HEALTH AND SAFETY CODE
TITLE 12. HEALTH AND MENTAL HEALTH
CHAPTER 1002. TEXAS INSTITUTE OF HEALTH CARE QUALITY AND EFFICIENCY
SUBCHAPTER A. GENERAL PROVISIONS
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200, S.B. 277 and S.B. 219, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.001. DEFINITIONS. In this chapter:
(1) "Board" means the board of directors of the Texas Institute of Health Care Quality and Efficiency established under this chapter.
(2) "Commission" means the Health and Human Services Commission.
(3) "Department" means the Department of State Health Services.
(4) "Executive commissioner" means the executive commissioner of the Health and Human Services Commission.
(5) "Health care collaborative" has the meaning assigned by Section 848.001, Insurance Code.
(6) "Health care facility" means:
(A) a hospital licensed under Chapter 241;
(B) an institution licensed under Chapter 242;
(C) an ambulatory surgical center licensed under Chapter 243;
(D) a birthing center licensed under Chapter 244;
(E) an end stage renal disease facility licensed under Chapter 251; or
(F) a freestanding emergency medical care facility licensed under Chapter 254.
(7) "Institute" means the Texas Institute of Health Care Quality and Efficiency established under this chapter.
(8) "Potentially preventable admission" means an admission of a person to a hospital or long-term care facility that may have reasonably been prevented with adequate access to ambulatory care or health care coordination.
(9) "Potentially preventable ancillary service" means a health care service provided or ordered by a physician or other health care provider to supplement or support the evaluation or treatment of a patient, including a diagnostic test, laboratory test, therapy service, or radiology service, that may not be reasonably necessary for the provision of quality health care or treatment.
(10) "Potentially preventable complication" means a harmful event or negative outcome with respect to a person, including an infection or surgical complication, that:
(A) occurs after the person's admission to a hospital or long-term care facility; and
(B) may have resulted from the care, lack of care, or treatment provided during the hospital or long-term care facility stay rather than from a natural progression of an underlying disease.
(11) "Potentially preventable event" means a potentially preventable admission, a potentially preventable ancillary service, a potentially preventable complication, a potentially preventable emergency room visit, a potentially preventable readmission, or a combination of those events.
(12) "Potentially preventable emergency room visit" means treatment of a person in a hospital emergency room or freestanding emergency medical care facility for a condition that may not require emergency medical attention because the condition could be, or could have been, treated or prevented by a physician or other health care provider in a nonemergency setting.
(13) "Potentially preventable readmission" means a return hospitalization of a person within a period specified by the commission that may have resulted from deficiencies in the care or treatment provided to the person during a previous hospital stay or from deficiencies in post-hospital discharge follow-up. The term does not include a hospital readmission necessitated by the occurrence of unrelated events after the discharge. The term includes the readmission of a person to a hospital for:
(A) the same condition or procedure for which the person was previously admitted;
(B) an infection or other complication resulting from care previously provided; or
(C) a condition or procedure that indicates that a surgical intervention performed during a previous admission was unsuccessful in achieving the anticipated outcome.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.002. ESTABLISHMENT; PURPOSE. The Texas Institute of Health Care Quality and Efficiency is established to improve health care quality, accountability, education, and cost containment in this state by encouraging health care provider collaboration, effective health care delivery models, and coordination of health care services.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
SUBCHAPTER B. ADMINISTRATION
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.051. APPLICATION OF SUNSET ACT. The institute is subject to Chapter 325, Government Code (Texas Sunset Act). Unless continued in existence as provided by that chapter, the institute is abolished and this chapter expires September 1, 2017.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200, S.B. 277 and S.B. 219, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.052. COMPOSITION OF BOARD OF DIRECTORS. (a) The institute is governed by a board of 15 directors appointed by the governor.
(b) The following ex officio, nonvoting members also serve on the board:
(1) the commissioner of the department;
(2) the executive commissioner;
(3) the commissioner of insurance;
(4) the executive director of the Employees Retirement System of Texas;
(5) the executive director of the Teacher Retirement System of Texas;
(6) the state Medicaid director of the Health and Human Services Commission;
(7) the executive director of the Texas Medical Board;
(8) the commissioner of the Department of Aging and Disability Services;
(9) the executive director of the Texas Workforce Commission;
(10) the commissioner of the Texas Higher Education Coordinating Board; and
(11) a representative from each state agency or system of higher education that purchases or provides health care services, as determined by the governor.
(c) The governor shall appoint as board members health care providers, payors, consumers, and health care quality experts or persons who possess expertise in any other area the governor finds necessary for the successful operation of the institute.
(d) A person may not serve as a voting member of the board if the person serves on or advises another board or advisory board of a state agency.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.053. TERMS OF OFFICE. (a) Appointed members of the board serve staggered terms of four years, with the terms of as close to one-half of the members as possible expiring January 31 of each odd-numbered year.
