is not included under Subdivision (1).
(b) The executive commissioner may exclude an adverse event
described by Subsection (a)(2) from the reporting requirement of
Subsection (a) if the executive commissioner, in consultation with
the advisory panel, determines that the adverse event is not an
appropriate indicator of a preventable adverse event.
(g) Subsections (a), (b), and (g), Section 98.106, Health
and Safety Code, as added by Chapter 359 (S.B. 288), Acts of the
80th Legislature, Regular Session, 2007, are amended to read as
follows:
(a) The department shall compile and make available to the
public a summary, by health care facility, of:
(1) the infections reported by facilities under
Sections 98.103 and 98.104; and
(2) the preventable adverse events reported by
facilities under Section 98.1045.
(b) Information included in the [The] departmental summary
with respect to infections reported by facilities under Sections
98.103 and 98.104 must be risk adjusted and include a comparison of
the risk-adjusted infection rates for each health care facility in
this state that is required to submit a report under Sections 98.103
and 98.104.
(g) The department shall make the departmental summary
available on an Internet website administered by the department and
may make the summary available through other formats accessible to
the public. The website must contain a statement informing the
public of the option to report suspected health care-associated
infections and preventable adverse events to the department.
(h) Section 98.108, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended to read as follows:
Sec. 98.108. FREQUENCY OF REPORTING. In consultation with
the advisory panel, the executive commissioner by rule shall
establish the frequency of reporting by health care facilities
required under Sections 98.103, [and] 98.104, and 98.1045.
Facilities may not be required to report more frequently than
quarterly.
(i) Section 98.109, Health and Safety Code, as added by
Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
Session, 2007, is amended by adding Subsection (b-1) and amending
Subsection (e) to read as follows:
(b-1) A state employee or officer may not be examined in a
civil, criminal, or special proceeding, or any other proceeding,
regarding the existence or contents of information or materials
obtained, compiled, or reported by the department under this
chapter.
(e) A department summary or disclosure may not contain
information identifying a [facility] patient, employee,
contractor, volunteer, consultant, health care professional,
student, or trainee in connection with a specific [infection]
incident.
(j) Sections 98.110 and 98.111, Health and Safety Code, as
added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
Regular Session, 2007, are amended to read as follows:
Sec. 98.110. DISCLOSURE AMONG CERTAIN AGENCIES [WITHIN
DEPARTMENT]. Notwithstanding any other law, the department may
disclose information reported by health care facilities under
Section 98.103, [or] 98.104, or 98.1045 to other programs within
the department, to the Health and Human Services Commission, and to
other health and human services agencies, as defined by Section
531.001, Government Code, for public health research or analysis
purposes only, provided that the research or analysis relates to
health care-associated infections or preventable adverse events.
The privilege and confidentiality provisions contained in this
chapter apply to such disclosures.
Sec. 98.111. CIVIL ACTION. Published infection rates or
preventable adverse events may not be used in a civil action to
establish a standard of care applicable to a health care facility.
(k) As soon as possible after the effective date of this
Act, the commissioner of state health services shall appoint two
additional members to the advisory panel who meet the
qualifications prescribed by Subdivision (4), Subsection (a),
Section 98.052, Health and Safety Code, as amended by this section.
(l) Not later than February 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt rules and procedures necessary to implement the reporting of
health care-associated preventable adverse events as required
under Chapter 98, Health and Safety Code, as amended by this
section.
SECTION 3. (a) Subchapter B, Chapter 32, Human Resources
Code, is amended by adding Section 32.0312 to read as follows:
Sec. 32.0312. REIMBURSEMENT FOR SERVICES ASSOCIATED WITH
PREVENTABLE ADVERSE EVENTS. The executive commissioner of the
Health and Human Services Commission shall adopt rules regarding
the denial or reduction of reimbursement under the medical
assistance program for preventable adverse events that occur in a
hospital setting. In adopting the rules, the executive
commissioner:
(1) shall ensure that the commission imposes the same
reimbursement denials or reductions for preventable adverse events
as the Medicare program imposes for the same types of health
care-associated adverse conditions and the same types of health
care providers and facilities under a policy adopted by the federal
Centers for Medicare and Medicaid Services;
(2) shall consult an advisory committee on health care
quality, if established by the executive commissioner, to obtain
the advice of that committee regarding denial or reduction of
reimbursement claims for any other preventable adverse events that
cause patient death or serious disability in health care settings,
including events on the list of adverse events identified by the
National Quality Forum; and
(3) may allow the commission to impose reimbursement
denials or reductions for preventable adverse events described by
Subdivision (2).
(b) Not later than September 1, 2010, the executive
commissioner of the Health and Human Services Commission shall
adopt the rules required by Section 32.0312, Human Resources Code,
as added by this section.
(c) Rules adopted by the executive commissioner of the
Health and Human Services Commission under Section 32.0312, Human
Resources Code, as added by this section, may apply only to a
preventable adverse event occurring on or after the effective date
of the rules.
SECTION 4. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 203 passed the Senate on
April 16, 2009, by the following vote: Yeas 31, Nays 0; and that
the Senate concurred in House amendment on May 29, 2009, by the
following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 203 passed the House, with
amendment, on May 27, 2009, by the following vote: Yeas 148,
Nays 0, one present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor