HEALTH & SAFETY CODE
CHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCIL
§ 108.001. CREATION OF COUNCIL. The Texas Health Care
Information Council shall administer this chapter and report to the
governor, the legislature, and the public.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
§ 108.002. DEFINITIONS. In this chapter:
(1) "Accurate and consistent data" means data that has
been edited by the council and subject to provider validation and
certification.
(2) "Board" means the Texas Board of Health.
(3) "Certification" means the process by which a
provider confirms the accuracy and completeness of the data set
required to produce the public use data file in accordance with
council rule.
(4) "Charge" or "rate" means the amount billed by a
provider for specific procedures or services provided to a patient
before any adjustment for contractual allowances. The term does
not include copayment charges to enrollees in health benefit plans
charged by providers paid by capitation or salary.
(5) "Council" means the Texas Health Care Information
Council.
(6) "Data" means information collected under Section
108.0065 or 108.009 in the form initially received.
(7) "Department" means the Texas Department of Health.
(8) "Edit" means to use an electronic standardized
process developed and implemented by council rule to identify
potential errors and mistakes in data elements by reviewing data
fields for the presence or absence of data and the accuracy and
appropriateness of data.
(9) "Health benefit plan" means a plan provided by:
(A) a health maintenance organization; or
(B) an approved nonprofit health corporation
that is certified under Section 162.001, Occupations Code, and that
holds a certificate of authority issued by the commissioner of
insurance under Chapter 844, Insurance Code.
(10) "Health care facility" means:
(A) a hospital;
(B) an ambulatory surgical center licensed under
Chapter 243;
(C) a chemical dependency treatment facility
licensed under Chapter 464;
(D) a renal dialysis facility;
(E) a birthing center;
(F) a rural health clinic; or
(G) a federally qualified health center as
defined by 42 U.S.C. Section 1396d(l)(2)(B).
(11) "Health maintenance organization" means an
organization as defined in Section 843.002, Insurance Code.
(12) "Hospital" means a public, for-profit, or
nonprofit institution licensed or owned by this state that is a
general or special hospital, private mental hospital, chronic
disease hospital, or other type of hospital.
(13) "Outcome data" means measures related to the
provision of care, including:
(A) patient demographic information;
(B) patient length of stay;
(C) mortality;
(D) co-morbidity;
(E) complications; and
(F) charges.
(14) "Physician" means an individual licensed under
the laws of this state to practice medicine under Subtitle B, Title
3, Occupations Code.
(15) "Provider" means a physician or health care
facility.
(16) "Provider quality" means the extent to which a
provider renders care that, within the capabilities of modern
medicine, obtains for patients medically acceptable health
outcomes and prognoses, after severity adjustment.
(17) "Public use data" means patient level data
relating to individual hospitalizations that has not been
summarized or analyzed, that has had patient identifying
information removed, that identifies physicians only by use of
uniform physician identifiers, and that is severity and risk
adjusted, edited, and verified for accuracy and consistency.
Public use data may exclude some data elements submitted to the
council.
(18) "Rural provider" means a provider described by
Section 108.0025.
(19) "Severity adjustment" means a method to stratify
patient groups by degrees of illness and mortality.
(20) "Uniform patient identifier" means a number
assigned by the council to an individual patient and composed of
numeric, alpha, or alphanumeric characters.
(21) "Uniform physician identifier" means a number
assigned by the council to an individual physician and composed of
numeric, alpha, or alphanumeric characters.
(22) "Validation" means the process by which a
provider verifies the accuracy and completeness of data and
corrects any errors identified before certification in accordance
with council rule.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 1, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 1, eff. Sept. 1, 1999;
Acts 1999, 76th Leg., ch. 1460, § 8.02, eff. Sept. 1, 1999; Acts
2001, 77th Leg., ch. 1420, § 14.775, eff. Sept. 1, 2001; Acts
2003, 78th Leg., ch. 1276, § 10A.523, eff. Sept. 1, 2003.
