BG C.S.H.B. 1616 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.H.B. 1616 By: Maxey 4-17-97 Committee Report (Substituted) BACKGROUND The 74th Legislature created the Health Care Information Council (the 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. The data, which will be available to state policy makers, researchers, providers, and the public, will facilitate the promotion and accessibility of cost-effective, high quality health care. During the implementation of this important new system, the Council and other stakeholders identified numerous provisions in the new law that needed clarification. This bill proposes to address those issues. PURPOSE HB 1616 clarifies the functions and duties of the Texas Health Care Information Council and provides a criminal penalty for the release of data in violation of the Act. RULEMAKING AUTHORITY It is the committee's opinion that this bill expressly grants additional rulemaking authority to the Council in SECTION 3 (Section 108.003(g), Health and Safety Code) and in SECTION 11 (Section 108.011(g), Health and Safety Code). Reference to Council rulemaking is made in SECTION 9 (Section 108.009(b), Health and Safety Code) and SECTION 10 (Section 108.010(e), Health and Safety Code). SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 108.002, Health and Safety Code, as follows: Subsection (2) revises the language in the definition of "charge" or "rate" to conform with the new definition for health benefit plans as specified in subsection (6). Subsection (6) is added to provide the definition for "health benefit plans" to mean heath maintenance organizations or approved nonprofit health corporations that are certified by the Texas Board of Medical Examiners and hold a certificate of authority from the Texas Department of Insurance. Subsections (7) - (13) make conforming changes. Subsection(14) adds a definition of "public use data" to mean patient level data that identifies patients and physicians only by their uniform identifier numbers, that is not summarized or analyzed, and that has been severity and risk adjusted and verified for accuracy. Subsection (15) revises the term "rural provider" to mean a provider as described in Section 108.0025 and omits the previous language of the definition. Subsections (16) and (17) make conforming changes, also subsection (17) clarifies that the assigning of the "uniform patient identifier" is by the Council. Subsection (18) makes conforming change and revises the definition of "uniform physician identifier" to clarify that the Council is responsible for assigning this identifying number for individual patients. SECTION 2. Adds a new Section 108.0025, Health and Safety Code, which defines rural provider for purposes of this chapter to mean a provider that is located in a county with a population of not more than 35,000, according to the most recently published U.S. Census estimates and not part of a metropolitan statistical area; or in a county without more than 100 licensed hospitals and not delineated as urbanized; and not state-owned or managed or owned or part of one or more other hospitals as specified. SECTION 3. Amends Section 108.003, Health and Safety Code, as follows: Subsection (a) changes from three to four ex officio members. It also removes the word "nonvoting." Subsection (b) deletes "nonvoting" to establish that ex officio members of the council are voting members. Adds, "or the commissioner's designee", to clarify that the commissioner can designate another person to attend a Council meeting. Adds the "public insurance counsel, or the counsel's designee " to identify another ex officio member and clarify that the counsel's designee may attend. Subsection (c)(7) adds the word "utilization" to clarify that expert members of the Council cannot be professionally involved in review of health care or insurance as specified. Replaces the term "statistics or health data management" with "information systems." Subsection (f) revises the word "subcommittees" to "committees" in reference to who the Council may appoint to provide assistance. Subsection (g) adds language to require the Council to consult with technical advisory committees prior to adopting new rules, except when adopting emergency rules as specified. Requires the Council to submit adopted emergency rules to the appropriate advisory committee by the first meeting of the committee following an emergency rule adoption. Allows the Council to consult with the appropriate technical advisory committee for other formal action, and allows the advisory committee to consult with other professionals. Deletes language requiring technical advisory committees to coordinate their work with one another. Makes conforming changes to reflect the definition of health benefit plans; and adds language to require that technical advisory committees be composed of individuals with expertise in information systems and management as specified. SECTION 4. Amends Sections 108.004, Health and Safety Code, (a) and (c) as follows: Subsection (a) conforms language with changes made in Section 108.003 referring to council "committees" rather than "subcommittees." Subsection (c) revises language to require that the Council publish notice of its meetings in the Texas Register and deletes that notice of meetings be made in at least four newspapers of general circulation in the state. SECTION 5. Amends Chapter 108, Health and Safety Code, by adding Section 108.0045 which establishes that the Council is subject to the open records law, Chapter 552, Government Code. SECTION 6. Amends Sections 108.006, Health and Safety Code, as follows: Subsection (a) revises language to establish that "public use" data, rather than collected data be made available to interested persons, to clarify that "the process" and not the format for providers to submit data is prescribed by rule. Replaces "information that is released" with "public use or provider quality data before the data is disseminated" in regards to provided consumer education. Adds language requiring the Council to develop and implement a health care information plan to be used by the Texas Department of Health (TDH) as specified. Makes conforming changes. Subsection (b) removes words concerning