By Maxey H.B. No. 1616
75R3134 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the functions and duties of the Texas Health Care
1-3 Information Council; providing a penalty.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 108.002, Health and Safety Code, is
1-6 amended to read as follows:
1-7 Sec. 108.002. DEFINITIONS. In this chapter:
1-8 (1) "Board" means the Texas Board of Health.
1-9 (2) "Charge" or "rate" means the amount billed by a
1-10 provider for specific procedures or services provided to a patient
1-11 before any adjustment for contractual allowances. The term does
1-12 not include copayment charges to enrollees in health benefit plans
1-13 charged [maintenance organization enrollees] by providers paid by
1-14 capitation or salary [in a health maintenance organization].
1-15 (3) "Council" means the Texas Health Care Information
1-16 Council.
1-17 (4) "Data" means information collected under Section
1-18 108.009 in the form initially received.
1-19 (5) "Department" means the Texas Department of Health.
1-20 (6) "Health benefit plan" means a plan provided by:
1-21 (A) a health maintenance organization; or
1-22 (B) an approved nonprofit health corporation
1-23 that is certified under Section 5.01(a), Medical Practice
1-24 Act (Article 4495b, Vernon's Texas Civil Statutes), and that
2-1 holds a certificate of authority issued by the commissioner of
2-2 insurance under Article 21.52F, Insurance Code.
2-3 (7) [(6)] "Health care facility" means:
2-4 (A) a hospital;
2-5 (B) an ambulatory surgical center licensed under
2-6 Chapter 243;
2-7 (C) a chemical dependency treatment facility
2-8 licensed under Chapter 464;
2-9 (D) a renal dialysis facility;
2-10 (E) a birthing center;
2-11 (F) a rural health clinic; or
2-12 (G) a federally qualified health center as
2-13 defined by 42 U.S.C. Section 1396d(l)(2)(B).
2-14 (8) [(7)] "Health maintenance organization" means an
2-15 organization as defined in Section 2, Texas Health Maintenance
2-16 Organization Act (Article 20A.02, Vernon's Texas Insurance Code).
2-17 (9) [(8)] "Hospital" means a public, for-profit, or
2-18 nonprofit institution licensed or owned by this state that is a
2-19 general or special hospital, private mental hospital, chronic
2-20 disease hospital, or other type of hospital.
2-21 (10) [(9)] "Outcome data" means measures related to
2-22 the provision of care, including:
2-23 (A) patient demographic information;
2-24 (B) patient length of stay;
2-25 (C) mortality;
2-26 (D) co-morbidity;
2-27 (E) complications; and
3-1 (F) charges.
3-2 (11) [(10)] "Physician" means an individual licensed
3-3 under the laws of this state to practice medicine under the Medical
3-4 Practice Act (Article 4495b, Vernon's Texas Civil Statutes).
3-5 (12) [(11)] "Provider" means a physician or[,] health
3-6 care facility[, or health maintenance organization].
3-7 (13) [(12)] "Provider quality" means the extent to
3-8 which a provider renders care that, within the capabilities of
3-9 modern medicine, obtains for patients medically acceptable health
3-10 outcomes and prognoses, after severity adjustment.
3-11 (14) "Public use data" means patient level data
3-12 relating to individual hospitalizations that has not been
3-13 summarized or analyzed, that identifies patients and physicians
3-14 only by use of uniform patient and physician identifiers, and that
3-15 is severity adjusted and verified for accuracy.
3-16 (15) [(13)] "Rural provider" means a provider
3-17 described by Section 108.0025 [located in:]
3-18 [(A) a county with a population of not more than
3-19 35,000;]
3-20 [(B) those portions of extended cities that the
3-21 United States Bureau of the Census has determined to be rural; or]
3-22 [(C) an area that is not delineated as an
3-23 urbanized area by the United States Bureau of the Census].
3-24 (16) [(14)] "Severity adjustment" means a method to
3-25 stratify patient groups by degrees of illness and mortality.
3-26 (17) [(15)] "Uniform patient identifier" means a
3-27 number assigned by the council to an individual patient and
4-1 composed of numeric, alpha, or alphanumeric characters.
