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CHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCIL

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HEALTH AND SAFETY CODETITLE 2. HEALTHSUBTITLE E. HEALTH CARE COUNCILS AND RESOURCE CENTERSCHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCILSec. 108.001.CREATION OF COUNCIL.The Texas Health CareInformation Council shall administer this chapter and report tothe governor, the legislature, and the public.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995.Sec. 108.002.DEFINITIONS.In this chapter:(1)"Accurate and consistent data" means data that has beenedited by the council and subject to provider validation andcertification.(2)"Board" means the Texas Board of Health.(3)"Certification" means the process by which a providerconfirms the accuracy and completeness of the data set requiredto produce the public use data file in accordance with councilrule.(4)"Charge" or "rate" means the amount billed by a provider forspecific procedures or services provided to a patient before anyadjustment for contractual allowances. The term does not includecopayment charges to enrollees in health benefit plans charged byproviders paid by capitation or salary.(5)"Council" means the Texas Health Care Information Council.(6)"Data" means information collected under Section 108.0065 or108.009 in the form initially received.(7)"Department" means the Texas Department of Health.(8)"Edit" means to use an electronic standardized processdeveloped and implemented by council rule to identify potentialerrors and mistakes in data elements by reviewing data fields forthe presence or absence of data and the accuracy andappropriateness 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 certifiedunder Section 162.001, Occupations Code, and that holds acertificate of authority issued by the commissioner of insuranceunder 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 underChapter 464;(D)a renal dialysis facility;(E)a birthing center;(F)a rural health clinic;(G)a federally qualified health center as defined by 42 U.S.C.Section 1396d(l)(2)(B); or(H)a free-standing imaging center.(11)"Health maintenance organization" means an organization asdefined in Section 843.002, Insurance Code.(12)"Hospital" means a public, for-profit, or nonprofitinstitution licensed or owned by this state that is a general orspecial hospital, private mental hospital, chronic diseasehospital, or other type of hospital.(13)"Outcome data" means measures related to the provision ofcare, 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 ofthis 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 providerrenders care that, within the capabilities of modern medicine,obtains for patients medically acceptable health outcomes andprognoses, after severity adjustment.(17)"Public use data" means patient level data relating toindividual hospitalizations that has not been summarized oranalyzed, that has had patient identifying information removed,that identifies physicians only by use of uniform physicianidentifiers, and that is severity and risk adjusted, edited, andverified for accuracy and consistency. Public use data mayexclude some data elements submitted to the council.(18)"Rural provider" means a provider described by Section108.0025.(19)"Severity adjustment" means a method to stratify patientgroups by degrees of illness and mortality.(20)"Uniform patient identifier" means a number assigned by thecouncil to an individual patient and composed of numeric, alpha,or alphanumeric characters.(21)"Uniform physician identifier" means a number assigned bythe council to an individual physician and composed of numeric,alpha, or alphanumeric characters.(22)"Validation" means the process by which a provider verifiesthe accuracy and completeness of data and corrects any errorsidentified before certification in accordance with council rule.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 1, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 1, eff. Sept.1, 1999; Acts 1999, 76th Leg., ch. 1460, Sec. 8.02, eff. Sept. 1,1999; Acts 2001, 77th Leg., ch. 1420, Sec. 14.775, eff. Sept. 1,2001; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.523, eff. Sept. 1,2003.Amended by:Acts 2007, 80th Leg., R.S., Ch.997, Sec. 2, eff. September 1, 2007.Sec. 108.0025.RURAL PROVIDER.For purposes of this chapter, aprovider is a rural provider if the provider:(1)is located in a county that:(A)has a population estimated by the United States Bureau ofthe Census to be not more than 35,000 as of July 1 of the mostrecent year for which county population estimates have beenpublished; or(B)has a population of more than 35,000, but that does not havemore than 100 licensed hospital beds and is not located in anarea that is delineated as an urbanized area by the United StatesBureau of the Census; and(2)is not a state-owned hospital or a hospital that is managedor directly or indirectly owned by an individual, association,partnership, corporation, or other legal entity that owns ormanages one or more other hospitals.Added by Acts 1997, 75th Leg., ch. 261, Sec. 2, eff. Sept. 1,1997.Sec. 108.003.COUNCIL COMPOSITION; EXPENSES.(a)The councilis composed of four ex officio state agency members and 15members appointed by the governor in accordance with thissection.(b)The ex officio members of the council are:(1)the commissioner of public health or the commissioner'sdesignee;(2)the commissioner of health and human services or thecommissioner's designee;(3)the commissioner of insurance or the commissioner'sdesignee; and(4)the public insurance counsel or the counsel's designee.