87R20216 RDS-F
By: Walle H.B. No. 1907
Substitute the following for H.B. No. 1907:
By: Oliverson C.S.H.B. No. 1907
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of a statewide all payor claims
database to increase public transparency of health care data and
improve quality of health care in this state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 38, Insurance Code, is amended by adding
Subchapter I to read as follows:
SUBCHAPTER I. TEXAS ALL PAYOR CLAIMS DATABASE
Sec. 38.401. PURPOSE OF SUBCHAPTER. The purpose of this
subchapter is to authorize the department to establish an all payor
claims database in this state to increase public transparency of
health care data and improve the quality of health care in this
state.
Sec. 38.402. DEFINITIONS. In this subchapter:
(1) "Center" means the Center for Healthcare Data at
The University of Texas Health Science Center at Houston.
(2) "Data" means the specific claims and encounters,
enrollment, and benefit information submitted to the center under
this subchapter.
(3) "Database" means the Texas All Payor Claims
Database established under this subchapter.
(4) "Payor" means any of the following entities that
pay, reimburse, or otherwise contract with a health care provider
for the provision of health care services or supplies to a patient:
(A) an insurance company providing health or
dental insurance;
(B) the sponsor or administrator of a health or
dental plan;
(C) a health maintenance organization operating
under Chapter 843;
(D) the state Medicaid program, including the
Medicaid managed care program operating under Chapter 533,
Government Code;
(E) a health benefit plan offered or administered
by or on behalf of this state or a political subdivision of this
state or an agency or instrumentality of the state or a political
subdivision of this state, including contracted-for plans and plans
not otherwise subject to regulation by the department;
(F) a third-party administrator or
administrative services organization;
(G) a pharmacy benefit manager; or
(H) any other entity providing a health insurance
or health benefit plan subject to regulation by the department.
(5) "Stakeholder advisory group" means the
stakeholder advisory group established under Section 38.403.
Sec. 38.403. STAKEHOLDER ADVISORY GROUP. (a) The
commissioner, in consultation with the center, shall establish a
stakeholder advisory group to assist the commissioner and the
center in the administration of this subchapter.
(b) The advisory group created under this section must be
composed of:
(1) the state Medicaid director or the director's
designee;
(2) a member designated by the Teacher Retirement
System of Texas;
(3) a member designated by the Employees Retirement
System of Texas; and
(4) nine members designated by the commissioner,
including:
(A) two members representing the business
community, with at least one of those members representing small
businesses that purchase health benefits but are not involved in
the provision of health care services or health benefit plans;
(B) two members who represent consumers and who
are not professionally involved in the purchase, provision,
administration, or review of health care services or health benefit
plans;
(C) one member representing hospitals;
(D) one member representing health maintenance
organizations;
(E) one member representing physicians involved
in direct patient care; and
(F) two members who are not professionally
involved in the purchase, provision, administration, or review of
health care services or health benefit plans and who have expertise
in:
(i) health planning;
(ii) health economics;
(iii) provider quality assurance;
(iv) statistics or health data management;
or
(v) the reimbursement of medical education
and research costs.
Sec. 38.404. ESTABLISHMENT AND ADMINISTRATION OF DATABASE.
(a) The department shall collaborate with and leverage the
existing resources and infrastructure of the center to establish
the Texas All Payor Claims Database to collect, process, analyze,
and store data relating to medical, dental, pharmaceutical, and
other relevant health care claims and encounters, enrollment, and
benefit information for the purposes of increasing cost
transparency and improving the quality of health care in this
state.
(b) The center shall serve as the administrator of the
database, design and build the database infrastructure, and manage
the data submitted for inclusion in the database.
(c) In determining the information a payor is required to
submit to the center, the center must consider requiring inclusion
of information useful to researchers, employers, and policy makers
for improving health care quality and outcomes and lowering health
care costs and information useful to consumers and employers for
price transparency. The required data at a minimum must include the
following information as it relates to all health care services and
supplies paid or otherwise adjudicated by the payor:
(1) the name and National Provider Identifier, as
described in 45 C.F.R. Section 162.410, of each health care
provider paid by the payor;
(2) the claim line detail that documents the health
care services or supplies provided by the health care provider; and
(3) the amount of charges billed by the health care
provider and the allowed amount paid by the payor and the recipient
of the health care services or supplies.
(d) Each payor shall submit the required data under
Subsection (c) at a schedule and frequency determined by the
department.