4-2 (18) [(16)] "Uniform physician identifier" means a
4-3 number assigned by the council to an individual physician and
4-4 composed of numeric, alpha, or alphanumeric characters.
4-5 SECTION 2. Chapter 108, Health and Safety Code, is amended
4-6 by adding Section 108.0025 to read as follows:
4-7 Sec. 108.0025. RURAL PROVIDER. For purposes of this
4-8 chapter, a provider is a rural provider if the provider is:
4-9 (1) located in a county that:
4-10 (A) has a population estimated by the United
4-11 States Census Bureau to be not more than 35,000 as of July 1 of the
4-12 most recent year for which county population estimates have been
4-13 published; and
4-14 (B) is not part of a metropolitan statistical
4-15 area as defined by the United States Census Bureau; and
4-16 (2) a provider of inpatient hospital services that:
4-17 (A) does not have more than 50 licensed beds; or
4-18 (B) is part of a hospital system that includes
4-19 more than one hospital.
4-20 SECTION 3. Sections 108.003(c), (f), and (g), Health and
4-21 Safety Code, are amended to read as follows:
4-22 (c) The governor shall appoint the following members of the
4-23 council:
4-24 (1) three representatives of the business community,
4-25 with at least one representing small businesses, who are purchasers
4-26 of health care but who are not involved in the provision of health
4-27 care or health insurance;
5-1 (2) two representatives from labor, one of whom is not
5-2 directly involved with management of health care benefits;
5-3 (3) two representatives of consumers who are not
5-4 professionally involved in the purchase, provision, administration,
5-5 or review of health care or health care insurance;
5-6 (4) two representatives of hospitals;
5-7 (5) one representative of health maintenance
5-8 organizations;
5-9 (6) three representatives of physicians who are
5-10 involved in direct patient care; and
5-11 (7) two members who are not professionally involved in
5-12 the purchase, provision, administration, or utilization review of
5-13 health care or health care insurance and who have expertise in:
5-14 (A) health planning;
5-15 (B) health economics;
5-16 (C) provider quality assurance;
5-17 (D) statistics or health data management; or
5-18 (E) the reimbursement of medical education and
5-19 research costs.
5-20 (f) The council may appoint committees [subcommittees] and
5-21 may elect any officers subordinate to those provided for in
5-22 Subsection (d).
5-23 (g) The council shall appoint technical advisory committees
5-24 and must consult with the appropriate technical advisory committee
5-25 with respect to a rule before the rule is finally adopted by the
5-26 council. The council is not required to consult with a technical
5-27 advisory committee before adopting an emergency rule in accordance
6-1 with Section 2001.034, Government Code. The council shall submit an
6-2 emergency rule adopted by the council to the appropriate advisory
6-3 committee for review not later than the first advisory committee
6-4 meeting that occurs after the rule is adopted[. The technical
6-5 advisory committees shall work in coordination with each other and
6-6 may consult with other professionals, as necessary]. The technical
6-7 advisory committees shall include:
6-8 (1) a technical advisory committee that includes,
6-9 among other individuals, at least five practicing physicians
6-10 licensed in this state to provide advice and recommendations to the
6-11 council on:
6-12 (A) the development and implementation of the
6-13 methodology and the interpretation of provider quality data under
6-14 Section 108.010; and
6-15 (B) the development and dissemination of
6-16 consumer education information and materials;
6-17 (2) a technical advisory committee composed of at
6-18 least five practicing physicians licensed in this state who have
6-19 been actively engaged in organized peer review at a hospital in
6-20 this state to provide advice, recommendations, and peer review
6-21 expertise to the council on:
6-22 (A) the use of peer review in the determination
6-23 of quality inpatient care;
6-24 (B) the development and interpretation of data
6-25 elements necessary to the determination of quality inpatient care;
6-26 and
6-27 (C) the development and format of reports and
7-1 information relating to provider quality;
7-2 (3) a technical advisory committee composed of
7-3 individuals who have expertise in the reimbursement of medical
7-4 education and research costs; and
7-5 (4) a technical advisory committee composed of
7-6 representatives of each type of issuer of health benefit plans
7-7 [maintenance organizations] to assist the council in complying with
7-8 Section 108.009(o).
