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A BILL TO BE ENTITLED
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AN ACT
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relating to data or information collected by the statewide all |
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payor claims database and the composition of the stakeholder |
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advisory group. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 38.402, Insurance Code, is amended by |
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amending Subdivision (9) and adding Subdivisions (9-a) and (9-b) to |
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read as follows: |
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(9) "Qualified research entity" means: |
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(A) an organization engaging in public interest |
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research for the purpose of analyzing the delivery of health care in |
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this state that is exempt from federal income tax under Section |
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501(a), Internal Revenue Code of 1986, by being listed as an exempt |
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organization in Section 501(c)(3) of that code; or |
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(B) an institution of higher education engaged in |
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public interest research related to the delivery of health care in |
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this state[; or |
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[(C) a health care provider in this state |
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engaging in efforts to improve the quality and cost of health care]. |
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(9-a) "Qualified market consultant entity" means a |
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commercial entity that consults regarding the design of health |
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benefit plans in this state and is engaging in efforts to improve |
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the quality and cost of health care. |
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(9-b) "Qualified market participant entity" means a |
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health care provider or payor engaging in efforts to improve the |
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quality and cost of health care in this state. |
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SECTION 2. Section 38.403(b), Insurance Code, is amended to |
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read as follows: |
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(b) The advisory group created under this section must be |
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composed of: |
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(1) the state Medicaid director or the director's |
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designee; |
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(2) a member designated by the Teacher Retirement |
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System of Texas; |
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(3) a member designated by the Employees Retirement |
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System of Texas; and |
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(4) 12 members designated by the governor [center], |
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including: |
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(A) two members representing the business |
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community, with at least one of those members representing small |
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businesses that purchase health benefits but are not involved in |
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the provision of health care services, supplies, or devices or |
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health benefit plans; |
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(B) two members who represent consumers and who |
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are not professionally involved in the purchase, provision, |
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administration, or review of health care services, supplies, or |
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devices or health benefit plans, with at least one member |
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representing the behavioral health community; |
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(C) two members representing hospitals that are |
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licensed in this state; |
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(D) two members representing health benefit plan |
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issuers that are regulated by the department; |
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(E) two members who are physicians licensed to |
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practice medicine in this state, one of whom is a primary care |
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physician; and |
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(F) two members who are not professionally |
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involved in the purchase, provision, administration, or review of |
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health care services, supplies, or devices or health benefit plans |
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and who have expertise in: |
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(i) health planning; |
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(ii) health economics; |
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(iii) provider quality assurance; |
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(iv) statistics or health data management; |
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or |
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(v) medical privacy laws. |
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SECTION 3. Section 38.404, Insurance Code, is amended by |
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adding Subsection (c-1) to read as follows: |
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(c-1) Notwithstanding Subsection (c), the center may not |
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require the submission of data that is not included in a standard |
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claim form. |
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SECTION 4. Section 38.405(c), Insurance Code, is amended to |
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read as follows: |
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(c) Any information or data that is accessible through the |
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portal created under this section: |
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(1) must be segmented by type of insurance or health |
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benefit plan in a manner that does not combine payment rates |
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relating to different types of insurance or health benefit plans; |
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(2) may [must] be aggregated by like Current |
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Procedural Terminology codes and health care services in a |
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statewide, regional, local, metropolitan, zip-code, or geozip |
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area; and |
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(3) may not identify a specific patient, health care |
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provider, health benefit plan, health benefit plan issuer, or other |
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payor. |
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SECTION 5. Subchapter I, Chapter 38, Insurance Code, is |
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amended by adding Section 38.4055 to read as follows: |
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Sec. 38.4055. APPLICATION FOR ACCESS TO CERTAIN DATA OR |
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INFORMATION IN DATABASE. (a) An entity seeking to access data or |
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information that is contained in the database but not accessible |
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through the portal described by Section 38.405 must submit an |
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application to the center for access to that data or information. |
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The application must include: |
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(1) the sources and identity of all funding and |
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funders of the research the entity will perform; |
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(2) the names of all individuals who may have access to |
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the data or information that is contained in the database but not |
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accessible through the portal described by Section 38.405, and any |
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affiliations those individuals have with entities other than the |
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entity submitting the application; |
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(3) the proposed study, research, or project that the |
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entity plans to undertake, including any anticipated final product |
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from the research; |
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(4) how the proposed research will further the |
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purposes of this subchapter, improve the quality of care, or reduce |
