Texas 2021 - 87th Regular

Texas House Bill HB1907 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
	1	+	87R20216 RDS-F
1	2		By: Walle H.B. No. 1907
	3	+	Substitute the following for H.B. No. 1907:
	4	+	By: Oliverson C.S.H.B. No. 1907
2	5
3	6
4	7		A BILL TO BE ENTITLED
5	8		AN ACT
6	9		relating to the establishment of a statewide all payor claims
7	10		database to increase public transparency of health care data and
8	11		improve quality of health care in this state.
9	12		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	13		SECTION 1. Chapter 38, Insurance Code, is amended by adding
11	14		Subchapter I to read as follows:
12	15		SUBCHAPTER I. TEXAS ALL PAYOR CLAIMS DATABASE
13	16		Sec. 38.401. PURPOSE OF SUBCHAPTER. The purpose of this
14	17		subchapter is to authorize the department to establish an all payor
15	18		claims database in this state to increase public transparency of
16		-	health care ~~information~~ and improve the quality of health care in
17		-	~~this~~ state.
	19	+	health care data and improve the quality of health care in this
	20	+	state.
18	21		Sec. 38.402. DEFINITIONS. In this subchapter:
19		-	(1) "Allowed amount" means the amount of a billed
20		-	charge that a health benefit plan issuer determines to be covered
21		-	for services provided by a non-network provider. The allowed amount
22		-	includes both the insurer's payment and any applicable deductible,
23		-	copayment, or coinsurance amounts for which the insured is
24		-	responsible.
25		-	(2) "Center" means the Center for Healthcare Data at
	22	+	(1) "Center" means the Center for Healthcare Data at
26	23		The University of Texas Health Science Center at Houston.
27		-	(3) "Contracted rate" means the fee or reimbursement
28		-	amount for a network provider's services, treatments, or supplies
29		-	as established by agreement between the provider and health benefit
30		-	plan issuer.
31		-	(4) "Data" means the specific claims and encounters,
	24	+	(2) "Data" means the specific claims and encounters,
32	25		enrollment, and benefit information submitted to the center under
33	26		this subchapter.
34		-	(5) "Database" means the Texas All Payor Claims
	27	+	(3) "Database" means the Texas All Payor Claims
35	28		Database established under this subchapter.
36		-	(6) "Geozip" means an area that includes all zip codes
37		-	with identical first three digits.
38		-	(7) "Payor" means any of the following entities that
	29	+	(4) "Payor" means any of the following entities that
39	30		pay, reimburse, or otherwise contract with a health care provider
40		-	for the provision of health care services, supplies, or devices to a
41		-	patient:
	31	+	for the provision of health care services or supplies to a patient:
42	32		(A) an insurance company providing health or
43	33		dental insurance;
44	34		(B) the sponsor or administrator of a health or
45	35		dental plan;
46	36		(C) a health maintenance organization operating
47	37		under Chapter 843;
48	38		(D) the state Medicaid program, including the
49	39		Medicaid managed care program operating under Chapter 533,
50	40		Government Code;
51	41		(E) a health benefit plan offered or administered
52	42		by or on behalf of this state or a political subdivision of this
53	43		state or an agency or instrumentality of the state or a political
54		-	subdivision of this state, including:
55		-	(i) a basic coverage plan under Chapter
56		-	1551;
57		-	(ii) a basic plan under Chapter 1575; and
58		-	(iii) a primary care coverage plan under
59		-	Chapter 1579; or
60		-	(F) any other entity providing a health insurance
	44	+	subdivision of this state, including contracted-for plans and plans
	45	+	not otherwise subject to regulation by the department;
	46	+	(F) a third-party administrator or
	47	+	administrative services organization;
	48	+	(G) a pharmacy benefit manager; or
	49	+	(H) any other entity providing a health insurance
61	50		or health benefit plan subject to regulation by the department.
62		-	(8) "Protected health information" has the meaning
63		-	assigned by 45 C.F.R. Section 160.103.
