Amend SB 1731 on third reading as follows:
(1) Strike the SECTIONS of the bill, as added by Amendment
No. 6 by McReynolds, that add or amend the following:
Subdivisions (1), (3), (4-a), (5), (6), (7), (8), (8-a),
(10), (11-a), (12), (14-a), (16), (17), (17-a), (20), (21), (21-a),
and (22), Section 108.002, Health and Safety Code; and
Sections 108.006, 108.009, 108.0095, 108.010, 108.011,
108.012, 108.013, 108.0135, and 108.014, Health and Safety Code.
(2) Add the following appropriately numbered SECTIONS to
the bill:
SECTION ____. Section 108.002, Health and Safety Code, is
amended by amending Subdivisions (1), (3), (5), (7), (8), (12),
(17), (20), (21), and (22) and adding Subdivisions (4-a), (8-a),
and (14-a) to read as follows:
(1) "Accurate and consistent data" means data that has
been edited by the department [council] and subject to provider
validation and certification.
(3) "Certification" means the process by which a
provider confirms the accuracy and completeness of the data set
required to produce the public use data file in accordance with
department [council] rule.
(4-a) "Commission" means the Health and Human Services
Commission.
(5) "Confidential data" means data that is made
confidential under this chapter, other state law, or federal
law ["Council" means the Texas Health Care Information Council].
(7) "Department" means the [Texas] Department of State
Health Services.
(8) "Edit" means to use an electronic standardized
process developed and implemented by the department [council rule]
to identify potential errors and mistakes in data elements by
reviewing data fields for the presence or absence of data and the
accuracy and appropriateness of data.
(8-a) "Executive commissioner" means the executive
commissioner of the Health and Human Services Commission.
(12) "Hospital" means a public, for-profit, or
nonprofit institution licensed or owned by this state that is a
general or special hospital, private mental hospital, [chronic
disease hospital,] or other type of hospital.
(14-a) "Program director" means the primary
department employee responsible for performing the functions and
exercising the authority of the program director and includes the
program director's designee.
(17) "Public use data" means patient level data
relating to individual hospitalizations that has [not been
summarized or analyzed, that has] had patient identifying
information removed, that identifies physicians only by use of
uniform physician identifiers, and that is severity and risk
adjusted, edited, and verified for accuracy and consistency.
Public use data may exclude some data elements submitted to the
department [council]. Public use data does not include
confidential data.
(20) "Uniform patient identifier" means an identifier
[a number] assigned by the department [council] to an individual
patient and composed of numeric, alpha, or alphanumeric characters.
(21) "Uniform physician identifier" means an
identifier [a number] assigned by the department [council] to an
individual physician and composed of numeric, alpha, or
alphanumeric characters.
(22) "Validation" means the process by which a
provider verifies the accuracy and completeness of data and
corrects any errors identified before certification in accordance
with department [council] rule.
SECTION ____. Section 108.009, Health and Safety Code, is
amended to read as follows:
Sec. 108.009. DATA SUBMISSION AND COLLECTION. (a) The
department [council] may collect, and, except as provided by
Subsections (c) and (d), providers shall submit to the department
[council] or another entity as determined by the department
[council], all data required by this section. The data shall be
collected according to uniform submission formats, coding systems,
and other technical specifications necessary to make the incoming
data substantially valid, consistent, compatible, and manageable
using electronic data processing, if available.
(b) The department [council] shall recommend [adopt] rules
to implement the data submission requirements imposed by Subsection
(a) in appropriate stages to allow for the development of efficient
systems for the collection and submission of the data. A rule
[adopted by the council] that requires submission of a data element
that, before adoption of the rule, was not required to be submitted
may not take effect before the 90th day after the date the rule is
adopted and must take effect not later than the first anniversary
after the date the rule is adopted.
