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Statutes > Texas > Health-and-safety-code > Title-2-health > Chapter-108-texas-health-care-information-council

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.