BG C.S.S.B. 802 75(R)BILL ANALYSIS PUBLIC HEALTH C.S.S.B. 802 By: Zaffirini (Maxey) 4-30-97 Committee Report (Substituted) BACKGROUND The 74th Legislature created the Health Care Information Council (council) to develop and implement a statewide health care data collection system to collect information on regarding health care fees, provider quality, and health care effectiveness outcomes. The data, which is 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. Additionally, certain hospitals are required or authorized to provide information collected by the Texas Department of Health (department) regarding financial and utilization data. For hospitals that do not seek to receive reimbursement of any kind (private pay, third-party insurance, Medicaid, et al.) for medical services, the cost of collecting, coding and reporting the extensive financially-focused data required by the council and the department can be prohibitive and can divert money away from other medical services. This bill would allow, but not require, hospitals that are exempt from state franchise, sales, ad valorem, or other state or local taxes, and that do not seek or receive reimbursement for providing health care services to patients from any source, to provide such information to the council and the department. PURPOSE C.S.S.B. 802 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. The bill clarifies that the directive that certain hospitals provide certain information to the Texas Health Care Information Council and the Texas Department of Health is not unequivocal. 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 GENERAL. 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 (i) 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. Amends Chapter 311C, Health and Safety Code, by adding Section 311.039, as follows: Sec. 311.039. EXEMPTION. Allows, but does not require, a hospital to provide data required by Section 311.033 if the hospital is exempt from certain taxes, and does not seek reimbursement for providing health care services to patients from any source. SECTION 16. Establishes that changes made by this Act apply only to the collection and dissemination of data under Chapter 108 on or after the effective date of this Act. The collection and dissemination of data before that date is governed by existing law which is continued in effect for that purpose. SECTION 17. Effective date is September 1, 1997. SECTION 18. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE CSSB 802 incorporates the language of CSHB 1616, which related to functions and the duties of the Texas Health Care Information Council, with the text of the engrossed S.B. 802.