By Patterson S.B. No. 1143
74R7235 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 Council; providing civil penalties.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subtitle E, Title 2, Health and Safety Code, is
1-6 amended by adding Chapter 108 to read as follows:
1-7 CHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCIL
1-8 Sec. 108.001. CREATION OF COUNCIL. The Texas Health Care
1-9 Information Council shall administer this chapter and report to the
1-10 governor, the legislature, and the public.
1-11 Sec. 108.002. DEFINITIONS. In this chapter:
1-12 (1) "Board" means the Texas Board of Health.
1-13 (2) "Charge" or "rate" means the amount billed by a
1-14 provider for specific procedures or services provided to a patient
1-15 before any adjustment for contractual allowances. The term does
1-16 not include copayment charges to health maintenance organization
1-17 enrollees by providers paid by capitation or salary in a health
1-18 maintenance organization.
1-19 (3) "Council" means the Texas Health Care Information
1-20 Council.
1-21 (4) "Data" means information collected under Section
1-22 108.009 in the form initially received.
1-23 (5) "Department" means the Texas Department of Health.
1-24 (6) "Health care facility" means:
2-1 (A) a hospital;
2-2 (B) an ambulatory surgical center licensed under
2-3 Chapter 243;
2-4 (C) a chemical dependency treatment facility
2-5 licensed under Chapter 464;
2-6 (D) a renal dialysis facility;
2-7 (E) a birthing center;
2-8 (F) a rural health clinic; or
2-9 (G) a federally qualified health center as
2-10 defined by 42 U.S.C. Section 1396d(l)(2)(B).
2-11 (7) "Health maintenance organization" means an
2-12 organization as defined in Section 2, Texas Health Maintenance
2-13 Organization Act (Article 20A.02, Vernon's Texas Insurance Code).
2-14 (8) "Hospital" means a public, for-profit, or
2-15 nonprofit institution licensed in this state that is a general or
2-16 special hospital, private mental hospital, chronic disease
2-17 hospital, or other type of hospital.
2-18 (9) "Outcome data" means measures related to the
2-19 provision of care, including:
2-20 (A) patient demographic information;
2-21 (B) patient length of stay;
2-22 (C) mortality;
2-23 (D) co-morbidity;
2-24 (E) complications;
2-25 (F) charges; and
2-26 (G) patient satisfaction.
2-27 (10) "Physician" means an individual licensed under
3-1 the laws of this state to practice medicine under the Medical
3-2 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
3-3 (11) "Provider" means a physician, health care
3-4 facility, or health maintenance organization.
3-5 (12) "Provider quality" means the extent to which a
3-6 provider renders care that, within the capabilities of modern
3-7 medicine, obtains for patients medically acceptable health outcomes
3-8 and prognoses, after severity adjustment.
3-9 (13) "Rural provider" means a provider located in:
3-10 (A) a county with a population of not more than
3-11 35,000;
3-12 (B) those portions of extended cities that the
3-13 United States Bureau of the Census has determined to be rural; or
3-14 (C) an area that is not delineated as an
3-15 urbanized area by the United States Bureau of the Census.
3-16 (14) "Severity adjustment" means a method to stratify
3-17 patient groups by degrees of illness and mortality.
3-18 (15) "Uniform patient identifier" means a number
3-19 composed of numeric, alpha, or alphanumeric characters.
3-20 Sec. 108.003. COUNCIL COMPOSITION; EXPENSES. (a) The
3-21 council is composed of three nonvoting ex officio state agency
3-22 members and 15 members appointed by the governor and lieutenant
3-23 governor in accordance with this section.
3-24 (b) The nonvoting ex officio members of the council are:
3-25 (1) the commissioner of public health;
3-26 (2) the commissioner of health and human services; and
3-27 (3) the commissioner of insurance.
4-1 (c) The governor shall appoint the following members of the
4-2 council:
4-3 (1) two representatives of the business community, at
4-4 least one of whom represents small businesses, who are purchasers
4-5 of health care but who are not involved in the provision of health
4-6 care or health insurance;
4-7 (2) two representatives of consumers who are not
4-8 professionally involved in the provision of health care or health
4-9 insurance;
4-10 (3) one representative of hospitals;
4-11 (4) one representative of health care facilities other
4-12 than hospitals;
4-13 (5) one representative of labor; and
4-14 (6) one member who is not professionally involved in
4-15 the purchase or provision of health care or health care insurance
4-16 and who has expertise in:
4-17 (A) health planning;
4-18 (B) health economics;
4-19 (C) provider quality assurance; or
4-20 (D) statistics or health data management.