(b) Board members may serve consecutive terms.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.054. ADMINISTRATIVE SUPPORT. (a) The institute is administratively attached to the commission.
(b) The commission shall coordinate administrative responsibilities with the institute to streamline and integrate the institute's administrative operations and avoid unnecessary duplication of effort and costs.
(c) The institute may collaborate with, and coordinate its administrative functions, including functions related to research and reporting activities with, other public or private entities, including academic institutions and nonprofit organizations, that perform research on health care issues or other topics consistent with the purpose of the institute.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.055. EXPENSES. (a) Members of the board serve without compensation but, subject to the availability of appropriated funds, may receive reimbursement for actual and necessary expenses incurred in attending meetings of the board.
(b) Information relating to the billing and payment of expenses under this section is subject to Chapter 552, Government Code.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.056. OFFICER; CONFLICT OF INTEREST. (a) The governor shall designate a member of the board as presiding officer to serve in that capacity at the pleasure of the governor.
(b) Any board member or a member of a committee formed by the board with direct interest, personally or through an employer, in a matter before the board shall abstain from deliberations and actions on the matter in which the conflict of interest arises and shall further abstain on any vote on the matter, and may not otherwise participate in a decision on the matter.
(c) Each board member shall:
(1) file a conflict of interest statement and a statement of ownership interests with the board to ensure disclosure of all existing and potential personal interests related to board business; and
(2) update the statements described by Subdivision (1) at least annually.
(d) A statement filed under Subsection (c) is subject to Chapter 552, Government Code.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.057. PROHIBITION ON CERTAIN CONTRACTS AND EMPLOYMENT. (a) The board may not compensate, employ, or contract with any individual who serves as a member of the board of, or on an advisory board or advisory committee for, any other governmental body, including any agency, council, or committee, in this state.
(b) The board may not compensate, employ, or contract with any person that provides financial support to the board, including a person who provides a gift, grant, or donation to the board.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.058. MEETINGS. (a) The board may meet as often as necessary, but shall meet at least once each calendar quarter.
(b) The board shall develop and implement policies that provide the public with a reasonable opportunity to appear before the board and to speak on any issue under the authority of the institute.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.059. BOARD MEMBER IMMUNITY. (a) A board member may not be held civilly liable for an act performed, or omission made, in good faith in the performance of the member's powers and duties under this chapter.
(b) A cause of action does not arise against a member of the board for an act or omission described by Subsection (a).
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.060. PRIVACY OF INFORMATION. (a) Protected health information and individually identifiable health information collected, assembled, or maintained by the institute is confidential and is not subject to disclosure under Chapter 552, Government Code.
(b) The institute shall comply with all state and federal laws and rules relating to the protection, confidentiality, and transmission of health information, including the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) and rules adopted under that Act, 42 U.S.C. Section 290dd-2, and 42 C.F.R. Part 2.
(c) The commission, department, or institute or an officer or employee of the commission, department, or institute, including a board member, may not disclose any information that is confidential under this section.
(d) Information, documents, and records that are confidential as provided by this section are not subject to subpoena or discovery and may not be introduced into evidence in any civil or criminal proceeding.
(e) An officer or employee of the commission, department, or institute, including a board member, may not be examined in a civil, criminal, special, administrative, or other proceeding as to information that is confidential under this section.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.061. FUNDING. (a) The institute may be funded through the General Appropriations Act and may request, accept, and use gifts, grants, and donations as necessary to implement its functions.
(b) The institute may participate in other revenue-generating activity that is consistent with the institute's purposes.
(c) Except as otherwise provided by law, each state agency represented on the board as a nonvoting member shall provide funds to support the institute and implement this chapter. The commission shall establish a funding formula to determine the level of support each state agency is required to provide.
(d) This section does not permit the sale of information that is confidential under Section 1002.060.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
SUBCHAPTER C. POWERS AND DUTIES
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.101. GENERAL POWERS AND DUTIES. The institute shall make recommendations to the legislature on:
(1) improving quality and efficiency of health care delivery by:
(A) providing a forum for regulators, payors, and providers to discuss and make recommendations for initiatives that promote the use of best practices, increase health care provider collaboration, improve health care outcomes, and contain health care costs;
(B) researching, developing, supporting, and promoting strategies to improve the quality and efficiency of health care in this state;
(C) determining the outcome measures that are the most effective measures of quality and efficiency:
(i) using nationally accredited measures; or
(ii) if no nationally accredited measures exist, using measures based on expert consensus;
(D) reducing the incidence of potentially preventable events; and
(E) creating a state plan that takes into consideration the regional differences of the state to encourage the improvement of the quality and efficiency of health care services;
(2) improving reporting, consolidation, and transparency of health care information; and
(3) implementing and supporting innovative health care collaborative payment and delivery systems under Chapter 848, Insurance Code.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200, S.B. 277 and S.B. 219, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.102. GOALS FOR QUALITY AND EFFICIENCY OF HEALTH CARE; STATEWIDE PLAN. (a) The institute shall study and develop recommendations to improve the quality and efficiency of health care delivery in this state, including:
(1) quality-based payment systems that align payment incentives with high-quality, cost-effective health care;
(2) alternative health care delivery systems that promote health care coordination and provider collaboration;
(3) quality of care and efficiency outcome measurements that are effective measures of prevention, wellness, coordination, provider collaboration, and cost-effective health care; and
(4) meaningful use of electronic health records by providers and electronic exchange of health information among providers.