(e) In the manner and subject to the standards and
requirements relating to the use of data contained in the database
established by the center in consultation with the stakeholder
advisory group, the department or the center may use the data
contained in the database:
(1) to produce price, resource use, and quality
information for consumers;
(2) for research and other analysis conducted by the
department or the center; and
(3) for research and other analysis conducted by a
third party to the extent that such use is consistent with all
applicable federal and state law, including the data security
requirements of Section 38.406.
(f) The center, in consultation with the stakeholder
advisory group, shall monitor data collection procedures and test
the quality of data submitted to the center under this section to
ensure that the data is accurate, valid, reliable, and complete.
Sec. 38.405. PUBLIC ACCESS PORTAL. (a) Except as provided
by Sections 38.404 and 38.406 and in a manner consistent with all
applicable federal and state law, the center shall collect,
compile, and analyze data submitted to or stored in the database and
disseminate information in a format that allows the public to
easily access and navigate the information. The information must
be accessible through an open access Internet portal that may be
accessed by the public through an Internet website.
(b) The portal created under this section must allow the
public and qualified research entities to easily search and
retrieve the data contained in the database.
Sec. 38.406. DATA SECURITY. (a) The data contained in the
database and any reports or information created by the center using
that data are confidential, subject to applicable state and federal
law pertaining to records privacy and protected health information,
including Chapter 181, Health and Safety Code, and are not subject
to disclosure under Chapter 552, Government Code.
(b) Notwithstanding any provision of this subchapter, the
department and the center may not disclose an individual's personal
health information in violation of any state or federal law.
(c) The center shall include in the database only the
minimum amount of protected health information identifiers
necessary to link public and private data sources and the
geographic and services data to undertake studies.
(d) The center shall maintain protected health information
identifiers collected under this subchapter but excluded from the
database under Subsection (c) in a separate database. The separate
database may not be aggregated with any other information and must
use a proxy or encrypted record identifier for analysis.
Sec. 38.407. CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.
Any sponsor or administrator of a health benefit plan subject to the
Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
1001 et seq.) may elect or decline to participate in or submit data
to the center for inclusion in the database as consistent with
federal law.
Sec. 38.408. REPORT TO LEGISLATURE. Not later than
September 1 of each even-numbered year, the department shall submit
to the legislature a written report containing:
(1) an analysis of the data submitted to the center for
use in the database;
(2) information regarding the submission of data to
the center for use in the database and the maintenance, analysis,
and use of the data; and
(3) recommendations to further improve the
transparency, cost-effectiveness, and quality of health care in
this state.
Sec. 38.409. RULES. (a) The commissioner, in consultation
with the center, shall adopt rules:
(1) specifying the types of data a payor is required to
provide to the center under Section 38.404 to determine health
benefits costs and other reporting metrics, including, if
necessary, types of data not expressly identified in that section;
(2) specifying the schedule, frequency, and manner in
which a payor must provide data to the center under Section 38.404,
which must:
(A) require the payor to provide data to the
center not less frequently than annually; and
(B) include provisions relating to data layout,
data governance, historical data, data submission, use and sharing,
information security, privacy protection, reporting, and any other
matter necessary for the department to perform its functions under
this section; and
(3) establishing oversight and enforcement mechanisms
to ensure that the database is operated and maintained in
accordance with this subchapter.
(b) In adopting rules governing methods for data
submission, the commissioner shall to the maximum extent
practicable use methods that are reasonable and cost-effective for
payors.
SECTION 2. (a) Not later than January 1, 2022, the
commissioner of insurance shall establish the stakeholder advisory
group in accordance with Section 38.403, Insurance Code, as added
by this Act.
(b) Not later than June 1, 2022, the Texas Department of
Insurance shall adopt rules necessary to implement Subchapter I,
Chapter 38, Insurance Code, as added by this Act.
SECTION 3. As soon as practicable after the effective date
of this Act, the commissioner of insurance, in consultation with
the Center for Healthcare Data at The University of Texas Health
Science Center at Houston, shall actively seek financial support
from the federal grant program for development of state all payer
claims databases established under the Consolidated Appropriations
Act, 2021 (Pub. L. No. 116-260) and from any other available source
of financial support provided by the federal government for
purposes of implementing Subchapter I, Chapter 38, Insurance Code,
as added by this Act.
SECTION 4. If before implementing any provision of this Act
the commissioner of insurance determines that a waiver or
authorization from a federal agency is necessary for implementation
of that provision, the commissioner shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 5. This Act takes effect September 1, 2021.