87R3078 JG-D
By: Walle H.B. No. 1907
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of a statewide all payor claims
database to store publicly accessible information.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 2, Health and Safety Code, is
amended by adding Chapter 108A to read as follows:
CHAPTER 108A. STATEWIDE ALL PAYOR CLAIMS DATABASE
Sec. 108A.001. DEFINITIONS. In this chapter:
(1) "Center" means the Center for Healthcare Data at
The University of Texas Health Science Center at Houston.
(2) "Database" means the statewide all payor claims
database established under this chapter.
(3) "Payor" means an insurance company, a health
maintenance organization, a Medicaid managed care organization, or
another organization that pays a health care provider to provide
health care benefits to a patient.
Sec. 108A.002. ESTABLISHMENT AND ADMINISTRATION OF
STATEWIDE ALL PAYOR CLAIMS DATABASE. (a) The department shall
collaborate with and leverage the existing resources and
infrastructure of the center to establish a statewide all payor
claims database to collect, process, and store health care claims
information.
(b) The center shall serve as the administrator of the
database and manage information submitted for inclusion in the
database. In determining the information a payor is required to
submit to the center, the center must consider requiring inclusion
of information useful to researchers and policymakers for improving
health care quality and outcomes and lowering health care costs and
information useful to consumers for price transparency. The
required information at a minimum must include:
(1) the name of the health care provider paid by the
payor;
(2) the type of health care benefits provided by the
health care provider;
(3) the amount paid by the payor for the health care
benefits; and
(4) the estimated copayment amount paid by the patient
who received the health care benefits.
(c) Each payor annually shall submit to the center for
inclusion in the database the health care claims information
required by the center under Subsection (b) for all health care
benefits paid by the payor during the preceding year.
(d) The center shall ensure that health care claims
information submitted to the center under Subsection (c) is stored
in the database and accessible to the public in the manner described
by Section 108A.003.
Sec. 108A.003. PUBLIC ACCESS TO DATABASE. (a) The center
shall aggregate information submitted to or stored in the database
in an open-source format that is machine-readable and allows the
public to easily access and navigate the information.
(b) The database must be accessible through the center's
Internet website and allow the public to search the information in
the database at a minimum by the categories described by Section
108A.002(b).
(c) The center shall ensure information in the database that
is accessible to the public does not disclose a patient's
personally identifiable information or information that is
confidential under state or federal law.
Sec. 108A.004. MEMORANDUM OF UNDERSTANDING; RULES. The
executive commissioner on behalf of the department, the Texas
Higher Education Coordinating Board on behalf of the center, and
the commissioner of insurance on behalf of the Texas Department of
Insurance shall each by rule adopt a memorandum of understanding
that:
(1) ensures the database is operated and maintained in
accordance with this chapter;
(2) as applicable, defines each agency's
responsibilities with respect to payors that are:
(A) required to submit health care claims
information to the database; and
(B) under the jurisdiction of the agency; and
(3) identifies and establishes enforcement mechanisms
for each agency to ensure:
(A) the center, in collaboration with the
department, operates and maintains the database in accordance with
this chapter; and
(B) payors under the jurisdiction of the agency
submit the required health care claims information to the database
in accordance with this chapter.
SECTION 2. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission, the Texas Higher Education Coordinating
Board, and the commissioner of insurance shall adopt rules
necessary to implement Chapter 108A, Health and Safety Code, as
added by this Act.
SECTION 3. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 4. This Act takes effect September 1, 2021.