88R12309 KBB-F

By: Oliverson, Walle, Bonnen, Harless, Frank H.B. No. 3414

A BILL TO BE ENTITLED

AN ACT

relating to data or information collected by the statewide all payor claims database and the composition of the stakeholder advisory group.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 38.402, Insurance Code, is amended by amending Subdivision (9) and adding Subdivisions (9-a) and (9-b) to read as follows:

(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; or

(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].

(9-a) "Qualified market consultant entity" means a commercial entity that consults regarding the design of health benefit plans in this state and is engaging in efforts to improve the quality and cost of health care.

(9-b) "Qualified market participant entity" means a health care provider or payor engaging in efforts to improve the quality and cost of health care in this state.

SECTION 2. Section 38.403(b), Insurance Code, is amended to read as follows:

(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 governor [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.

SECTION 3. Section 38.404, Insurance Code, is amended by adding Subsection (c-1) to read as follows:

(c-1) Notwithstanding Subsection (c), the center may not require the submission of data that is not included in a standard claim form.

SECTION 4. Section 38.405(c), Insurance Code, is amended to read as follows:

(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) may [must] be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, local, metropolitan, zip-code, or geozip area; and

(3) may not identify a specific patient, health care provider, health benefit plan, health benefit plan issuer, or other payor.

SECTION 5. Subchapter I, Chapter 38, Insurance Code, is amended by adding Section 38.4055 to read as follows:

Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR INFORMATION IN DATABASE. (a) 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 must submit an application to the center for access to that data or information. The application must 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 may 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, including any anticipated final product from the research;

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

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

(b) The center shall review all applications in a timely manner and approve applications under the applicable terms of Sections 38.406(b), (b-1), and (b-2) unless:

(1) the application is incomplete;

(2) 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 this state; or

(3) the applicant does not qualify as the type of entity identified in the application.

(c) If the center denies an application, the center must identify with particularity the deficiencies in the application.

(d) If the center does not affirmatively approve or deny an application before the 31st day after the date the application is submitted, the application is considered approved.

SECTION 6. Section 38.406, Insurance Code, is amended by amending Subsections (a), (b), (c), and (d) and adding Subsections (b-1) and (b-2) to read as follows:

(a) Except as provided by Subsections (b), (b-1), and (b-2), any [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 may [with] access [to] data or information that is contained in the database but not accessible through the portal described in Section 38.405, and the qualified research entity:

(1) may use the data or information contained in the database only for purposes consistent with the purposes of this subchapter and must 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) may not sell or share any data or information contained in the database; and

(3) may report or publish data or information that identifies one or more health care providers, health benefit plans, health benefit plan issuers, or other payors only if reporting or publishing furthers the purposes of this subchapter [not use the information contained in the database for a commercial purpose].

(b-1) A qualified market participant entity may access data or information that is contained in the database but not accessible through the portal described by Section 38.405 only to the extent that the data or information regards a patient who was at one time treated by or whose care was at one time paid for by the qualified market participant entity, and the qualified market participant entity:

(1) may use the data or information contained in the database only for purposes consistent with the purposes of this subchapter and must 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) may not sell or share any data or information contained in the database; and

(3) may not publicly report or publish data or information that identifies a health care provider, health benefit plan, health benefit plan issuer, or other payor.

(b-2) A qualified market consultant entity may access data or information that is contained in the database but not accessible through the portal described by Section 38.405, and the qualified market consultant entity:

(1) may use the data or information contained in the database only for purposes consistent with the purposes of this subchapter and must 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) may not sell or share any data or information contained in the database; and

(3) may not publicly report or publish data or information that identifies a health care provider, health benefit plan, health benefit plan issuer, or other payor.

(c) A qualified research entity, qualified market participant entity, or qualified market consultant entity with access to data or 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), (b-1), and (b-2), as applicable [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 other state or federal law.

SECTION 7. Notwithstanding the amendment by this Act of Section 38.403(b), Insurance Code, a member of the advisory group serving under that section immediately before the effective date of this Act may continue to serve until the end of the member's term. The governor shall designate advisory group members under that section to fill vacancies that arise on or after the effective date of this Act.

SECTION 8. This Act takes effect immediately if it receives a vote of two-thirds of all the members elected to each house, as provided by Section 39, Article III, Texas Constitution. If this Act does not receive the vote necessary for immediate effect, this Act takes effect September 1, 2023.