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
 
 
 
 
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.
 
 
  ______________________________ ______________________________
     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       
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