reglab/housing_qa huggingface dataset:
TX Ins Code § 38.355 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter H. Health Care Reimbursement Rate Information|Section 38.355. Data Call; Standardized Format

Sec. 38.355.  DATA CALL; STANDARDIZED FORMAT.  (a)  Each health benefit plan issuer shall submit to the department, at the time and in the form and manner required by the department, aggregate reimbursement rates by region paid by the health benefit plan issuer for health care services identified by the department.(b)  The department shall require that data submitted under this section be submitted in a standardized format, established by rule, to permit comparison of health care reimbursement rates.  To the extent feasible, the department shall develop the data submission requirements in a manner that allows collection of reimbursement rates as a dollar amount and not by comparison to other standard reimbursement rates, such as Medicare reimbursement rates.(c)  The department shall specify the period for which reimbursement rates must be filed under this section.(d)  The department may contract with a private third party to obtain the data under this subchapter.  If the department contracts with a third party, the department may determine the aggregate data to be collected and published under Section 38.357 if consistent with the purposes of this subchapter described in Section 38.351.  The department shall prohibit the third party contractor from selling, leasing, or publishing the data obtained by the contractor under this subchapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.|
TX Ins Code § 38.356 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter H. Health Care Reimbursement Rate Information|Section 38.356. Confidentiality of Data

Sec. 38.356.  CONFIDENTIALITY OF DATA.  Except as provided by Section 38.357, data collected under this subchapter is confidential and not subject to disclosure under Chapter 552, Government Code.|Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.|
TX Ins Code § 38.357 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter H. Health Care Reimbursement Rate Information|Section 38.357. Publication of Aggregate Health Care Reimbursement Rate Information

Sec. 38.357.  PUBLICATION OF AGGREGATE HEALTH CARE REIMBURSEMENT RATE INFORMATION.  The department shall provide to the Department of State Health Services for publication, for identified regions of this state, aggregate health care reimbursement rate information derived from the data collected under this subchapter.  The published information may not reveal the name of any health care provider or health benefit plan issuer.  The department may make the aggregate health care reimbursement rate information available through the department's Internet website.|Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.|
TX Ins Code § 38.358 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter H. Health Care Reimbursement Rate Information|Section 38.358. Penalties

Sec. 38.358.  PENALTIES.  A health benefit plan issuer that fails to submit data as required in accordance with this subchapter is subject to an administrative penalty under Chapter 84.  For purposes of penalty assessment, each day the health benefit plan issuer fails to submit the data as required is a separate violation.|Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 8, eff. September 1, 2007.|
TX Ins Code § 38.401 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.401. Purpose of Subchapter

Sec. 38.401.  PURPOSE OF SUBCHAPTER.  The purpose of this subchapter is to authorize the department to establish an all payor claims database in this state to increase public transparency of health care information and improve the quality of health care in this state.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.402 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.402. Definitions

Sec. 38.402.  DEFINITIONS.  In this subchapter:(1)  "Allowed amount" means the amount of a billed charge that a health benefit plan issuer determines to be covered for services provided by a non-network provider. The allowed amount includes both the insurer's payment and any applicable deductible, copayment, or coinsurance amounts for which the insured is responsible.(2)  "Center" means the Center for Healthcare Data at The University of Texas Health Science Center at Houston.(3)  "Contracted rate" means the fee or reimbursement amount for a network provider's services, treatments, or supplies as established by agreement between the provider and health benefit plan issuer.(4)  "Data" means the specific claims and encounters, enrollment, and benefit information submitted to the center under this subchapter.(5)  "Database" means the Texas All Payor Claims Database established under this subchapter.(6)  "Geozip" means an area that includes all zip codes with identical first three digits.(7)  "Payor" means any of the following entities that pay, reimburse, or otherwise contract with a health care provider for the provision of health care services, supplies, or devices to a patient:(A)  an insurance company providing health or dental insurance;(B)  the sponsor or administrator of a health or dental plan;(C)  a health maintenance organization operating under Chapter 843;(D)  the state Medicaid program, including the Medicaid managed care program operating under Chapter 533, Government Code;(E)  a health benefit plan offered or administered by or on behalf of this state or a political subdivision of this state or an agency or instrumentality of the state or a political subdivision of this state, including:(i)  a basic coverage plan under Chapter 1551;(ii)  a basic plan under Chapter 1575; and(iii)  a primary care coverage plan under Chapter 1579; or(F)  any other entity providing a health insurance or health benefit plan subject to regulation by the department.(8)  "Protected health information" has the meaning assigned by 45 C.F.R. Section 160.103.(9)  "Qualified research entity" means:(A)  an organization engaging in public interest research for the purpose of analyzing the delivery of health care in this state that is exempt from federal income tax under Section 501(a), Internal Revenue Code of 1986, by being listed as an exempt organization in Section 501(c)(3) of that code;(B)  an institution of higher education engaged in public interest research related to the delivery of health care in this state; or(C)  a health care provider in this state engaging in efforts to improve the quality and cost of health care. (10)  "Stakeholder advisory group" means the stakeholder advisory group established under Section 38.403.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.403 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.403. Stakeholder Advisory Group