4-21 (d) The lieutenant governor shall appoint the following
4-22 members of the council:
4-23 (1) one representative of the business community who
4-24 is a purchaser of health care but who is not involved in the
4-25 provision of health care or health insurance;
4-26 (2) one representative of consumers who is not
4-27 professionally involved in the provision of health care or health
5-1 insurance;
5-2 (3) one representative of hospitals;
5-3 (4) one representative of health maintenance
5-4 organizations;
5-5 (5) one representative of labor;
5-6 (6) one representative of physicians; and
5-7 (7) one member who is not professionally involved in
5-8 the purchase or provision of health care or health care insurance
5-9 and who has expertise in:
5-10 (A) health planning;
5-11 (B) health economics;
5-12 (C) provider quality assurance; or
5-13 (D) statistics or health data management.
5-14 (e) The chairman is appointed by and serves at the pleasure
5-15 of the governor. Members annually shall elect a vice chairman.
5-16 (f) A majority of voting members constitutes a quorum for
5-17 the transaction of any business. An act by the majority of the
5-18 voting members present at any meeting at which there is a quorum is
5-19 considered to be an act of the council.
5-20 (g) The council may appoint technical advisory committees or
5-21 subcommittees of the council or elect any officers subordinate to
5-22 those provided for in Subsection (e).
5-23 (h) Members of the council do not receive a salary or per
5-24 diem allowance for serving as members of the council but shall be
5-25 reimbursed for actual and necessary expenses incurred in the
5-26 performance of their duties, which may include reimbursement of
5-27 travel and living expenses while engaged in council business.
6-1 (i) Appointments to the council shall be made without regard
6-2 to the race, color, disability, sex, sexual orientation, religion,
6-3 age, or national origin of appointees. Additionally, in making the
6-4 appointments to the council, the governor shall consider
6-5 geographical representation.
6-6 (j) A person may not serve as a member of the council if the
6-7 person is required to register as a lobbyist under Chapter 305,
6-8 Government Code, because of the person's activities for
6-9 compensation on behalf of a profession related to the operation of
6-10 the council.
6-11 Sec. 108.004. MEETINGS. (a) The council, council
6-12 subcommittees, and technical advisory committees are subject to the
6-13 open meetings law, Chapter 551, Government Code.
6-14 (b) The council shall meet as often as necessary, but not
6-15 less often than quarterly, to perform its duties under this
6-16 chapter.
6-17 (c) The council shall publish a notice of its meetings in at
6-18 least four newspapers of general circulation in this state.
6-19 Sec. 108.005. TERMS. (a) The terms of the agency members
6-20 are concurrent with their terms of office. The appointed council
6-21 members serve six-year staggered terms, with the terms of five
6-22 members expiring September 1 of each odd-numbered year.
6-23 (b) An appointed member may not serve more than two full
6-24 consecutive terms.
6-25 (c) It is a ground for removal from the council if a member
6-26 of the council:
6-27 (1) does not have at the time of appointment the
7-1 qualifications required by Section 108.003;
7-2 (2) does not maintain during service the
7-3 qualifications required by Section 108.003;
7-4 (3) cannot discharge the member's duties for a
7-5 substantial part of the term for which the member is appointed
7-6 because of illness or disability; or
7-7 (4) fails to attend at least one-half of the regularly
7-8 scheduled meetings that the member is eligible to attend during a
7-9 calendar year.
