Bill Text: TX HB3414 | 2023-2024 | 88th Legislature | Introduced
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Introduced.html
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-Introduced.html
88R12309 KBB-F | ||
By: Oliverson | H.B. No. 3414 |
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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[ |
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(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 [ |
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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; 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 [ |
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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 [ |
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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 [ |
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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 [ |
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(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 [ |
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with the requirements of Subsections (a), [ |
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(b-2), as applicable [ |
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(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. |