BILL ANALYSIS

 

 

 

H.B. 3414

By: Oliverson

Insurance

Committee Report (Unamended)

 

 

 

BACKGROUND AND PURPOSE

 

The Texas all payor claims database is a database of health care claims files created by H.B. 2090 during the 87th legislative session. All "payers," mostly insurance companies, that are subject to Texas law must submit claims forms to the database. The database is administered by the Center for Healthcare Data at The University of Texas Health Science Center at Houston and overseen by the Texas Department of Insurance. The data within it is fully deidentified, meaning that patient privacy is always fully protected. The data could be a powerful tool for researchers, employers, and legislators to identify trends in health and health care, improve the quality of care, and lower its cost. If its full potential were realized, the data could be invaluable to help study patient outcomes, make quality of care assessments, develop more intelligent health benefit plans, and inform future legislative efforts to address the cost and quality of care. The data that is being collected is excellent, however, there are concerns that researchers face severe restrictions on what they can publish, which limits the database from reaching its true potential. Specifically, current law prohibits the reporting of any information from the database that might identify a medical provider or insurer by name. It has been suggested that due to these restrictions, the database is not a usable source of information for many researcher entities, such as the RAND Corporation, who have been producing periodic reports on the value and effectiveness of employer-sponsored health plans. At least 11 other states have similar databases that research entities have been able to use in producing these reports. Ensuring the usefulness of the database can improve the integrity of research around the quality and cost of medical care. It is important that researchers have access to information to conduct studies without sacrificing editorial independence and integrity, so that legislators and the public can have faith in the results. H.B. 3414 seeks to provide research entities, market participants, and market consultants access to the database, with specific and appropriate restrictions on access and use of data by each applicable entity.

 

CRIMINAL JUSTICE IMPACT

 

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

 

RULEMAKING AUTHORITY

 

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

 

ANALYSIS

 

H.B. 3414 amends the Insurance Code to make changes relating to the Texas all payor claims database established by the Center for Healthcare Data at The University of Texas Health Science Center at Houston and to the composition of the stakeholder advisory group established to assist the center with that database.

 

 

Database Administration

 

H.B. 3414 prohibits the center from requiring the submission of data for the database that is not included in a standard claim form. The bill replaces a requirement for any information or data that is accessible through the database's public access portal to be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, or geozip  area with an authorization for the information or data to be aggregated as such and includes among such areas local, metropolitan, and zip-code areas.

 

Database Access by Certain Qualified Entities

 

H.B. 3414 revises the conditions on a qualified research entity's access to and use of data or information contained in the database by doing the following:

·         removing the prohibition against the entity using the information for a commercial purpose; and

·         authorizing the entity to report or publish data or information that identifies one or more health care providers, health benefit plans, health benefit plan issuers, or other payors but only if doing so furthers the purposes of state law governing the database.

 

H.B. 3414 removes health care providers in Texas engaging in efforts to improve the quality and cost of health care from the entities that are considered qualified research entities for purposes of the database. The bill instead classifies a health care provider or payor engaging in such efforts as a qualified market participant entity and sets out provisions regarding access to and use of the database by such an entity or by a qualified market consultant entity, which is defined by the bill as a commercial entity that consults regarding the design of health benefit plans in Texas and is engaging in efforts to improve the quality and cost of health care. In those provisions, the bill does the following:

·         authorizes a qualified market participant entity or qualified market consultant entity to access data or information that is contained in the database but not accessible through the public access portal but limits access by a qualified market participant entity to data or information regarding a patient who was at one time treated by or whose care was at one time paid for by the entity;

·         limits the purposes for which a market entity may use the data or information contained in the database to purposes consistent with state law governing the database;

·         requires a market entity to use the data or information in accordance with standards, requirements, policies, and procedures established by the center in consultation with the stakeholder advisory group; and

·         prohibits a market entity from selling or sharing any data or information contained in the database or publicly reporting or publishing data or information that identifies a health care provider, health benefit plan, health benefit plan issuer, or other payor.

The bill makes the requirement for a qualified research entity with access to data or information that is contained in the database but not accessible through the public access portal to execute a compliance agreement with the center also applicable to a qualified market participant entity or qualified market consultant entity with such access.   

 

H.B. 3414 requires an entity seeking to access data or information that is contained in the database but not accessible through the public access portal to submit an application to the center for access to that data or information. The bill requires that application to include the following information:

·         the sources and identity of all funding and funders of the research the entity will perform;

·         the names of all individuals who may have access to the applicable data or information, and any affiliations those individuals have with entities other than the entity submitting the application;

·         the proposed study, research, or project that the entity plans to undertake, including any anticipated final product from the research;

·         how the proposed research will further the purposes of the database, improve the quality of care, or reduce the cost of care; and

·         a statement of whether access is sought as a qualified research entity, qualified market participant entity, or qualified market consultant entity.

The bill requires the center to review all applications in a timely manner and approve applications under applicable terms unless the application is incomplete, the application fails to establish that access to the data or information would be likely to improve the quality of care or reduce the cost of care in Texas, or the applicant does not qualify as the type of entity identified in the application. The bill requires the center to identify with particularity the deficiencies in an application the center denies. The bill establishes that an application is considered approved if the center does not affirmatively approve or deny the application before the 31st day after the submission date.

 

Composition of Stakeholder Advisory Group

 

H.B. 3414 replaces the center with the governor as the entity that designates 12 members of the stakeholder advisory group. The bill establishes that a member of the advisory group serving immediately before the bill's effective date may continue to serve until the end of the member's term and requires the governor to designate advisory group members to fill vacancies that arise on or after the bill's effective date.

 

EFFECTIVE DATE

 

On passage, or, if the bill does not receive the necessary vote, September 1, 2023.