Bill Text: TX HB3414 | 2023-2024 | 88th Legislature | Enrolled
Bill Title: Relating to the statewide all payor claims database.
Spectrum: Moderate Partisan Bill (Republican 5-1)
Status: (Passed) 2023-06-11 - Effective immediately [HB3414 Detail]
Download: Texas-2023-HB3414-Enrolled.html
H.B. No. 3414 |
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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; [ |
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(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 [ |
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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; [ |
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(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 [ |
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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 [ |
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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 | ||
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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; [ |
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(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. | ||
______________________________ | ______________________________ | |
President of the Senate | Speaker of the House | |
I certify that H.B. No. 3414 was passed by the House on April | ||
28, 2023, by the following vote: Yeas 146, Nays 1, 2 present, not | ||
voting; and that the House concurred in Senate amendments to H.B. | ||
No. 3414 on May 24, 2023, by the following vote: Yeas 139, Nays 5, | ||
1 present, not voting. | ||
______________________________ | ||
Chief Clerk of the House | ||
I certify that H.B. No. 3414 was passed by the Senate, with | ||
amendments, on May 17, 2023, by the following vote: Yeas 31, Nays | ||
0. | ||
______________________________ | ||
Secretary of the Senate | ||
APPROVED: __________________ | ||
Date | ||
__________________ | ||
Governor |