74(R) HB 1048 House Committee Report

BILL ANALYSIS

C.S.H.B. 1048
By: Maxey
04-04-95
Committee Report (Substituted)

BACKGROUND

Consumers are spending billions of dollars on health care every
year, but they lack access to information to evaluate the services
being purchased. Health data collection would create a more
financially efficient health care system and an atmosphere where
better quality care is more easily identifiable. Businesses and
state health planning groups can use health data to determine
funding and human resource needs so that employees and the public
in general can have access to the services desired, and providers
can better identify the services required. Health data can also
help in identifying fraud and abuse.

Thirty states collect patient-level data on a statewide basis.
The efforts in Texas up to now have been sporadic, with little
coordination between the private and public sectors. The Texas
Department of Health (TDH) has the authority to collect hospital
discharge data, but it has not had the ability to do so on a
comprehensive statewide basis. TDH is just beginning to collect and
analyze data from Medicaid payments.

A statewide health data collection system has been recommended
by the Texas House of Representatives Public Health Committee
(1994), the State Comptroller Performance Review (1993 and 1995),
the Texas Statewide Health Coordinating Council (1994), and the
Governor s Health Policy Task Force (1992-3).

PURPOSE

H.B. 1048, as substituted, creates the Texas Health Care
Information Council to develop and implement a statewide health
care data collection system to collect information on health care
charges, provider quality, and health care outcomes to facilitate
the promotion and accessibility of cost-effective, quality health
care. The data would be collected from health care providers by the
Texas Department of Health in a manner to be specified by rules
adopted by the council.

RULEMAKING AUTHORITY

It is the committee s opinion that rulemaking authority is granted
to the Texas Health Care Information Council in Section
108.006(a)(3), (7), and (8) and Section 108.006(b)(1) and (3);
Section 108.007(a); Section 108.008(b)(2); Section 108.009(b) and
(i); Section 108.010(a) and (f); 108.011 (c); and 108.013(a) and
(b). It is the committee's opinion that additional rulemaking
authority is granted to the Texas Department of Health in Section
108.007(a) and to the Texas Board of Health in Section
108.008(b)(2).

SECTION BY SECTION ANALYSIS

SECTION 1. Adds Chapter 108 to Subtitle E, Title 2, Health and
Safety Code, relating to the Texas Health Care Information Council
(the council).

Section 108.001. CREATION OF COUNCIL. Creates the council and
requires it to administer Chapter 108 and report to the governor,
the legislature, and the public.

Section 108.002. DEFINITIONS. Defines the following terms:
board, charge or rate, council, data, department, health care
facility, health maintenance organization, hospital, outcome data,
physician, provider, provider quality, rural provider, severity
adjustment, uniform patient identifier, and uniform physician
identifier.

Section 108.003. COUNCIL COMPOSITION; EXPENSES. (a)
Establishes that the council be composed of three non-voting, ex
officio state agency members and 15 voting members appointed by the
governor.

(b) Designates the three state agency members as the
commissioners of public health, health and human services, and
insurance.

(c) Requires the governor to appoint three representatives
from the business community, two representatives from labor, two
representatives of consumers, two representatives of hospitals, one
representative of health maintenance organizations, three
representative of physicians, and two public members with specified
expertise.

(d) Stipulates that the chairman is to be appointed by the
governor and requires the members of the council to elect a vice
chairman annually.

(e) Establishes a quorum as a majority of the voting members
and requires valid acts of the council to be supported by a
majority of those present when a quorum exists.

(f) Permits the council to appoint subcommittees of the
council and to elect other officers.

(g) Requires the council to appoint technical advisory
committees and requires them to work in coordination with each
other. Allows these committees to consult with other
professionals. Among the committees authorized, this subsection
requires the council to appoint two committees to advise and make
recommendations to the council. The required committees include one
with at least five practicing physicians, among others, to advise
on the provider quality methodology, interpretation of provider
quality data, and consumer education information. The second
required committee inclwdes at least five practicing physicians
with experience in organized peer review in a Texas hospital to
advise on the use of peer review in determining quality in-patient
care, the development and interpretation of data elements needed to
determine quality of in-patient care, and the development and
format of reports and information relating to provider quality.