(c)The governor shall appoint the following members of thecouncil:(1)three representatives of the business community, with atleast one representing small businesses, who are purchasers ofhealth care but who are not involved in the provision of healthcare or health insurance;(2)two representatives from labor, one of whom is not directlyinvolved with management of health care benefits;(3)two representatives of consumers who are not professionallyinvolved in the purchase, provision, administration, or review ofhealth 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 indirect patient care; and(7)two members who are not professionally involved in thepurchase, provision, administration, or utilization review ofhealth 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 ofthe governor. Members annually shall elect a vice chairman.(e)A majority of voting members constitutes a quorum for thetransaction of any business. An act by the majority of the votingmembers present at any meeting at which there is a quorum isconsidered to be an act of the council.(f)The council may appoint committees and may elect anyofficers subordinate to those provided for in Subsection (d).(g)The council shall appoint technical advisory committees andshall consult with the appropriate technical advisory committeewith respect to a rule before the rule is finally adopted by thecouncil. The council is not required to consult with a technicaladvisory committee before adopting an emergency rule inaccordance with Section 2001.034, Government Code. The councilshall submit an emergency rule adopted by the council to theappropriate advisory committee for review not later than thefirst advisory committee meeting that occurs after the rule isadopted. The council may consult with the appropriate technicaladvisory committee with respect to other formal action of thecouncil. A technical advisory committee may consult with otherprofessionals as necessary. Chapter 2110, Government Code, doesnot apply to an advisory committee appointed under thissubsection. The technical advisory committees shall include:(1)a technical advisory committee that includes, among otherindividuals, at least five practicing physicians licensed in thisstate to provide advice and recommendations to the council on thedevelopment and implementation of the methodology and theinterpretation of a provider quality report and data underSection 108.010;(2)a technical advisory committee composed of at least fivepracticing physicians licensed in this state who have beenactively engaged in organized peer review at a hospital in thisstate to provide advice, recommendations, and peer reviewexpertise to the council on:(A)the use of peer review in the determination of qualityinpatient care;(B)the development and interpretation of data elementsnecessary to the determination of quality inpatient care; and(C)the development and format of reports and informationrelating to provider quality;(3)a technical advisory committee that includes providers andconsumers to provide advice and recommendations to the councilrelating to education about the development and dissemination ofprovider reports and data;(4)a technical advisory committee that includes representativesof consumers and each type of issuer of health benefit plans toassist 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 hospitalinformation systems, health information management, qualitymanagement, and security of confidential data.(h)A member of the council may not receive compensation forservice on the council. However, the member shall be reimbursedfor the member's actual and necessary meals, lodging,transportation, and incidental expenses if incurred whileperforming council business.(i)A member of an advisory committee appointed by the councilmay not receive compensation or reimbursement of any expenseincurred while serving on the committee.(j)Appointments to the council shall be made without regard tothe race, color, disability, sex, religion, age, or nationalorigin of appointees. Additionally, in making the appointments tothe council, the governor shall consider geographicalrepresentation.(k)A person may not serve as a member of the council if theperson is required to register as a lobbyist under Chapter 305,Government Code, because of the person's activities forcompensation on behalf of a profession related to the operationof the council.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 3, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 2, eff. Sept.1, 1999.Sec. 108.004.MEETINGS.(a)The council, council committees,and technical advisory committees are subject to the openmeetings law, Chapter 551, Government Code.(b)The council shall meet as often as necessary, but not lessoften than quarterly, to perform its duties under this chapter.(c)The council shall publish a notice of its meetings in theTexas Register.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 4, eff.Sept. 1, 1997.Sec. 108.0045.OPEN RECORDS.Subject to the restrictions ofthis chapter, the council is subject to the open records law,Chapter 552, Government Code.Added by Acts 1997, 75th Leg., ch. 261, Sec. 5, eff. Sept. 1,1997.Sec. 108.005.TERMS.(a)The terms of the agency members areconcurrent with their terms of office. The appointed councilmembers serve six-year staggered terms, with the terms of fivemembers expiring September 1 of each odd-numbered year.(b)An appointed member may not serve more than two fullconsecutive terms.(c)It is a ground for removal from the council if a member ofthe council:(1)does not have at the time of appointment the qualificationsrequired by Section 108.003;(2)does not maintain during service the qualifications requiredby Section 108.003;(3)cannot discharge the member's duties for a substantial partof the term for which the member is appointed because of illnessor disability; or(4)fails to attend at least one-half of the regularly scheduledmeetings that the member is eligible to attend during a calendaryear.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995.Sec. 108.006.POWERS AND DUTIES OF COUNCIL.