By Maxey, Hirschi, McDonald H.B. No. 1048
74R4833 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the creation of the Texas Health Care Information
1-3 Office and the Texas Health Care Information Council; providing
1-4 civil penalties.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subtitle E, Title 2, Health and Safety Code, is
1-7 amended by adding Chapter 108 to read as follows:
1-8 CHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCIL AND OFFICE
1-9 Sec. 108.001. CREATION OF COUNCIL AND OFFICE. The Texas
1-10 Health Care Information Council and the Texas Health Care
1-11 Information Office are created. The office, under the direction of
1-12 the council, shall administer this chapter and report to the
1-13 governor, the legislature, and the public.
1-14 Sec. 108.002. DEFINITIONS. In this chapter:
1-15 (1) "Board" means the Texas Board of Health.
1-16 (2) "Charge" or "rate" means the amount billed by a
1-17 provider for specific procedures or services provided to a patient
1-18 before any adjustment for contractual allowances. The term does
1-19 not include copayment charges to health maintenance organization
1-20 enrollees by providers paid by capitation or salary in a health
1-21 maintenance organization.
1-22 (3) "Council" means the Texas Health Care Information
1-23 Council.
1-24 (4) "Covered service" means any health care service or
2-1 procedure provided in or by a health care facility, including the
2-2 services of a physician or another licensed provider.
2-3 (5) "Data" means data collected by the office under
2-4 Section 108.009 in the form initially received.
2-5 (6) "Department" means the Texas Department of Health.
2-6 (7) "Health care facility" means:
2-7 (A) a hospital;
2-8 (B) an ambulatory surgical center licensed under
2-9 Chapter 243;
2-10 (C) a chemical dependency treatment facility
2-11 licensed under Chapter 464;
2-12 (D) a renal dialysis facility;
2-13 (E) a diagnostic imaging center;
2-14 (F) a freestanding radiation therapy center;
2-15 (G) a clinical laboratory;
2-16 (H) a cardiac catheterization laboratory;
2-17 (I) a physical rehabilitation center;
2-18 (J) a lithotripsy center;
2-19 (K) a birthing center;
2-20 (L) a subacute care facility;
2-21 (M) a rural health clinic;
2-22 (N) a federally qualified health center as
2-23 defined by 42 U.S.C. Section 1396d; or
2-24 (O) another outpatient diagnostic or treatment
2-25 facility.
2-26 (8) "Health maintenance organization" means an
2-27 organization as defined in Section 2, Texas Health Maintenance
3-1 Organization Act (Article 20A.02, Vernon's Texas Insurance Code).
3-2 (9) "Hospital" means a public, for-profit, or
3-3 nonprofit institution licensed in this state that is a general or
3-4 special hospital, private mental hospital, chronic disease
3-5 hospital, or other type of hospital.
3-6 (10) "Office" means the Texas Health Care Information
3-7 Office.
3-8 (11) "Physician" means an individual licensed under
3-9 the laws of this state to practice medicine under the Medical
3-10 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
3-11 (12) "Provider" means a physician, health care
3-12 facility, or health maintenance organization.
3-13 (13) "Provider quality" means the extent to which a
3-14 provider renders care that, within the capabilities of modern
3-15 medicine, obtains for patients medically acceptable health outcomes
3-16 and prognoses, after severity adjustment.
3-17 (14) "Rural area" means a county with a population
3-18 density of not greater than 100 persons per square mile as defined
3-19 by the Census Bureau of the United States Department of Commerce.
3-20 (15) "Severity adjustment" means a method to stratify
3-21 patient groups by degrees of illness and mortality.
3-22 (16) "Uniform patient identifier" means a number
3-23 composed of numeric, alpha, or alphanumeric characters that has
3-24 been assigned to identify a patient.