(h) Prohibits council members from receiving a salary or per
diem allowance, but requires them to be reimbursed for actual and
necessary expenses incurred performing council duties. Establishes
that advisory committee members are not entitled to compensation or
reimbursement for travel.

(i) Establishes that council members shall be appointed
without discrimination and instructs the governor to consider
geographic representation in making appointments.

(j) Prohibits a registered lobbyist who works on behalf of a
profession related to the operation of the council from serving as
a council member.

Section 108.004. MEETINGS. (a) States that the council and all
of its subcommittees and technical advisory committees are subject
to the open meetings law.

(b) Requires the council to meet at least quarterly, but
allows additional meetings as often as needed.

Section 108.005. TERMS. (a) Dictates the terms of the agency
members of the council to be concurrent with their terms of office
and the terms of appointed members to be six-year staggered terms,
with the terms of five members to expire on September 1 of each
odd-numbered year.
(b) Prohibits a member from serving more than two full
consecutive terms.

Section 108.006. POWERS AND DUTIES OF COUNCIL. (a) Directs the
council to develop a statewide health care data collection system
(hereinafter referred to as "the system") to collect information on
health care charges, utilization, provider quality, and outcomes to
facilitate the promotion and accessibility of cost-effective, good
quality health care. Requires the council to direct the collection,
dissemination, and analysis of the data; contract with the Texas
Department of Health (hereinafter referred to as "the department")
to collect the data; adopt policies and rules, including rules
about data collection requirements; build on and not duplicate
other data collection efforts required by law, an accreditation
organization, or the Texas Board of Health (hereinafter referred to
as "the board") rule; work with other state agencies to review
existing public health data collection programs in Texas and
recommend consolidation of such efforts, where appropriate, or
legislation needed to effect consolidation; assure the data is
available and accessible to interested persons; prescribe by rule
the format for providers to submit data; adopt and implement by
rule a methodology for collecting and disseminating provider
quality data; report to the legislature, governor, and public on
provider charges, on the effectiveness of the council, on any
recommendations for legislation, and on quality, effectiveness, and
access to health care in Texas; develop an annual work plan and set
priorities; provide consumer education on understanding the
information released to the public; work with the Department of
Information Resources (DIR) in developing the system and maintain
DIR standards.

(b) Permits the council to employ or contract with the
department to employ an executive director and other staff; engage
professional consultants; adopt rules regarding which health care
facilities must provide data; and apply for and receive an
appropriation, donations or other funds from state or federal
government sources, or from other public or private sources, within
the limitations and conditions of legislative appropriation.

(d) Prohibits the council from taking action affecting or
relating to the validity, status or terms of a department
interagency agreement or contract without the board s approval.

(e) Requires the council to consider existing research and
initiatives being pursued by certain federal agencies and national
organizations in order to reduce duplication or inconsistencies.
Prohibits the council from adopting rules that would conflict with
or duplicate federally mandated data collection or requirements of
comparable scope.

Section 108.007. REVIEW POWERS. (a) Permits the council,
through the department, to inspect documents and records used by
data sources in providing health data to the council, subject to
reasonable council rules and guidelines. Authorizes the council to
compel providers to produce accurate documents and records.

(b) Allows the council to enter into memoranda of
understandings with state agencies, including the State Medicaid
Office and institutions of higher education, for the purposes of
sharing data, providing expertise, obtaining data for the council,
or making data available to the council. Requires any such
agreement to protect patient confidentiality.

Section 108.008. DUTIES OF THE DEPARTMENT. (a) Establishes
that the department is responsible for collecting data relating to
state health planning and development under Chapter 311 of this
Code.