Sec. 38.403.  STAKEHOLDER ADVISORY GROUP.  (a)  The center shall establish a stakeholder advisory group to assist the center as provided by this subchapter, including assistance in:(1)  establishing and updating the standards, requirements, policies, and procedures relating to the collection and use of data contained in the database required by Sections 38.404(e) and (f);(2)  evaluating and prioritizing the types of reports the center should publish under Section 38.404(e);(3)  evaluating data requests from qualified research entities under Section 38.404(e)(2); and(4)  assisting the center in developing the center's recommendations under Section 38.408(3).(b)  The advisory group created under this section must be composed of:(1)  the state Medicaid director or the director's designee;(2)  a member designated by the Teacher Retirement System of Texas;(3)  a member designated by the Employees Retirement System of Texas; and(4)  12 members designated by the center, including:(A)  two members representing the business community, with at least one of those members representing small businesses that purchase health benefits but are not involved in the provision of health care services, supplies, or devices or health benefit plans;(B)  two members who represent consumers and who are not professionally involved in the purchase, provision, administration, or review of health care services, supplies, or devices or health benefit plans, with at least one member representing the behavioral health community;(C)  two members representing hospitals that are licensed in this state;(D)  two members representing health benefit plan issuers that are regulated by the department;(E)  two members who are physicians licensed to practice medicine in this state, one of whom is a primary care physician; and(F)  two members who are not professionally involved in the purchase, provision, administration, or review of health care services, supplies, or devices or health benefit plans and who have expertise in:(i)  health planning;(ii)  health economics;(iii)  provider quality assurance;(iv)  statistics or health data management; or(v)  medical privacy laws.(c)  A person serving on the stakeholder advisory group must disclose any conflict of interest.(d)  Members of the stakeholder advisory group serve fixed terms as prescribed by commissioner rules adopted under this subchapter.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.405 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.405. Public Access Portal

Sec. 38.405.  PUBLIC ACCESS PORTAL.  (a)  Except as provided by this section and Sections 38.404 and 38.406 and in a manner consistent with all applicable federal and state law, the center shall collect, compile, and analyze data submitted to or stored in the database and disseminate the information described in Section 38.404(e)(1) in a format that allows the public to easily access and navigate the information.  The information must be accessible through an open access Internet portal that may be accessed by the public through an Internet website.(b)  The portal created under this section must allow the public to easily search and retrieve the information disseminated under Subsection (a), subject to data privacy and security restrictions described in this subchapter and consistent with all applicable federal and state law.(c)  Any information or data that is accessible through the portal created under this section:(1)  must be segmented by type of insurance or health benefit plan in a manner that does not combine payment rates relating to different types of insurance or health benefit plans;(2)  must be aggregated by like Current Procedural Terminology codes and health care services in a statewide, regional, or geozip area; and(3)  may not identify a specific patient, health care provider, health benefit plan, health benefit plan issuer, or other payor.(d)  Before making information or data accessible through the portal, the center shall remove any data or information that may identify a specific patient in accordance with the de-identification standards described in 45 C.F.R. Section 164.514.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.406 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.406. Data Privacy and Security

Sec. 38.406.  DATA PRIVACY AND SECURITY.  (a)  Any information that may identify a patient, health care provider, health benefit plan, health benefit plan issuer, or other payor is confidential and subject to applicable state and federal law relating to records privacy and protected health information, including Chapter 181, Health and Safety Code, and is not subject to disclosure under Chapter 552, Government Code.(b)  A qualified research entity with access to data or information that is contained in the database but not accessible through the portal described in Section 38.405:(1)  may use information contained in the database only for purposes consistent with the purposes of this subchapter and must use the information in accordance with standards, requirements, policies, and procedures established by the center in consultation with the stakeholder advisory group;(2)  may not sell or share any information contained in the database; and(3)  may not use the information contained in the database for a commercial purpose.(c)  A qualified research entity with access to information that is contained in the database but not accessible through the portal must execute an agreement with the center relating to the qualified research entity's compliance with the requirements of Subsections (a) and (b), including the confidentiality of information contained in the database but not accessible through the portal.(d)  Notwithstanding any provision of this subchapter, the department and the center may not disclose an individual's protected health information in violation of any state or federal law.(e)  The center shall include in the database only the minimum amount of protected health information identifiers necessary to link public and private data sources and the geographic and services data to undertake studies.(f)  The center shall maintain protected health information identifiers collected under this subchapter but excluded from the database under Subsection (e) in a separate database.  The separate database may not be aggregated with any other information and must use a proxy or encrypted record identifier for analysis.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.407 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.407. Certain Entities Not Required to Submit Data

Sec. 38.407.  CERTAIN ENTITIES NOT REQUIRED TO SUBMIT DATA.  Any sponsor or administrator of a health benefit plan subject to the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.) may elect or decline to participate in or submit data to the center for inclusion in the database as consistent with federal law.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.408 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.408. Report to Legislature