(a)The councilshall develop a statewide health care data collection system tocollect health care charges, utilization data, provider qualitydata, and outcome data to facilitate the promotion andaccessibility of cost-effective, good quality health care. Thecouncil shall:(1)direct the collection, dissemination, and analysis of dataunder this chapter;(2)contract with the department to collect the data under thischapter;(3)adopt policies and rules necessary to carry out thischapter, including rules concerning data collection requirements;(4)build on and not duplicate other data collection required bystate or federal law, by an accreditation organization, or byboard rule;(5)working with appropriate agencies, review public health datacollection programs in this state and recommend, whereappropriate, consolidation of the programs and any legislationnecessary to effect the consolidation;(6)assure that public use data is made available and accessibleto interested persons;(7)prescribe by rule the process for providers to submit dataconsistent with Section 108.009;(8)adopt by rule and implement a methodology to collect anddisseminate data reflecting provider quality in accordance withSection 108.010;(9)make reports to the legislature, the governor, and thepublic on:(A)the charges and rate of change in the charges for healthcare services in this state;(B)the effectiveness of the council in carrying out thelegislative intent of this chapter;(C)if applicable, any recommendations on the need for furtherlegislation; and(D)the quality and effectiveness of health care and access tohealth care for all citizens of this state;(10)develop an annual work plan and establish priorities toaccomplish its duties;(11)provide consumer education on the interpretation andunderstanding of the public use or provider quality data beforethe data is disseminated to the public;(12)work with the Health and Human Services Commission and eachhealth and human services agency that administers a part of thestate Medicaid program to avoid duplication of expenditures ofstate funds for computer systems, staff, or services in thecollection and analysis of data relating to the state Medicaidprogram;(13)work with the Department of Information Resources indeveloping and implementing the statewide health care datacollection system and maintain consistency with Department ofInformation Resources standards; and(14)develop and implement a health care information plan to beused by the department to:(A)support public health and preventative health initiatives;(B)assist in the delivery of primary and preventive health careservices;(C)facilitate the establishment of appropriate benchmark datato measure performance improvements;(D)establish and maintain a systematic approach to thecollection, storage, and analysis of health care data forlongitudinal, epidemiological, and policy impact studies; and(E)develop and use system-based protocols to identifyindividuals and populations at risk.(b)The council may:(1)employ or contract with the department to employ anexecutive director and other staff, including administrativepersonnel, necessary to comply with this chapter and rulesadopted under this chapter;(2)engage professional consultants as it considers necessary tothe performance of its duties;(3)adopt rules clarifying which health care facilities mustprovide data under this chapter; and(4)apply for and receive any appropriation, donation, or otherfunds from the state or federal government or any other public orprivate source, subject to Section 108.015 and limitations andconditions provided by legislative appropriation.(c)The council may not establish or recommend rates of paymentfor health care services.(d)The council may not take an action that affects or relatesto the validity, status, or terms of an interagency agreement ora contract with the department without the board's approval.(e)In the collection of data, the council shall consider theresearch and initiatives being pursued by the United StatesDepartment of Health and Human Services, the National Committeefor Quality Assurance, and the Joint Commission on Accreditationof Healthcare Organizations to reduce potential duplication orinconsistencies. The council may not adopt rules that conflictwith or duplicate any federally mandated data collection programsor requirements of comparable scope.(f)The council shall prescribe by rule a public use data fileminimum data set that maintains patient confidentiality andestablishes data accuracy and consistency.(g)The public use data file minimum data set as defined bycouncil rule is subject to annual review by the council with theassistance of the advisory committee under Section 108.003(g)(5).The purpose of the review is to evaluate requests to modify theexisting minimum data set and editing process. A decision tomodify the minimum data set by the addition or deletion of dataelements shall include consideration of the value of the specificdata to be added or deleted and the technical feasibility ofestablishing data accuracy and consistency. The council may alsoconsider the costs to the council and providers associated withmodifying the minimum data set.(h)In accordance with Section 108.0135, the council may releasedata collected under Section 108.009 that is not included in thepublic use data file minimum data set established underSubsection (f).Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 6, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 3, eff. Sept.1, 1999.Sec. 108.0062.DRUG PURCHASING COOPERATIVES.(a)The councilshall develop criteria for evaluating drug purchasingcooperatives that purchase drugs on behalf of consumers andcreate an evaluation form for consumers to evaluate drugpurchasing cooperatives.(b)The council shall distribute the evaluation forms to thedepartment, local health departments, the Texas Department ofInsurance, and the consumer protection division of the office ofthe attorney general.