§ 108.0025. RURAL PROVIDER. For purposes of this
chapter, a provider is a rural provider if the provider:
(1) is located in a county that:
(A) has a population estimated by the United
States Bureau of the Census to be not more than 35,000 as of July 1
of the most recent year for which county population estimates have
been published; or
(B) has a population of more than 35,000, but
that does not have more than 100 licensed hospital beds and is not
located in an area that is delineated as an urbanized area by the
United States Bureau of the Census; and
(2) is not a state-owned hospital or a hospital that is
managed or directly or indirectly owned by an individual,
association, partnership, corporation, or other legal entity that
owns or manages one or more other hospitals.
Added by Acts 1997, 75th Leg., ch. 261, § 2, eff. Sept. 1, 1997.
§ 108.003. COUNCIL COMPOSITION; EXPENSES. (a) The
council is composed of four ex officio state agency members and 15
members appointed by the governor in accordance with this section.
(b) The ex officio members of the council are:
(1) the commissioner of public health or the
commissioner's designee;
(2) the commissioner of health and human services or
the commissioner's designee;
(3) the commissioner of insurance or the
commissioner's designee; and
(4) the public insurance counsel or the counsel's
designee.
(c) The governor shall appoint the following members of the
council:
(1) three representatives of the business community,
with at least one representing small businesses, who are purchasers
of health care but who are not involved in the provision of health
care or health insurance;
(2) two representatives from labor, one of whom is not
directly involved with management of health care benefits;
(3) two representatives of consumers who are not
professionally involved in the purchase, provision,
administration, or review of health care or health care insurance;
(4) two representatives of hospitals;
(5) one representative of health maintenance
organizations;
(6) three representatives of physicians who are
involved in direct patient care; and
(7) two members who are not professionally involved in
the purchase, provision, administration, or utilization review of
health care or health care insurance and who have expertise in:
(A) health planning;
(B) health economics;
(C) provider quality assurance;
(D) information systems; or
(E) the reimbursement of medical education and
research costs.
(d) The chairman is appointed by and serves at the pleasure
of the governor. Members annually shall elect a vice chairman.
(e) A majority of voting members constitutes a quorum for
the transaction of any business. An act by the majority of the
voting members present at any meeting at which there is a quorum is
considered to be an act of the council.
(f) The council may appoint committees and may elect any
officers subordinate to those provided for in Subsection (d).
(g) The council shall appoint technical advisory committees
and shall consult with the appropriate technical advisory committee
with respect to a rule before the rule is finally adopted by the
council. The council is not required to consult with a technical
advisory committee before adopting an emergency rule in accordance
with Section 2001.034, Government Code. The council shall submit
an emergency rule adopted by the council to the appropriate
advisory committee for review not later than the first advisory
committee meeting that occurs after the rule is adopted. The
council may consult with the appropriate technical advisory
committee with respect to other formal action of the council. A
technical advisory committee may consult with other professionals
as necessary. Chapter 2110, Government Code, does not apply to an
advisory committee appointed under this subsection. The technical
advisory committees shall include:
(1) a technical advisory committee that includes,
among other individuals, at least five practicing physicians
licensed in this state to provide advice and recommendations to the
council on the development and implementation of the methodology
and the interpretation of a provider quality report and data under
Section 108.010;
(2) a technical advisory committee composed of at
least five practicing physicians licensed in this state who have
been actively engaged in organized peer review at a hospital in this
state to provide advice, recommendations, and peer review expertise
to the council on:
(A) the use of peer review in the determination
of quality inpatient care;
(B) the development and interpretation of data
elements necessary to the determination of quality inpatient care;
and
(C) the development and format of reports and
information relating to provider quality;
(3) a technical advisory committee that includes
providers and consumers to provide advice and recommendations to
the council relating to education about the development and
dissemination of provider reports and data;
(4) a technical advisory committee that includes
representatives of consumers and each type of issuer of health
benefit plans to assist the council in complying with Section
108.009(o); and
(5) a technical advisory committee composed of
providers, consumers, and individuals who have expertise in
hospital information systems, health information management,
quality management, and security of confidential data.
(h) A member of the council may not receive compensation for
service on the council. However, the member shall be reimbursed for
the member's actual and necessary meals, lodging, transportation,
and incidental expenses if incurred while performing council
business.
(i) A member of an advisory committee appointed by the
council may not receive compensation or reimbursement of any
expense incurred while serving on the committee.