64		-	(9) "Qualified research entity" means:
65		-	(A) an organization engaging in public interest
66		-	research for the purpose of analyzing the delivery of health care in
67		-	this state that is exempt from federal income tax under Section
68		-	501(a), Internal Revenue Code of 1986, by being listed as an exempt
69		-	organization in Section 501(c)(3) of that code;
70		-	(B) an institution of higher education engaged in
71		-	public interest research related to the delivery of health care in
72		-	this state; or
73		-	(C) a health care provider in this state engaging
74		-	in efforts to improve the quality and cost of health care.
75		-	(10) "Stakeholder advisory group" means the
	51	+	(5) "Stakeholder advisory group" means the
76	52		stakeholder advisory group established under Section 38.403.
77		-	Sec. 38.403. STAKEHOLDER ADVISORY GROUP. (a) The center
78		-	shall establish a stakeholder advisory group to assist the center
79		-	as provided by this subchapter, including assistance in:
80		-	(1) establishing and updating the standards,
81		-	requirements, policies, and procedures relating to the collection
82		-	and use of data contained in the database required by Sections
83		-	38.404(e) and (f);
84		-	(2) evaluating and prioritizing the types of reports
85		-	the center should publish under Section 38.404(e);
86		-	(3) evaluating data requests from qualified research
87		-	entities under Section 38.404(e)(2); and
88		-	(4) assisting the center in developing the center's
89		-	recommendations under Section 38.408(3).
	53	+	Sec. 38.403. STAKEHOLDER ADVISORY GROUP. (a) The
	54	+	commissioner, in consultation with the center, shall establish a
	55	+	stakeholder advisory group to assist the commissioner and the
	56	+	center in the administration of this subchapter.
90	57		(b) The advisory group created under this section must be
91	58		composed of:
92	59		(1) the state Medicaid director or the director's
93	60		designee;
94	61		(2) a member designated by the Teacher Retirement
95	62		System of Texas;
96	63		(3) a member designated by the Employees Retirement
97	64		System of Texas; and
98		-	(4) 12 members designated by the center, including:
	65	+	(4) nine members designated by the commissioner,
	66	+	including:
99	67		(A) two members representing the business
100	68		community, with at least one of those members representing small
101	69		businesses that purchase health benefits but are not involved in
102		-	the provision of health care services, supplies, or devices or
103		-	health benefit plans;
	70	+	the provision of health care services or health benefit plans;
104	71		(B) two members who represent consumers and who
105	72		are not professionally involved in the purchase, provision,
106		-	administration, or review of health care services, supplies, or
107		-	devices or health benefit plans, with at least one member
108		-	representing the behavioral health community;
109		-	(C) two members representing hospitals that are
110		-	licensed in this state;
111		-	(D) two members representing health benefit plan
112		-	issuers that are regulated by the department;
113		-	(E) two members who are physicians licensed to
114		-	practice medicine in this state, one of whom is a primary care
115		-	physician; and
	73	+	administration, or review of health care services or health benefit
	74	+	plans;
	75	+	(C) one member representing hospitals;
	76	+	(D) one member representing health maintenance
	77	+	organizations;
	78	+	(E) one member representing physicians involved
	79	+	in direct patient care; and
116	80		(F) two members who are not professionally
117	81		involved in the purchase, provision, administration, or review of
118		-	health care services~~, supplies, or devices~~ or health benefit plans
119		-	~~and who have expertise~~ in:
	82	+	health care services or health benefit plans and who have expertise
	83	+	in:
120	84		(i) health planning;
121	85		(ii) health economics;
122	86		(iii) provider quality assurance;
123	87		(iv) statistics or health data management;
124	88		or
125		-	(v) medical privacy laws.
126		-	(c) A person serving on the stakeholder advisory group must
127		-	disclose any conflict of interest.
128		-	(d) Members of the stakeholder advisory group serve fixed
129		-	terms as prescribed by commissioner rules adopted under this
130		-	subchapter.
	89	+	(v) the reimbursement of medical education
	90	+	and research costs.
131	91		Sec. 38.404. ESTABLISHMENT AND ADMINISTRATION OF DATABASE.
132		-	(a) The department shall collaborate with the center under this
133		-	subchapter to aid in the center's establishment of the database.