(c)The council shall compile the information from completedevaluation forms and make the information available to thepublic.Added by Acts 2001, 77th Leg., ch. 1256, Sec. 1, eff. Sept. 1,2001.Sec. 108.0065.POWERS AND DUTIES OF COUNCIL RELATING TO MEDICAIDMANAGED CARE.(a)In this section:(1)"Commission" means the Health and Human Services Commission.(2)"Medicaid managed care organization" means a managed careorganization, as defined by Section 533.001, Government Code,that is contracting with the commission to implement the Medicaidmanaged care program under Chapter 533, Government Code.(b)The commission may direct the council to collect data underthis chapter with respect to Medicaid managed care organizations.The council shall coordinate the collection of the data with thecollection of data for health benefit plan providers, but withthe approval of the commission may collect data in addition tothe data otherwise required of health benefit plan providers.(c)Each Medicaid managed care organization shall provide thedata required by the council in the form required by the councilor, if the data is also being submitted to the commission orMedicaid operating agency, in the form required by the commissionor Medicaid operating agency.(d)Dissemination of data collected under this section issubject to Sections 108.010, 108.011, 108.012, 108.013, 108.014,and 108.0141.(e)The commission shall analyze the data collected inaccordance with this section and shall use the data to:(1)evaluate the effectiveness and efficiency of the Medicaidmanaged care system;(2)determine the extent to which Medicaid managed care does ordoes not serve the needs of Medicaid recipients in this state;and(3)assess the cost-effectiveness of the Medicaid managed caresystem in comparison to the fee-for-service system, consideringany improvement in the quality of care provided.(f)Not later than October 1 of each even-numbered year, thecommission 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 anyimprovement made in the delivery of services under the Medicaidmanaged care system since the date of the commission's lastreport under this section;(2)recommendations for implementation by the state agenciesoperating the Medicaid managed care system for improvement to theMedicaid managed care system; and(3)any recommendations for legislation.(g)The report made under Subsection (f) may be consolidatedwith any report made under Section 108.006(a)(9).(h)The commission, using existing funds, may contract with anentity to comply with the requirements under Subsections (e) and(f).Added by Acts 1999, 76th Leg., ch. 1460, Sec. 8.03, eff. Sept. 1,1999.Sec. 108.007.REVIEW POWERS.(a)The council, through thedepartment and subject to reasonable rules and guidelines, may:(1)inspect documents and records used by data sources that arerequired to compile data and reports; and(2)compel providers to produce accurate documents and records.(b)The council may enter into a memorandum of understandingwith a state agency, including the division of the Health andHuman Services Commission responsible for the state Medicaidprogram, or with a school of public health or another institutionof higher education, to share data and expertise, to obtain datafor the council, or to make data available to the council. Anagreement entered into under this subsection must protect patientconfidentiality.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995.Sec. 108.008.DUTIES OF DEPARTMENT.(a)The department, as thestate 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 thischapter;(2)provide administrative assistance to the council;(3)coordinate administrative responsibilities with the councilto avoid unnecessary duplication of the collection of data andother duties;(4)on request of the council, give the council access to datacollected by the department;(5)submit or assist in the council's budget request to thelegislature; and(6)work with the Department of Information Resources indeveloping and implementing the statewide health care datacollection system and maintain consistency with Department ofInformation Resources standards.(c)The department may not take an action that affects orrelates to the validity, status, or terms of an interagencyagreement or a contract with the council without the council'sapproval.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 7, eff.Sept. 1, 1997.Sec. 108.0081.MEMORANDUM OF UNDERSTANDING.The council and thedepartment shall enter into a memorandum of understanding toimplement the department's duties under Section 108.008(b). Thememorandum 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 beprovided by the department for the council; and(8)the manner in which the council will reimburse thedepartment for the cost of services provided by the departmentfor the council.Added by Acts 1997, 75th Leg., ch. 261, Sec. 8, eff. Sept. 1,1997.Sec. 108.0085.DUTIES OF ATTORNEY GENERAL.The attorney generalshall furnish the council with advice and legal assistance thatmay be required to implement this chapter.Added by Acts 1997, 75th Leg., ch. 261, Sec. 8, eff. Sept. 1,1997.Sec. 108.009.DATA SUBMISSION AND COLLECTION.(a)The councilmay collect, and, except as provided by Subsections (c) and (d),providers shall submit to the council or another entity asdetermined by the council, all data required by this section. Thedata shall be collected according to uniform submission formats,coding systems, and other technical specifications necessary tomake the incoming data substantially valid, consistent,compatible, and manageable using electronic data processing, ifavailable.(b)The council shall adopt rules to implement the datasubmission requirements imposed by Subsection (a) in appropriatestages to allow for the development of efficient systems for thecollection and submission of the data. A rule adopted by thecouncil that requires submission of a data element that, beforeadoption of the rule, was not required to be submitted may nottake effect before the 90th day after the date the rule isadopted and must take effect not later than the first anniversaryafter the date the rule is adopted.