(c) A rural provider may, but is not required to, provide
the data required by this chapter. A hospital may, but is not
required to, provide the data required by this chapter if the
hospital:
(1) is exempt from state franchise, sales, ad valorem,
or other state or local taxes; and
(2) does not seek or receive reimbursement for
providing health care services to patients from any source,
including:
(A) the patient or any person legally obligated
to support the patient;
(B) a third-party payor; or
(C) Medicaid, Medicare, or any other federal,
state, or local program for indigent health care.
(d) The department [council] may not collect data from
individual physicians or from an entity that is composed entirely
of physicians and that is a professional association organized
under the Texas Professional Association Act (Article 1528f,
Vernon's Texas Civil Statutes) or formed under the Texas
Professional Association Law, as described by Section 1.008,
Business Organizations Code, a limited liability partnership
organized under Section 3.08, Texas Revised Partnership Act
(Article 6132b-3.08, Vernon's Texas Civil Statutes), or described
by Subchapter J, Chapter 152, Business Organizations Code, or a
limited liability company organized under the Texas Limited
Liability Company Act (Article 1528n, Vernon's Texas Civil
Statutes) or formed under the Texas Limited Liability Company Law,
as described by Section 1.008, Business Organizations Code, except
to the extent the entity owns and operates a health care facility in
this state. This subsection does not prohibit the release of data
about physicians using uniform physician identifiers that has been
collected from a health care facility under this chapter.
[(e) The council shall establish the department as the
single collection point for receipt of data from providers. With
the approval of the council and the board, the department may
transfer collection of any data required to be collected by the
department under any other law to the statewide health care data
collection system.]
(f) The department [council] may not require providers to
submit data more frequently than quarterly, but providers may
submit data on a more frequent basis.
(g) The department may [council shall] coordinate data
collection with the data collection formats used by federally
qualified health centers. To satisfy the requirements of this
chapter:
(1) a federally qualified health center shall submit
annually to the department [council] a copy of the Medicaid cost
report of federally qualified health centers; and
(2) a provider receiving federal funds under 42 U.S.C.
Section 254b, 254c, or 256 shall submit annually to the department
[council] a copy of the Bureau of Common Reporting Requirements
data report developed by the United States Public Health Service.
(h) The department [council] shall coordinate data
collection with the data submission formats used by hospitals and
other providers. The department [council] shall accept data in the
format developed by the National Uniform Billing Committee (Uniform
Hospital Billing Form UB 92) and HCFA-1500 or their successors or
other universally accepted standardized forms that hospitals and
other providers use for other complementary purposes.
(i) The department [council] shall recommend rules on
[develop by rule] reasonable alternate data submission procedures
for providers that do not possess electronic data processing
capacity.
(k) The department [council] shall collect health care data
elements relating to payer type, the racial and ethnic background
of patients, and the use of health care services by consumers.
(m) To the extent feasible, the department [council] shall
obtain from public records the information that is available from
those records.
(o) A provider of a health benefit plan shall annually
submit to the department [council] aggregate data by service area
required by the Health Plan Employer Data Information Set (HEDIS)
as operated by the National Committee for Quality Assurance. The
department [council] may approve the submission of data in
accordance with other methods generally used by the health benefit
plan industry. If the Health Plan Employer Data Information Set
does not generally apply to a health benefit plan, the department
[council] shall require submission of data in accordance with other
methods. This subsection does not relieve a health care facility
that provides services under a health benefit plan from the
requirements of this chapter. Information submitted under this
section is subject to Section 108.011 but is not subject to Section
108.010.
SECTION ____. Section 108.006, Health and Safety Code, is
amended to read as follows:
Sec. 108.006. POWERS AND DUTIES OF DEPARTMENT [COUNCIL].
