BILL ANALYSIS

Senate Research Center	C.S.H.B. 3414
88R27867 KBB-F	By: Oliverson et al. (Hancock)
	Health & Human Services
	5/11/2023
	Committee Report (Substituted)

AUTHOR'S / SPONSOR'S STATEMENT OF INTENT

The All Payor Claims Database (APCD) is a database of health care claims files created by HB 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 APCD is administered by the UTHealth School of Public Health and overseen by the Texas Department of Insurance. The data within it is fully de-identified, meaning that patient privacy is always fully protected.

The data that is being collected is excellent, however, researchers face severe restrictions on what they can publish, which limits the APCD from reaching its full potential.

H.B. 3414 allows access to the data, specifies how entities qualify to access the data and includes what data is shareable in its aggregated form. The committee substitute also includes higher education health insurance plans and includes a higher education spot on the advisory board.

(Original Author's/Sponsor's Statement of Intent)

C.S.H.B. 3414 amends current law relating to the statewide all payor claims database.

RULEMAKING AUTHORITY

This bill does not expressly grant any additional rulemaking authority to a state officer, institution, or agency.

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Section 38.402(7), Insurance Code, to redefine "payor."

SECTION 2. Amends Section 38.403, Insurance Code, by amending Subsections (b) and (d) and adding Subsection (e), as follows:

(b) Requires that the advisory group created under Section 38.403 (Stakeholder Advisory

Group) be composed of:

(1)-(3) makes no changes to these subdivisions;

(4) 13, rather than 12, members designated by the Center for Healthcare Data at The University of Texas Health Science Center at Houston (center) including:

(A)-(D) makes no changes to these paragraphs;

(E)-(F) makes nonsubstantive changes to these paragraphs; and

(G) one member representing an institution or higher education.

(d) Creates an exception under Subsection (e) and makes nonsubstantive changes.

(e) Provides that a member representing an institution of higher education under Subsection (b)(4)(G) serves a term of one year.

SECTION 3. Amends Section 38.404, Insurance Code, by adding Subsection (c-1) to prohibit the center, notwithstanding Subsection (c) (relating to requiring the center, in determining the information the payor is required to submit to the center under Subchapter I (Texas All Payor Claims Database), from requiring a payor to collect or otherwise obtain from individuals covered by the payor data that is not included in a standard claim form, though the center is authorized to require submission of such data if it is otherwise collected by the payor, including provider and eligibility files.

SECTION 4. Amends Section 38.405(c), Insurance Code, as follows:

(c) Provides that any information or data that is accessible through the portal created under Section 38.405 (Public Access Portal):

(1) makes no changes to this subdivision;

(2) is required to be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, metropolitical statistical, zip-code, or geozip area; and

(3) makes no changes to this subdivision.

SECTION 5. Amends Subchapter I, Chapter 38, Insurance Code, by adding Section 38.4055, as follows:

Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR INFORMATION IN DATABASE. (a) Requires an entity seeking to access data or information that is contained in the database but not accessible through the portal described by Section 38.405 to submit an application to the center for access to that data or information. Requires that the application include:

(1) the sources and identity of all funding and funders of the research the

entity will perform;

(2) the names of all individuals who are authorized to have access to the data or information that is contained in the database but not accessible through the portal described by Section 38.405, and any affiliations those individuals have with entities other than the entity submitting the application;

(3) the proposed study, research, or project that the entity plans to undertake and the purpose of the study, research, or project, including any anticipated final product from the study, research, or project;

(4) how the proposed research will further the purposes of this subchapter, improve the quality of care, or reduce the cost of care;

(5) a description of the proposed methodology;

(6) a description of the publication method of the manuscripts, reports, or other forms of output from the research; and

(7) for access to data that would require such an approval, an institutional review board determination letter that is an approval or an approval with modifications.

(b) Requires the center to review and make a determination on all applications in a timely manner.

(c) Requires the center to identify with particularity the deficiencies in the application if the center denies an application.

SECTION 6. Amends Sections 38.406(a) and (b), Insurance Code, as follows:

(a) Provides that information that may identify a patient is confidential and subject to applicable state and federal law relating to records privacy and protected health information, including Chapter 181 (Medical Records Privacy), Health and Safety Code, and is not subject to disclosure under Chapter 552 (Public Information), Government Code. Provides that any information that may identify a health care provider, rather than a patient health care provider, health benefit plan, health benefit plan issuer, or other payor, Government Code, except as provided by Subsection (b), is confidential and subject to the 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.

(b) Provides that 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) is authorized to use the data or information contained in the database only for purposes consistent with the purposes of this subchapter and is required 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;

(2) makes a conforming change to this subdivision; and

(3) is authorized to report or publish data or information that identifies one or more health care providers, health benefit plans, health benefit plan issuers, or other mandatory payors only if the report or publication is made available to the public at no cost, rather than is prohibited from using the information contained in the database for a commercial purpose.

SECTION 7. Amends Section 38.408, Insurance Code, as follows:

Sec. 38.408. REPORT TO LEGISLATURE. Requires the center, not later than September 1 of each even-numbered year, to submit to the legislature a written report containing:

(1)-(2) makes no changes to these subdivisions;

(3)-(4) makes nonsubstantive changes to these subdivisions;

(5) a list of approved applications;

(6) a list of disapproved applications with the justification required by Section 38.4055(c); and

(7) a list of all applications that were neither approved nor disapproved by the 91st day after the application was submitted, including the particular reasons why each application was not approved or disapproved within that timeframe.

SECTION 8. Requires the center to implement a provision of Subchapter I, Chapter 38, Insurance Code, as amended by this Act, only if the legislature appropriates money specifically for that purpose. Provides that the center is authorized but not required to implement a provision of that subchapter using other money available for that purpose if the legislature does not appropriate money specifically for that purpose.

SECTION 9. Effective date: upon passage or September 1, 2023.