| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to the establishment of a statewide all payor claims |
|
|
database to store publicly accessible information. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subtitle E, Title 2, Health and Safety Code, is |
|
|
amended by adding Chapter 108A to read as follows: |
|
|
CHAPTER 108A. STATEWIDE ALL PAYOR CLAIMS DATABASE |
|
|
Sec. 108A.001. DEFINITIONS. In this chapter: |
|
|
(1) "Center" means the Center for Healthcare Data at |
|
|
The University of Texas Health Science Center at Houston. |
|
|
(2) "Database" means the statewide all payor claims |
|
|
database established under this chapter. |
|
|
(3) "Payor" means an insurance company, a health |
|
|
maintenance organization, a Medicaid managed care organization, or |
|
|
another organization that pays a health care provider to provide |
|
|
health care benefits to a patient. |
|
|
Sec. 108A.002. ESTABLISHMENT AND ADMINISTRATION OF |
|
|
STATEWIDE ALL PAYOR CLAIMS DATABASE. (a) The department shall |
|
|
collaborate with and leverage the existing resources and |
|
|
infrastructure of the center to establish a statewide all payor |
|
|
claims database to collect, process, and store health care claims |
|
|
information. |
|
|
(b) The center shall serve as the administrator of the |
|
|
database and manage information submitted for inclusion in the |
|
|
database. In determining the information a payor is required to |
|
|
submit to the center, the center must consider requiring inclusion |
|
|
of information useful to researchers and policymakers for improving |
|
|
health care quality and outcomes and lowering health care costs and |
|
|
information useful to consumers for price transparency. The |
|
|
required information at a minimum must include: |
|
|
(1) the name of the health care provider paid by the |
|
|
payor; |
|
|
(2) the type of health care benefits provided by the |
|
|
health care provider; |
|
|
(3) the amount paid by the payor for the health care |
|
|
benefits; and |
|
|
(4) the estimated copayment amount paid by the patient |
|
|
who received the health care benefits. |
|
|
(c) Each payor annually shall submit to the center for |
|
|
inclusion in the database the health care claims information |
|
|
required by the center under Subsection (b) for all health care |
|
|
benefits paid by the payor during the preceding year. |
|
|
(d) The center shall ensure that health care claims |
|
|
information submitted to the center under Subsection (c) is stored |
|
|
in the database and accessible to the public in the manner described |
|
|
by Section 108A.003. |
|
|
Sec. 108A.003. PUBLIC ACCESS TO DATABASE. (a) The center |
|
|
shall aggregate information submitted to or stored in the database |
|
|
in an open-source format that is machine-readable and allows the |
|
|
public to easily access and navigate the information. |
|
|
(b) The database must be accessible through the center's |
|
|
Internet website and allow the public to search the information in |
|
|
the database at a minimum by the categories described by Section |
|
|
108A.002(b). |
|
|
(c) The center shall ensure information in the database that |
|
|
is accessible to the public does not disclose a patient's |
|
|
personally identifiable information or information that is |
|
|
confidential under state or federal law. |
|
|
Sec. 108A.004. MEMORANDUM OF UNDERSTANDING; RULES. The |
|
|
executive commissioner on behalf of the department, the Texas |
|
|
Higher Education Coordinating Board on behalf of the center, and |
|
|
the commissioner of insurance on behalf of the Texas Department of |
|
|
Insurance shall each by rule adopt a memorandum of understanding |
|
|
that: |
|
|
(1) ensures the database is operated and maintained in |
|
|
accordance with this chapter; |
|
|
(2) as applicable, defines each agency's |
|
|
responsibilities with respect to payors that are: |
|
|
(A) required to submit health care claims |
|
|
information to the database; and |
|
|
(B) under the jurisdiction of the agency; and |
|
|
(3) identifies and establishes enforcement mechanisms |
|
|
for each agency to ensure: |
|
|
(A) the center, in collaboration with the |
|
|
department, operates and maintains the database in accordance with |
|
|
this chapter; and |
|
|
(B) payors under the jurisdiction of the agency |
|
|
submit the required health care claims information to the database |
|
|
in accordance with this chapter. |
|
|
SECTION 2. As soon as practicable after the effective date |
|
|
of this Act, the executive commissioner of the Health and Human |
|
|
Services Commission, the Texas Higher Education Coordinating |
|
|
Board, and the commissioner of insurance shall adopt rules |
|
|
necessary to implement Chapter 108A, Health and Safety Code, as |
|
|
added by this Act. |
|
|
SECTION 3. If before implementing any provision of this Act |
|
|
a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 4. This Act takes effect September 1, 2021. |