7-10 Sec. 108.006. POWERS AND DUTIES OF COUNCIL. (a) The
7-11 council shall develop a statewide health care data collection
7-12 system to collect health care charges, utilization, provider
7-13 quality data, and outcome data to facilitate the promotion and
7-14 accessibility of cost-effective, good quality health care. The
7-15 council shall:
7-16 (1) direct the collection, dissemination, and analysis
7-17 of data under this chapter;
7-18 (2) contract with the department to collect the data
7-19 under this chapter;
7-20 (3) adopt policies and rules necessary to carry out
7-21 this chapter, including rules concerning data collection
7-22 requirements;
7-23 (4) build on and not duplicate other data collection
7-24 required by state or federal law, by an accreditation organization,
7-25 or by board rule;
7-26 (5) working with appropriate agencies, review health
7-27 data collection programs in this state and recommend, where
8-1 appropriate, consolidation of the programs and any legislation
8-2 necessary to effect the consolidation;
8-3 (6) assure that data collected is made available and
8-4 accessible to interested persons;
8-5 (7) prescribe by rule a format for all providers to
8-6 submit data consistent with Section 108.009;
8-7 (8) adopt by rule and implement a methodology to
8-8 collect and disseminate data reflecting provider quality in
8-9 accordance with Section 108.010;
8-10 (9) make reports to the legislature, the governor, and
8-11 the public on:
8-12 (A) the charges and rate of change in the
8-13 charges for health care services in this state;
8-14 (B) the effectiveness of the council in carrying
8-15 out the legislative intent of this chapter;
8-16 (C) if applicable, any recommendations on the
8-17 need for further legislation; and
8-18 (D) the quality and effectiveness of health care
8-19 and access to health care for all citizens of this state;
8-20 (10) develop an annual work plan and establish
8-21 priorities to accomplish its duties; and
8-22 (11) provide consumer education on the interpretation
8-23 and understanding of the information that is released to the
8-24 public.
8-25 (b) The council may:
8-26 (1) employ or contract with the department to employ
8-27 an executive director and other staff, including administrative and
9-1 legal personnel, necessary to comply with this chapter and rules
9-2 adopted under this chapter;
9-3 (2) engage professional consultants as it considers
9-4 necessary to the performance of its duties;
9-5 (3) adopt rules clarifying which health care
9-6 facilities must provide data under this chapter; and
9-7 (4) apply for and receive any appropriation, donation,
9-8 or other funds from the state or federal government or any other
9-9 public or private source, subject to Section 108.016 and
9-10 limitations and conditions provided by legislative appropriation.
9-11 (c) The council may not establish or recommend rates of
9-12 payment for health care services.
9-13 (d) The council may not take an action that affects or
9-14 relates to the validity, status, or terms of a department
9-15 interagency agreement or a contract without the board's approval.
9-16 (e) In the collection of data, the council shall consider
9-17 the research and initiatives being pursued by the United States
9-18 Department of Health and Human Services and the Joint Commission on
9-19 Accreditation of Healthcare Organizations to reduce potential
9-20 duplication or inconsistencies. The council may not adopt rules
9-21 that conflict with or duplicate any federally mandated data
9-22 collection programs or requirements of comparable scope.
9-23 Sec. 108.007. REVIEW POWERS. (a) The council, through the
9-24 department and subject to reasonable rules and guidelines, may:
9-25 (1) inspect documents and records used by data sources
9-26 that are required to compile data and reports; and
9-27 (2) compel providers to produce accurate documents and
10-1 records.
10-2 (b) The council may enter into a memorandum of understanding
10-3 with a state agency, including the division of the Health and Human
10-4 Services Commission responsible for the state Medicaid program, or
10-5 with a school of public health or another institution of higher
10-6 education, to share data and expertise, to obtain data for the
10-7 council, or to make data available to the council.
10-8 Sec. 108.008. DUTIES OF DEPARTMENT. (a) The department, as
10-9 the state health planning and development agency under Chapter 104,
10-10 is responsible for the collection of data under Chapter 311.
10-11 (b) The department shall:
10-12 (1) contract with the council to collect data under
10-13 this chapter;
10-14 (2) provide administrative and legal assistance to the
10-15 council in accordance with rules adopted by the council and set out
10-16 in the contract with the council;
10-17 (3) coordinate administrative responsibilities with
10-18 the council to avoid unnecessary duplication of the collection of
10-19 data and other duties;
10-20 (4) give the council access to data collected by the
10-21 department on request of the council; and
10-22 (5) submit or assist in the council's budget request
10-23 to the legislature.