3-25 Sec. 108.003. COUNCIL COMPOSITION; EXPENSES. (a) The
3-26 council is composed of three nonvoting ex officio state agency
3-27 members and 15 voting members appointed by the governor and
4-1 confirmed by the senate as follows:
4-2 (1) the commissioner of health;
4-3 (2) the commissioner of health and human services;
4-4 (3) the commissioner of insurance;
4-5 (4) three representatives of the business community,
4-6 with at least one representing small businesses, who are purchasers
4-7 of health care but who are not involved in the provision of health
4-8 care or health insurance;
4-9 (5) two representatives from labor;
4-10 (6) three representatives of consumers who are not
4-11 professionally involved in the purchase or provision of health care
4-12 or health care insurance;
4-13 (7) three representatives of health care facilities,
4-14 with at least two representing hospitals;
4-15 (8) one representative of health maintenance
4-16 organizations;
4-17 (9) one representative of physicians; and
4-18 (10) two public members who are not professionally
4-19 involved in the purchase or provision of health care or health care
4-20 insurance and who have expertise in:
4-21 (A) health planning;
4-22 (B) health economics;
4-23 (C) provider quality assurance; or
4-24 (D) statistics or health data management.
4-25 (b) The chairman is appointed by and serves at the pleasure
4-26 of the governor. Members annually shall elect a vice chairman.
4-27 (c) A majority of voting members constitutes a quorum for
5-1 the transaction of any business. An act by the majority of the
5-2 voting members present at any meeting at which there is a quorum is
5-3 considered to be an act of the council.
5-4 (d) The council may appoint technical advisory committees or
5-5 subcommittees of the council or elect any officers subordinate to
5-6 those provided for in Subsection (b).
5-7 (e) Members of the council do not receive a salary or per
5-8 diem allowance for serving as members of the council but shall be
5-9 reimbursed for actual and necessary expenses incurred in the
5-10 performance of their duties, which may include reimbursement of
5-11 travel and living expenses while engaged in council business.
5-12 (f) Appointments to the council shall be made without regard
5-13 to the race, color, disability, sex, sexual orientation, religion,
5-14 age, or national origin of appointees. Additionally, in making the
5-15 appointments to the council, the governor shall consider
5-16 geographical representation.
5-17 (g) A person may not serve as a member of the council if the
5-18 person is required to register as a lobbyist under Chapter 305,
5-19 Government Code, because of the person's activities for
5-20 compensation on behalf of a profession related to the operation of
5-21 the council.
5-22 Sec. 108.004. MEETINGS. (a) The council, council
5-23 subcommittees, and technical advisory committees are subject to the
5-24 open meetings law, Chapter 551, Government Code.
5-25 (b) The council shall meet as often as necessary, but not
5-26 less often than quarterly, to perform its duties under this
5-27 chapter.
6-1 (c) The council shall publish a notice of its meetings in at
6-2 least four newspapers of general circulation in this state.
6-3 Sec. 108.005. TERMS. (a) The terms of the agency members
6-4 are concurrent with their terms of office. The appointed council
6-5 members serve six-year staggered terms, with the terms of five
6-6 members expiring September 1 of each odd-numbered year.
6-7 (b) An appointed member may not serve more than two full
6-8 consecutive terms.
6-9 (c) It is a ground for removal from the council if a member
6-10 of the council:
6-11 (1) does not have at the time of appointment the
6-12 qualifications required by Section 108.003;
6-13 (2) does not maintain during service the
6-14 qualifications required by Section 108.003;
6-15 (3) cannot discharge the member's duties for a
6-16 substantial part of the term for which the member is appointed
6-17 because of illness or disability; or
6-18 (4) fails to attend at least one-half of the regularly
6-19 scheduled meetings that the member is eligible to attend during a
6-20 calendar year.
