HBA-JRA, MPM H.B. 1513 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 1513 By: Maxey Public Health 7/26/1999 Enrolled BACKGROUND AND PURPOSE The Texas Health Care Information Council (council) was created by the 73rd Texas Legislature to develop a statewide health care data collection system to collect health care charges, utilization data, provider quality data, and outcome data to facilitate the promotion and accessibility of cost-effective, quality health care. By collecting hospital-based data and requiring HMO reporting, the council has been able to provide useful report cards on HMOs. H.B. 1513 provides a new definition for "public use data" to include patient level data that has had patient identifying information removed and that identifies physicians only by use of uniform physician identifiers, rather than identifying both physicians and patients by their respective identifiers. Furthermore, it makes changes to the compositions of the council's technical advisory committees, deletes specific data from the data the council is prohibited from releasing and to which a person or entity may not gain access unless authorized. It also requires the council to establish a committee which has experience in ethics, patient confidentiality, and health care data to approve requests for information and to adopt rules regarding the release of data. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the Texas Health Care Information Council in SECTIONS 3 and 7 (Sections 108.006 and 108.013, Health and Safety Code) and modifies rulemaking authority previously delegated to the Texas Health Care Information Council in SECTION 4 (Section 108.009, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 108.002, Health and Safety Code, to define "accurate and consistent data," "certification," "edit," and "validation" and to redefine "public use data" to include patient level data that has had patient identifying information removed and that identifies physicians only by use of uniform physician identifiers, rather than identifying both physicians and patients by their respective identifiers. Authorizes the exclusion of some data elements submitted to the Texas Health Care Information Council (council) from public use data. Makes conforming changes. SECTION 2. Amends Section 108.003(g), Health and Safety Code, to provide that Chapter 2110 (State Agency Advisory Committees), Government Code, does not apply to the five technical advisory committees (committees) appointed by the council as described in this subsection. Deletes the requirement that the first of these committees provide advice and recommendations to the council on the development and dissemination of consumer education information and materials. Provides that the third of these technical advisory committees include providers and consumers to provide advice and recommendations to the council relating to education about the development and dissemination of the provider quality report and data. Deletes the requirement that this committee be comprised of individuals with expertise in the reimbursement of medical education and research costs. Provides that the fourth technical advisory committee be comprised of representatives of consumers, in addition to representatives of each type of issuer of health benefit plans. Provides that the fifth technical advisory committee be comprised of providers and consumers, in addition to individuals with expertise in the security of confidential data, in addition to hospital information systems, health information management, and quality management. SECTION 3. Amends Section 108.006, Health and Safety Code, by adding Subsections (f), (g), and (h), as follows: (f) Requires the council to prescribe by rule a public use date file minimum data set that maintains patient confidentiality and establishes data accuracy and consistency. (g) Subjects this minimum data set to annual review by the council with the assistance of the technical advisory committee under Section 108.003(g)(5),composed of individuals with expertise in hospital information systems, health information management, quality management, and security of confidential data, to evaluate requests to modify the existing minimum data set and editing process. Requires the council and the advisory committee to consider the value of the any data to be added or deleted from the minimum data set and the technical feasibility of establishing data accuracy and consistency in making a decision to modify the minimum data set. Authorizes the council to consider the costs to the council and providers associated with such modification. (h) Authorizes the council to release data collected under Section 108.009 that is not included in the public use data file minimum data set. SECTION 4. Amends Section 108.009(b), Health and Safety Code, to provide that a rule adopted by the council that requires the submission of a data element not previously required must take effect by the first anniversary after the date the rule is adopted. SECTION 5. Amends Section 108.010(i), Health and Safety Code, to require the council to release provider quality data in an aggregate form without uniform physician identifiers when the data relates to providers described by Section 108.0025(l) (Rural Provider) or the cell size of the data is below the minimum size established by council rule that would enable identification of an individual patient. Deletes text qualifying provider quality data as that relating to providers described by Section 108.0025(l), but that are not rural providers because they do not meet the requirement of Section 108.0025(2). SECTION 6. Amends Section 108.011(d) and (i), Health and Safety Code, to make conforming and nonsubstantive changes. SECTION 7. Amends Sections 108.013 by amending Subsections (c), (e), (f), (g), and (h) and adding Subsection (j), as follows: (c) Deletes data that could be reasonably expected to reveal the zip code of a patient's primary residence from that data the council is prohibited to release, and data to which a person or entity may not gain access unless authorized by this chapter. Adds data that could reasonably be expected to reveal the identify of a physician and data that is submitted to the council in a uniform submission format that is not included in the public use data set, except in accordance with Section 108.0135, to the data the council is prohibited to release. (e) Makes conforming changes. (f) Provides that data on physicians and compilations produced from the data collected that identify physicians are not subject to discovery, subpoena, or other means of legal compulsion for release to any person or entity except as provided by this section, nor are they admissible in any civil, administrative, or criminal proceeding. Removes the provision authorizing the council to use zip code information to analyze data on a geographic basis, regardless of Subsection (c). (g) Prohibits the council from releasing data elements in a way that will reveal a physician's identity. (j) Requires the council, by rule, and with the assistance of the advisory committee under Section 108.003, to develop and implement a mechanism to comply with this section. Makes conforming and nonsubstantive changes. SECTION 8. Amends Chapter 108, Health and Safety Code, by adding Section 108.0135, as follows: Sec. 108.0135. SCIENTIFIC REVIEW PANEL. (a) Requires the council to establish a scientific review panel (panel) which is required to have experience and expertise in ethics, patient confidentiality, and health care data to review and approve requests for information. Requires the council to adopt rules similar to the federal Health Care Financing Administration's guidelines on releasing data to help the panel determine whether to approve a request for information. Provides that a request for information other than public use data must be made on a form created by the council. SECTION 9. Amends Section 108.014, Health and Safety Code, by amending Subsection (c) and adding Subsection (d), as follows: (c) Provides that the venue of an action brought under this section is in Travis County. (d) Requires a civil penalty recovered in a suit instituted by the attorney general under this chapter to be deposited in the general revenue fund to the credit of the health care information account. SECTION 10. Amends Section 108.0141, Health and Safety Code, to provide that a person who knowingly accesses data in violation of this chapter or who, with criminal negligence releases data in violation of this chapter, commits an offense. Provides that an offense under this section is a state jail felony, rather than a Class A misdemeanor. SECTION 11. Effective date: September 1, 1999. Requires the council to adopt initial rules required by Section 108.013(j), Health and Safety Code, as added by this Act, no later than January 1, 2000. Makes change in law made by this Act to Section 108.0141, Health and Safety Code, prospective. Requires the Texas Health Care Information Council to edit the physician identifier fields by January 1, 2000. Requires the uniform physician identifier to be included in the public use data file minimum data sets that contain information from hospital discharges for patients released on or after January 1, 2000. SECTION 12. Emergency clause.