10-24 (c) The department may not take an action that affects or
10-25 relates to the validity, status, or terms of a council interagency
10-26 agreement or a contract without the council's approval.
10-27 Sec. 108.009. DATA SUBMISSION AND COLLECTION. (a) The
11-1 council may collect, and, except as provided by Subsection (c),
11-2 providers shall submit to the council or another entity as
11-3 determined by the council, all data required by this section. The
11-4 data shall be collected according to uniform submission formats,
11-5 coding systems, and other technical specifications necessary to
11-6 make the incoming data substantially valid, consistent, compatible,
11-7 and manageable using electronic data processing, if available.
11-8 (b) The council shall adopt rules to implement the data
11-9 submission requirements imposed by Subsection (a) in appropriate
11-10 stages to allow for the development of efficient systems for the
11-11 collection and submission of the data.
11-12 (c) A rural provider may, but is not required to, provide
11-13 the data required by this section.
11-14 (d) The council may not collect data from the office of an
11-15 individual physician.
11-16 (e) The department is the single collection point for
11-17 receipt of data from providers. With the approval of the council
11-18 and the board, the department may transfer collection of any data
11-19 required to be collected by the department under any other law.
11-20 (f) The council may not require providers to submit data
11-21 more frequently than quarterly, but providers may submit data on a
11-22 more frequent basis.
11-23 (g) The council shall coordinate data collection with the
11-24 data collection formats used by federally qualified health centers.
11-25 To satisfy the requirements of this chapter:
11-26 (1) a federally qualified health center shall submit
11-27 annually to the council a copy of the Medicaid cost report of
12-1 federally qualified health centers; and
12-2 (2) a provider receiving federal funds under 42 U.S.C.
12-3 Section 254b, 254c, or 256 shall submit annually to the council a
12-4 copy of the Bureau of Common Reporting Requirements data report
12-5 developed by the United States Public Health Service.
12-6 (h) The council shall, to the extent feasible, coordinate
12-7 data collection with the data collection formats used by hospitals
12-8 and other providers. The council shall accept data in the format
12-9 developed by the National Uniform Billing Committee (Uniform
12-10 Hospital Billing Form UB 92, UB 82, and HCFA-1500 or their
12-11 successors) or other universally accepted standardized forms
12-12 approved by the council.
12-13 (i) The council shall develop by rule alternate data
12-14 submission procedures for entities that do not possess electronic
12-15 data processing capacity.
12-16 (j) The council shall collect data and disseminate reports
12-17 reflecting provider quality in accordance with Section 108.010.
12-18 (k) In developing the statewide health care data collection
12-19 system, the council shall identify health care data elements
12-20 relating to health care charges, provider quality, payer type, the
12-21 outcomes of health care services, and the use of health care
12-22 services by consumers.
12-23 (l) The council shall develop and implement a health care
12-24 information system to:
12-25 (1) support public health and preventive health
12-26 initiatives;
12-27 (2) assist in the delivery of primary and preventive
13-1 health care services;
13-2 (3) facilitate the establishment of appropriate
13-3 benchmark data to measure performance improvements;
13-4 (4) establish and maintain a systematic approach for
13-5 the collection, storage, and analysis of health care data for
13-6 longitudinal, epidemiological, and policy impact studies; and
13-7 (5) develop and use system-based protocols to identify
13-8 individuals and populations at risk.
13-9 (m) To the extent feasible, the council shall obtain from
13-10 public records the information that is available from those
13-11 records.
13-12 Sec. 108.010. COLLECTION AND DISSEMINATION OF PROVIDER
13-13 QUALITY DATA. (a) Subject to Section 108.009, the council shall
13-14 collect data reflecting provider quality based on a methodology and
13-15 review process established through the council's rulemaking
13-16 process. The methodology shall identify and measure quality
13-17 standards and adhere to any federal mandates.
13-18 (b) Within the first 12 months of operation following
13-19 appointment of all council members, the council shall develop the
13-20 initial methodology for the collection of provider quality data.
13-21 (c) The methodology must be consistent with other data
13-22 collection methods used in this state, including methods used by
13-23 health maintenance organizations such as the Health Plan Employer
13-24 Data Information SET (HEDIS) provided by the National Committee on
13-25 Quality Assurance, or other universally accepted methods approved
13-26 by the council.