(j) Appointments to the council shall be made without regard
to the race, color, disability, sex, religion, age, or national
origin of appointees. Additionally, in making the appointments to
the council, the governor shall consider geographical
representation.
(k) A person may not serve as a member of the council if the
person is required to register as a lobbyist under Chapter 305,
Government Code, because of the person's activities for
compensation on behalf of a profession related to the operation of
the council.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 3, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 2, eff. Sept. 1, 1999.
§ 108.004. MEETINGS. (a) The council, council
committees, and technical advisory committees are subject to the
open meetings law, Chapter 551, Government Code.
(b) The council shall meet as often as necessary, but not
less often than quarterly, to perform its duties under this
chapter.
(c) The council shall publish a notice of its meetings in
the Texas Register.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 4, eff. Sept. 1,
1997.
§ 108.0045. OPEN RECORDS. Subject to the restrictions
of this chapter, the council is subject to the open records law,
Chapter 552, Government Code.
Added by Acts 1997, 75th Leg., ch. 261, § 5, eff. Sept. 1, 1997.
§ 108.005. TERMS. (a) The terms of the agency members
are concurrent with their terms of office. The appointed council
members serve six-year staggered terms, with the terms of five
members expiring September 1 of each odd-numbered year.
(b) An appointed member may not serve more than two full
consecutive terms.
(c) It is a ground for removal from the council if a member
of the council:
(1) does not have at the time of appointment the
qualifications required by Section 108.003;
(2) does not maintain during service the
qualifications required by Section 108.003;
(3) cannot discharge the member's duties for a
substantial part of the term for which the member is appointed
because of illness or disability; or
(4) fails to attend at least one-half of the regularly
scheduled meetings that the member is eligible to attend during a
calendar year.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
§ 108.006. POWERS AND DUTIES OF COUNCIL. (a) The
council shall 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, good quality health care. The
council shall:
(1) direct the collection, dissemination, and
analysis of data under this chapter;
(2) contract with the department to collect the data
under this chapter;
(3) adopt policies and rules necessary to carry out
this chapter, including rules concerning data collection
requirements;
(4) build on and not duplicate other data collection
required by state or federal law, by an accreditation organization,
or by board rule;
(5) working with appropriate agencies, review public
health data collection programs in this state and recommend, where
appropriate, consolidation of the programs and any legislation
necessary to effect the consolidation;
(6) assure that public use data is made available and
accessible to interested persons;
(7) prescribe by rule the process for providers to
submit data consistent with Section 108.009;
(8) adopt by rule and implement a methodology to
collect and disseminate data reflecting provider quality in
accordance with Section 108.010;
(9) make reports to the legislature, the governor, and
the public on:
(A) the charges and rate of change in the charges
for health care services in this state;
(B) the effectiveness of the council in carrying
out the legislative intent of this chapter;
(C) if applicable, any recommendations on the
need for further legislation; and
(D) the quality and effectiveness of health care
and access to health care for all citizens of this state;
(10) develop an annual work plan and establish
priorities to accomplish its duties;
(11) provide consumer education on the interpretation
and understanding of the public use or provider quality data before
the data is disseminated to the public;
(12) work with the Health and Human Services
Commission and each health and human services agency that
administers a part of the state Medicaid program to avoid
duplication of expenditures of state funds for computer systems,
staff, or services in the collection and analysis of data relating
to the state Medicaid program;
(13) work with the Department of Information Resources
in developing and implementing the statewide health care data
collection system and maintain consistency with Department of
Information Resources standards; and
(14) develop and implement a health care information
plan to be used by the department to:
(A) support public health and preventative
health initiatives;
(B) assist in the delivery of primary and
preventive health care services;
(C) facilitate the establishment of appropriate
benchmark data to measure performance improvements;
(D) establish and maintain a systematic approach
to the collection, storage, and analysis of health care data for
longitudinal, epidemiological, and policy impact studies; and
(E) develop and use system-based protocols to
identify individuals and populations at risk.