7-9 SECTION 4. Sections 108.004(a) and (c), Health and Safety
7-10 Code, are amended to read as follows:
7-11 (a) The council, council committees [subcommittees], and
7-12 technical advisory committees are subject to the open meetings law,
7-13 Chapter 551, Government Code.
7-14 (c) The council shall publish a notice of its meetings in
7-15 the Texas Register [at least four newspapers of general circulation
7-16 in this state].
7-17 SECTION 5. Chapter 108, Health and Safety Code, is amended
7-18 by adding Section 108.0045 to read as follows:
7-19 Sec. 108.0045. OPEN RECORDS. Subject to the restrictions of
7-20 this chapter, the council is subject to the open records law,
7-21 Chapter 552, Government Code.
7-22 SECTION 6. Sections 108.006(a), (b), and (d), Health and
7-23 Safety Code, are amended to read as follows:
7-24 (a) The council shall develop a statewide health care data
7-25 collection system to collect health care charges, utilization data,
7-26 provider quality data, and outcome data to facilitate the promotion
7-27 and accessibility of cost-effective, good quality health care. The
8-1 council shall:
8-2 (1) direct the collection, dissemination, and analysis
8-3 of data under this chapter;
8-4 (2) contract with the department to collect the data
8-5 under this chapter;
8-6 (3) adopt policies and rules necessary to carry out
8-7 this chapter, including rules concerning data collection
8-8 requirements;
8-9 (4) build on and not duplicate other data collection
8-10 required by state or federal law, by an accreditation organization,
8-11 or by board rule;
8-12 (5) working with appropriate agencies, review public
8-13 health data collection programs in this state and recommend, where
8-14 appropriate, consolidation of the programs and any legislation
8-15 necessary to effect the consolidation;
8-16 (6) assure that public use data [collected] is made
8-17 available and accessible to interested persons;
8-18 (7) prescribe by rule a format for providers to submit
8-19 data consistent with Section 108.009;
8-20 (8) adopt by rule and implement a methodology to
8-21 collect and disseminate data reflecting provider quality in
8-22 accordance with Section 108.010;
8-23 (9) make reports to the legislature, the governor, and
8-24 the public on:
8-25 (A) the charges and rate of change in the
8-26 charges for health care services in this state;
8-27 (B) the effectiveness of the council in carrying
9-1 out the legislative intent of this chapter;
9-2 (C) if applicable, any recommendations on the
9-3 need for further legislation; and
9-4 (D) the quality and effectiveness of health care
9-5 and access to health care for all citizens of this state;
9-6 (10) develop an annual work plan and establish
9-7 priorities to accomplish its duties;
9-8 (11) provide consumer education on the interpretation
9-9 and understanding of the information that is released to the
9-10 public;
9-11 (12) work with the Health and Human Services
9-12 Commission and each health and human services agency that
9-13 administers a part of the state Medicaid program to avoid
9-14 duplication of expenditures of state funds for computer systems,
9-15 staff, or services in the collection and analysis of data relating
9-16 to the state Medicaid program; [and]
9-17 (13) work with the Department of Information Resources
9-18 in developing and implementing the statewide health care data
9-19 collection system and maintain consistency with Department of
9-20 Information Resources standards; and
9-21 (14) develop and implement a health care information
9-22 plan to be used by the department to:
9-23 (A) support public health and preventative
9-24 health initiatives;
9-25 (B) assist in the delivery of primary and
9-26 preventive health care services;
9-27 (C) facilitate the establishment of appropriate
10-1 benchmark data to measure performance improvements;
10-2 (D) establish and maintain a systematic approach
10-3 to the collection, storage, and analysis of health care data for
10-4 longitudinal, epidemiological, and policy impact studies; and
10-5 (E) develop and use system-based protocols to
10-6 identify individuals and populations at risk.
10-7 (b) The council may:
10-8 (1) employ or contract with the department to employ
10-9 an executive director and other staff, including administrative
10-10 [and legal] personnel, necessary to comply with this chapter and
10-11 rules adopted under this chapter;
10-12 (2) engage professional consultants as it considers
10-13 necessary to the performance of its duties;
10-14 (3) adopt rules clarifying which health care
10-15 facilities must provide data under this chapter; and
10-16 (4) apply for and receive any appropriation, donation,
10-17 or other funds from the state or federal government or any other
10-18 public or private source, subject to Section 108.015 and
10-19 limitations and conditions provided by legislative appropriation.