6-21 Sec. 108.006. POWERS AND DUTIES OF COUNCIL AND OFFICE. (a)
6-22 The council shall develop a statewide health care data collection
6-23 system to collect health care charges, provider quality, and
6-24 outcome data to facilitate the promotion and accessibility of
6-25 cost-effective, quality health care. The council shall:
6-26 (1) control the collection, dissemination, and
6-27 analysis of data under this chapter;
7-1 (2) contract for the department to collect the data
7-2 under this chapter;
7-3 (3) adopt policies and rules necessary to carry out
7-4 this chapter, including rules concerning data collection
7-5 requirements;
7-6 (4) to the extent possible, build on and not duplicate
7-7 other data collection required by law or by board rule;
7-8 (5) working with appropriate agencies, review health
7-9 data collection programs in this state and recommend, where
7-10 appropriate, consolidation of the programs and any legislation
7-11 necessary to effect the consolidation;
7-12 (6) assure that data collected on health care charges
7-13 is made available and accessible to interested persons;
7-14 (7) prescribe by rule a format for all providers to
7-15 submit data consistent with Section 108.009; and
7-16 (8) adopt by rule and implement a methodology to
7-17 collect and disseminate data reflecting provider quality in
7-18 accordance with Section 108.010.
7-19 (b) The council may:
7-20 (1) employ or contract with the department to employ
7-21 an executive director and other staff for the office necessary to
7-22 comply with this chapter and rules adopted under this chapter;
7-23 (2) engage professional consultants as it considers
7-24 necessary to the performance of its duties;
7-25 (3) adopt rules clarifying which health care
7-26 facilities must provide data under this chapter; and
7-27 (4) apply for and receive on behalf of the office any
8-1 appropriation, donation, or other funds from the state or federal
8-2 government or any other public or private source, subject to
8-3 limitations and conditions provided by legislative appropriation.
8-4 (c) The council may not establish or recommend rates of
8-5 payment for health care services.
8-6 (d) The office shall:
8-7 (1) make reports to the legislature, the governor, and
8-8 the public on:
8-9 (A) the charges and rate of change in the
8-10 charges for health care in this state;
8-11 (B) the effectiveness of the office in carrying
8-12 out the legislative intent of this chapter;
8-13 (C) if applicable, any recommendations on the
8-14 need for further legislation; and
8-15 (D) the quality and effectiveness of health care
8-16 and access to health care for all citizens of this state;
8-17 (2) develop an annual work plan and establish
8-18 priorities to accomplish its duties; and
8-19 (3) if feasible and agreed to by the department, share
8-20 legal and administrative personnel with the department.
8-21 (e) The council or office may not take an action that
8-22 affects or relates to the validity, status, or terms of a
8-23 department interagency agreement or a contract without the
8-24 department's approval.
8-25 (f) In the collection of data, the council and office shall
8-26 consider the research and initiatives being pursued by the United
8-27 States Department of Health and Human Services and the Joint
9-1 Commission on Accreditation of Healthcare Organizations to reduce
9-2 potential duplication or inconsistencies. The council may not
9-3 adopt rules that would conflict with any federally mandated data
9-4 collection programs or requirements of comparable scope.
9-5 Sec. 108.007. REVIEW POWERS. (a) The office or the
9-6 office's representative, subject to reasonable rules and
9-7 guidelines, may inspect documents and records used by data sources
9-8 that are required to compile data and reports. The office may
9-9 compel providers to produce accurate documents and records.
9-10 (b) The council may enter into a memorandum of understanding
9-11 with a state agency, including the division of the Health and Human
9-12 Services Commission responsible for the state Medicaid program, or
9-13 with a school of public health or another institution of higher
9-14 education, to share data and expertise, to obtain data for the
9-15 council, or to make data available to the council.
9-16 Sec. 108.008. DUTIES OF DEPARTMENT. (a) The department, as
9-17 the state health planning and development agency under Chapter 104,
9-18 is responsible for the collection of data under Chapter 311.
9-19 (b) The department shall:
9-20 (1) provide administrative assistance to the office in
9-21 accordance with rules adopted by the council and agreed on by the
9-22 department;
9-23 (2) coordinate administrative responsibilities with
9-24 the office to avoid unnecessary duplication of the collection of
9-25 data and other duties;
9-26 (3) give the office access to data collected by the
9-27 department on request of the office; and
10-1 (4) submit or assist in the office's budget request to
10-2 the legislature, at the council's request.
