By: Oliverson, et al. (Senate Sponsor - Hancock) H.B. No. 3414

(In the Senate - Received from the House May 1, 2023; May 1, 2023, read first time and referred to Committee on Health & Human Services; May 15, 2023, reported adversely, with favorable Committee Substitute by the following vote: Yeas 9, Nays 0; May 15, 2023, sent to printer.) Click here to see the committee vote

COMMITTEE SUBSTITUTE FOR H.B. No. 3414 By: Hancock

A BILL TO BE ENTITLED

AN ACT

relating to the statewide all payor claims database.

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

SECTION 1. Section 38.402(7), Insurance Code, is amended to read as follows:

(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; and

(iv) a plan providing basic coverage under Chapter 1601; or

(F) any other entity providing a health insurance or health benefit plan subject to regulation by the department.

SECTION 2. Section 38.403, Insurance Code, is amended by amending Subsections (b) and (d) and adding Subsection (e) 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) 13 [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; and

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

(d) Except as provided by Subsection (e), members [Members] of the stakeholder advisory group serve fixed terms as prescribed by commissioner rules adopted under this subchapter.

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

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 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 may require submission of such data if it is otherwise collected by the payor, including provider and eligibility files.

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) must be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, metropolitan statistical, 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 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) The center shall review and make a determination on all applications in a timely manner.

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

SECTION 6. Sections 38.406(a) and (b), Insurance Code, are amended to read as follows:

(a) 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, Health and Safety Code, and is not subject to disclosure under Chapter 552, Government Code. Except as provided by Subsection (b), 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 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 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 mandatory payors only if the report or publication is made available to the public at no cost [not use the information contained in the database for a commercial purpose].

SECTION 7. Section 38.408, Insurance Code, is amended to read as follows:

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;

(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. The Center for Healthcare Data at The University of Texas Health Science Center at Houston is required 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. If the legislature does not appropriate money specifically for that purpose, the center may, but is not required to, implement a provision of that subchapter using other money available for that purpose.

SECTION 9. 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.

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