134		-	The center shall leverage the existing resources and infrastructure
135		-	of the center to establish the database to collect, process,
136		-	analyze, and store data relating to medical, dental,
137		-	pharmaceutical, and other relevant health care claims and
138		-	encounters, enrollment, and benefit information for the purposes of
139		-	increasing transparency of health care costs, utilization, and
140		-	access and improving the affordability, availability, and quality
141		-	of health care in this state, including by improving population
142		-	health in this state.
	92	+	(a) The department shall collaborate with and leverage the
	93	+	existing resources and infrastructure of the center to establish
	94	+	the Texas All Payor Claims Database to collect, process, analyze,
	95	+	and store data relating to medical, dental, pharmaceutical, and
	96	+	other relevant health care claims and encounters, enrollment, and
	97	+	benefit information for the purposes of increasing cost
	98	+	transparency and improving the quality of health care in this
	99	+	state.
143	100		(b) The center shall serve as the administrator of the
144		-	database, design, build, and secure the database infrastructure,
145		-	and determine the accuracy of the data submitted for inclusion in
146		-	the database.
	101	+	database, design and build the database infrastructure, and manage
	102	+	the data submitted for inclusion in the database.
147	103		(c) In determining the information a payor is required to
148		-	submit to the center under this subchapter, the center must
149		-	consider requiring inclusion of information useful to health policy
150		-	makers, employers, and consumers for purposes of improving health
151		-	care quality and outcomes, improving population health, and
152		-	controlling health care costs. The required information at a
153		-	minimum must include the following information as it relates to all
154		-	health care services, supplies, and devices paid or otherwise
155		-	adjudicated by the payor:
	104	+	submit to the center, the center must consider requiring inclusion
	105	+	of information useful to researchers, employers, and policy makers
	106	+	for improving health care quality and outcomes and lowering health
	107	+	care costs and information useful to consumers and employers for
	108	+	price transparency. The required data at a minimum must include the
	109	+	following information as it relates to all health care services and
	110	+	supplies paid or otherwise adjudicated by the payor:
156	111		(1) the name and National Provider Identifier, as
157	112		described in 45 C.F.R. Section 162.410, of each health care
158	113		provider paid by the payor;
159	114		(2) the claim line detail that documents the health
160		-	care services, supplies, or devices provided by the health care
161		-	provider;
	115	+	care services or supplies provided by the health care provider; and
162	116		(3) the amount of charges billed by the health care
163		-	provider and the payor's:
164		-	(A) allowed amount or contracted rate for the
165		-	health care services, supplies, or devices; and
166		-	(B) adjudicated claim amount for the health care
167		-	services, supplies, or devices;
168		-	(4) the name of the payor, the name of the health
169		-	benefit plan, and the type of health benefit plan, including
170		-	whether health care services, supplies, or devices were provided to
171		-	an individual through:
172		-	(A) a Medicaid or Medicare program;
173		-	(B) workers' compensation insurance;
174		-	(C) a health maintenance organization operating
175		-	under Chapter 843;
176		-	(D) a preferred provider benefit plan offered by
177		-	an insurer under Chapter 1301;
178		-	(E) a basic coverage plan under Chapter 1551;
179		-	(F) a basic plan under Chapter 1575;
180		-	(G) a primary care coverage plan under Chapter
181		-	1579; or
182		-	(H) a health benefit plan that is subject to the
183		-	Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
184		-	1001 et seq.); and
185		-	(5) claim level information that allows the center to
186		-	identify the geozip where the health care services, supplies, or
187		-	devices were provided.
	117	+	provider and the allowed amount paid by the payor and the recipient
	118	+	of the health care services or supplies.
188	119		(d) Each payor shall submit the required data under
189		-	Subsection (c) at a schedule and frequency determined by the center
190		-	and adopted by the commissioner by rule.