10-3 (c) The department may provide the office with
10-4 administrative services and materials as requested by the council.
10-5 (d) The department may not take an action that affects or
10-6 relates to the validity, status, or terms of an office interagency
10-7 agreement or a contract without the council's approval.
10-8 Sec. 108.009. DATA SUBMISSION AND COLLECTION. (a) The
10-9 office may collect, and, except as provided by Subsection (c),
10-10 providers shall submit to the office or another entity as
10-11 determined by the council, all data required by this section. The
10-12 information shall be collected according to uniform submission
10-13 formats, coding systems, and other technical specifications
10-14 necessary to make the incoming data substantially valid,
10-15 consistent, compatible, and manageable using electronic data
10-16 processing, if available.
10-17 (b) The council shall adopt rules to implement the data
10-18 submission requirements imposed by Subsection (a) in appropriate
10-19 stages to allow for the development of efficient systems for the
10-20 collection and submission of the data.
10-21 (c) A provider in a rural area may, but is not required to,
10-22 provide the data required by this section.
10-23 (d) The council shall establish a single collection point
10-24 for receipt of data from providers. With the approval of the
10-25 council and the board, the department may transfer collection of
10-26 any data required to be collected by the department under any other
10-27 law.
11-1 (e) The office may not require providers to submit data more
11-2 frequently than quarterly, but providers may submit data on a more
11-3 frequent basis.
11-4 (f) The office shall, to the extent feasible, coordinate
11-5 data collection with the data collection formats used by hospitals
11-6 and other providers. The office shall accept data in the format
11-7 developed by the National Uniform Billing Committee (Uniform
11-8 Hospital Billing Form UB 92, UB 82, and HCFA-1500 or their
11-9 successors) or other universally accepted standardized forms
11-10 approved by the council.
11-11 (g) The council shall develop by rule alternate data
11-12 submission procedures for entities that do not possess electronic
11-13 data processing capacity.
11-14 (h) The office shall collect data and disseminate reports
11-15 reflecting provider quality in accordance with Section 108.010.
11-16 (i) In developing the statewide health care data collection
11-17 system, the council shall identify health care data elements
11-18 relating to health care charges, provider quality, payer type, the
11-19 outcomes of health care services, and the use of health care
11-20 services by consumers.
11-21 (j) Except as otherwise provided by law and in accordance
11-22 with rules adopted by the council, the office may collect and
11-23 providers shall submit additional health care data to be used by
11-24 the department to:
11-25 (1) support public health and preventive health
11-26 initiatives;
11-27 (2) assist in the delivery of primary and preventive
12-1 health care services;
12-2 (3) facilitate the establishment of appropriate
12-3 benchmark data to measure performance improvements;
12-4 (4) establish and maintain a systematic approach for
12-5 the collection, storage, and analysis of health care data for
12-6 longitudinal, epidemiological, and policy impact studies; and
12-7 (5) develop and use system-based protocols to identify
12-8 individuals and populations at risk.
12-9 (k) To the extent feasible, the office shall obtain from
12-10 public records the information that is available from those
12-11 records.
12-12 Sec. 108.010. COLLECTION AND DISSEMINATION OF PROVIDER
12-13 QUALITY DATA. (a) Subject to Section 108.009, the office shall
12-14 collect data reflecting provider quality based on a methodology
12-15 established through the council's rulemaking process. The
12-16 methodology shall identify and measure quality standards and adhere
12-17 to any federal mandates.
12-18 (b) Within the first 12 months of operation, the council
12-19 shall develop the initial methodology for the collection of
12-20 provider quality data.
12-21 (c) The methodology must be consistent with other data
12-22 collection methods used in this state, including methods used by
12-23 health maintenance organizations such as the Health Employer Data
12-24 Information System provided by the National Committee on Quality
12-25 Assurance, or other universally accepted methods approved by the
12-26 council.