(c)A rural provider may, but is not required to, provide thedata required by this chapter. A hospital may, but is notrequired to, provide the data required by this chapter if thehospital:(1)is exempt from state franchise, sales, ad valorem, or otherstate or local taxes; and(2)does not seek or receive reimbursement for providing healthcare services to patients from any source, including:(A)the patient or any person legally obligated to support thepatient;(B)a third-party payor; or(C)Medicaid, Medicare, or any other federal, state, or localprogram for indigent health care.(d)The council may not collect data from individual physiciansor from an entity that is composed entirely of physicians andthat is a professional association organized under the TexasProfessional Association Act (Article 1528f, Vernon's Texas CivilStatutes), a limited liability partnership organized underSection 3.08, Texas Revised Partnership Act (Article 6132b-3.08,Vernon's Texas Civil Statutes), or a limited liability companyorganized under the Texas Limited Liability Company Act (Article1528n, Vernon's Texas Civil Statutes), except to the extent theentity owns and operates a health care facility in this state.This subsection does not prohibit the release of data aboutphysicians using uniform physician identifiers that has beencollected from a health care facility under this chapter.(e)The council shall establish the department as the singlecollection point for receipt of data from providers. With theapproval of the council and the board, the department maytransfer collection of any data required to be collected by thedepartment under any other law to the statewide health care datacollection system.(f)The council may not require providers to submit data morefrequently than quarterly, but providers may submit data on amore frequent basis.(g)The council shall coordinate data collection with the datacollection formats used by federally qualified health centers. Tosatisfy the requirements of this chapter:(1)a federally qualified health center shall submit annually tothe council a copy of the Medicaid cost report of federallyqualified health centers; and(2)a provider receiving federal funds under 42 U.S.C. Section254b, 254c, or 256 shall submit annually to the council a copy ofthe Bureau of Common Reporting Requirements data report developedby the United States Public Health Service.(h)The council shall coordinate data collection with the datasubmission formats used by hospitals and other providers. Thecouncil shall accept data in the format developed by the NationalUniform Billing Committee (Uniform Hospital Billing Form UB 92)and HCFA-1500 or their successors or other universally acceptedstandardized forms that hospitals and other providers use forother complementary purposes.(i)The council shall develop by rule reasonable alternate datasubmission procedures for providers that do not possesselectronic data processing capacity.(j)Repealed by Acts 1997, 75th Leg., ch. 261, Sec. 14, eff.Sept. 1, 1997.(k)The council shall collect health care data elements relatingto payer type, the racial and ethnic background of patients, andthe use of health care services by consumers.The council shallprioritize data collection efforts on inpatient and outpatientsurgical and radiological procedures from hospitals, ambulatorysurgical centers, and free-standing radiology centers.(l)Repealed by Acts 1997, 75th Leg., ch. 261, Sec. 14, eff.Sept. 1, 1997.(m)To the extent feasible, the council shall obtain from publicrecords the information that is available from those records.(n)Repealed by Acts 1997, 75th Leg., ch. 261, Sec. 14, eff.Sept. 1, 1997.(o)A provider of a health benefit plan shall annually submit tothe council aggregate data by service area required by the HealthPlan Employer Data Information Set (HEDIS) as operated by theNational Committee for Quality Assurance. The council may approvethe submission of data in accordance with other methods generallyused by the health benefit plan industry. If the Health PlanEmployer Data Information Set does not generally apply to ahealth benefit plan, the council shall require submission of datain accordance with other methods. This subsection does notrelieve a health care facility that provides services under ahealth benefit plan from the requirements of this chapter.Information submitted under this section is subject to Section108.011 but is not subject to Section 108.010.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 9, 14, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 4, eff. Sept.1, 1999.Amended by:Acts 2007, 80th Leg., R.S., Ch.997, Sec. 3, eff. September 1, 2007.Sec. 108.010.COLLECTION AND DISSEMINATION OF PROVIDER QUALITYDATA.(a)Subject to Section 108.009, the council shall collectdata reflecting provider quality based on a methodology andreview process established through the council's rulemakingprocess. The methodology shall identify and measure qualitystandards and adhere to any federal mandates.(b)The council shall study and analyze initial methodologiesfor obtaining provider quality data, including outcome data.(c)The council shall test the methodology by collectingprovider quality data for one year, subject to Section 108.009.The council may test using pilot methodologies. After collectingprovider quality data for one year, the council shall reportfindings applicable to a provider to that provider and allow theprovider to review and comment on the initial provider qualitydata applicable to that provider. The council shall verify theaccuracy of the data during this review and revision process.After the review and revision process, provider quality data forsubsequent reports shall be published and made available to thepublic, on a time schedule the council considers appropriate.