10-20 (d) The council may not take an action that affects or
10-21 relates to the validity, status, or terms of an [a department]
10-22 interagency agreement or a contract with the department without the
10-23 board's approval.
10-24 SECTION 7. Sections 108.008(b) and (c), Health and Safety
10-25 Code, are amended to read as follows:
10-26 (b) The department shall:
10-27 (1) contract with the council to collect data under
11-1 this chapter;
11-2 (2) provide administrative [and legal] assistance to
11-3 the council [in accordance with rules adopted by the board after
11-4 consulting with the council and set out in the contract with the
11-5 council];
11-6 (3) coordinate administrative responsibilities with
11-7 the council to avoid unnecessary duplication of the collection of
11-8 data and other duties;
11-9 (4) on request of the council, give the council access
11-10 to data collected by the department [on request of the council];
11-11 (5) submit or assist in the council's budget request
11-12 to the legislature; and
11-13 (6) work with the Department of Information Resources
11-14 in developing and implementing the statewide health care data
11-15 collection system and maintain consistency with Department of
11-16 Information Resources standards.
11-17 (c) The department may not take an action that affects or
11-18 relates to the validity, status, or terms of an [a council]
11-19 interagency agreement or a contract with the council without the
11-20 council's approval.
11-21 SECTION 8. Chapter 108, Health and Safety Code, is amended
11-22 by adding Sections 108.0081 and 108.0085 to read as follows:
11-23 Sec. 108.0081. MEMORANDUM OF UNDERSTANDING. The council and
11-24 the department shall enter into a memorandum of understanding to
11-25 implement the department's duties under Section 108.008(b). The
11-26 memorandum of understanding must address:
11-27 (1) payroll and travel reimbursement services;
12-1 (2) purchasing services;
12-2 (3) personnel services;
12-3 (4) budget management services;
12-4 (5) computer support and maintenance services;
12-5 (6) any other administrative support or other services
12-6 to be provided by the department for the council; and
12-7 (7) the manner in which the council will reimburse the
12-8 department for the cost of services provided by the department for
12-9 the council.
12-10 Sec. 108.0085. DUTIES OF ATTORNEY GENERAL. The attorney
12-11 general shall furnish the council with advice and legal assistance
12-12 that may be required to implement this chapter.
12-13 SECTION 9. Sections 108.009(c), (d), (k), and (o), Health
12-14 and Safety Code, are amended to read as follows:
12-15 (c) A rural provider may, but is not required to, provide
12-16 the data required by this chapter [section]. A hospital may, but
12-17 is not required to, provide the data required by this chapter if
12-18 the hospital:
12-19 (1) is exempt from state franchise, sales, ad valorem,
12-20 or other state or local taxes; and
12-21 (2) does not seek or receive reimbursement for
12-22 providing health care services to patients from any source,
12-23 including:
12-24 (A) the patient or any person legally obligated
12-25 to support the patient;
12-26 (B) a third-party payor; or
12-27 (C) Medicaid, Medicare, or any other federal,
13-1 state, or local program for indigent health care.
13-2 (d) The council may not collect data from individual
13-3 physicians or from an entity that is composed entirely of
13-4 physicians and that is a professional association organized under
13-5 the Texas Professional Association Act (Article 1528f, Vernon's
13-6 Texas Civil Statutes), a limited liability partnership organized
13-7 under Section 3.08, Texas Revised Partnership Act (Article
13-8 6132b-3.08, Vernon's Texas Civil Statutes), or a limited liability
13-9 company organized under the Texas Limited Liability Company Act
13-10 (Article 1528n, Vernon's Texas Civil Statutes), except to the
13-11 extent the entity owns and operates a health care facility in this
13-12 state. This subsection does not prohibit the release of data about
13-13 physicians using uniform physician identifiers that has been
13-14 collected from a health care facility under this chapter.
13-15 (k) The [In developing the statewide health care data
13-16 collection system, the] council shall collect [identify] health
13-17 care data elements relating to [health care charges, provider
13-18 quality,] payer type, the racial and ethnic background of
13-19 patients, [the outcome data related to health care services,] and
13-20 the use of health care services by consumers.