12-27 (d) After collecting provider quality data for one year, the
13-1 council shall report its findings to the appropriate providers and
13-2 allow them to review and comment on the initial quality outcome
13-3 data. The council shall verify the accuracy of the data during
13-4 this review and revision process. After the review and revision
13-5 process, quality outcome data for subsequent reports shall be
13-6 published and made available to the public, on a time schedule the
13-7 council considers appropriate.
13-8 (e) The methodology adopted by the council for measuring
13-9 quality shall include case-mix qualifiers, severity adjustment
13-10 factors, and any other factors necessary to accurately reflect
13-11 provider quality.
13-12 (f) In addition to the requirements of this section, any
13-13 release of provider quality data shall comply with Sections
13-14 108.011(d), (e), and (f).
13-15 Sec. 108.011. DATA DISSEMINATION AND PUBLICATION. (a) The
13-16 office shall promptly provide data to those requesting it, subject
13-17 to the restrictions on access to council data prescribed by
13-18 Sections 108.010 and 108.013.
13-19 (b) Subject to the restrictions on access to council data
13-20 prescribed by Sections 108.010 and 108.013, and using the data
13-21 collected under Section 108.009 and other data, records, and
13-22 matters of record available to it, the office shall prepare and
13-23 issue reports to the governor, the legislature, and the public as
13-24 provided by this section and Section 108.006(d). The office must
13-25 issue the reports at least annually.
13-26 (c) The office shall prepare and issue reports that provide
13-27 information relating to providers, such as the incidence rate of
14-1 selected medical or surgical procedures and the provider quality.
14-2 The reports must provide the data in a manner that identifies
14-3 individual providers and that identifies any data elements that
14-4 vary significantly for a provider from norms for all providers.
14-5 (d) The council shall adopt procedures to verify the
14-6 accuracy of the data before a report containing the data is
14-7 released to the public.
14-8 (e) If provider data is requested from the office for a
14-9 specific provider, the provider shall be notified before the
14-10 release of the data. This subsection does not authorize the
14-11 provider to challenge or interfere with the release of that data.
14-12 (f) A report issued by the office shall include a reasonable
14-13 review and comment period before final publication of the report.
14-14 Sec. 108.012. COMPUTER ACCESS TO DATA. (a) The office
14-15 shall provide a means for computer-to-computer access to the data.
14-16 All reports shall maintain patient confidentiality as provided by
14-17 Section 108.013.
14-18 (b) The office may charge a person requesting data a fee for
14-19 the data. The fees may reflect the quantity of information
14-20 provided and the expense incurred by the office in collecting and
14-21 providing the data. Fees collected under this section shall be
14-22 deposited in the designated account in the general revenue fund
14-23 created in Section 108.015. The office may not charge a fee for
14-24 providing data to another state agency.
14-25 Sec. 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
14-26 (a) The data received by the office shall be used by the office
14-27 for the benefit of the public. Subject to specific limitations
15-1 established by council rule, the office shall make determinations
15-2 on requests for information in favor of access.
15-3 (b) Unless specifically authorized by this chapter, the
15-4 office may not release and a person or entity may not gain access
15-5 to any data:
15-6 (1) that could reasonably be expected to reveal the
15-7 identity of a patient or that reveals the zip code of a patient's
15-8 primary residence;
15-9 (2) disclosing discounts or differentials between
15-10 payments accepted by providers for services and their billed
15-11 charges obtained by identified payers from identified providers
15-12 unless comparable data on all other payers is also released and the
15-13 office determines that the release of that information is not
15-14 prejudicial or inequitable to any individual payer or provider or
15-15 group, considering the fact that the office is primarily concerned
15-16 with the analysis and dissemination of payments to providers and
15-17 not with discounts; or
15-18 (3) relating to actual payments to an identified
15-19 provider made by a payer other than a payer requesting data on the
15-20 group for which it purchases or otherwise provides covered services
15-21 or an entity entitled to that payer's data.
15-22 (c) All data collected and used by the department and the
15-23 office under this chapter is subject to the confidentiality
15-24 provisions and criminal penalties of:
15-25 (1) Section 311.037;
15-26 (2) Section 81.103; and
15-27 (3) Section 5.08, Medical Practice Act (Article 4495b,
16-1 Vernon's Texas Civil Statutes).