(d)If the council determines that provider quality data to bepublished under Subsection (c) does not provide the intendedresult or is inaccurate or inappropriate for dissemination, thecouncil is not required to publish the data or reports based inwhole or in part on the data. This subsection does not affect therelease of public use data in accordance with Section 108.011 orthe release of information submitted under Section 108.009(o).(e)The council shall adopt rules allowing a provider to submitconcise written comments regarding any specific provider qualitydata to be released concerning the provider. The council shallmake the comments available to the public at the office of thecouncil and in an electronic form accessible through theInternet. The comments shall be attached to any public release ofprovider quality data. Providers shall submit the comments to thecouncil to be attached to the public release of provider qualitydata in the same format as the provider quality data that is tobe released.(f)The methodology adopted by the council for measuring qualityshall include case-mix qualifiers, severity adjustment factors,adjustments for medical education and research, and any otherfactors necessary to accurately reflect provider quality.(g)In addition to the requirements of this section, any releaseof provider quality data shall comply with Sections 108.011(e)and (f).(h)A provider quality data report may not identify anindividual physician by name, but must identify the physician bythe uniform physician identifier designated by the council underSection 108.011(c).(i)The council shall release provider quality data in anaggregate form without uniform physician identifiers when:(1)the data relates to providers described by Section108.0025(1); or(2)the cell size of the data is below the minimum sizeestablished by council rule that would enable identification ofan individual patient or physician.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 10, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 5, eff. Sept.1, 1999.Sec. 108.011.DISSEMINATION OF PUBLIC USE DATA AND COUNCILPUBLICATIONS.(a)The council shall promptly provide public usedata and data collected in accordance with Section 108.009(o) tothose requesting it. The public use data does not includeprovider quality data prescribed by Section 108.010 orconfidential data prescribed by Section 108.013.(b)Subject to the restrictions on access to council dataprescribed by Sections 108.010 and 108.013, and using the publicuse data and other data, records, and matters of record availableto it, the council shall prepare and issue reports to thegovernor, the legislature, and the public as provided by thissection and Section 108.006(a). The council must issue thereports at least annually.(c)Subject to the restrictions on access to council dataprescribed by Sections 108.010 and 108.013, the council shall usepublic use data to prepare and issue reports that provideinformation relating to providers, such as the incidence rate ofselected medical or surgical procedures. The reports must providethe data in a manner that identifies individual providers,including individual physicians, and that identifies and comparesdata elements for all providers. Individual physicians may not beidentified by name, but shall be identified by uniform physicianidentifiers. The council by rule shall designate the charactersto be used as uniform physician identifiers.(c-1)The council shall use public use data to prepare and issuereports that provide information for review and analysis by theHealth and Human Services Commission relating to services thatare provided in a niche hospital, as defined by Section 105.002,Occupations Code, and that are provided by a physician with anownership interest in the niche hospital.(c-2)Subsection (c-1) does not apply to an ownership interestin publicly available shares of a registered investment company,such as a mutual fund, that owns publicly traded equitysecurities or debt obligations issued by a niche hospital or anentity that owns the niche hospital.(d)The council shall adopt procedures to establish the accuracyand consistency of the public use data before releasing thepublic use data to the public.(e)If public use data is requested from the council about aspecific provider, the council shall notify the provider aboutthe release of the data. This subsection does not authorize theprovider to interfere with the release of that data.(f)A report issued by the council shall include a reasonablereview and comment period for the affected providers beforepublic release of the report.(g)The council shall adopt rules allowing a provider to submitconcise written comments regarding any specific public use datato be released concerning the provider. The council shall makethe comments available to the public and the office of thecouncil and in an electronic form accessible through theInternet. The comments shall be attached to any public release ofthe public use data. Providers shall submit the comments to thecouncil to be attached to the public release of public use datain the same format as the public use data that is to be released.(h)Tapes containing public use data and provider qualityreports that are released to the public must include generalconsumer education material, including an explanation of thebenefits and limitations of the information provided in thepublic use data and provider quality reports.(i)The council shall release public use data in an aggregateform without uniform physician identifiers when:(1)the data relates to providers described by Section108.0025(1); or(2)the cell size of the data is below the minimum sizeestablished by council rule that would enable identification ofan individual patient or physician.