HBA-MPM C.S.H.B. 1513 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1513 By: Maxey Public Health 4/6/1999 Committee Report (Substituted) 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. C.S.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. This bill also authorizes the Health and Human Services Commission to charge a provider or a health benefit plan a fee for any incorrect data submitted; excludes provider quality data relating to rural providers from the list of those providers about whom the council is required to release data. It 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 SECTION 5 (Section 108.013, Health and Safety Code), SECTION 6 (Section 108.0135, Health and Safety Code) and SECTION 8 (Section 108.0135, Health and Safety Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Section 108.002(14), Health and Safety Code, 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. 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 Texas Health Care Information Council (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 108.010(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 4. Amends Section 108.011(i), Health and Safety Code, to make conforming changes. SECTION 5. 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 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 6. 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 7. 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 8. 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 9. Amends Chapter 108, Health and Safety Code, by adding Sections 108.0142 and 108.0143, as follows: Sec. 108.0142. CIVIL CAUSE OR ACTION FOR IMPROPER ACCESS OR DISCLOSURE. (a) Provides that a person injured by the accessing or releasing of information in violation of this chapter has a civil cause of action for damages against the person who accessed or released it. (b) Authorizes a plaintiff prevailing in a suit under this section to recover actual damages, including those for mental anguish, even if an injury other than mental anguish is not shown; exemplary damages; court costs; and reasonable attorney's fees. Sec. 108.0143. RELEASE OF LIABILITY. Provides that notwithstanding any other law, a provider or health benefit plan that submits data to the council under this chapter is not liable to the extent that the release of information violates the law. SECTION 10. 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. SECTION 11. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1513 modifies the original bill as follows: SECTION 1. Makes no changes. SECTION 2. The substitute modifies the original in Section 108.003(g), Health and Safety Code (regarding the five technical advisory committees appointed by the Texas Health Care Information Council (council)), as follows: _reinstates text regarding the technical advisory committee in Subdivision (1) to include, among other individuals, at least five practicing physicians licensed in this state; _reinstates text regarding the technical advisory committee in Subdivision (2) to include at least five practicing physicians; _reinstates the technical advisory committee in Subdivision (3) (deleted in the original), which includes 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. The existing text describing this committee provides that it was composed of individuals with expertise in the reimbursement of medical education and research costs; _includes representatives of consumers, as well as each type of issuer of health benefit plans, in the technical advisory committee in Subdivision (4); and _includes providers and consumers, as well as individuals, with expertise in security of confidential data, as well as other areas, among those individuals comprising the technical advisory committee in Subdivision (5). This substitute differs from the original by deleting SECTION 3 and SECTION 4. These sections amended Sections 108.0045 and 108.009, Health and Safety Code, regarding the prohibition of producing public information for inspection or duplication before the 20th business day after it is requested; and a fee levied against a provider or a health benefits plan for any incorrect data, respectively. SECTION 3. Redesignated from SECTION 5 of the original bill. The substitute modifies the original by changing Section 108.010(i), Health and Safety Code, to require that the provider quality data released by the council be in an aggregate form without uniform physician identifiers when the cell size of the data is below the minimum size established by council rule that would enable identification of an individual patient. SECTION 4. Redesignated from SECTION 6 of the original bill. The substitute modifies the original by changing Section 108.011(i) to make conforming changes with respect to the modified Section 108.010(i), Health and Safety Code. SECTION 5. Redesignated from SECTION 7 of the original bill. The substitute modifies the original by changing Section 108.013, Health and Safety Code, to add new Subsection (j), which 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 Subsection (c), regarding types of data the council is prohibited from releasing unless authorized by this chapter. Makes nonsubstantive changes. SECTION 6. Redesignated from SECTION 8 of the original bill. The substitute modifies Section 108.0135, Health and Safety Code, by changing the title of the new section proposed in the original bill from "Release of Information" to "Scientific Review Panel" in the substitute. Requires the council to establish a scientific review panel (panel), rather than a committee, to review, as well as approve requests for information other than public use data. Requires the members of the panel, rather than the committee, to have expertise, as well as experience, in ethics, patient confidentiality, and health care data. Make conforming changes. SECTION 7. Redesignated from SECTION 9 of the original bill. Makes no change. SECTION 8. 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 9. Redesignated from SECTION 10 of the original bill. The substitute amends the original by adding Section 108.0143, Health and Safety Code, in addition to Section 108.0142, which was added in the original. The changes are as follows: Sec. 108.0142. CIVIL CAUSE OF ACTION FOR IMPROPER ACCESS OR DISCLOSURE. Provides that a person injured by accessing or releasing information in violation of this chapter has a civil cause of action for damages against the person who accessed or released it. Authorizes a plaintiff prevailing in a suit under this section to recover actual damages, including those for mental anguish, even if an injury other than mental anguish is not shown; exemplary damages; court costs; and reasonable attorney's fees. Sec. 108.0143. RELEASE OF LIABILITY. Redesignated from Section 108.0142 in the original. SECTION 10. Redesignated from SECTION 11 of the original. In addition to setting forth the effective date of September 1, 1999, as stated in the original, the substitute also 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. SECTION 11. Redesignates the emergency clause from SECTION 12 of the original.