13-21 (o) A provider of a health benefit plan [maintenance
13-22 organization] shall annually submit to the council aggregate data
13-23 by service area required by the Health Plan Employer Data
13-24 Information Set (HEDIS) as operated by the National Committee for
13-25 Quality Assurance. The council may approve the submission of data
13-26 in accordance with other methods generally used by the health
13-27 benefit plan [maintenance organization] industry. This subsection
14-1 does not relieve a health care facility that provides services
14-2 under [to] a health benefit plan [maintenance organization] from
14-3 the requirements of this chapter. Information submitted under this
14-4 section is subject to Section 108.011 but is not subject to Section
14-5 108.010.
14-6 SECTION 10. Sections 108.010(b), (c), (d), (e), (g), and
14-7 (h), Health and Safety Code, are amended to read as follows:
14-8 (b) The [After a majority of the council has been appointed,
14-9 the] council shall study and analyze initial methodologies for
14-10 obtaining provider quality data, including outcome data. [The
14-11 council shall adopt an initial methodology not later than January
14-12 1, 1997, but may not adopt the initial methodology before the first
14-13 anniversary of the date on which a majority of the council is
14-14 appointed. If the council determines additional time for
14-15 development of the initial methodology is needed, the council, by a
14-16 two-thirds vote of the full council, may extend the deadline
14-17 established by this subsection for adopting the initial
14-18 methodology.]
14-19 (c) The council shall test the methodology by collecting
14-20 provider quality data for one year, subject to Section 108.009.
14-21 The council may test using pilot methodologies. After collecting
14-22 provider quality data for one year, the council shall report
14-23 findings applicable to a provider to that provider and allow the
14-24 provider to review and comment on the initial provider quality
14-25 [outcome] data applicable to that provider. The council shall
14-26 verify the accuracy of the data during this review and revision
14-27 process. After the review and revision process, provider quality
15-1 [outcome] data for subsequent reports shall be published and made
15-2 available to the public, on a time schedule the council considers
15-3 appropriate.
15-4 (d) If the council determines that provider quality
15-5 [outcome] data to be published under Subsection (c) does not
15-6 provide the intended result or is inaccurate or inappropriate for
15-7 dissemination, the council is not required to publish the data or
15-8 reports based in whole or in part on the data. This subsection
15-9 does not affect the release of public use data in accordance with
15-10 [collected under] Section 108.011 or the release of information
15-11 submitted under Section 108.009(o) [108.009].
15-12 (e) The council shall adopt rules allowing a provider to
15-13 submit written comments regarding any specific provider quality
15-14 data to be released concerning the provider. The council shall
15-15 make the comments available to the public at the office of the
15-16 council and in an electronic form accessible through the Internet
15-17 [The comments may be attached to any public release of data].
15-18 (g) In addition to the requirements of this section, any
15-19 release of provider quality data shall comply with Sections
15-20 108.011(e)-(f) [108.011(d)-(f)].
15-21 (h) A provider quality [outcome] data report may not
15-22 identify an individual physician by name, but must identify the
15-23 physician by the uniform physician identifier designated by the
15-24 council under Section 108.011(c).
15-25 SECTION 11. Sections 108.011 and 108.012, Health and Safety
15-26 Code, are amended to read as follows:
15-27 Sec. 108.011. [DATA] DISSEMINATION OF PUBLIC USE DATA AND
16-1 COUNCIL PUBLICATIONS [PUBLICATION]. (a) The council shall
16-2 promptly provide public use data and data collected in accordance
16-3 with Section 108.009(o) to those requesting it. The public use
16-4 data does not include provider quality [, subject to the
16-5 restrictions on access to council] data prescribed by Section
16-6 [Sections] 108.010 or confidential data prescribed by Section [and]
16-7 108.013.
16-8 (b) Subject to the restrictions on access to council data
16-9 prescribed by Sections 108.010 and 108.013, and using the public
16-10 use data [collected under Section 108.009] and other data, records,
16-11 and matters of record available to it, the council shall prepare
16-12 and issue reports to the governor, the legislature, and the public
16-13 as provided by this section and Section 108.006(a). The council
16-14 must issue the reports at least annually.