191		-	(e) In the manner and subject to the standards,
192		-	requirements, policies, and procedures relating to the use of data
193		-	contained in the database established by the center in consultation
194		-	with the stakeholder advisory group, the center may use the data
195		-	contained in the database for a noncommercial purpose:
196		-	(1) to produce statewide, regional, and geozip
197		-	consumer reports available through the public access portal
198		-	described in Section 38.405 that address:
199		-	(A) health care costs, quality, utilization,
200		-	outcomes, and disparities;
201		-	(B) population health; or
202		-	(C) the availability of health care services; and
	120	+	Subsection (c) at a schedule and frequency determined by the
	121	+	department.
	122	+	(e) In the manner and subject to the standards and
	123	+	requirements relating to the use of data contained in the database
	124	+	established by the center in consultation with the stakeholder
	125	+	advisory group, the department or the center may use the data
	126	+	contained in the database:
	127	+	(1) to produce price, resource use, and quality
	128	+	information for consumers;
203	129		(2) for research and other analysis conducted by the
204		-	~~center~~ or ~~a qualified research entity to~~ the ~~extent that such use is~~
205		-	~~consistent with all applicable federal~~ and ~~state law,~~ ~~including the~~
206		-	~~data privacy and security requirements of Section 38.406 and~~ the
207		-	~~purposes of this subchapter.~~
208		-	~~(f) The center shall establish data collection procedures~~
209		-	~~and evaluate and update data collection procedures established~~
210		-	~~under this section. The center~~ shall ~~test the quality of~~ data
211		-	~~collected by and reported~~ to the center under this section to ~~ensure~~
212		-	that the data is accurate, reliable, and complete.
	130	+	department or the center; and
	131	+	(3) for research and other analysis conducted by a
	132	+	third party to the extent that such use is consistent with all
	133	+	applicable federal and state law, including the data security
	134	+	requirements of Section 38.406.
	135	+	(f) The center, in consultation with the stakeholder
	136	+	advisory group, shall monitor data collection procedures and test
	137	+	the quality of data submitted to the center under this section to
	138	+	ensure that the data is accurate, valid, reliable, and complete.
213	139		Sec. 38.405. PUBLIC ACCESS PORTAL. (a) Except as provided
214		-	by this section and Sections 38.404 and 38.406 and in a manner
215		-	consistent with all applicable federal and state law, the center
216		-	shall collect, compile, and analyze data submitted to or stored in
217		-	the database and disseminate the information described in Section
218		-	38.404(e)(1) in a format that allows the public to easily access and
219		-	navigate the information. The information must be accessible
220		-	through an open access Internet portal that may be accessed by the
221		-	public through an Internet website.
	140	+	by Sections 38.404 and 38.406 and in a manner consistent with all
	141	+	applicable federal and state law, the center shall collect,
	142	+	compile, and analyze data submitted to or stored in the database and
	143	+	disseminate information in a format that allows the public to
	144	+	easily access and navigate the information. The information must
	145	+	be accessible through an open access Internet portal that may be
	146	+	accessed by the public through an Internet website.
222	147		(b) The portal created under this section must allow the
223		-	public to easily search and retrieve the information disseminated
224		-	under Subsection (a), subject to data privacy and security
225		-	restrictions described in this subchapter and consistent with all
226		-	applicable federal and state law.
227		-	(c) Any information or data that is accessible through the
228		-	portal created under this section:
229		-	(1) must be segmented by type of insurance or health
230		-	benefit plan in a manner that does not combine payment rates
231		-	relating to different types of insurance or health benefit plans;
232		-	(2) must be aggregated by like Current Procedural
233		-	Terminology codes and health care services in a statewide,
234		-	regional, or geozip area; and
235		-	(3) may not identify a specific patient, health care
236		-	provider, health benefit plan, health benefit plan issuer, or other
237		-	payor.
238		-	(d) Before making information or data accessible through
239		-	the portal, the center shall remove any data or information that may
240		-	identify a specific patient in accordance with the
241		-	de-identification standards described in 45 C.F.R. Section
242		-	164.514.
243		-	Sec. 38.406. DATA PRIVACY AND SECURITY. (a) Any
244		-	information that may identify a patient, health care provider,
245		-	health benefit plan, health benefit plan issuer, or other payor is
246		-	confidential and subject to applicable state and federal law
247		-	relating to records privacy and protected health information,
248		-	including Chapter 181, Health and Safety Code, and is not subject to
249		-	disclosure under Chapter 552, Government Code.