(b) The council may:
(1) employ or contract with the department to employ
an executive director and other staff, including administrative
personnel, necessary to comply with this chapter and rules adopted
under this chapter;
(2) engage professional consultants as it considers
necessary to the performance of its duties;
(3) adopt rules clarifying which health care
facilities must provide data under this chapter; and
(4) apply for and receive any appropriation, donation,
or other funds from the state or federal government or any other
public or private source, subject to Section 108.015 and
limitations and conditions provided by legislative appropriation.
(c) The council may not establish or recommend rates of
payment for health care services.
(d) The council may not take an action that affects or
relates to the validity, status, or terms of an interagency
agreement or a contract with the department without the board's
approval.
(e) In the collection of data, the council shall consider
the research and initiatives being pursued by the United States
Department of Health and Human Services, the National Committee for
Quality Assurance, and the Joint Commission on Accreditation of
Healthcare Organizations to reduce potential duplication or
inconsistencies. The council may not adopt rules that conflict
with or duplicate any federally mandated data collection programs
or requirements of comparable scope.
(f) The council shall prescribe by rule a public use data
file minimum data set that maintains patient confidentiality and
establishes data accuracy and consistency.
(g) The public use data file minimum data set as defined by
council rule is subject to annual review by the council with the
assistance of the advisory committee under Section 108.003(g)(5).
The purpose of the review is to evaluate requests to modify the
existing minimum data set and editing process. A decision to modify
the minimum data set by the addition or deletion of data elements
shall include consideration of the value of the specific data to be
added or deleted and the technical feasibility of establishing data
accuracy and consistency. The council may also consider the costs
to the council and providers associated with modifying the minimum
data set.
(h) In accordance with Section 108.0135, the council may
release data collected under Section 108.009 that is not included
in the public use data file minimum data set established under
Subsection (f).
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 6, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 3, eff. Sept. 1, 1999.
§ 108.0062. DRUG PURCHASING COOPERATIVES. (a) The
council shall develop criteria for evaluating drug purchasing
cooperatives that purchase drugs on behalf of consumers and create
an evaluation form for consumers to evaluate drug purchasing
cooperatives.
(b) The council shall distribute the evaluation forms to the
department, local health departments, the Texas Department of
Insurance, and the consumer protection division of the office of
the attorney general.
(c) The council shall compile the information from
completed evaluation forms and make the information available to
the public.
Added by Acts 2001, 77th Leg., ch. 1256, § 1, eff. Sept. 1, 2001.
§ 108.0065. POWERS AND DUTIES OF COUNCIL RELATING TO
MEDICAID MANAGED CARE. (a) In this section:
(1) "Commission" means the Health and Human Services
Commission.
(2) "Medicaid managed care organization" means a
managed care organization, as defined by Section 533.001,
Government Code, that is contracting with the commission to
implement the Medicaid managed care program under Chapter 533,
Government Code.
(b) The commission may direct the council to collect data
under this chapter with respect to Medicaid managed care
organizations. The council shall coordinate the collection of the
data with the collection of data for health benefit plan providers,
but with the approval of the commission may collect data in addition
to the data otherwise required of health benefit plan providers.
(c) Each Medicaid managed care organization shall provide
the data required by the council in the form required by the council
or, if the data is also being submitted to the commission or
Medicaid operating agency, in the form required by the commission
or Medicaid operating agency.
(d) Dissemination of data collected under this section is
subject to Sections 108.010, 108.011, 108.012, 108.013, 108.014,
and 108.0141.
(e) The commission shall analyze the data collected in
accordance with this section and shall use the data to:
(1) evaluate the effectiveness and efficiency of the
Medicaid managed care system;
(2) determine the extent to which Medicaid managed
care does or does not serve the needs of Medicaid recipients in this
state; and
(3) assess the cost-effectiveness of the Medicaid
managed care system in comparison to the fee-for-service system,
considering any improvement in the quality of care provided.
(f) Not later than October 1 of each even-numbered year, the
commission shall report to the governor, the lieutenant governor,
and the speaker of the house of representatives with respect to:
(1) the commission's conclusions under Subsection (e)
and any improvement made in the delivery of services under the
Medicaid managed care system since the date of the commission's
last report under this section;
(2) recommendations for implementation by the state
agencies operating the Medicaid managed care system for improvement
to the Medicaid managed care system; and
(3) any recommendations for legislation.
