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.