250		-	(b) A qualified research entity with access to data or
251		-	information that is contained in the database but not accessible
252		-	through the portal described in Section 38.405:
253		-	(1) may use information contained in the database only
254		-	for purposes consistent with the purposes of this subchapter and
255		-	must use the information in accordance with standards,
256		-	requirements, policies, and procedures established by the center in
257		-	consultation with the stakeholder advisory group;
258		-	(2) may not sell or share any information contained in
259		-	the database; and
260		-	(3) may not use the information contained in the
261		-	database for a commercial purpose.
262		-	(c) A qualified research entity with access to information
263		-	that is contained in the database but not accessible through the
264		-	portal must execute an agreement with the center relating to the
265		-	qualified research entity's compliance with the requirements of
266		-	Subsections (a) and (b), including the confidentiality of
267		-	information contained in the database but not accessible through
268		-	the portal.
269		-	(d) Notwithstanding any provision of this subchapter, the
270		-	department and the center may not disclose an individual's
271		-	protected health information in violation of any state or federal
272		-	law.
273		-	(e) The center shall include in the database only the
	148	+	public and qualified research entities to easily search and
	149	+	retrieve the data contained in the database.
	150	+	Sec. 38.406. DATA SECURITY. (a) The data contained in the
	151	+	database and any reports or information created by the center using
	152	+	that data are confidential, subject to applicable state and federal
	153	+	law pertaining to records privacy and protected health information,
	154	+	including Chapter 181, Health and Safety Code, and are not subject
	155	+	to disclosure under Chapter 552, Government Code.
	156	+	(b) Notwithstanding any provision of this subchapter, the
	157	+	department and the center may not disclose an individual's personal
	158	+	health information in violation of any state or federal law.
	159	+	(c) The center shall include in the database only the
274	160		minimum amount of protected health information identifiers
275	161		necessary to link public and private data sources and the
276	162		geographic and services data to undertake studies.
277		-	(f) The center shall maintain protected health information
	163	+	(d) The center shall maintain protected health information
278	164		identifiers collected under this subchapter but excluded from the
279		-	database under Subsection (e) in a separate database. The separate
	165	+	database under Subsection (c) in a separate database. The separate
280	166		database may not be aggregated with any other information and must
281	167		use a proxy or encrypted record identifier for analysis.
282	168		Sec. 38.407. CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.
283	169		Any sponsor or administrator of a health benefit plan subject to the
284	170		Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
285	171		1001 et seq.) may elect or decline to participate in or submit data
286	172		to the center for inclusion in the database as consistent with
287	173		federal law.
288	174		Sec. 38.408. REPORT TO LEGISLATURE. Not later than
289		-	September 1 of each even-numbered year, the ~~center~~ shall submit to
290		-	the legislature a written report containing:
	175	+	September 1 of each even-numbered year, the department shall submit
	176	+	to the legislature a written report containing:
291	177		(1) an analysis of the data submitted to the center for
292	178		use in the database;
293	179		(2) information regarding the submission of data to
294	180		the center for use in the database and the maintenance, analysis,
295		-	and use of the data;
296		-	(3) recommendations from the center, in consultation
297		-	with the stakeholder advisory group, to further improve the
298		-	transparency, cost-effectiveness, accessibility, and quality of
299		-	health care in this state; and
300		-	(4) an analysis of the trends of health care
301		-	affordability, availability, quality, and utilization.
	181	+	and use of the data; and
	182	+	(3) recommendations to further improve the
	183	+	transparency, cost-effectiveness, and quality of health care in
	184	+	this state.