(a) The department [council] shall develop a statewide health care
data collection system to collect health care charges, utilization
data, provider quality data, and outcome data to facilitate the
promotion and accessibility of cost-effective, good quality health
care. The department [council] shall:
(1) direct the collection, dissemination, and
analysis of data under this chapter;
(2) [contract with the department to collect the data
under this chapter;
[(3)] adopt policies and recommend rules necessary to
carry out this chapter, including rules concerning data collection
requirements;
(3) [(4)] build on and not duplicate other data
collection required by state or federal law, by an accreditation
organization, or by executive commissioner [board] rule;
(4) [(5)] working with appropriate agencies, review
public health data collection programs in this state and recommend,
where appropriate, consolidation of the programs and any
legislation necessary to effect the consolidation or obtain data
collected by other state agencies;
(5) [(6)] assure that public use data is made
available and accessible to interested persons;
(6) recommend rules regarding [(7) prescribe by
rule] the process for providers to submit data consistent with
Section 108.009;
(7) [(8) adopt by rule and implement a methodology to
collect and disseminate data reflecting provider quality in
accordance with Section 108.010;
[(9)] make annual reports to the legislature, the
governor, and the public on:
(A) the charges and rate of change in the charges
for health care services in this state;
(B) the effectiveness of the department
[council] in carrying out the legislative intent of this chapter;
(C) if applicable, any recommendations on the
need for further legislation; and
(D) the quality and effectiveness of health care
and access to health care for all citizens of this state;
(8) [(10)] develop an annual work plan and establish
priorities to accomplish its duties;
(9) [(11)] provide consumer education on the
interpretation and understanding of the public use or provider
quality data before the data is disseminated to the public;
(10) [(12)] work with the commission [Health and Human
Services Commission] and each health and human services agency that
administers a part of the state Medicaid program to avoid
duplication of expenditures of state funds for computer systems,
staff, or services in the collection and analysis of data relating
to the state Medicaid program; and
(11) provide data and [(13) work with the Department
of Information Resources in developing and implementing the
statewide health care data collection system and maintain
consistency with Department of Information Resources standards;
and
[(14) develop and implement a health care] information
[plan] to be used by the department to:
(A) support public health and preventative
health initiatives;
(B) assist in the delivery of primary and
preventive health care services;
(C) facilitate the establishment of appropriate
benchmark data to measure performance improvements;
(D) establish and maintain a systematic approach
to the collection, storage, and analysis of health care data for
longitudinal, epidemiological, and policy impact studies; and
(E) develop and use system-based protocols to
identify individuals and populations at risk.
(b) The department [council] may recommend[:
[(1) employ or contract with the department to employ
an executive director and other staff, including administrative
personnel, necessary to comply with this chapter and rules adopted
under this chapter;
[(2) engage professional consultants as it considers
necessary to the performance of its duties;
[(3) adopt] rules clarifying which health care
facilities must provide data under this chapter[; and
[(4) apply for and receive any appropriation,
donation, or other funds from the state or federal government or any
other public or private source, subject to Section 108.015 and
limitations and conditions provided by legislative appropriation].
(c) The department [council] may not establish or recommend
rates of payment for health care services.
[(d) The council may not take an action that affects or
relates to the validity, status, or terms of an interagency
agreement or a contract with the department without the board's
approval.]
(e) In the collection of data, the department [council]
shall consider the research and initiatives being pursued by the
United States Department of Health and Human Services, the National
Committee for Quality Assurance, and the Joint Commission on
Accreditation of Healthcare Organizations to reduce potential
duplication or inconsistencies. The executive commissioner
[council] may not adopt rules that conflict with or duplicate any
federally mandated data collection programs or requirements of
comparable scope.
(f) The department [council] shall recommend rules on
[prescribe by rule] a public use data element list [file minimum
data set] that maintains patient confidentiality and establishes
data accuracy and consistency.
(g) The public use data element list [file minimum data set]
as defined by [council] rule is subject to annual review by the
department [council with the assistance of the advisory committee
under Section 108.003(g)(5). The purpose of the review is] to
evaluate requests to modify the existing public use [minimum] data
element list [set] and editing process of those data elements. A
decision to modify the public use [minimum] data element list [set]
by the addition or deletion of data elements shall include
consideration of the value of the specific data to be added or
deleted and the technical feasibility of establishing data accuracy
and consistency. The department [council] may also consider the
costs to the department [council] and providers associated with
modifying the public use [minimum] data element list [set].