employment of legal personnel. Subsection (d) makes nonsubstantive language changes. SECTION 7. Amends Sections 108.008, Health and Safety Code, as follows: Subsection (b) omits language that required TDH to provide legal assistance to the Council. Clarifies language requiring TDH to give data collected to the Council so as to specify that it is upon the Council's request. Subsection (c) makes nonsubstantive language changes. SECTION 8. Amends Chapter 108, Health and Safety Code by adding Sections 108.0081 and 108.0085 as follows: Sec. 108.0081. MEMORANDUM OF UNDERSTANDING. Requires the Council and TDH to enter into a memorandum of understanding to implement TDH's duties as specified. Specifies certain issues that the memorandum must address. Sec. 108.0085 DUTIES OF ATTORNEY. Requires the attorney general to furnish advice and legal assistance to the Council as specified. SECTION 9. Amends Sections 108.009, Health and Safety Code, as follows: Subsection (b) adds language to prohibits a commission rule which requires submission of a data element before adoption but was adopted before submission was requires to take effect before 90 days after adoption. Subsection (c) adds language to specify that certain hospitals, as specified, is allowed , but not required, to provide the data required by this chapter. Specifies exemption of nonprofit hospitals that do not seek or receive reimbursement for providing health care services to patients. Subsection (d) clarifies that data released about physicians "using uniform physician identifiers" is not prohibited by this subsection. Subsection (h) provides clarifying language regarding the types of forms these health care providers submit. Subsection (k) deletes references to the development of a statewide health care data collection system. Deletes language about identifying health care charges, provider quality and health care services outcome data. Adds the racial and ethnic background of patients to the data collection requirement. Subsection (o) conforms language to reflect the definition of health benefit plans, and to require both HMOS and certain approved nonprofit health corporations to submit Health Plan Employer Data Information Set (HEDIS) to the Council. Adds language to establish that submitted HEDIS information is subject to Section 108.011 relating to public dissemination and publication of data, but not subject to the restrictions on release of provider quality data as set out in Section 108.010. SECTION 10. Amends Sections 108.010, Health and Safety Code, as follows: Subsection (b) removes language relating to initial actions and methodology of the Council. Adds outcome data as a component the Council is required to study and analyze. Subsection (c) replaces the term "quality outcome data" with "provider quality data." Subsection (d) makes conforming change, clarifies that this subsection does not affect the release of "public use" data as specified. Subsection (e) clarifies that Council rules allowing providers to submit written comments should be "concise" and specifically about "provider quality" data. Requires the Council to make comments available to the public at the Council office and in an electronic form accessible through the Internet. Requires that the comments be attached to all public releases of the provider quality data. Requires providers to submit the comments to the Council in the same format as the released data. Subsection (g) makes conforming change concerning reference to compliance with a specified section. Subsection (h) makes conforming change. Subsection (p) is added to require the council to release provider quality data as specified. SECTION 11. Amends Sections 108.011 and 108.012, Health and Safety Code, as follows: Sec. 108.011. Revises the section title to read "dissemination of public use data and council publications." Subsection (a) revises language to establish that the Council is required to provide "public use" data and HEDIS data as specified. Adds that public use data does not include provider quality data or confidential data as specified. Subsection (b) adds "public use" to clarify kind of data, and removes reference to data collected under Section 108.009. Subsection (c) makes conforming changes and adds "including individual physicians" to data that must be provided in reports that identify individual providers as specified. Subsections (d) and (e) make conforming and non-substantive language changes. Subsection (g) is added to require the Council to adopt rules to allow providers to submit concise, written comments about specific public use data to be released. Requires the Council to make comments available to the public and the office of the council and in an electronic form accessible through the Internet. Requires that the providers' comments be attached to all public releases of the public use data. Requires providers to submit such comments to the Council in the same format as the released data. Subsection (h) is added to require that tapes, as specified, that are released to the public must include general consumer education material regarding the information provided, including an explanation of its benefits and limitations. Subsection (i) is added, requires the council to release public use data, described in Sec. 108.0025(1) but that does not meet the requirements of Sec. 108.0025(2), in the aggregate. Sec. 108.012. Adds "public use" and "public use or provider quality" to clarify types of data referenced. SECTION 12. Amends Sections 108.013, Health and Safety Code, as follows: Subsection (a) removes a reference to the Council being subject to the open records law. Subsection (b) makes conforming change and adds language to establish that the manner in which identifying characters are assigned is confidential. Subsection (e) deletes the words "reports or analyses" in reference to produced data compilations. Subsection (g) is added to prohibit the council from releasing data elements in a way that reveals identities as specified. Subsection (h) is added to establish that subsection (c)(1) and subsection (g) of this section do not prohibit the release of a uniform physician identifier or a uniform patient identifier as specified. Subsection (i) is added to establish that the council and TDH may not provide confidential information to other state agencies, notwithstanding other laws. SECTION 13. Amends Chapter 108, Health and Safety Code, by adding Section 108.0141 as follows: Sec. 108.0141. CRIMINAL PENALTY. Establishes that a person who releases data in violation of this chapter with criminal negligence commits a Class A misdemeanor. SECTION 14. Repeals Sections 108.009 (j), (l), and (n), Health and Safety Code. SECTION 15. Establishes that changes made by this Act apply only to the collection and dissemination of data on or after September 1, 1997 and that any collection and dissemination of data before that date is governed by existing law which is continued in effect for that purpose. SECTION 16. Effective date is September 1, 1997. SECTION 17. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE In SECTION 1, in the definitions of Sec. 108.002, Health and Safety Code, the substitute bill adds the words "risk adjusted" in order to conform with existing rule. In SECTION 2, CSHB 1616 revises the language of Sec. 108.0025, subdivision (1) as was in the original bill by changing the last word of (1)(A) from "and" to "or", and changing (1)(B) to counties with a population more than 35,000, but with less than 100 licensed hospital beds and not classified as an urban area, as opposed to the original version's metropolitan statistical area and 50 bed provision. New wording is also in subdivision (2) to correct an error in the original bill that said hospitals would be exempt if part of a chain and also to specify hospitals that are not owned by the state or an entity which owns or manages one or more other hospitals. (These changes were made in negotiations with the rural hospitals which are exempt from reporting, unless they are part of a system or chain.) SECTION 3 of the substitute bill makes the following changes to Sec. 108.003, Health and Safety Code that were not in HB 1616. Subsection (a) was not amended by the original bill, the substitute provides for four ex officio state agency members since OPIC has been added as an ex-officio and all ex-officio members now have voting privileges. CSHB 1616 also provides for 15 members appointed by the governor in order to achieve greater input by affected agencies. Subsection (b) is newly amended by the substitute bill. It revises language to conform to member voting status and clarify that a designee may take the place of an ex-officio. Subsection (c)(7) in the substitute bill is changed from the original bill. It replaces "statistics or health data-management" as part of a compromise reached with providers who felt it necessary to have an "expert" with "information systems" knowledge. Subsection (g) was "cleaned-up" in CSHB 1616 to clarify that the council is allowed to consult with appropriate technical advisory committees who may consult with with professionals as necessary and add (g)(5) regarding the technical advisory committee. No changes were made in SECTIONS 4 and 5. SECTION 6 of the substitute bill makes changes in amendments made by the original bill to Section 108.0045, Health and Safety Code. CSHB 1616 replaces "a format" with "the process" in subsection (a)(7). The intent of this revision is to limit the council to being able to draft rules on "the process" for submitting data, and leave the actual format as set in the statute. Additionally, the substitute bill "cleaned-up" subsection (a)(11) in its replacing of "information that is is released" with "public use or provider quality data before the data is disseminated." SECTION 7 has no change from the original to the substitute bill. Clean-up of text occurred in SECTION 8, where CSHB 1616 adds a 6th issue (meeting coordination services) in the memorandum of understanding as per Sec. 108.0081, Health and Safety Code. SECTION 9 is modified in the substitute bill to amend Sec. 108.009(b) which the original did not address. The addition in CSHB 1616 concerns the 90 day period before a new data element requirement takes effect, in order to give providers time to prepare for any additional information requested by the Council. CSHB 1616 also amends subsection (h), which was not addressed in HB 1616, to remove the phrase "to the extent feasible"; replace the word "collection" with "submission"; and replace the phrase "approved by the council" with "that hospitals and other providers use for other complementary purposes" in order to conform and clarify the type of formats to be collected. The substitute bill changes SECTION 10 by adding clarification to Sec. 108.010 (e) to provide for "concise" written comments. CSHB 1616 in the same subsection replaces permissive language with the requirement that comments be attached to provider quality data. The substitute's subsection additionally directs providers to submit the data in the same format as the released provider quality. Subsection (p), which is newly added by the substitute bill, results from a compromise reached with the Texas Medical Association to protect rural physician and patient confidentiality. As part of compromises reached with hospitals, CSHB 1616 adds more subsections to Section 108.011, Health and Safety Code in SECTION 11. It adds subsection (g) regarding the adoption of council rules allowing providers to submit written comments on data and details the directing of how comments are to be released and available to public. Subsection (h) is added to require the inclusion of consumer educational material in tapes released to the public. Plus subsection (i) is added to direct that data released will be in aggregate form and without uniform patient and physician identifiers. SECTION 12 (Sec. 108.013, Health and Safety Code) has been revised to add a phrase in subsection (b) as to the confidentiality in the assignment of characters used as uniform patient identifiers. Also subsection (g) was added as protection against unauthorized disclosures of personal information. Subsection (h) of the substitute was the original's subsection (h) and is relettered and reworded to conform to the new subsection (g). Subsection (i) is cleanup text added to the substitute bill. There is no change in SECTIONS 13, 14, 15, 16, or 17 between HB 1616 and CSHB 1616.