Texas 2023 - 88th Regular

Texas House Bill HB3414 Compare Versions

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Version 2 (New)

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1	1	H.B. No. 3414
2	2
3	3
4	4	AN ACT
5	5	relating to the statewide all payor claims database.
6	6	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
7	7	SECTION 1. Section 38.402(7), Insurance Code, is amended to
8	8	read as follows:
9	9	(7) "Payor" means any of the following entities that
10	10	pay, reimburse, or otherwise contract with a health care provider
11	11	for the provision of health care services, supplies, or devices to a
12	12	patient:
13	13	(A) an insurance company providing health or
14	14	dental insurance;
15	15	(B) the sponsor or administrator of a health or
16	16	dental plan;
17	17	(C) a health maintenance organization operating
18	18	under Chapter 843;
19	19	(D) the state Medicaid program, including the
20	20	Medicaid managed care program operating under Chapter 533,
21	21	Government Code;
22	22	(E) a health benefit plan offered or administered
23	23	by or on behalf of this state or a political subdivision of this
24	24	state or an agency or instrumentality of the state or a political
25	25	subdivision of this state, including:
26	26	(i) a basic coverage plan under Chapter
27	27	1551;
28	28	(ii) a basic plan under Chapter 1575; [and]
29	29	(iii) a primary care coverage plan under
30	30	Chapter 1579; and
31	31	(iv) a plan providing basic coverage under
32	32	Chapter 1601; or
33	33	(F) any other entity providing a health insurance
34	34	or health benefit plan subject to regulation by the department.
35	35	SECTION 2. Section 38.403, Insurance Code, is amended by
36	36	amending Subsections (b) and (d) and adding Subsection (e) to read
37	37	as follows:
38	38	(b) The advisory group created under this section must be
39	39	composed of:
40	40	(1) the state Medicaid director or the director's
41	41	designee;
42	42	(2) a member designated by the Teacher Retirement
43	43	System of Texas;
44	44	(3) a member designated by the Employees Retirement
45	45	System of Texas; and
46	46	(4) 13 [12] members designated by the center,
47	47	including:
48	48	(A) two members representing the business
49	49	community, with at least one of those members representing small
50	50	businesses that purchase health benefits but are not involved in
51	51	the provision of health care services, supplies, or devices or
52	52	health benefit plans;
53	53	(B) two members who represent consumers and who
54	54	are not professionally involved in the purchase, provision,
55	55	administration, or review of health care services, supplies, or
56	56	devices or health benefit plans, with at least one member
57	57	representing the behavioral health community;
58	58	(C) two members representing hospitals that are
59	59	licensed in this state;
60	60	(D) two members representing health benefit plan
61	61	issuers that are regulated by the department;
62	62	(E) two members who are physicians licensed to
63	63	practice medicine in this state, one of whom is a primary care
64	64	physician; [and]
65	65	(F) two members who are not professionally
66	66	involved in the purchase, provision, administration, or review of
67	67	health care services, supplies, or devices or health benefit plans
68	68	and who have expertise in:
69	69	(i) health planning;
70	70	(ii) health economics;
71	71	(iii) provider quality assurance;
72	72	(iv) statistics or health data management;
73	73	or
74	74	(v) medical privacy laws; and
75	75	(G) one member representing an institution of
76	76	higher education.
77	77	(d) Except as provided by Subsection (e), members [Members]
78	78	of the stakeholder advisory group serve fixed terms as prescribed
79	79	by commissioner rules adopted under this subchapter.
80	80	(e) A member representing an institution of higher
81	81	education under Subsection (b)(4)(G) serves a term of one year.
82	82	SECTION 3. Section 38.404, Insurance Code, is amended by
83	83	adding Subsection (c-1) to read as follows:
84	84	(c-1) Notwithstanding Subsection (c), the center may not
85	85	require a payor to collect or otherwise obtain from individuals
86	86	covered by the payor data that is not included in a standard claim
87	87	form, though the center may require submission of such data if it is
88	88	otherwise collected by the payor, including provider and
89	89	eligibility files.
90	90	SECTION 4. Section 38.405(c), Insurance Code, is amended to
91	91	read as follows:
92	92	(c) Any information or data that is accessible through the
93	93	portal created under this section:
94	94	(1) must be segmented by type of insurance or health
95	95	benefit plan in a manner that does not combine payment rates
96	96	relating to different types of insurance or health benefit plans;
97	97	(2) must be aggregated by like Current Procedural
98	98	Terminology codes and health care services in a statewide,
99	99	regional, metropolitan statistical, zip-code, or geozip area; and
100	100	(3) may not identify a specific patient, health care
101	101	provider, health benefit plan, health benefit plan issuer, or other
102	102	payor.
103	103	SECTION 5. Subchapter I, Chapter 38, Insurance Code, is
104	104	amended by adding Section 38.4055 to read as follows:
105	105	Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR
106	106	INFORMATION IN DATABASE. (a) An entity seeking to access data or
107	107	information that is contained in the database but not accessible
108	108	through the portal described by Section 38.405 must submit an
109	109	application to the center for access to that data or information.
110	110	The application must include:
111	111	(1) the sources and identity of all funding and
112	112	funders of the research the entity will perform;
113	113	(2) the names of all individuals who may have access to
114	114	the data or information that is contained in the database but not
115	115	accessible through the portal described by Section 38.405, and any
116	116	affiliations those individuals have with entities other than the