Sec. 38.408.  REPORT TO LEGISLATURE.  Not later than September 1 of each even-numbered year, the center shall submit to the legislature a written report containing:(1)  an analysis of the data submitted to the center for use in the database;(2)  information regarding the submission of data to the center for use in the database and the maintenance, analysis, and use of the data;(3)  recommendations from the center, in consultation with the stakeholder advisory group, to further improve the transparency, cost-effectiveness, accessibility, and quality of health care in this state; and(4)  an analysis of the trends of health care affordability, availability, quality, and utilization.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 38.409 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 38 - Data Collection and Reports|Subchapter I. Texas All Payor Claims Database|Section 38.409. Rules

Sec. 38.409.  RULES.  (a)  The commissioner, in consultation with the center, shall adopt rules:(1)  specifying the types of data a payor is required to provide to the center under Section 38.404 to determine health benefits costs and other reporting metrics, including, if necessary, types of data not expressly identified in that section;(2)  specifying the schedule, frequency, and manner in which a payor must provide data to the center under Section 38.404, which must:(A)  require the payor to provide data to the center not less frequently than quarterly; and(B)  include provisions relating to data layout, data governance, historical data, data submission, use and sharing, information security, and privacy protection in data submissions; and(3)  establishing oversight and enforcement mechanisms to ensure that payors submit data to the database in accordance with this subchapter.(b)  In adopting rules governing methods for data submission, the commissioner shall to the maximum extent practicable use methods that are reasonable and cost-effective for payors.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 40.001 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter A. General Provisions|Section 40.001. Definition

Sec. 40.001.  DEFINITION.  In this chapter, "office" means the State Office of Administrative Hearings.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|
TX Ins Code § 40.002 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter A. General Provisions|Section 40.002. Duties of State Office of Administrative Hearings

Sec. 40.002.  DUTIES OF STATE OFFICE OF ADMINISTRATIVE HEARINGS.  The office shall conduct an administrative hearing required to be held or that may be held under this code or another insurance law of this state.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|
TX Ins Code § 40.003 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter A. General Provisions|Section 40.003. Application of Chapter; Exceptions

Sec. 40.003.  APPLICATION OF CHAPTER;  EXCEPTIONS.  (a)  This chapter applies only to a hearing required to be held before a decision may be rendered or action taken by the commissioner or the department.(b)  If a provision of this code or another insurance law of this state requires that the commissioner take an action at a hearing subject to this chapter, the commissioner shall take the action after receipt of a proposal for decision from the office regarding the hearing conducted by the office.(c)  This chapter does not apply to a proceeding conducted under Chapter 201 or to a proceeding relating to:(1)  approving or reviewing rates or rating manuals filed by an individual company, unless the rates or manuals are contested;(2)  adopting a rule;(3)  adopting or approving a policy form or policy form endorsement;(4)  adopting or approving a plan of operation for an organization subject to the jurisdiction of the department;(5)  adopting a presumptive rate under Chapter 1153; or(6)  a workers' compensation claim brought under Title 5, Labor Code.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.  Amended by Acts 2001, 77th Leg., ch. 1318, Sec. 3, eff. Sept. 1, 2001.Amended by: Acts 2005, 79th Leg., Ch. 265 (H.B. 7), Sec. 6.057, eff. September 1, 2005.|
TX Ins Code § 40.004 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter A. General Provisions|Section 40.004. Memorandum of Understanding

Sec. 40.004.  MEMORANDUM OF UNDERSTANDING.  (a)  The commissioner and the chief administrative law judge of the office by rule shall adopt a memorandum of understanding governing hearings conducted by the office under this code or another insurance law of this state.(b)  The memorandum of understanding must require the chief administrative law judge and the commissioner to cooperate in conducting hearings under this chapter and may authorize the office to perform any procedural act, including giving notice, that is required to be performed by the commissioner under this code or another insurance law of this state.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|
TX Ins Code § 40.005 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter A. General Provisions|Section 40.005. Conflict With Other Law

Sec. 40.005.  CONFLICT WITH OTHER LAW.  This chapter prevails over another provision of this code or another insurance law of this state unless the provision or other law states that this chapter does not apply.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|
TX Ins Code § 40.051 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter B. Proceedings Relating to Promulgation of Rates|Section 40.051. Application of Subchapter

Sec. 40.051.  APPLICATION OF SUBCHAPTER.  Subject to Section 40.003, a proceeding to promulgate rates is governed by this subchapter.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|
TX Ins Code § 40.052 (2021)
2021 Texas Statutes|Insurance Code|Title 2 - Texas Department of Insurance|Subtitle A - Administration of the Texas Department of Insurance|Chapter 40 - Duties of State Office of Administrative Hearings and Commissioner in Certain Proceedings; Rate Setting Proceedings|Subchapter B. Proceedings Relating to Promulgation of Rates|Section 40.052. Application of Administrative Procedure Act

Sec. 40.052.  APPLICATION OF ADMINISTRATIVE PROCEDURE ACT.  A proceeding to promulgate rates is a contested case under Chapter 2001, Government Code, and to the extent not inconsistent with this subchapter, that chapter and the Texas Rules of Civil Procedure apply.|Added by Acts 1999, 76th Leg., ch. 101, Sec. 1, eff. Sept. 1, 1999.|