(b) Requires the department to contract with the council to
collect data; provide administrative and legal assistance to the
council, in accordance with board rules and set out in the
contract; coordinate administrative duties with the council and
avoid duplication of collection efforts and other duties; give the
council access to data collected by the department when requested
by the council; submit or assist in the council s legislative
budget request; and work with the DIR in developing a implementing
the statewide health care data collection system and maintain
consistency with DIR standards.

(c) Prohibits the department from taking action affecting or
relating to the validity, status, or terms of a council interagency
agreement or contract without the council s approval.

Section 108.009. DATA SUBMISSION AND COLLECTION. (a)
Authorizes the council to collect and requires providers, except
for rural providers and individual physicians, to submit to the
council, or its designee, the data specified under this section.
Requires the data to be collected in a uniform manner that assures
data validity, consistency, compatibility; requires the data to be
managed using electronic data processing, if available.

(b) Requires the council to adopt rules for data submission
requirements in stages that will create an efficient data
collection system.

(d) Prohibits the council from collecting data from individual
physicians and specified physician groups (professional
associations, limited liability partnerships, or limited liability
companies) except those owning and operating health care facilities
in Texas. Clarifies that this subsection does not prohibit the
release of data about physicians collected from health care
facilities in accordance with this chapter.

(e) Requires the council to establish the department as the
single collection point for receipt of the data and, with approval
from the council and the board, allows the department to transfer
current data collection responsibilities to the system.

(f) Prohibits the council from requiring data submission more
frequently than quarterly, but allows providers to submit more
frequently.

(g) Requires the council to coordinate data collection with
the formats used by federally qualified health centers and
specifies how these centers shall submit data.

(h) Requires the council, to the extent feasible, to
coordinate with already existing data collection formats used by
providers. Requires the council to accept data in the National
Uniform Billing Committee format or other universally accepted
standardized forms approved by the council.

(i) Requires the council to adopt rules for alternate data
submission procedures for providers without electronic data
processing capacity.

(j) Requires the council to collect data and disseminate
reports on provider quality in accordance with Section 108.010.

(k) Requires the council s statewide health care data
collection system to identify health care charges, provider
quality, payer type, outcomes of services, and the use of services
by consumers.

(l) Requires the council to develop a plan to be used by the
department to support public and preventive health initiatives;
assist in delivery of primary and preventive health services; help
create benchmarks for measuring improvements in performance;
establish and maintain a system for collecting, storing, and
analyzing data for longitudinal, epidemiological, and policy impact
studies; and develop and use system-based protocols to identify at-risk individuals and populations.

(m) Requires the council to get needed information from public
records, when feasible.

(n) Requires the council to develop the system according to
Department of Information Resources standards.

Section 108.010. COLLECTION AND DISSEMINATION OF PROVIDER
QUALITY DATA. (a) Subject to Section 108.009, requires the council
to collect data reflecting provider quality using a methodology
developed through the council rulemaking process that identifies
and measures quality standards and complies with any federal
mandates.
(b) After a majority of the council is appointed, requires the
council to study and analyze initial methodologies for obtaining
provider quality data for at least one year. Requires the council
to adopt an initial methodology no later than January 1, 1997.
Allows the council to extend the deadline for adopting the initial
methodology if, by a two-thirds vote of the full council, it is
determined that additional time is needed.

(c) Requires the methodology to be consistent with other state
data collection methods, including methods used by HMOs such as the
Health Plan Employer Data Information Set (HEDIS), or other
universally accepted methods approved by the council.

(d) Requires the council to test the methodology by collecting
provider quality data for one year, subject to Section 108.009.
Allows the council to conduct this test using pilot methodologies.
After the first year of collection, requires the council to report
findings applicable to a provider to that provider and allow the
provider to review and comment on the data. Requires the council
to use this process to verify the accuracy of the data. After this
process is completed, requires quality outcome data for subsequent
reports to be published and made available to the public. Provides
that the council determine the appropriate time schedule for such
release.