(h) In accordance with Sections 108.013(k), (l), (m), and
(n) and [Section] 108.0135, the department [council] may release
data collected under Section 108.009 that is not included in the
public use data element list [file minimum data set] established
under this chapter [Subsection (f)].
SECTION ____. Section 108.010, Health and Safety Code, is
amended to read as follows:
Sec. 108.010. [COLLECTION AND] DISSEMINATION OF PROVIDER
QUALITY REPORTS [DATA]. (a) Subject to Section 108.009, the
department [council] shall gather [collect] data reflecting
provider quality based on a methodology and review process
established through the executive commissioner's [council's]
rulemaking process. The methodology shall identify and measure
quality standards and adhere to any federal mandates.
[(b) The council shall study and analyze initial
methodologies for obtaining provider quality data, including
outcome data.]
(c) The department [council] shall test the methodology for
a period of time to be determined by the department [by collecting
provider quality data for one year, subject to Section 108.009].
This requirement to test a methodology applies only to
methodologies that have not previously been used by the department.
The department [council] may test using pilot methodologies. Any
[After collecting provider quality data for one year, the council
shall report findings applicable to a provider to that provider and
allow the provider to review and comment on the initial provider
quality data applicable to that provider. The council shall verify
the accuracy of the data during this review and revision process.
After the review and revision process,] provider quality [data for
subsequent] reports shall be published and made available to the
public, on a time schedule the department [council] considers
appropriate.
(d) If the department [council] determines that a provider
quality data to be published under Subsection (c) does not provide
the intended result or is inaccurate or inappropriate for
dissemination, the department [council] is not required to publish
or release the data or reports based in whole or in part on the data.
This subsection does not affect the release of public use data in
accordance with Section 108.011 or the release of information
submitted under Section 108.009(o).
(e) The department shall allow [council shall adopt rules
allowing] a provider to submit concise written comments regarding
any specific provider quality data to be released concerning the
provider. The department [council] shall make the comments
available to the public at the department [office of the council]
and in an electronic form accessible through the Internet. The
comments shall be attached to any public release of provider
quality data. Providers shall submit the comments to the
department [council] to be attached to the public release of
provider quality data in the same format as the provider quality
data that is to be released.
(f) The methodology adopted by the department [council] for
measuring quality shall include case-mix qualifiers, severity
adjustment factors, adjustments for medical education and
research, or [and] any other factors necessary to accurately
reflect provider quality.
(g) In addition to the requirements of this section, any
release of provider quality data shall comply with Sections
108.011(e) and (f).
(h) A provider quality [data] report may not identify an
individual physician by name, but must identify the physician by
the uniform physician identifier designated by the department
[council] under Section 108.011(c).
(i) The department [council] shall release provider quality
data in an aggregate form without uniform physician identifiers
when:
(1) the data relates to providers described by Section
108.0025(1); or
(2) the cell size of the data is below the minimum size
established by council rule that would enable identification of an
individual patient or physician.
SECTION ____. Section 108.011, Health and Safety Code, is
amended to read as follows:
Sec. 108.011. DISSEMINATION OF PUBLIC USE DATA AND
DEPARTMENT [COUNCIL] PUBLICATIONS. (a) The department [council]
shall promptly provide public use data and data collected in
accordance with Section 108.009(o) to those requesting it. The
public use data does not include provider quality data prescribed
by Section 108.010 or confidential data prescribed by Section
108.013.
(b) Subject to the restrictions on access to department
[council] data prescribed by Sections 108.010 and 108.013, and
using the public use data and other data, records, and matters of
record available to it, the department [council] shall prepare and
issue reports to the governor, the legislature, and the public as
provided by this section and Section 108.006(a). The department
[council] must issue the reports at least annually.
(c) Subject to the restrictions on access to department
[council] data prescribed by Sections 108.010 and 108.013, the
department [council] shall use public use data to prepare and issue
reports that provide information relating to providers, such as the
incidence rate of selected medical or surgical procedures. The
reports must provide the data in a manner that identifies
individual providers, including individual physicians, and that
identifies and compares data elements for all providers.
Individual physicians may not be identified by name, but shall be
identified by uniform physician identifiers. The department
[council by rule] shall recommend rules and designate the
characters to be used as uniform physician identifiers.
(c-1) The department [council] shall use public use data to
prepare and issue reports that provide information for review and
analysis by the commission [Health and Human Services Commission]
relating to services that are provided in a niche hospital, as
defined by Section 105.002, Occupations Code, and that are provided
by a physician with an ownership interest in the niche hospital.
(c-2) Subsection (c-1) does not apply to an ownership
interest in publicly available shares of a registered investment
company, such as a mutual fund, that owns publicly traded equity
securities or debt obligations issued by a niche hospital or an
entity that owns the niche hospital.
(d) The department [council] shall adopt procedures to
establish the accuracy and consistency of the public use data
before releasing the public use data to the public.
(e) If public use data is requested from the department
[council] about a specific provider, the department [council] shall
notify the provider about the release of the data. This subsection
does not authorize the provider to interfere with the release of
that data.
(f) A report issued by the department [council] shall
include a reasonable review and comment period for the affected
providers before public release of the report.
(g) The department [council] shall provide a process [adopt
rules] allowing a provider to submit concise written comments
regarding any specific public use data to be released concerning
the provider. The department [council] shall make the comments
available to the public [and the office of the council] and in an
electronic form accessible through the Internet. The comments
shall be attached to any public release of the public use data.
Providers shall submit the comments to the department [council] to
be attached to the public release of public use data in the same
format as the public use data that is to be released.
(h) Media devices [Tapes] containing public use data and
provider quality reports that are released to the public must
include general consumer education material, including an
explanation of the benefits and limitations of the information
provided in the public use data and provider quality reports.
(i) The department [council] shall release public use data
[in an aggregate form] without uniform physician identifiers when:
(1) the data relates to providers described by Section
108.0025(1); or
(2) the cell size of the data is below the minimum size
established by department [council] rule that would enable
identification of an individual patient or physician when combined
with other data elements from the public use data element list.
(j) Notwithstanding Section 552.021 or 552.221, Government
Code, the department is not required to make data available or
produce data for inspection or duplication under Chapter 552,
Government Code.
SECTION ____. Section 108.012, Health and Safety Code, is
amended to read as follows:
Sec. 108.012. COMPUTER ACCESS TO DATA. (a) The department
[council] shall provide a means for computer
[computer-to-computer] access to the public use data. All data and
reports shall maintain patient confidentiality as provided by
Section 108.013.
(b) The department [council] may charge a person requesting
public use or provider quality data a fee for the data. The fees may
reflect the quantity of information provided and the expense
incurred by the department [council] in collecting and providing
the data [and shall be set at a level that will raise revenue
sufficient for the operation of the council. The council may not
charge a fee for providing public use data to another state agency].
SECTION ____. Section 108.013, Health and Safety Code, is
amended to read as follows:
Sec. 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO DATA.
(a) The data received by the department [council] shall be used by
the department [council] for the benefit of the public. [Subject to
specific limitations established by this chapter and council rule,
the council shall make determinations on requests for information
in favor of access.]
(b) The department [council by rule] shall designate the
characters to be used as uniform patient and physician identifiers.
The basis for assignment of the characters and the manner in which
the characters are assigned are confidential.
(c) Unless specifically authorized by this chapter, the
department [council] may not release and a person or entity may not
gain access to any data:
(1) that could reasonably be expected to reveal the
identity of a patient;
(2) that could reasonably be expected to reveal the
identity of a physician;
(3) disclosing provider discounts or differentials
between payments and billed charges;
(4) relating to actual payments to an identified
provider made by a payer; or
(5) submitted to the department [council] in a uniform
submission format that is not included in the public use data
element list described by [set established under] Sections
108.006(f) and (g), except in accordance with Subsections (k), (l),
(m), and (n) and Section 108.0135.
(d) All data collected and used by the department [and the
council] under this chapter is subject to the confidentiality
provisions and criminal penalties of:
(1) Section 311.037;
(2) Section 81.103; and
(3) Section 159.002, Occupations Code.
(e) Data on patients and compilations produced from the data
collected that identify patients are not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity except as
provided by this section; or
(2) admissible in any civil, administrative, or
criminal proceeding.
(f) Data on physicians and compilations produced from the
data collected that identify physicians are not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity except as
provided by this section; or
(2) admissible in any civil, administrative, or
criminal proceeding.
(g) The department [council] may not release data elements
in a manner that will reveal the identity of a patient. The
department [council] may not release data elements in a manner that
will reveal the identity of a physician.
(h) Subsections (c) and (g) do not prohibit the release of a
uniform physician identifier in conjunction with associated public
use data in accordance with Section 108.011 or a provider quality
report in accordance with Section 108.010.
(i) Notwithstanding any other law, the [council and the]
department may not provide information made confidential by this
section to any other agency of this state.
(j) The department [council] shall recommend a [by] rule to
[, with the assistance of the advisory committee under Section
108.003(g)(5),] develop and implement a mechanism to comply with
Subsections (c)(1) and (2).
(k) The department may disclose data collected under this
chapter that is not included in public use data to any program
within the department upon review and approval by the institutional
or other review board established under Section 108.0135. This
subsection does not authorize disclosure of physician identifying
data.
(l) The department shall implement safeguards to ensure
that the department maintains the confidentiality of confidential
data in the possession of the department. The department shall
identify the confidential data to a program within the department
receiving the data as described by Subsection (k). The program
receiving the data must ensure that the confidential data remains
confidential.
(m) Notwithstanding other law, the confidential data
collected under this chapter that is disclosed to another program
within the department under this section remains subject to the
confidentiality provisions of this chapter.
(n) Subsections (c), (d), and (g) and Sections 108.010(g)
and (h) and 108.011(e) and (f) do not apply to the disclosure of
data to a department program with respect to which the department is
given approval to disclose data under this section. This
subsection does not authorize disclosure of physician identifying
data.
SECTION ____. Section 108.0135, Health and Safety Code, is
amended to read as follows:
Sec. 108.0135. INSTITUTIONAL [SCIENTIFIC] REVIEW BOARD
[PANEL]. (a) The department [council] shall establish a
department institutional review board or similar privacy board
[scientific review panel] to review and approve valid requests for
access to data not contained in the [information other than] public
use data element list established by rule, excluding the names and
identification numbers of the patients and physicians. The members
of the board [panel] shall have experience and expertise in ethics,
patient confidentiality, and health care data.
(b) For purposes of Subsection (a), an identification
number is any unique identifier composed of numeric, alpha, or
alphanumeric characters assigned by a person to the patient or
physician, but does not include a uniform identifier assigned by
the department under this chapter [To assist the panel in
determining whether to approve a request for information, the
council shall adopt rules similar to the federal Health Care
Financing Administration's guidelines on releasing data].
[(c) A request for information other than public use data
must be made on the form created by the council.]
SECTION ____. Subsections (b), (c), and (d), Section
108.014, Health and Safety Code, are amended to read as follows:
(b) A person who fails to supply available data under this
chapter [Sections 108.009 and 108.010] is liable for a civil
penalty of not less than $500 [$1,000 or more than $10,000] for each
act of violation.
(c) The attorney general, at the request of the department
[council], shall enforce this chapter. The venue of an action
brought under this section is in Travis County.
(d) A civil penalty recovered in a suit instituted by the
attorney general under this chapter shall be deposited in the
general revenue fund and may be appropriated to [the credit of] the
department [health care information account].
(3) Renumber subsequent SECTIONS of the bill accordingly.