88R12309 KBB-F
By: Oliverson, Walle, Bonnen, Harless, Frank H.B. No. 3414
A BILL TO BE ENTITLED
AN ACT
relating to data or information collected by the statewide all
payor claims database and the composition of the stakeholder
advisory group.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 38.402, Insurance Code, is amended by
amending Subdivision (9) and adding Subdivisions (9-a) and (9-b) to
read as follows:
(9) "Qualified research entity" means:
(A) an organization engaging in public interest
research for the purpose of analyzing the delivery of health care in
this state that is exempt from federal income tax under Section
501(a), Internal Revenue Code of 1986, by being listed as an exempt
organization in Section 501(c)(3) of that code; or
(B) an institution of higher education engaged in
public interest research related to the delivery of health care in
this state[; or
[(C) a health care provider in this state
engaging in efforts to improve the quality and cost of health care].
(9-a) "Qualified market consultant entity" means a
commercial entity that consults regarding the design of health
benefit plans in this state and is engaging in efforts to improve
the quality and cost of health care.
(9-b) "Qualified market participant entity" means a
health care provider or payor engaging in efforts to improve the
quality and cost of health care in this state.
SECTION 2. Section 38.403(b), Insurance Code, is amended 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) 12 members designated by the governor [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.
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 the submission of data that is not included in a standard
claim form.
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) may [must] be aggregated by like Current
Procedural Terminology codes and health care services in a
statewide, regional, local, metropolitan, 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, including any anticipated final product
from the research;
(4) how the proposed research will further the
purposes of this subchapter, improve the quality of care, or reduce
the cost of care; and
(5) a statement of whether access is sought as a
qualified research entity, qualified market participant entity, or
qualified market consultant entity.
(b) The center shall review all applications in a timely
manner and approve applications under the applicable terms of
Sections 38.406(b), (b-1), and (b-2) unless:
(1) the application is incomplete;
(2) the application fails to establish that access to
the data or information would be likely to improve the quality of
care or reduce the cost of care in this state; or
(3) the applicant does not qualify as the type of
entity identified in the application.
(c) If the center denies an application, the center must
identify with particularity the deficiencies in the application.
(d) If the center does not affirmatively approve or deny an
application before the 31st day after the date the application is
submitted, the application is considered approved.
SECTION 6. Section 38.406, Insurance Code, is amended by
amending Subsections (a), (b), (c), and (d) and adding Subsections
(b-1) and (b-2) to read as follows:
(a) Except as provided by Subsections (b), (b-1), and (b-2),
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 may [with] access [to] data
or information that is contained in the database but not accessible
through the portal described in Section 38.405, and the qualified
research entity:
(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 payors only if reporting or
publishing furthers the purposes of this subchapter [not use the
information contained in the database for a commercial purpose].
(b-1) A qualified market participant entity may access data
or information that is contained in the database but not accessible
through the portal described by Section 38.405 only to the extent
that the data or information regards a patient who was at one time
treated by or whose care was at one time paid for by the qualified
market participant entity, and the qualified market participant
entity:
(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 not publicly report or publish data or
information that identifies a health care provider, health benefit
plan, health benefit plan issuer, or other payor.
(b-2) A qualified market consultant entity may access data
or information that is contained in the database but not accessible
through the portal described by Section 38.405, and the qualified
market consultant entity:
(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 not publicly report or publish data or
information that identifies a health care provider, health benefit
plan, health benefit plan issuer, or other payor.
(c) A qualified research entity, qualified market
participant entity, or qualified market consultant entity with
access to data or information that is contained in the database but
not accessible through the portal must execute an agreement with
the center relating to the [qualified research] entity's compliance
with the requirements of Subsections (a), [and] (b), (b-1), and
(b-2), as applicable [including the confidentiality of information
contained in the database but not accessible through the portal].
(d) Notwithstanding any provision of this subchapter, the
department and the center may not disclose an individual's
protected health information in violation of any other state or
federal law.
SECTION 7. Notwithstanding the amendment by this Act of
Section 38.403(b), Insurance Code, a member of the advisory group
serving under that section immediately before the effective date of
this Act may continue to serve until the end of the member's term.
The governor shall designate advisory group members under that
section to fill vacancies that arise on or after the effective date
of this Act.
SECTION 8. 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.