16-2 (d) Information on patients and compilations, reports, or
16-3 analyses produced from the information collected that identify
16-4 patients are not:
16-5 (1) subject to discovery, subpoena, or other means of
16-6 legal compulsion for release to any person or entity except as
16-7 provided by this section; or
16-8 (2) admissible in any civil, administrative, or
16-9 criminal proceeding.
16-10 (e) Notwithstanding Subsection (b)(1), the council may use
16-11 zip code information to analyze data on a geographic basis.
16-12 Sec. 108.014. CIVIL PENALTY. (a) A person who knowingly or
16-13 negligently releases data in violation of this chapter is liable
16-14 for a civil penalty of not more than $10,000.
16-15 (b) A person who fails to supply data under Section 108.009
16-16 is liable for a civil penalty of not less than $1,000 or more than
16-17 $10,000 for each act of violation.
16-18 (c) The attorney general, at the request of the office,
16-19 shall enforce this chapter.
16-20 Sec. 108.015. DESIGNATED ACCOUNT. A designated account is
16-21 in the general revenue fund for all grants and contributions of
16-22 money to the office and all fees collected by the office.
16-23 Designated account funds shall be carried over from fiscal year to
16-24 fiscal year and from biennium to biennium.
16-25 SECTION 2. Section 311.032(a), Health and Safety Code, is
16-26 amended to read as follows:
16-27 (a) The department shall establish a uniform reporting and
17-1 collection system for hospital financial and<,> utilization<, and
17-2 patient discharge> data.
17-3 SECTION 3. Section 311.035(c), Health and Safety Code, is
17-4 amended to read as follows:
17-5 (c) The department shall enter into an interagency agreement
17-6 with the Texas Department of Mental Health and Mental Retardation,
17-7 Texas Commission on Alcohol and Drug Abuse, and Texas Department of
17-8 Insurance relating to the mental health and chemical dependency
17-9 <hospital discharge> data collected under Section 311.0335. The
17-10 agreement shall address the collection, analysis, and sharing of
17-11 the data by the agencies.
17-12 SECTION 4. The following laws are repealed:
17-13 (1) Section 311.035(b), Health and Safety Code; and
17-14 (2) Section 311.034, Health and Safety Code.
17-15 SECTION 5. (a) The governor shall make appointments to the
17-16 Texas Health Care Information Council as soon as practicable after
17-17 the effective date of this Act.
17-18 (b) The governor shall make the initial appointments to the
17-19 Texas Health Care Information Council as follows:
17-20 (1) one representative of business, one consumer
17-21 representative, one representative of health care facilities, the
17-22 representative of physicians, and one public member serve terms
17-23 expiring September 1, 1997;
17-24 (2) one representative from labor, one representative
17-25 of business, one consumer representative, one representative of
17-26 health care facilities, and the representative of a health
17-27 maintenance organization serve terms expiring September 1, 1999;
18-1 and
18-2 (3) one representative from labor, one representative
18-3 of business, one consumer representative, one representative of
18-4 health care facilities, and one public member serve terms expiring
18-5 September 1, 2001.
18-6 SECTION 6. Not later than December 1, 1996, the Texas Health
18-7 Care Information Council appointed under Chapter 108, Health and
18-8 Safety Code, as added by this Act, shall make recommendations under
18-9 Section 108.006(a)(5) of that code relating to consolidation of
18-10 health data collection programs existing on the effective date of
18-11 this Act, together with proposed legislation necessary to effect
18-12 any recommended consolidation.
18-13 SECTION 7. This Act takes effect September 1, 1995.
18-14 SECTION 8. The importance of this legislation and the
18-15 crowded condition of the calendars in both houses create an
18-16 emergency and an imperative public necessity that the
18-17 constitutional rule requiring bills to be read on three several
18-18 days in each house be suspended, and this rule is hereby suspended.