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 11, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 6, eff. Sept.1, 1999.Amended by:Acts 2005, 79th Leg., Ch.836, Sec. 4, eff. September 1, 2005.Sec. 108.012.COMPUTER ACCESS TO DATA.(a)The council shallprovide a means for computer-to-computer access to the public usedata. All reports shall maintain patient confidentiality asprovided by Section 108.013.(b)The council may charge a person requesting public use orprovider quality data a fee for the data. The fees may reflectthe quantity of information provided and the expense incurred bythe council in collecting and providing the data and shall be setat a level that will raise revenue sufficient for the operationof the council. The council may not charge a fee for providingpublic use data to another state agency.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 11, eff.Sept. 1, 1997.Sec. 108.013.CONFIDENTIALITY AND GENERAL ACCESS TO DATA.(a)The data received by the council shall be used by the council forthe benefit of the public. Subject to specific limitationsestablished by this chapter and council rule, the council shallmake determinations on requests for information in favor ofaccess.(b)The council by rule shall designate the characters to beused as uniform patient identifiers. The basis for assignment ofthe characters and the manner in which the characters areassigned are confidential.(c)Unless specifically authorized by this chapter, the councilmay not release and a person or entity may not gain access to anydata:(1)that could reasonably be expected to reveal the identity ofa patient;(2)that could reasonably be expected to reveal the identity ofa physician;(3)disclosing provider discounts or differentials betweenpayments and billed charges;(4)relating to actual payments to an identified provider madeby a payer; or(5)submitted to the council in a uniform submission format thatis not included in the public use data set established underSections 108.006(f) and (g), except in accordance with Section108.0135.(d)All data collected and used by the department and thecouncil under this chapter is subject to the confidentialityprovisions 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 datacollected that identify patients are not:(1)subject to discovery, subpoena, or other means of legalcompulsion for release to any person or entity except as providedby this section; or(2)admissible in any civil, administrative, or criminalproceeding.(f)Data on physicians and compilations produced from the datacollected that identify physicians are not:(1)subject to discovery, subpoena, or other means of legalcompulsion for release to any person or entity except as providedby this section; or(2)admissible in any civil, administrative, or criminalproceeding.(g)The council may not release data elements in a manner thatwill reveal the identity of a patient. The council may notrelease data elements in a manner that will reveal the identityof a physician.(h)Subsections (c) and (g) do not prohibit the release of auniform physician identifier in conjunction with associatedpublic use data in accordance with Section 108.011 or a providerquality report in accordance with Section 108.010.(i)Notwithstanding any other law, the council and thedepartment may not provide information made confidential by thissection to any other agency of this state.(j)The council shall by rule, with the assistance of theadvisory committee under Section 108.003(g)(5), develop andimplement a mechanism to comply with Subsections (c)(1) and (2).Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 12, eff.Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 7, eff. Sept.1, 1999; Acts 2001, 77th Leg., ch. 1420, Sec. 14.776, eff. Sept.1, 2001.Sec. 108.0135.SCIENTIFIC REVIEW PANEL.(a)The council shallestablish a scientific review panel to review and approverequests for information other than public use data. The membersof 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 arequest for information, the council shall adopt rules similar tothe federal Health Care Financing Administration's guidelines onreleasing data.(c)A request for information other than public use data must bemade on the form created by the council.Added by Acts 1999, 76th Leg., ch. 802, Sec. 8, eff. Sept. 1,1999.Sec. 108.014.CIVIL PENALTY.(a)A person who knowingly ornegligently releases data in violation of this chapter is liablefor a civil penalty of not more than $10,000.(b)A person who fails to supply available data under Sections108.009 and 108.010 is liable for a civil penalty of not lessthan $1,000 or more than $10,000 for each act of violation.(c)The attorney general, at the request of the council, shallenforce this chapter. The venue of an action brought under thissection is in Travis County.(d)A civil penalty recovered in a suit instituted by theattorney general under this chapter shall be deposited in thegeneral revenue fund to the credit of the health care informationaccount.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995. Amended by Acts 1999, 76th Leg., ch. 802, Sec. 9, eff.Sept. 1, 1999.Sec. 108.0141.CRIMINAL PENALTY.(a)A person who knowinglyaccesses data in violation of this chapter or who with criminalnegligence releases data in violation of this chapter commits anoffense.(b)An offense under this section is a state jail felony.Added by Acts 1997, 75th Leg., ch. 261, Sec. 13, eff. Sept. 1,1997. Amended by Acts 1999, 76th Leg., ch. 802, Sec. 10, eff.Sept. 1, 1999.Sec. 108.015.CONFLICT OF INTEREST.The council may not accepta donation from a person required to provide data under thischapter or from a person or business entity who provides goods orservices to the council for compensation.Added by Acts 1995, 74th Leg., ch. 726, Sec. 1, eff. Sept. 1,1995.
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  • HEALTH AND SAFETY CODE