(e) Clarifies that the council is not required to publish the
data in subsection (d) of this section, or reports based on that
data, if the council determines that the data does not provide the
intended result or is inaccurate or inappropriate for
dissemination. Clarifies that this does not affect the release of
data collected under Section 108.009.

(f) Requires the council to adopt rules allowing a provider to
submit written comment about the data to be released about the
provider and allows the council to attach the comments to public
release of the data.

(g) Requires the methodology for measuring provider quality to
include case-mix qualifiers, severity adjustment factors, and any
other factors necessary to accurately reflect provider quality.

(h) Requires release of provider quality data to comply with
Sections 108.011(d), (e), and (f), in addition to the conditions in
this section.

(i) Prohibits quality outcome reports from identifying
individual physicians by name, but permits them to be identified
using uniform physician identifiers to be designated by the
council.

Section 108.011. DATA DISSEMINATION AND PUBLICATION. (a)
Requires the council to promptly make the data available to all
persons requesting the data, subject to the restrictions specified
in Section 108.010 on provider quality and in Section 108.013 on
confidentiality.

(b) Requires the council to issue reports to the governor,
legislature, and the public, subject to certain restrictions on
access to data specified by this Act. Requires certain reports to
be issued annually.

(c) Requires the council to issue reports about providers on
issues such as incidence rates of selected procedures and provider
quality, subject to certain restrictions on access to data
specified by this Act. Requires these reports to identify
individual providers and to give comparative information about
providers. Prohibits identification of individual physicians by
name, but requires them to be identified using uniform physician
identifiers. Requires the council by rule to designate the
characters to be used in the uniform physician identifiers.

(d) Requires the council to adopt procedures to verify the
accuracy of data before a report using the data is released to the
public.

(e) Requires the council to notify an individual provider if
information has been requested and provided on that specific
provider. Clarifies that the provider is not authorized to
challenge or interfere with the release of such data.
(f) Requires any report issued by the council to include a
reasonable review and comment period prior to publication.

Section 108.012. COMPUTER ACCESS TO DATA. (a) Requires the
council to provide computer-to-computer access to the data and to
maintain patient confidentiality as specified in Section 108.013.

(b) Authorizes the council to charge a fee for the data which
may reflect the quantity of information provided and the expense
incurred for collecting and providing it. Requires these fees to be
deposited in a designated account in the general revenue fund as
specified in Section 108.015. Prohibits the council from charging
other state agencies fees for the data.

Section 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
(a) Requires the council to use the data collected for the benefit
of the public. Subjects the council to the open records law.
Requires the council to make decisions on the release of
information in favor of access, subject to council rule and
limitations established by this chapter.

(b) Requires the council to designate by rule the characters
of the uniform patient identifiers.

(c) Unless specifically authorized by this chapter, prohibits
the council from releasing or allowing access to data: that could
identify a patient or physician, or the zip code of the patient s
residence; disclosing provider discounts (the differences between
payments accepted by providers and their billed charges); or
relating to payments made to an identified provider by a payer.

(d) Subjects all data collected and used by the department and
the council under this chapter to the confidentiality provisions
and criminal penalties specified in Sections 311.037 and 81.103 of
the Health and Safety Code and Section 5.08 of the Medical Practice
Act.

(e) Establishes that patient and physician information and
compilations, reports, or analyses using such information that
identify individual patients or physicians are not subject to
discovery, subpoena, or other means of legal compulsion for release
except as provided by this section, nor is the information
admissible in any civil, administrative, or criminal proceedings.

(f) Notwithstanding Subsection (c)(1) of this section,
Subsection (f) permits zip code information to be used to analyze
data on a geographic basis.

Section 108.014. CIVIL PENALTY. (a) Establishes a civil
penalty of not more than $10,000 for a person who knowingly or
negligently releases data in violation of this chapter.

(b) Creates a civil penalty between $1,000 and $10,000 for
each act of violation for failure to supply data as required under
Section 108.009 or 108.010.