13-27 (d) The council shall test the methodology by collecting
14-1 provider quality data for one year. The council may test using
14-2 pilot methodologies. After collecting provider quality data for
14-3 one year, the council shall report findings applicable to a
14-4 provider to that provider and allow the provider to review and
14-5 comment on the initial quality outcome data applicable to that
14-6 provider. The council shall verify the accuracy of the data during
14-7 this review and revision process. After the review and revision
14-8 process, quality outcome data for subsequent reports shall be
14-9 published and made available to the public, on a time schedule the
14-10 council considers appropriate.
14-11 (e) The council shall adopt rules allowing providers to
14-12 submit written comments regarding any specific data to be released
14-13 concerning the provider. The comments may be attached to any
14-14 public release of data.
14-15 (f) The methodology adopted by the council for measuring
14-16 quality shall include case-mix qualifiers, severity adjustment
14-17 factors, and any other factors necessary to accurately reflect
14-18 provider quality.
14-19 (g) In addition to the requirements of this section, any
14-20 release of provider quality data shall comply with Sections
14-21 108.011(d), (e), and (f).
14-22 Sec. 108.011. DATA DISSEMINATION AND PUBLICATION. (a) The
14-23 council shall promptly provide data to those requesting it, subject
14-24 to the restrictions on access to council data prescribed by
14-25 Sections 108.010 and 108.013.
14-26 (b) Subject to the restrictions on access to council data
14-27 prescribed by Sections 108.010 and 108.013, and using the data
15-1 collected under Section 108.009 and other data, records, and
15-2 matters of record available to it, the council shall prepare and
15-3 issue reports to the governor, the legislature, and the public as
15-4 provided by this section and Section 108.006(a). The council must
15-5 issue the reports at least annually.
15-6 (c) The council shall prepare and issue reports that provide
15-7 information relating to providers, such as the incidence rate of
15-8 selected medical or surgical procedures and the provider quality.
15-9 The reports must provide the data in a manner that identifies
15-10 individual providers and that identifies and compares data elements
15-11 that vary significantly for a provider from norms for all
15-12 providers.
15-13 (d) The council shall adopt procedures to verify the
15-14 accuracy of the data before a report containing the data is
15-15 released to the public.
15-16 (e) If provider data is requested from the council for a
15-17 specific provider, the council shall notify the provider about the
15-18 release of the data. This subsection does not authorize the
15-19 provider to interfere with the release of that data.
15-20 (f) A report issued by the council shall include a
15-21 reasonable review and comment period before final publication of
15-22 the report.
15-23 Sec. 108.012. COMPUTER ACCESS TO DATA. (a) The council
15-24 shall provide a means for computer-to-computer access to the data.
15-25 All reports shall maintain patient confidentiality as provided by
15-26 Section 108.013.
15-27 (b) The council may charge a person requesting data a fee
16-1 for the data. The fees may reflect the quantity of information
16-2 provided and the expense incurred by the council in collecting and
16-3 providing the data. Fees collected under this section shall be
16-4 deposited in the designated account in the general revenue fund
16-5 created in Section 108.015. The council may not charge a fee for
16-6 providing data to another state agency.
16-7 Sec. 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
16-8 (a) The data received by the council shall be used by the council
16-9 for the benefit of the public. Subject to specific limitations
16-10 established by council rule, the council shall make determinations
16-11 on requests for information in favor of access.
16-12 (b) The council by rule shall designate the characters to be
16-13 used by providers as uniform patient identifiers.
16-14 (c) Unless specifically authorized by this chapter, the
16-15 council may not release and a person or entity may not gain access
16-16 to any data:
16-17 (1) that could reasonably be expected to reveal the
16-18 identity of a patient or that reveals the zip code of a patient's
16-19 primary residence;
16-20 (2) disclosing provider discounts or differentials
16-21 between payments and billed charges; or
16-22 (3) relating to actual payments to an identified
16-23 provider made by a payer other than the payer requesting data or
16-24 an entity entitled to that payer's data.