(g) The report made under Subsection (f) may be consolidated
with any report made under Section 108.006(a)(9).
(h) The commission, using existing funds, may contract with
an entity to comply with the requirements under Subsections (e) and
(f).
Added by Acts 1999, 76th Leg., ch. 1460, § 8.03, eff. Sept. 1,
1999.
§ 108.007. REVIEW POWERS. (a) The council, through
the department and subject to reasonable rules and guidelines, may:
(1) inspect documents and records used by data sources
that are required to compile data and reports; and
(2) compel providers to produce accurate documents and
records.
(b) The council may enter into a memorandum of understanding
with a state agency, including the division of the Health and Human
Services Commission responsible for the state Medicaid program, or
with a school of public health or another institution of higher
education, to share data and expertise, to obtain data for the
council, or to make data available to the council. An agreement
entered into under this subsection must protect patient
confidentiality.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
§ 108.008. DUTIES OF DEPARTMENT. (a) The department,
as the state health planning and development agency under Chapter
104, is responsible for the collection of data under Chapter 311.
(b) The department shall:
(1) contract with the council to collect data under
this chapter;
(2) provide administrative assistance to the council;
(3) coordinate administrative responsibilities with
the council to avoid unnecessary duplication of the collection of
data and other duties;
(4) on request of the council, give the council access
to data collected by the department;
(5) submit or assist in the council's budget request to
the legislature; and
(6) work with the Department of Information Resources
in developing and implementing the statewide health care data
collection system and maintain consistency with Department of
Information Resources standards.
(c) The department may not take an action that affects or
relates to the validity, status, or terms of an interagency
agreement or a contract with the council without the council's
approval.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 7, eff. Sept. 1,
1997.
§ 108.0081. MEMORANDUM OF UNDERSTANDING. The council
and the department shall enter into a memorandum of understanding
to implement the department's duties under Section 108.008(b). The
memorandum of understanding must address:
(1) payroll and travel reimbursement services;
(2) purchasing services;
(3) personnel services;
(4) budget management services;
(5) computer support and maintenance services;
(6) meeting coordination services;
(7) any other administrative support or other services
to be provided by the department for the council; and
(8) the manner in which the council will reimburse the
department for the cost of services provided by the department for
the council.
Added by Acts 1997, 75th Leg., ch. 261, § 8, eff. Sept. 1, 1997.
§ 108.0085. DUTIES OF ATTORNEY GENERAL. The attorney
general shall furnish the council with advice and legal assistance
that may be required to implement this chapter.
Added by Acts 1997, 75th Leg., ch. 261, § 8, eff. Sept. 1, 1997.
§ 108.009. DATA SUBMISSION AND COLLECTION. (a) The
council may collect, and, except as provided by Subsections (c) and
(d), providers shall submit to the council or another entity as
determined by the council, all data required by this section. The
data shall be collected according to uniform submission formats,
coding systems, and other technical specifications necessary to
make the incoming data substantially valid, consistent,
compatible, and manageable using electronic data processing, if
available.
(b) The council shall adopt rules to implement the data
submission requirements imposed by Subsection (a) in appropriate
stages to allow for the development of efficient systems for the
collection and submission of the data. A rule adopted by the
council that requires submission of a data element that, before
adoption of the rule, was not required to be submitted may not take
effect before the 90th day after the date the rule is adopted and
must take effect not later than the first anniversary after the date
the rule is adopted.
(c) A rural provider may, but is not required to, provide
the data required by this chapter. A hospital may, but is not
required to, provide the data required by this chapter if the
hospital:
(1) is exempt from state franchise, sales, ad valorem,
or other state or local taxes; and
(2) does not seek or receive reimbursement for
providing health care services to patients from any source,
including:
(A) the patient or any person legally obligated
to support the patient;
(B) a third-party payor; or
(C) Medicaid, Medicare, or any other federal,
state, or local program for indigent health care.