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the cost of care; and |
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(5) a statement of whether access is sought as a |
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qualified research entity, qualified market participant entity, or |
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qualified market consultant entity. |
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(b) The center shall review all applications in a timely |
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manner and approve applications under the applicable terms of |
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Sections 38.406(b), (b-1), and (b-2) unless: |
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(1) the application is incomplete; |
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(2) the application fails to establish that access to |
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the data or information would be likely to improve the quality of |
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care or reduce the cost of care in this state; or |
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(3) the applicant does not qualify as the type of |
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entity identified in the application. |
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(c) If the center denies an application, the center must |
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identify with particularity the deficiencies in the application. |
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(d) If the center does not affirmatively approve or deny an |
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application before the 31st day after the date the application is |
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submitted, the application is considered approved. |
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SECTION 6. Section 38.406, Insurance Code, is amended by |
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amending Subsections (a), (b), (c), and (d) and adding Subsections |
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(b-1) and (b-2) to read as follows: |
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(a) Except as provided by Subsections (b), (b-1), and (b-2), |
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any [Any] information that may identify a patient, health care |
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provider, health benefit plan, health benefit plan issuer, or other |
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payor is confidential and subject to applicable state and federal |
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law relating to records privacy and protected health information, |
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including Chapter 181, Health and Safety Code, and is not subject to |
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disclosure under Chapter 552, Government Code. |
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(b) A qualified research entity may [with] access [to] data |
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or information that is contained in the database but not accessible |
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through the portal described in Section 38.405, and the qualified |
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research entity: |
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(1) may use the data or information contained in the |
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database only for purposes consistent with the purposes of this |
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subchapter and must use the data or information in accordance with |
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standards, requirements, policies, and procedures established by |
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the center in consultation with the stakeholder advisory group; |
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(2) may not sell or share any data or information |
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contained in the database; and |
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(3) may report or publish data or information that |
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identifies one or more health care providers, health benefit plans, |
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health benefit plan issuers, or other payors only if reporting or |
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publishing furthers the purposes of this subchapter [not use the |
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information contained in the database for a commercial purpose]. |
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(b-1) A qualified market participant entity may access data |
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or information that is contained in the database but not accessible |
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through the portal described by Section 38.405 only to the extent |
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that the data or information regards a patient who was at one time |
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treated by or whose care was at one time paid for by the qualified |
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market participant entity, and the qualified market participant |
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entity: |
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(1) may use the data or information contained in the |
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database only for purposes consistent with the purposes of this |
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subchapter and must use the data or information in accordance with |
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standards, requirements, policies, and procedures established by |
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the center in consultation with the stakeholder advisory group; |
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(2) may not sell or share any data or information |
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contained in the database; and |
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(3) may not publicly report or publish data or |
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information that identifies a health care provider, health benefit |
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plan, health benefit plan issuer, or other payor. |
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(b-2) A qualified market consultant entity may access data |
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or information that is contained in the database but not accessible |
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through the portal described by Section 38.405, and the qualified |
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market consultant entity: |
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(1) may use the data or information contained in the |
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database only for purposes consistent with the purposes of this |
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subchapter and must use the data or information in accordance with |
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standards, requirements, policies, and procedures established by |
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the center in consultation with the stakeholder advisory group; |
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(2) may not sell or share any data or information |
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contained in the database; and |
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(3) may not publicly report or publish data or |
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information that identifies a health care provider, health benefit |
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plan, health benefit plan issuer, or other payor. |
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(c) A qualified research entity, qualified market |
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participant entity, or qualified market consultant entity with |
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access to data or information that is contained in the database but |
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not accessible through the portal must execute an agreement with |
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the center relating to the [qualified research] entity's compliance |
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with the requirements of Subsections (a), [and] (b), (b-1), and |
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(b-2), as applicable [including the confidentiality of information |
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contained in the database but not accessible through the portal]. |
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(d) Notwithstanding any provision of this subchapter, the |
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department and the center may not disclose an individual's |
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protected health information in violation of any other state or |
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federal law. |
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SECTION 7. Notwithstanding the amendment by this Act of |
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Section 38.403(b), Insurance Code, a member of the advisory group |
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serving under that section immediately before the effective date of |
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this Act may continue to serve until the end of the member's term. |
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The governor shall designate advisory group members under that |
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section to fill vacancies that arise on or after the effective date |
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of this Act. |
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SECTION 8. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2023. |