(b) The institute shall study and develop recommendations for measuring quality of care and efficiency across:
(1) all state employee and state retiree benefit plans;
(2) employee and retiree benefit plans provided through the Teacher Retirement System of Texas;
(3) the state medical assistance program under Chapter 32, Human Resources Code; and
(4) the child health plan under Chapter 62.
(c) In developing recommendations under Subsection (b), the institute shall use nationally accredited measures or, if no nationally accredited measures exist, measures based on expert consensus.
(d) The institute may study and develop recommendations for measuring the quality of care and efficiency in state or federally funded health care delivery systems other than those described by Subsection (b).
(e) In developing recommendations under Subsections (a) and (b), the institute may not base its recommendations solely on actuarial data.
(f) Using the studies described by Subsections (a) and (b), the institute shall develop recommendations for a statewide plan for quality and efficiency of the delivery of health care.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
SUBCHAPTER D. HEALTH CARE COLLABORATIVE GUIDELINES AND SUPPORT
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.151. INSTITUTE STUDIES AND RECOMMENDATIONS REGARDING HEALTH CARE PAYMENT AND DELIVERY SYSTEMS. (a) The institute shall study and make recommendations for alternative health care payment and delivery systems.
(b) The institute shall recommend methods to evaluate a health care collaborative's effectiveness, including methods to evaluate:
(1) the efficiency and effectiveness of cost-containment methods used by the collaborative;
(2) alternative health care payment and delivery systems used by the collaborative;
(3) the quality of care;
(4) health care provider collaboration and coordination;
(5) the protection of patients;
(6) patient satisfaction; and
(7) the meaningful use of electronic health records by providers and electronic exchange of health information among providers.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
SUBCHAPTER E. IMPROVED TRANSPARENCY
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.201. HEALTH CARE ACCOUNTABILITY; IMPROVED TRANSPARENCY. (a) With the assistance of the department, the institute shall complete an assessment of all health-related data collected by the state, what information is available to the public, and how the public and health care providers currently benefit and could potentially benefit from this information, including health care cost and quality information.
(b) The institute shall develop a plan:
(1) for consolidating reports of health-related data from various sources to reduce administrative costs to the state and reduce the administrative burden to health care providers and payors;
(2) for improving health care transparency to the public and health care providers by making information available in the most effective format; and
(3) providing recommendations to the legislature on enhancing existing health-related information available to health care providers and the public, including provider reporting of additional information not currently required to be reported under existing law, to improve quality of care.
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
This section was amended by the 84th Legislature. Pending publication of the current statutes, see S.B. 200 and S.B. 277, 84th Legislature, Regular Session, for amendments affecting this section.
Sec. 1002.202. ALL PAYOR CLAIMS DATABASE. (a) The institute shall study the feasibility and desirability of establishing a centralized database for health care claims information across all payors.
(b) The study described by Subsection (a) shall:
(1) use the assessment described by Section 1002.201 to develop recommendations relating to the adequacy of existing data sources for carrying out the state's purposes under this chapter and Chapter 848, Insurance Code;
(2) determine whether the establishment of an all payor claims database would reduce the need for some data submissions provided by payors;
(3) identify the best available sources of data necessary for the state's purposes under this chapter and Chapter 848, Insurance Code, that are not collected by the state under existing law;
(4) describe how an all payor claims database may facilitate carrying out the state's purposes under this chapter and Chapter 848, Insurance Code;
(5) identify national standards for claims data collection and use, including standardized data sets, standardized methodology, and standard outcome measures of health care quality and efficiency; and
(6) estimate the costs of implementing an all payor claims database, including:
(A) the costs to the state for collecting and processing data;
(B) the cost to the payors for supplying the data; and
(C) the available funding mechanisms that might support an all payor claims database.
(c) The institute shall consult with the department and the Texas Department of Insurance to develop recommendations to submit to the legislature on the establishment of the centralized claims database described by Subsection (a).
Added by Acts 2011, 82nd Leg., 1st C.S., Ch. 7 (S.B. 7), Sec. 3.01, eff. September 28, 2011.