117	117	entity submitting the application;
118	118	(3) the proposed study, research, or project that the
119	119	entity plans to undertake and the purpose of the study, research, or
120	120	project, including any anticipated final product from the study,
121	121	research, or project;
122	122	(4) how the proposed research will further the
123	123	purposes of this subchapter, improve the quality of care, or reduce
124	124	the cost of care;
125	125	(5) a description of the proposed methodology;
126	126	(6) a description of the publication method of the
127	127	manuscripts, reports, or other forms of output from the research;
128	128	and
129	129	(7) for access to data that would require such an
130	130	approval, an institutional review board determination letter that
131	131	is an approval or an approval with modifications.
132	132	(b) The center shall review and make a determination on all
133	133	applications in a timely manner.
134	134	(c) If the center denies an application, the center must
135	135	identify with particularity the deficiencies in the application.
136	136	SECTION 6. Sections 38.406(a) and (b), Insurance Code, are
137	137	amended to read as follows:
138	138	(a) Information that may identify a patient is confidential
139	139	and subject to applicable state and federal law relating to records
140	140	privacy and protected health information, including Chapter 181,
141	141	Health and Safety Code, and is not subject to disclosure under
142	142	Chapter 552, Government Code. Except as provided by Subsection
143	143	(b), any [Any] information that may identify a [patient,] health
144	144	care provider, health benefit plan, health benefit plan issuer, or
145	145	other payor is confidential and subject to applicable state and
146	146	federal law relating to records privacy and protected health
147	147	information, including Chapter 181, Health and Safety Code, and is
148	148	not subject to disclosure under Chapter 552, Government Code.
149	149	(b) A qualified research entity with access to data or
150	150	information that is contained in the database but not accessible
151	151	through the portal described in Section 38.405:
152	152	(1) may use the data or information contained in the
153	153	database only for purposes consistent with the purposes of this
154	154	subchapter and must use the data or information in accordance with
155	155	standards, requirements, policies, and procedures established by
156	156	the center in consultation with the stakeholder advisory group;
157	157	(2) may not sell or share any data or information
158	158	contained in the database; and
159	159	(3) may report or publish data or information that
160	160	identifies one or more health care providers, health benefit plans,
161	161	health benefit plan issuers, or other mandatory payors only if the
162	162	report or publication is made available to the public at no cost
163	163	[not use the information contained in the database for a commercial
164	164	purpose].
165	165	SECTION 7. Section 38.408, Insurance Code, is amended to
166	166	read as follows:
167	167	Sec. 38.408. REPORT TO LEGISLATURE. Not later than
168	168	September 1 of each even-numbered year, the center shall submit to
169	169	the legislature a written report containing:
170	170	(1) an analysis of the data submitted to the center for
171	171	use in the database;
172	172	(2) information regarding the submission of data to
173	173	the center for use in the database and the maintenance, analysis,
174	174	and use of the data;
175	175	(3) recommendations from the center, in consultation
176	176	with the stakeholder advisory group, to further improve the
177	177	transparency, cost-effectiveness, accessibility, and quality of
178	178	health care in this state; [and]
179	179	(4) an analysis of the trends of health care
180	180	affordability, availability, quality, and utilization;
181	181	(5) a list of approved applications;
182	182	(6) a list of disapproved applications with the
183	183	justification required by Section 38.4055(c); and
184	184	(7) a list of all applications that were neither
185	185	approved nor disapproved by the 91st day after the application was
186	186	submitted, including the particular reasons why each application
187	187	was not approved or disapproved within that timeframe.
188	188	SECTION 8. The Center for Healthcare Data at The University
189	189	of Texas Health Science Center at Houston is required to implement a
190	190	provision of Subchapter I, Chapter 38, Insurance Code, as amended
191	191	by this Act, only if the legislature appropriates money
192	192	specifically for that purpose. If the legislature does not
193	193	appropriate money specifically for that purpose, the center may,
194	194	but is not required to, implement a provision of that subchapter
195	195	using other money available for that purpose.
196	196	SECTION 9. This Act takes effect immediately if it receives
197	197	a vote of two-thirds of all the members elected to each house, as
198	198	provided by Section 39, Article III, Texas Constitution. If this
199	199	Act does not receive the vote necessary for immediate effect, this
200	200	Act takes effect September 1, 2023.
201	201	______________________________ ______________________________
202	202	President of the Senate Speaker of the House
203	203	I certify that H.B. No. 3414 was passed by the House on April
204	204	28, 2023, by the following vote: Yeas 146, Nays 1, 2 present, not
205	205	voting; and that the House concurred in Senate amendments to H.B.
206	206	No. 3414 on May 24, 2023, by the following vote: Yeas 139, Nays 5,
207	207	1 present, not voting.
208	208	______________________________
209	209	Chief Clerk of the House
210	210	I certify that H.B. No. 3414 was passed by the Senate, with
211	211	amendments, on May 17, 2023, by the following vote: Yeas 31, Nays
212	212	0.
213	213	______________________________
214	214	Secretary of the Senate
215	215	APPROVED: __________________
216	216	Date
217	217	__________________
218	218	Governor