Section 108.015. DESIGNATED ACCOUNT. Establishes a
designated account in the general revenue fund for all grants,
contributions, and fees collected by the council. Requires the
funds in this account to be carried over between fiscal years and
bienniums.

Section 108.016. CONFLICT OF INTEREST. Prohibits the council
from accepting donations from persons required to provide data
under this chapter or from a person or business who provides goods
or services to the council.

SECTION 2. Amends Section 311.032(a), Health and Safety Code, by
removing the requirement for the department to establish a
reporting and collection system for patient discharge data.

SECTION 3. Amends 311.035(c), Health and Safety Code, by removing
the requirement for the department to collect mental health and
chemical dependency hospital discharge data collected under Section
311.0335 of the Health and Safety Code.

SECTION 4. Amends Subchapter C, Chapter 2054, Government Code, by
adding a new Section 2054.0541 requiring the Department of
Information Resources to assist the council and the department with
planning, analyses, and management functions relating to the
procurement, use, and implementation of the system.

SECTION 5. Repeals Section 311.035(b), Health and Safety Code,
which requires the department to publish reports on the use of
hospital services using the hospital discharge data collected by
the department and repeals Section 311.034, Health and Safety Code,
which authorizes the department to establish a sampling method to
collect hospital discharge abstract records and specifies the type
of data required in the abstract records.

SECTION 6. Requires the governor to make appointments to the
council as soon as practicable after the effective data of the Act.
Establishes the manner in which the governor shall make the council
appointments with staggered terms.

SECTION 7. Requires the council to make the recommendations
relating to consolidation of existing health data collection
programs no later than December 1, 1996.

SECTION 8. Effective date is September 1, 1995.

SECTION 9. Emergency clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

Substantive changes in C.S.H.B. 1048 include the following:

The definition of "rural area" has been replaced by "rural
provider;" the definition of "uniform physician identifier" has
been added.

The composition of the Texas Health Care Information Council has
been revised to include two consumer representatives (formerly
three), two representatives of hospitals (formerly three of health
care facilities) and three representatives of physicians (formerly
one).

The council will be required to appoint technical advisory
committees, provide consumer education to the public and work with
the Department of Information Resources in developing and
implementing its health care data collection system.

The council may not collect data from individual physicians or
groups of physicians, excluding a physician-owned health care
facility. However, this does not prohibit the release of data about
physicians that has been collected from a health care facility. At
the same time, physicians will not be identified by name, but
through a uniform patient identifier designated by the council.

The council shall adopt the initial methodology for obtaining
provider quality data not later than January 1, 1997, but may not
adopt the methodology before the first anniversary of the date on
which the majority of the council is appointed. This deadline may
be extended if two-thirds of the full council deems it necessary.

The council may not accept a donation from a person required to
provide data or from a person or business that provides goods or
services to the council for composition.

SUMMARY OF COMMITTEE ACTION

H.B. 1048 was considered by the committee on March 21, 1995.
The committee considered a complete substitute for the bill. No
action was taken on the substitute.

The following persons testified in favor of the bill:
Joe A. Da Silva, representing self and Texas Hospital Association.
John Rodrigue, representing self and Texas Business Group on
Health.
Lisa McGiffert, representing self and Consumers Union.
Henry Noey, representing self.
Richard Levy, representing Texas AFL-CIO.
James G. Cummings, representing Texas Business Group on Health.
Ann Heiligenstein, representing Conference of Catholic Health
Facilities.
Jacqueline Shannon, representing Texas Alliance for the Mentally
Ill.

The bill was left pending in committee on March 21, 1995.

The bill was considered by the committee in a public hearing on
April 4, 1995, as pending business before the committee. The
committee considered a complete substitute for the bill. The
substitute was adopted without objection. The bill was reported
favorably as substituted, with the recommendation that it do pass
and be printed, by a record vote of 9 Ayes, 0 Nays, 0 PNV, and 0
Absent.