(d) The council may not collect data from individual
physicians or from an entity that is composed entirely of
physicians and that is a professional association organized under
the Texas Professional Association Act (Article 1528f, Vernon's
Texas Civil Statutes), a limited liability partnership organized
under Section 3.08, Texas Revised Partnership Act (Article
6132b-3.08, Vernon's Texas Civil Statutes), or a limited liability
company organized under the Texas Limited Liability Company Act
(Article 1528n, Vernon's Texas Civil Statutes), except to the
extent the entity owns and operates a health care facility in this
state. This subsection does not prohibit the release of data about
physicians using uniform physician identifiers that has been
collected from a health care facility under this chapter.
(e) The council shall establish the department as the single
collection point for receipt of data from providers. With the
approval of the council and the board, the department may transfer
collection of any data required to be collected by the department
under any other law to the statewide health care data collection
system.
(f) The council may not require providers to submit data
more frequently than quarterly, but providers may submit data on a
more frequent basis.
(g) The council shall coordinate data collection with the
data collection formats used by federally qualified health centers.
To satisfy the requirements of this chapter:
(1) a federally qualified health center shall submit
annually to the council a copy of the Medicaid cost report of
federally qualified health centers; and
(2) a provider receiving federal funds under 42 U.S.C.
Section 254b, 254c, or 256 shall submit annually to the council a
copy of the Bureau of Common Reporting Requirements data report
developed by the United States Public Health Service.
(h) The council shall coordinate data collection with the
data submission formats used by hospitals and other providers. The
council shall accept data in the format developed by the National
Uniform Billing Committee (Uniform Hospital Billing Form UB 92) and
HCFA-1500 or their successors or other universally accepted
standardized forms that hospitals and other providers use for other
complementary purposes.
(i) The council shall develop by rule reasonable alternate
data submission procedures for providers that do not possess
electronic data processing capacity.
(j) Repealed by Acts 1997, 75th Leg., ch. 261, § 14, eff.
Sept. 1, 1997.
(k) The council shall collect health care data elements
relating to payer type, the racial and ethnic background of
patients, and the use of health care services by consumers.
(l) Repealed by Acts 1997, 75th Leg., ch. 261, § 14, eff.
Sept. 1, 1997.
(m) To the extent feasible, the council shall obtain from
public records the information that is available from those
records.
(n) Repealed by Acts 1997, 75th Leg., ch. 261, § 14, eff.
Sept. 1, 1997.
(o) A provider of a health benefit plan shall annually
submit to the council aggregate data by service area required by the
Health Plan Employer Data Information Set (HEDIS) as operated by
the National Committee for Quality Assurance. The council may
approve the submission of data in accordance with other methods
generally used by the health benefit plan industry. If the Health
Plan Employer Data Information Set does not generally apply to a
health benefit plan, the council shall require submission of data
in accordance with other methods. This subsection does not relieve
a health care facility that provides services under a health
benefit plan from the requirements of this chapter. Information
submitted under this section is subject to Section 108.011 but is
not subject to Section 108.010.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 9, 14, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 4, eff. Sept. 1, 1999.
§ 108.010. COLLECTION AND DISSEMINATION OF PROVIDER
QUALITY DATA. (a) Subject to Section 108.009, the council shall
collect data reflecting provider quality based on a methodology and
review process established through the council's rulemaking
process. The methodology shall identify and measure quality
standards and adhere to any federal mandates.
(b) The council shall study and analyze initial
methodologies for obtaining provider quality data, including
outcome data.
(c) The council shall test the methodology by collecting
provider quality data for one year, subject to Section 108.009. The
council may test using pilot methodologies. After collecting
provider quality data for one year, the council shall report
findings applicable to a provider to that provider and allow the
provider to review and comment on the initial provider quality data
applicable to that provider. The council shall verify the accuracy
of the data during this review and revision process. After the
review and revision process, provider quality data for subsequent
reports shall be published and made available to the public, on a
time schedule the council considers appropriate.
(d) If the council determines that provider quality data to
be published under Subsection (c) does not provide the intended
result or is inaccurate or inappropriate for dissemination, the
council is not required to publish the data or reports based in
whole or in part on the data. This subsection does not affect the
release of public use data in accordance with Section 108.011 or the
release of information submitted under Section 108.009(o).