302	185		Sec. 38.409. RULES. (a) The commissioner, in consultation
303	186		with the center, shall adopt rules:
304	187		(1) specifying the types of data a payor is required to
305	188		provide to the center under Section 38.404 to determine health
306	189		benefits costs and other reporting metrics, including, if
307	190		necessary, types of data not expressly identified in that section;
308	191		(2) specifying the schedule, frequency, and manner in
309	192		which a payor must provide data to the center under Section 38.404,
310	193		which must:
311	194		(A) require the payor to provide data to the
312		-	center not less frequently than ~~quarterly~~; and
	195	+	center not less frequently than annually; and
313	196		(B) include provisions relating to data layout,
314	197		data governance, historical data, data submission, use and sharing,
315		-	information security, and privacy protection in data submissions;
316		-	and
	198	+	information security, privacy protection, reporting, and any other
	199	+	matter necessary for the department to perform its functions under
	200	+	this section; and
317	201		(3) establishing oversight and enforcement mechanisms
318		-	to ensure that ~~payors submit data to~~ the database in ~~accordance with~~
319		-	this subchapter.
	202	+	to ensure that the database is operated and maintained in
	203	+	accordance with this subchapter.
320	204		(b) In adopting rules governing methods for data
321	205		submission, the commissioner shall to the maximum extent
322	206		practicable use methods that are reasonable and cost-effective for
323	207		payors.
324		-	SECTION 2. (a) Not later than January 1, 2022, the Center
325		-	for Healthcare Data at The University of Texas Health Science
326		-	Center at Houston shall establish the stakeholder advisory group in
327		-	accordance with Section 38.403, Insurance Code, as added by this
328		-	Act.
	208	+	SECTION 2. (a) Not later than January 1, 2022, the
	209	+	commissioner of insurance shall establish the stakeholder advisory
	210	+	group in accordance with Section 38.403, Insurance Code, as added
	211	+	by this Act.
329	212		(b) Not later than June 1, 2022, the Texas Department of
330		-	Insurance shall adopt rules, and the Center for Healthcare Data at
331		-	The University of Texas Health Science Center at Houston shall
332		-	adopt, in consultation with the stakeholder advisory group,
333		-	standards, requirements, policies, and procedures, necessary to
334		-	implement Subchapter I, Chapter 38, Insurance Code, as added by
335		-	this Act.
	213	+	Insurance shall adopt rules necessary to implement Subchapter I,
	214	+	Chapter 38, Insurance Code, as added by this Act.
336	215		SECTION 3. As soon as practicable after the effective date
337		-	of this Act, the ~~Center for Healthcare Data at The University~~ of
338		-	Texas Health ~~Science Center at Houston shall actively seek~~
339		-	financial support ~~from the federal grant program for development of~~
340		-	state all payer ~~claims databases established under the Consolidated~~
341		-	Appropriations ~~Act, 2021 (Pub. L. No. 116-260) and from any other~~
342		-	available source ~~of financial support provided by the federal~~
343		-	government for ~~purposes of implementing Subchapter I, Chapter 38,~~
344		-	Insurance Code, ~~as added by this Act.~~
345		-	~~SECTION 4~~. ~~If before implementing any provision of~~
346		-	~~Subchapter I,~~ ~~Chapter 38,~~ ~~Insurance Code,~~ ~~as added by~~ this Act~~, the~~
347		-	commissioner of insurance determines that a waiver or ~~authorization~~
348		-	from a federal agency is necessary for implementation ~~of that~~
349		-	provision, the commissioner shall request the waiver or
	216	+	of this Act, the commissioner of insurance, in consultation with
	217	+	the Center for Healthcare Data at The University of Texas Health
	218	+	Science Center at Houston, shall actively seek financial support
	219	+	from the federal grant program for development of state all payer
	220	+	claims databases established under the Consolidated Appropriations
	221	+	Act, 2021 (Pub. L. No. 116-260) and from any other available source
	222	+	of financial support provided by the federal government for
	223	+	purposes of implementing Subchapter I, Chapter 38, Insurance Code,
	224	+	as added by this Act.
	225	+	SECTION 4. If before implementing any provision of this Act
	226	+	the commissioner of insurance determines that a waiver or
	227	+	authorization from a federal agency is necessary for implementation
	228	+	of that provision, the commissioner shall request the waiver or
350	229		authorization and may delay implementing that provision until the
351	230		waiver or authorization is granted.
352	231		SECTION 5. This Act takes effect September 1, 2021.