H.B. No. 3414
AN ACT
relating to the statewide all payor claims database.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 38.402(7), Insurance Code, is amended to
read as follows:
(7) "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, supplies, or devices 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:
(i) a basic coverage plan under Chapter
1551;
(ii) a basic plan under Chapter 1575; [and]
(iii) a primary care coverage plan under
Chapter 1579; and
(iv) a plan providing basic coverage under
Chapter 1601; or
(F) any other entity providing a health insurance
or health benefit plan subject to regulation by the department.
SECTION 2. Section 38.403, Insurance Code, is amended by
amending Subsections (b) and (d) and adding Subsection (e) to read
as follows:
(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) 13 [12] members designated by the center,
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, supplies, or devices 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, supplies, or
devices or health benefit plans, with at least one member
representing the behavioral health community;
(C) two members representing hospitals that are
licensed in this state;
(D) two members representing health benefit plan
issuers that are regulated by the department;
(E) two members who are physicians licensed to
practice medicine in this state, one of whom is a primary care
physician; [and]
(F) two members who are not professionally
involved in the purchase, provision, administration, or review of
health care services, supplies, or devices 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) medical privacy laws; and
(G) one member representing an institution of
higher education.
(d) Except as provided by Subsection (e), members [Members]
of the stakeholder advisory group serve fixed terms as prescribed
by commissioner rules adopted under this subchapter.
(e) A member representing an institution of higher
education under Subsection (b)(4)(G) serves a term of one year.
SECTION 3. Section 38.404, Insurance Code, is amended by
adding Subsection (c-1) to read as follows:
(c-1) Notwithstanding Subsection (c), the center may not
require a payor to collect or otherwise obtain from individuals
covered by the payor data that is not included in a standard claim
form, though the center may require submission of such data if it is
otherwise collected by the payor, including provider and
eligibility files.
SECTION 4. Section 38.405(c), Insurance Code, is amended to
read as follows:
(c) Any information or data that is accessible through the
portal created under this section:
(1) must be segmented by type of insurance or health
benefit plan in a manner that does not combine payment rates
relating to different types of insurance or health benefit plans;
(2) must be aggregated by like Current Procedural
Terminology codes and health care services in a statewide,
regional, metropolitan statistical, zip-code, or geozip area; and
(3) may not identify a specific patient, health care
provider, health benefit plan, health benefit plan issuer, or other
payor.
SECTION 5. Subchapter I, Chapter 38, Insurance Code, is
amended by adding Section 38.4055 to read as follows:
Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR
INFORMATION IN DATABASE. (a) An entity seeking to access data or
information that is contained in the database but not accessible
through the portal described by Section 38.405 must submit an
application to the center for access to that data or information.
The application must include:
(1) the sources and identity of all funding and
funders of the research the entity will perform;
(2) the names of all individuals who may have access to
the data or information that is contained in the database but not
accessible through the portal described by Section 38.405, and any
affiliations those individuals have with entities other than the
entity submitting the application;
(3) the proposed study, research, or project that the
entity plans to undertake and the purpose of the study, research, or
project, including any anticipated final product from the study,
research, or project;
(4) how the proposed research will further the
purposes of this subchapter, improve the quality of care, or reduce
the cost of care;
(5) a description of the proposed methodology;
(6) a description of the publication method of the
manuscripts, reports, or other forms of output from the research;
and
(7) for access to data that would require such an
approval, an institutional review board determination letter that
is an approval or an approval with modifications.
(b) The center shall review and make a determination on all
applications in a timely manner.
(c) If the center denies an application, the center must
identify with particularity the deficiencies in the application.
SECTION 6. Sections 38.406(a) and (b), Insurance Code, are
amended to read as follows:
(a) Information that may identify a patient is confidential
and subject to applicable state and federal law relating to records
privacy and protected health information, including Chapter 181,
Health and Safety Code, and is not subject to disclosure under
Chapter 552, Government Code. Except as provided by Subsection
(b), any [Any] information that may identify a [patient,] health
care provider, health benefit plan, health benefit plan issuer, or
other payor is confidential and subject to applicable state and
federal law relating to records privacy and protected health
information, including Chapter 181, Health and Safety Code, and is
not subject to disclosure under Chapter 552, Government Code.
(b) A qualified research entity with access to data or
information that is contained in the database but not accessible
through the portal described in Section 38.405:
(1) may use the data or information contained in the
database only for purposes consistent with the purposes of this
subchapter and must use the data or information in accordance with
standards, requirements, policies, and procedures established by
the center in consultation with the stakeholder advisory group;
(2) may not sell or share any data or information
contained in the database; and
(3) may report or publish data or information that
identifies one or more health care providers, health benefit plans,
health benefit plan issuers, or other mandatory payors only if the
report or publication is made available to the public at no cost
[not use the information contained in the database for a commercial
purpose].
SECTION 7. Section 38.408, Insurance Code, is amended to
read as follows:
Sec. 38.408. REPORT TO LEGISLATURE. Not later than
September 1 of each even-numbered year, the center 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;
(3) recommendations from the center, in consultation
with the stakeholder advisory group, to further improve the
transparency, cost-effectiveness, accessibility, and quality of
health care in this state; [and]
(4) an analysis of the trends of health care
affordability, availability, quality, and utilization;
(5) a list of approved applications;
(6) a list of disapproved applications with the
justification required by Section 38.4055(c); and
(7) a list of all applications that were neither
approved nor disapproved by the 91st day after the application was
submitted, including the particular reasons why each application
was not approved or disapproved within that timeframe.
SECTION 8. The Center for Healthcare Data at The University
of Texas Health Science Center at Houston is required to implement a
provision of Subchapter I, Chapter 38, Insurance Code, as amended
by this Act, only if the legislature appropriates money
specifically for that purpose. If the legislature does not
appropriate money specifically for that purpose, the center may,
but is not required to, implement a provision of that subchapter
using other money available for that purpose.
SECTION 9. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2023.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 3414 was passed by the House on April
28, 2023, by the following vote: Yeas 146, Nays 1, 2 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 3414 on May 24, 2023, by the following vote: Yeas 139, Nays 5,
1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 3414 was passed by the Senate, with
amendments, on May 17, 2023, by the following vote: Yeas 31, Nays
0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor