By: Walle H.B. No. 1907
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the establishment of a statewide all payor claims
  database to increase public transparency of health care data and
  improve quality of health care in this state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 38, Insurance Code, is amended by adding
  Subchapter I to read as follows:
  SUBCHAPTER I. TEXAS ALL PAYOR CLAIMS DATABASE
         Sec. 38.401.  PURPOSE OF SUBCHAPTER. The purpose of this
  subchapter is to authorize the department to establish an all payor
  claims database in this state to increase public transparency of
  health care information and improve the quality of health care in
  this state.
         Sec. 38.402.  DEFINITIONS. In this subchapter:
               (1)  "Allowed amount" means the amount of a billed
  charge that a health benefit plan issuer determines to be covered
  for services provided by a non-network provider. The allowed amount
  includes both the insurer's payment and any applicable deductible,
  copayment, or coinsurance amounts for which the insured is
  responsible.
               (2)  "Center" means the Center for Healthcare Data at
  The University of Texas Health Science Center at Houston.
               (3)  "Contracted rate" means the fee or reimbursement
  amount for a network provider's services, treatments, or supplies
  as established by agreement between the provider and health benefit
  plan issuer.
               (4)  "Data" means the specific claims and encounters,
  enrollment, and benefit information submitted to the center under
  this subchapter.
               (5)  "Database" means the Texas All Payor Claims
  Database established under this subchapter.
               (6)  "Geozip" means an area that includes all zip codes
  with identical first three digits.
               (7)  "Payor" means any of the following entities that
  pay, reimburse, or otherwise contract with a health care provider
  for the provision of health care services, supplies, or devices to a
  patient:
                     (A)  an insurance company providing health or
  dental insurance;
                     (B)  the sponsor or administrator of a health or
  dental plan;
                     (C)  a health maintenance organization operating
  under Chapter 843;
                     (D)  the state Medicaid program, including the
  Medicaid managed care program operating under Chapter 533,
  Government Code;
                     (E)  a health benefit plan offered or administered
  by or on behalf of this state or a political subdivision of this
  state or an agency or instrumentality of the state or a political
  subdivision of this state, including:
                           (i)  a basic coverage plan under Chapter
  1551;
                           (ii)  a basic plan under Chapter 1575; and
                           (iii)  a primary care coverage plan under
  Chapter 1579; or
                     (F)  any other entity providing a health insurance
  or health benefit plan subject to regulation by the department.
               (8)  "Protected health information" has the meaning
  assigned by 45 C.F.R. Section 160.103.
               (9)  "Qualified research entity" means:
                     (A)  an organization engaging in public interest
  research for the purpose of analyzing the delivery of health care in
  this state that is exempt from federal income tax under Section
  501(a), Internal Revenue Code of 1986, by being listed as an exempt
  organization in Section 501(c)(3) of that code;
                     (B)  an institution of higher education engaged in
  public interest research related to the delivery of health care in
  this state; or
                     (C)  a health care provider in this state engaging
  in efforts to improve the quality and cost of health care. 
               (10)  "Stakeholder advisory group" means the
  stakeholder advisory group established under Section 38.403.
         Sec. 38.403.  STAKEHOLDER ADVISORY GROUP. (a)  The center
  shall establish a stakeholder advisory group to assist the center
  as provided by this subchapter, including assistance in:
               (1)  establishing and updating the standards,
  requirements, policies, and procedures relating to the collection
  and use of data contained in the database required by Sections
  38.404(e) and (f);
               (2)  evaluating and prioritizing the types of reports
  the center should publish under Section 38.404(e);
               (3)  evaluating data requests from qualified research
  entities under Section 38.404(e)(2); and
               (4)  assisting the center in developing the center's
  recommendations under Section 38.408(3).
         (b)  The advisory group created under this section must be
  composed of:
               (1)  the state Medicaid director or the director's
  designee;
               (2)  a member designated by the Teacher Retirement
  System of Texas;
               (3)  a member designated by the Employees Retirement
  System of Texas; and
               (4)  12 members designated by the center, including:
                     (A)  two members representing the business
  community, with at least one of those members representing small
  businesses that purchase health benefits but are not involved in
  the provision of health care services, supplies, or devices or
  health benefit plans;
                     (B)  two members who represent consumers and who
  are not professionally involved in the purchase, provision,
  administration, or review of health care services, supplies, or
  devices or health benefit plans, with at least one member
  representing the behavioral health community;
                     (C)  two members representing hospitals that are
  licensed in this state;
                     (D)  two members representing health benefit plan
  issuers that are regulated by the department;
                     (E)  two members who are physicians licensed to
  practice medicine in this state, one of whom is a primary care
  physician; and
                     (F)  two members who are not professionally
  involved in the purchase, provision, administration, or review of
  health care services, supplies, or devices or health benefit plans
  and who have expertise in:
                           (i)  health planning;
                           (ii)  health economics;
                           (iii)  provider quality assurance;
                           (iv)  statistics or health data management;
  or
                           (v)  medical privacy laws.
         (c)  A person serving on the stakeholder advisory group must
  disclose any conflict of interest.
         (d)  Members of the stakeholder advisory group serve fixed
  terms as prescribed by commissioner rules adopted under this
  subchapter.
         Sec. 38.404.  ESTABLISHMENT AND ADMINISTRATION OF DATABASE.
  (a) The department shall collaborate with the center under this
  subchapter to aid in the center's establishment of the database.
  The center shall leverage the existing resources and infrastructure
  of the center to establish the database to collect, process,
  analyze, and store data relating to medical, dental,
  pharmaceutical, and other relevant health care claims and
  encounters, enrollment, and benefit information for the purposes of
  increasing transparency of health care costs, utilization, and
  access and improving the affordability, availability, and quality
  of health care in this state, including by improving population
  health in this state.
         (b)  The center shall serve as the administrator of the
  database, design, build, and secure the database infrastructure,
  and determine the accuracy of the data submitted for inclusion in
  the database.
         (c)  In determining the information a payor is required to
  submit to the center under this subchapter, the center must
  consider requiring inclusion of information useful to health policy
  makers, employers, and consumers for purposes of improving health
  care quality and outcomes, improving population health, and
  controlling health care costs. The required information at a
  minimum must include the following information as it relates to all
  health care services, supplies, and devices paid or otherwise
  adjudicated by the payor:
               (1)  the name and National Provider Identifier, as
  described in 45 C.F.R. Section 162.410, of each health care
  provider paid by the payor;
               (2)  the claim line detail that documents the health
  care services, supplies, or devices provided by the health care
  provider;
               (3)  the amount of charges billed by the health care
  provider and the payor's:
                     (A)  allowed amount or contracted rate for the
  health care services, supplies, or devices; and
                     (B)  adjudicated claim amount for the health care
  services, supplies, or devices;
               (4)  the name of the payor, the name of the health
  benefit plan, and the type of health benefit plan, including
  whether health care services, supplies, or devices were provided to
  an individual through:
                     (A)  a Medicaid or Medicare program;
                     (B)  workers' compensation insurance;
                     (C)  a health maintenance organization operating
  under Chapter 843;
                     (D)  a preferred provider benefit plan offered by
  an insurer under Chapter 1301;
                     (E)  a basic coverage plan under Chapter 1551;
                     (F)  a basic plan under Chapter 1575;
                     (G)  a primary care coverage plan under Chapter
  1579; or
                     (H)  a health benefit plan that is subject to the
  Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
  1001 et seq.); and
               (5)  claim level information that allows the center to
  identify the geozip where the health care services, supplies, or
  devices were provided.
         (d)  Each payor shall submit the required data under
  Subsection (c) at a schedule and frequency determined by the center
  and adopted by the commissioner by rule.
         (e)  In the manner and subject to the standards,
  requirements, policies, and procedures relating to the use of data
  contained in the database established by the center in consultation
  with the stakeholder advisory group, the center may use the data
  contained in the database for a noncommercial purpose:
               (1)  to produce statewide, regional, and geozip
  consumer reports available through the public access portal
  described in Section 38.405 that address:
                     (A)  health care costs, quality, utilization,
  outcomes, and disparities;
                     (B)  population health; or
                     (C)  the availability of health care services; and
               (2)  for research and other analysis conducted by the
  center or a qualified research entity to the extent that such use is
  consistent with all applicable federal and state law, including the
  data privacy and security requirements of Section 38.406 and the
  purposes of this subchapter.
         (f)  The center shall establish data collection procedures
  and evaluate and update data collection procedures established
  under this section.  The center shall test the quality of data
  collected by and reported to the center under this section to ensure
  that the data is accurate, reliable, and complete.
         Sec. 38.405.  PUBLIC ACCESS PORTAL. (a) Except as provided
  by this section and Sections 38.404 and 38.406 and in a manner
  consistent with all applicable federal and state law, the center
  shall collect, compile, and analyze data submitted to or stored in
  the database and disseminate the information described in Section
  38.404(e)(1) in a format that allows the public to easily access and
  navigate the information. The information must be accessible
  through an open access Internet portal that may be accessed by the
  public through an Internet website.
         (b)  The portal created under this section must allow the
  public to easily search and retrieve the information disseminated
  under Subsection (a), subject to data privacy and security
  restrictions described in this subchapter and consistent with all
  applicable federal and state law.
         (c)  Any information or data that is accessible through the
  portal created under this section:
               (1)  must be segmented by type of insurance or health
  benefit plan in a manner that does not combine payment rates
  relating to different types of insurance or health benefit plans;
               (2)  must be aggregated by like Current Procedural
  Terminology codes and health care services in a statewide,
  regional, or geozip area; and
               (3)  may not identify a specific patient, health care
  provider, health benefit plan, health benefit plan issuer, or other
  payor.
         (d)  Before making information or data accessible through
  the portal, the center shall remove any data or information that may
  identify a specific patient in accordance with the
  de-identification standards described in 45 C.F.R. Section
  164.514.
         Sec. 38.406.  DATA PRIVACY AND SECURITY. (a) Any
  information that may identify a patient, health care provider,
  health benefit plan, health benefit plan issuer, or other payor is
  confidential and subject to applicable state and federal law
  relating to records privacy and protected health information,
  including Chapter 181, Health and Safety Code, and is not subject to
  disclosure under Chapter 552, Government Code.
         (b)  A qualified research entity with access to data or
  information that is contained in the database but not accessible
  through the portal described in Section 38.405:
               (1)  may use information contained in the database only
  for purposes consistent with the purposes of this subchapter and
  must use the information in accordance with standards,
  requirements, policies, and procedures established by the center in
  consultation with the stakeholder advisory group;
               (2)  may not sell or share any information contained in
  the database; and
               (3)  may not use the information contained in the
  database for a commercial purpose.
         (c)  A qualified research entity with access to information
  that is contained in the database but not accessible through the
  portal must execute an agreement with the center relating to the
  qualified research entity's compliance with the requirements of
  Subsections (a) and (b), including the confidentiality of
  information contained in the database but not accessible through
  the portal.
         (d)  Notwithstanding any provision of this subchapter, the
  department and the center may not disclose an individual's
  protected health information in violation of any state or federal
  law.
         (e)  The center shall include in the database only the
  minimum amount of protected health information identifiers
  necessary to link public and private data sources and the
  geographic and services data to undertake studies.
         (f)  The center shall maintain protected health information
  identifiers collected under this subchapter but excluded from the
  database under Subsection (e) in a separate database. The separate
  database may not be aggregated with any other information and must
  use a proxy or encrypted record identifier for analysis.
         Sec. 38.407.  CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.
  Any sponsor or administrator of a health benefit plan subject to the
  Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
  1001 et seq.) may elect or decline to participate in or submit data
  to the center for inclusion in the database as consistent with
  federal law.
         Sec. 38.408.  REPORT TO LEGISLATURE. Not later than
  September 1 of each even-numbered year, the center shall submit to
  the legislature a written report containing:
               (1)  an analysis of the data submitted to the center for
  use in the database;
               (2)  information regarding the submission of data to
  the center for use in the database and the maintenance, analysis,
  and use of the data;
               (3)  recommendations from the center, in consultation
  with the stakeholder advisory group, to further improve the
  transparency, cost-effectiveness, accessibility, and quality of
  health care in this state; and
               (4)  an analysis of the trends of health care
  affordability, availability, quality, and utilization.
         Sec. 38.409.  RULES. (a) The commissioner, in consultation
  with the center, shall adopt rules:
               (1)  specifying the types of data a payor is required to
  provide to the center under Section 38.404 to determine health
  benefits costs and other reporting metrics, including, if
  necessary, types of data not expressly identified in that section;
               (2)  specifying the schedule, frequency, and manner in
  which a payor must provide data to the center under Section 38.404,
  which must:
                     (A)  require the payor to provide data to the
  center not less frequently than quarterly; and
                     (B)  include provisions relating to data layout,
  data governance, historical data, data submission, use and sharing,
  information security, and privacy protection in data submissions;
  and
               (3)  establishing oversight and enforcement mechanisms
  to ensure that payors submit data to the database in accordance with
  this subchapter.
         (b)  In adopting rules governing methods for data
  submission, the commissioner shall to the maximum extent
  practicable use methods that are reasonable and cost-effective for
  payors.
         SECTION 2.  (a) Not later than January 1, 2022, the Center
  for Healthcare Data at The University of Texas Health Science
  Center at Houston shall establish the stakeholder advisory group in
  accordance with Section 38.403, Insurance Code, as added by this
  Act.
         (b)  Not later than June 1, 2022, the Texas Department of
  Insurance shall adopt rules, and the Center for Healthcare Data at
  The University of Texas Health Science Center at Houston shall
  adopt, in consultation with the stakeholder advisory group,
  standards, requirements, policies, and procedures, necessary to
  implement Subchapter I, Chapter 38, Insurance Code, as added by
  this Act.
         SECTION 3.  As soon as practicable after the effective date
  of this Act, the Center for Healthcare Data at The University of
  Texas Health Science Center at Houston shall actively seek
  financial support from the federal grant program for development of
  state all payer claims databases established under the Consolidated
  Appropriations Act, 2021 (Pub. L. No. 116-260) and from any other
  available source of financial support provided by the federal
  government for purposes of implementing Subchapter I, Chapter 38,
  Insurance Code, as added by this Act.
         SECTION 4.  If before implementing any provision of
  Subchapter I, Chapter 38, Insurance Code, as added by this Act, the
  commissioner of insurance determines that a waiver or authorization
  from a federal agency is necessary for implementation of that
  provision, the commissioner shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 5.  This Act takes effect September 1, 2021.