(e) The council shall adopt rules allowing a provider to
submit concise written comments regarding any specific provider
quality data to be released concerning the provider. The council
shall make the comments available to the public at the office of the
council and in an electronic form accessible through the Internet.
The comments shall be attached to any public release of provider
quality data. Providers shall submit the comments to the council to
be attached to the public release of provider quality data in the
same format as the provider quality data that is to be released.
(f) The methodology adopted by the council for measuring
quality shall include case-mix qualifiers, severity adjustment
factors, adjustments for medical education and research, and any
other factors necessary to accurately reflect provider quality.
(g) In addition to the requirements of this section, any
release of provider quality data shall comply with Sections
108.011(e) and (f).
(h) A provider quality data report may not identify an
individual physician by name, but must identify the physician by
the uniform physician identifier designated by the council under
Section 108.011(c).
(i) The council shall release provider quality data in an
aggregate form without uniform physician identifiers when:
(1) the data relates to providers described by Section
108.0025(1); or
(2) the cell size of the data is below the minimum size
established by council rule that would enable identification of an
individual patient or physician.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 10, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 5, eff. Sept. 1, 1999.
§ 108.011. DISSEMINATION OF PUBLIC USE DATA AND COUNCIL
PUBLICATIONS. (a) The council shall promptly provide public use
data and data collected in accordance with Section 108.009(o) to
those requesting it. The public use data does not include provider
quality data prescribed by Section 108.010 or confidential data
prescribed by Section 108.013.
(b) Subject to the restrictions on access to council data
prescribed by Sections 108.010 and 108.013, and using the public
use data and other data, records, and matters of record available to
it, the council shall prepare and issue reports to the governor, the
legislature, and the public as provided by this section and Section
108.006(a). The council must issue the reports at least annually.
(c) Subject to the restrictions on access to council data
prescribed by Sections 108.010 and 108.013, the council shall use
public use data to prepare and issue reports that provide
information relating to providers, such as the incidence rate of
selected medical or surgical procedures. The reports must provide
the data in a manner that identifies individual providers,
including individual physicians, and that identifies and compares
data elements for all providers. Individual physicians may not be
identified by name, but shall be identified by uniform physician
identifiers. The council by rule shall designate the characters to
be used as uniform physician identifiers.
(d) The council shall adopt procedures to establish the
accuracy and consistency of the public use data before releasing
the public use data to the public.
(e) If public use data is requested from the council about a
specific provider, the council shall notify the provider about the
release of the data. This subsection does not authorize the
provider to interfere with the release of that data.
(f) A report issued by the council shall include a
reasonable review and comment period for the affected providers
before public release of the report.
(g) The council shall adopt rules allowing a provider to
submit concise written comments regarding any specific public use
data to be released concerning the provider. The council shall make
the comments available to the public and the office of the council
and in an electronic form accessible through the Internet. The
comments shall be attached to any public release of the public use
data. Providers shall submit the comments to the council to be
attached to the public release of public use data in the same format
as the public use data that is to be released.
(h) Tapes containing public use data and provider quality
reports that are released to the public must include general
consumer education material, including an explanation of the
benefits and limitations of the information provided in the public
use data and provider quality reports.
(i) The council shall release public use data in an
aggregate form without uniform physician identifiers when:
(1) the data relates to providers described by Section
108.0025(1); or
(2) the cell size of the data is below the minimum size
established by council rule that would enable identification of an
individual patient or physician.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 11, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 6, eff. Sept. 1, 1999.
§ 108.012. COMPUTER ACCESS TO DATA. (a) The council
shall provide a means for computer-to-computer access to the public
use data. All reports shall maintain patient confidentiality as
provided by Section 108.013.
(b) The council may charge a person requesting public use or
provider quality data a fee for the data. The fees may reflect the
quantity of information provided and the expense incurred by the
council in collecting and providing the data and shall be set at a
level that will raise revenue sufficient for the operation of the
council. The council may not charge a fee for providing public use
data to another state agency.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 11, eff. Sept. 1,
1997.
§ 108.013. CONFIDENTIALITY AND GENERAL ACCESS TO
DATA. (a) The data received by the council shall be used by the
council for the benefit of the public. Subject to specific
limitations established by this chapter and council rule, the
council shall make determinations on requests for information in
favor of access.