16-15 (c) Subject to the restrictions on access to council data
16-16 prescribed by Sections 108.010 and 108.013, the council shall use
16-17 public use data to prepare and issue reports that provide
16-18 information relating to providers, such as the incidence rate of
16-19 selected medical or surgical procedures [and the provider quality].
16-20 The reports must provide the data in a manner that identifies
16-21 individual providers, including individual physicians, and that
16-22 identifies and compares data elements for all providers.
16-23 Individual physicians may not be identified by name, but shall be
16-24 identified by uniform physician identifiers. The council by rule
16-25 shall designate the characters to be used as uniform physician
16-26 identifiers.
16-27 (d) The council shall adopt procedures to verify the
17-1 accuracy of the public use data before releasing [a report
17-2 containing] the public use data [is released] to the public.
17-3 (e) If public use [provider] data is requested from the
17-4 council about [for] a specific provider, the council shall notify
17-5 the provider about the release of the data. This subsection does
17-6 not authorize the provider to interfere with the release of that
17-7 data.
17-8 (f) A report issued by the council shall include a
17-9 reasonable review and comment period for the affected providers
17-10 before public release of the report.
17-11 Sec. 108.012. COMPUTER ACCESS TO DATA. (a) The council
17-12 shall provide a means for computer-to-computer access to the public
17-13 use data. All reports shall maintain patient confidentiality as
17-14 provided by Section 108.013.
17-15 (b) The council may charge a person requesting public use or
17-16 provider quality data a fee for the data. The fees may reflect the
17-17 quantity of information provided and the expense incurred by the
17-18 council in collecting and providing the data and shall be set at a
17-19 level that will raise revenue sufficient for the operation of the
17-20 council. The council may not charge a fee for providing public use
17-21 data to another state agency.
17-22 SECTION 12. Section 108.013, Health and Safety Code, is
17-23 amended by amending Subsections (a), (b), and (e) and adding
17-24 Subsection (g) to read as follows:
17-25 (a) The data received by the council shall be used by the
17-26 council for the benefit of the public. [The council is subject to
17-27 the open records law, Chapter 552, Government Code.] Subject to
18-1 specific limitations established by this chapter and council rule,
18-2 the council shall make determinations on requests for information
18-3 in favor of access.
18-4 (b) The council by rule shall designate the characters to be
18-5 used [by providers] as uniform patient identifiers.
18-6 (e) Data on patients and physicians and compilations[,
18-7 reports, or analyses] produced from the data collected that
18-8 identify patients and physicians are not:
18-9 (1) subject to discovery, subpoena, or other means of
18-10 legal compulsion for release to any person or entity except as
18-11 provided by this section; or
18-12 (2) admissible in any civil, administrative, or
18-13 criminal proceeding.
18-14 (g) Subsection (c)(1) does not prohibit the release of a
18-15 uniform physician identifier or a uniform patient identifier in
18-16 conjunction with associated public use data in accordance with
18-17 Section 108.011 or provider quality data in accordance with Section
18-18 108.010.
18-19 SECTION 13. Chapter 108, Health and Safety Code, is amended
18-20 by adding Section 108.0141 to read as follows:
18-21 Sec. 108.0141. CRIMINAL PENALTY. (a) A person who with
18-22 criminal negligence releases data in violation of this chapter
18-23 commits an offense.
18-24 (b) An offense under this section is a Class A misdemeanor.
18-25 SECTION 14. Sections 108.009(j), (l), and (n), Health and
18-26 Safety Code, are repealed.
18-27 SECTION 15. The change in law made by this Act applies only
19-1 to the collection and dissemination of data under Chapter 108,
19-2 Health and Safety Code, on or after the effective date of this Act.
19-3 The collection and dissemination of data before the effective date
19-4 of this Act is governed by the law as it existed immediately before
19-5 the effective date of this Act, and that law is continued in effect
19-6 for that purpose.
19-7 SECTION 16. This Act takes effect September 1, 1997.
19-8 SECTION 17. The importance of this legislation and the
19-9 crowded condition of the calendars in both houses create an
19-10 emergency and an imperative public necessity that the
19-11 constitutional rule requiring bills to be read on three several
19-12 days in each house be suspended, and this rule is hereby suspended.