    TITLE 2. HEALTH

    SUBTITLE E. HEALTH CARE COUNCILS AND RESOURCE CENTERS

    CHAPTER 108. TEXAS HEALTH CARE INFORMATION COUNCIL

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995.

    Sec. 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;

    (G) a federally qualified health center as defined by 42 U.S.C.

    Section 1396d(l)(2)(B); or

    (H) a free-standing imaging center.

    (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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 1, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 1, eff. Sept.

    1, 1999; Acts 1999, 76th Leg., ch. 1460, Sec. 8.02, eff. Sept. 1,

    1999; Acts 2001, 77th Leg., ch. 1420, Sec. 14.775, eff. Sept. 1,

    2001; Acts 2003, 78th Leg., ch. 1276, Sec. 10A.523, eff. Sept. 1,

    2003.

    Amended by:

    Acts 2007, 80th Leg., R.S., Ch.

    997, Sec. 2, eff. September 1, 2007.

    Sec. 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, Sec. 2, eff. Sept. 1,

    1997.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 3, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 2, eff. Sept.

    1, 1999.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 4, eff.

    Sept. 1, 1997.

    Sec. 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, Sec. 5, eff. Sept. 1,

    1997.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 6, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 3, eff. Sept.

    1, 1999.

    Sec. 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, Sec. 1, eff. Sept. 1,

    2001.

    Sec. 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, Sec. 8.03, eff. Sept. 1,

    1999.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 7, eff.

    Sept. 1, 1997.

    Sec. 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, Sec. 8, eff. Sept. 1,

    1997.

    Sec. 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, Sec. 8, eff. Sept. 1,

    1997.

    Sec. 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, Sec. 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. The council shall

    prioritize data collection efforts on inpatient and outpatient

    surgical and radiological procedures from hospitals, ambulatory

    surgical centers, and free-standing radiology centers.

    (l) Repealed by Acts 1997, 75th Leg., ch. 261, Sec. 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, Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 9, 14, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 4, eff. Sept.

    1, 1999.

    Amended by:

    Acts 2007, 80th Leg., R.S., Ch.

    997, Sec. 3, eff. September 1, 2007.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 10, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 5, eff. Sept.

    1, 1999.

    Sec. 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.

    (c-1) The council shall use public use data to prepare and issue

    reports that provide information for review and analysis by the

    Health and Human Services Commission relating to services that

    are provided in a niche hospital, as defined by Section 105.002,

    Occupations Code, and that are provided by a physician with an

    ownership interest in the niche hospital.

    (c-2) Subsection (c-1) does not apply to an ownership interest

    in publicly available shares of a registered investment company,

    such as a mutual fund, that owns publicly traded equity

    securities or debt obligations issued by a niche hospital or an

    entity that owns the niche hospital.

    (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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 11, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 6, eff. Sept.

    1, 1999.

    Amended by:

    Acts 2005, 79th Leg., Ch.

    836, Sec. 4, eff. September 1, 2005.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 11, eff.

    Sept. 1, 1997.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1997, 75th Leg., ch. 261, Sec. 12, eff.

    Sept. 1, 1997; Acts 1999, 76th Leg., ch. 802, Sec. 7, eff. Sept.

    1, 1999; Acts 2001, 77th Leg., ch. 1420, Sec. 14.776, eff. Sept.

    1, 2001.

    Sec. 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, Sec. 8, eff. Sept. 1,

    1999.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995. Amended by Acts 1999, 76th Leg., ch. 802, Sec. 9, eff.

    Sept. 1, 1999.

    Sec. 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, Sec. 13, eff. Sept. 1,

    1997. Amended by Acts 1999, 76th Leg., ch. 802, Sec. 10, eff.

    Sept. 1, 1999.

    Sec. 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, Sec. 1, eff. Sept. 1,

    1995.

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