16-25 (d) All data collected and used by the department and the
16-26 council under this chapter is subject to the confidentiality
16-27 provisions and criminal penalties of:
17-1 (1) Section 311.037;
17-2 (2) Section 81.103; and
17-3 (3) Section 5.08, Medical Practice Act (Article 4495b,
17-4 Vernon's Texas Civil Statutes).
17-5 (e) Data on patients and compilations, reports, or analyses
17-6 produced from the data collected that identify patients are not:
17-7 (1) subject to discovery, subpoena, or other means of
17-8 legal compulsion for release to any person or entity except as
17-9 provided by this section; or
17-10 (2) admissible in any civil, administrative, or
17-11 criminal proceeding.
17-12 (f) Notwithstanding Subsection (c)(1), the council may use
17-13 zip code information to analyze data on a geographic basis.
17-14 Sec. 108.014. CIVIL PENALTY. (a) A person who knowingly or
17-15 negligently releases data in violation of this chapter is liable
17-16 for a civil penalty of not more than $10,000.
17-17 (b) A person who fails to supply available data under
17-18 Sections 108.009 and 108.010 is liable for a civil penalty of not
17-19 less than $1,000 or more than $10,000 for each act of violation.
17-20 (c) The attorney general, at the request of the council,
17-21 shall enforce this chapter.
17-22 Sec. 108.015. DESIGNATED ACCOUNT. A designated account is
17-23 in the general revenue fund for all grants and contributions of
17-24 money to the council and all fees collected by the council.
17-25 Designated account funds shall be carried over from fiscal year to
17-26 fiscal year and from biennium to biennium.
17-27 Sec. 108.016. CONFLICT OF INTEREST. The council may not
18-1 accept a donation from a person required to provide data under this
18-2 chapter or from a person or business entity who provides goods or
18-3 services to the council for compensation.
18-4 SECTION 2. Section 311.032(a), Health and Safety Code, is
18-5 amended to read as follows:
18-6 (a) The department shall establish a uniform reporting and
18-7 collection system for hospital financial and<,> utilization<, and
18-8 patient discharge> data.
18-9 SECTION 3. Section 311.035(c), Health and Safety Code, is
18-10 amended to read as follows:
18-11 (c) The department shall enter into an interagency agreement
18-12 with the Texas Department of Mental Health and Mental Retardation,
18-13 Texas Commission on Alcohol and Drug Abuse, and Texas Department of
18-14 Insurance relating to the mental health and chemical dependency
18-15 <hospital discharge> data collected under Section 311.0335. The
18-16 agreement shall address the collection, analysis, and sharing of
18-17 the data by the agencies.
18-18 SECTION 4. The following laws are repealed:
18-19 (1) Section 311.035(b), Health and Safety Code; and
18-20 (2) Section 311.034, Health and Safety Code.
18-21 SECTION 5. (a) The governor and lieutenant governor shall
18-22 make appointments to the Texas Health Care Information Council as
18-23 soon as practicable after the effective date of this Act.
18-24 (b) In making the initial appointments to the Texas Health
18-25 Care Information Council, the governor shall appoint three members
18-26 for terms expiring September 1, 1997, three members for terms
18-27 expiring September 1, 1999, and two members for terms expiring
19-1 September 1, 2001.
19-2 (c) In making the initial appointments to the Texas Health
19-3 Care Information Council, the lieutenant governor shall appoint two
19-4 members for terms expiring September 1, 1997, two members for terms
19-5 expiring September 1, 1999, and three members for terms expiring
19-6 September 1, 2001.
19-7 SECTION 6. Not later than December 1, 1996, the Texas Health
19-8 Care Information Council appointed under Chapter 108, Health and
19-9 Safety Code, as added by this Act, shall make recommendations under
19-10 Section 108.006(a)(5) of that code relating to consolidation of
19-11 health data collection programs existing on the effective date of
19-12 this Act, together with proposed legislation necessary to effect
19-13 any recommended consolidation.
19-14 SECTION 7. This Act takes effect September 1, 1995.
19-15 SECTION 8. The importance of this legislation and the
19-16 crowded condition of the calendars in both houses create an
19-17 emergency and an imperative public necessity that the
19-18 constitutional rule requiring bills to be read on three several
19-19 days in each house be suspended, and this rule is hereby suspended.