(b) The council by rule shall designate the characters to be
used as uniform patient identifiers. The basis for assignment of
the characters and the manner in which the characters are assigned
are confidential.
(c) Unless specifically authorized by this chapter, the
council may not release and a person or entity may not gain access
to any data:
(1) that could reasonably be expected to reveal the
identity of a patient;
(2) that could reasonably be expected to reveal the
identity of a physician;
(3) disclosing provider discounts or differentials
between payments and billed charges;
(4) relating to actual payments to an identified
provider made by a payer; or
(5) submitted to the council in a uniform submission
format that is not included in the public use data set established
under Sections 108.006(f) and (g), except in accordance with
Section 108.0135.
(d) All data collected and used by the department and the
council under this chapter is subject to the confidentiality
provisions and criminal penalties of:
(1) Section 311.037;
(2) Section 81.103; and
(3) Section 159.002, Occupations Code.
(e) Data on patients and compilations produced from the data
collected that identify patients are not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity except as
provided by this section; or
(2) admissible in any civil, administrative, or
criminal proceeding.
(f) Data on physicians and compilations produced from the
data collected that identify physicians are not:
(1) subject to discovery, subpoena, or other means of
legal compulsion for release to any person or entity except as
provided by this section; or
(2) admissible in any civil, administrative, or
criminal proceeding.
(g) The council may not release data elements in a manner
that will reveal the identity of a patient. The council may not
release data elements in a manner that will reveal the identity of a
physician.
(h) Subsections (c) and (g) do not prohibit the release of a
uniform physician identifier in conjunction with associated public
use data in accordance with Section 108.011 or a provider quality
report in accordance with Section 108.010.
(i) Notwithstanding any other law, the council and the
department may not provide information made confidential by this
section to any other agency of this state.
(j) The council shall by rule, with the assistance of the
advisory committee under Section 108.003(g)(5), develop and
implement a mechanism to comply with Subsections (c)(1) and (2).
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1997, 75th Leg., ch. 261, § 12, eff. Sept. 1,
1997; Acts 1999, 76th Leg., ch. 802, § 7, eff. Sept. 1, 1999;
Acts 2001, 77th Leg., ch. 1420, § 14.776, eff. Sept. 1, 2001.
§ 108.0135. SCIENTIFIC REVIEW PANEL. (a) The council
shall establish a scientific review panel to review and approve
requests for information other than public use data. The members of
the panel shall have experience and expertise in ethics, patient
confidentiality, and health care data.
(b) To assist the panel in determining whether to approve a
request for information, the council shall adopt rules similar to
the federal Health Care Financing Administration's guidelines on
releasing data.
(c) A request for information other than public use data
must be made on the form created by the council.
Added by Acts 1999, 76th Leg., ch. 802, § 8, eff. Sept. 1, 1999.
§ 108.014. CIVIL PENALTY. (a) A person who knowingly
or negligently releases data in violation of this chapter is liable
for a civil penalty of not more than $10,000.
(b) A person who fails to supply available data under
Sections 108.009 and 108.010 is liable for a civil penalty of not
less than $1,000 or more than $10,000 for each act of violation.
(c) The attorney general, at the request of the council,
shall enforce this chapter. The venue of an action brought under
this section is in Travis County.
(d) A civil penalty recovered in a suit instituted by the
attorney general under this chapter shall be deposited in the
general revenue fund to the credit of the health care information
account.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
Amended by Acts 1999, 76th Leg., ch. 802, § 9, eff. Sept. 1,
1999.
§ 108.0141. CRIMINAL PENALTY. (a) 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.
(b) An offense under this section is a state jail felony.
Added by Acts 1997, 75th Leg., ch. 261, § 13, eff. Sept. 1, 1997.
Amended by Acts 1999, 76th Leg., ch. 802, § 10, eff. Sept. 1,
1999.
§ 108.015. CONFLICT OF INTEREST. The council may not
accept a donation from a person required to provide data under this
chapter or from a person or business entity who provides goods or
services to the council for compensation.
Added by Acts 1995, 74th Leg., ch. 726, § 1, eff. Sept. 1, 1995.
