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�	S.B.�No.�203

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�	AN ACT
�	relating to health care-associated infections and preventable
�	adverse events in certain health care facilities.
�	�������BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
�	�������SECTION�1.��Subsections (a), (b), and (c), Section 98.103,
�	Health and Safety Code, as added by Chapter 359 (S.B. 288), Acts of
�	the 80th Legislature, Regular Session, 2007, are amended to read as
�	follows:
�	�������(a)��A health care facility, other than a pediatric and
�	adolescent hospital, shall report to the department the incidence
�	of surgical site infections, including the causative pathogen if
�	the infection is laboratory-confirmed, occurring in the following
�	procedures:
�	�������������(1)��colon surgeries;
�	�������������(2)��hip arthroplasties;
�	�������������(3)��knee arthroplasties;
�	�������������(4)��abdominal hysterectomies;
�	�������������(5)��vaginal hysterectomies;
�	�������������(6)��coronary artery bypass grafts; and
�	�������������(7)��vascular procedures.
�	�������(b)��A pediatric and adolescent hospital shall report the
�	incidence of surgical site infections, including the causative
�	pathogen if the infection is laboratory-confirmed, occurring in the
�	following procedures to the department:
�	�������������(1)��cardiac procedures, excluding thoracic cardiac
�	procedures;
�	�������������(2)��ventriculoperitoneal shunt procedures; and
�	�������������(3)��spinal surgery with instrumentation.
�	�������(c)��A general hospital shall report the following to the
�	department:
�	�������������(1)��the incidence of laboratory-confirmed central
�	line-associated primary bloodstream infections, including the
�	causative pathogen, occurring in any special care setting in the
�	hospital; and
�	�������������(2)��the incidence of respiratory syncytial virus
�	occurring in any pediatric inpatient unit in the hospital.
�	�������SECTION�2.��(a)��The heading to Chapter 98, Health and
�	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
�	Legislature, Regular Session, 2007, is amended to read as follows:
�	CHAPTER 98. REPORTING OF HEALTH CARE-ASSOCIATED INFECTIONS AND
�	PREVENTABLE ADVERSE EVENTS
�	�������(b)��Subdivisions (1) and (11), Section 98.001, Health and
�	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
�	Legislature, Regular Session, 2007, are amended to read as follows:
�	�������������(1)��"Advisory panel" means the Advisory Panel on
�	Health Care-Associated Infections and Preventable Adverse Events.
�	�������������(11)��"Reporting system" means the Texas Health
�	Care-Associated Infection and Preventable Adverse Events Reporting
�	System.
�	�������(c)��Section 98.051, Health and Safety Code, as added by
�	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
�	Session, 2007, is amended to read as follows:
�	�������Sec.�98.051.��ESTABLISHMENT. The commissioner shall
�	establish the Advisory Panel on Health Care-Associated Infections
�	and Preventable Adverse Events within [the infectious disease
�	surveillance and epidemiology branch of] the department to guide
�	the implementation, development, maintenance, and evaluation of
�	the reporting system. The commissioner may establish one or more
�	subcommittees to assist the advisory panel in addressing health
�	care-associated infections and preventable adverse events relating
�	to hospital care provided to children or other special patient
�	populations.
�	�������(d)��Subsection (a), Section 98.052, Health and Safety Code,
�	as added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
�	Regular Session, 2007, is amended to read as follows:
�	�������(a)��The advisory panel is composed of 18 [16] members as
�	follows:
�	�������������(1)��two infection control professionals who:
�	�������������������(A)��are certified by the Certification Board of
�	Infection Control and Epidemiology; and
�	�������������������(B)��are practicing in hospitals in this state, at
�	least one of which must be a rural hospital;
�	�������������(2)��two infection control professionals who:
�	�������������������(A)��are certified by the Certification Board of
�	Infection Control and Epidemiology; and
�	�������������������(B)��are nurses licensed to engage in professional
�	nursing under Chapter 301, Occupations Code;
�	�������������(3)��three board-certified or board-eligible
�	physicians who:
�	�������������������(A)��are licensed to practice medicine in this
�	state under Chapter 155, Occupations Code, at least two of whom have
�	active medical staff privileges at a hospital in this state and at
�	least one of whom is a pediatric infectious disease physician with
�	expertise and experience in pediatric health care epidemiology;
�	�������������������(B)��are active members of the Society for
�	Healthcare Epidemiology of America; and
�	�������������������(C)��have demonstrated expertise in quality
�	assessment and performance improvement or infection control in
�	health care facilities;
�	�������������(4)��four additional [two] professionals in quality
�	assessment and performance improvement[, one of whom is employed by
�	a general hospital and one of whom is employed by an ambulatory
�	surgical center];
�	�������������(5)��one officer of a general hospital;
�	�������������(6)��one officer of an ambulatory surgical center;
�	�������������(7)��three nonvoting members who are department
�	employees representing the department in epidemiology and the
�	licensing of hospitals or ambulatory surgical centers; and
�	�������������(8)��two members who represent the public as consumers.
�	�������(e)��Subsections (a) and (c), Section 98.102, Health and
�	Safety Code, as added by Chapter 359 (S.B. 288), Acts of the 80th
�	Legislature, Regular Session, 2007, are amended to read as follows:
�	�������(a)��The department shall establish the Texas Health
�	Care-Associated Infection and Preventable Adverse Events Reporting
�	System within the [infectious disease surveillance and
�	epidemiology branch of the] department. The purpose of the
�	reporting system is to provide for:
�	�������������(1)��the reporting of health care-associated
�	infections by health care facilities to the department;
�	�������������(2)��the reporting of health care-associated
�	preventable adverse events by health care facilities to the
�	department;
�	�������������(3)��the public reporting of information regarding the
�	health care-associated infections by the department;
�	�������������(4)��the public reporting of information regarding
�	health care-associated preventable adverse events by the
�	department; and
�	�������������(5)�[(3)]��the education and training of health care
�	facility staff by the department regarding this chapter.
�	�������(c)��The data reported by health care facilities to the
�	department must contain sufficient patient identifying information
�	to:
�	�������������(1)��avoid duplicate submission of records;
�	�������������(2)��allow the department to verify the accuracy and
�	completeness of the data reported; and
�	�������������(3)��for data reported under Section 98.103 or 98.104,
�	allow the department to risk adjust the facilities' infection
�	rates.
�	�������(f)��Subchapter C, Chapter 98, Health and Safety Code, as
�	added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
�	Regular Session, 2007, is amended by adding Section 98.1045 to read
�	as follows:
�	�������Sec.�98.1045.��REPORTING OF PREVENTABLE ADVERSE EVENTS.
�	(a)��Each health care facility shall report to the department the
�	occurrence of any of the following preventable adverse events
�	involving the facility's patient:
�	�������������(1)��a health care-associated adverse condition or
�	event for which the Medicare program will not provide additional
�	payment to the facility under a policy adopted by the federal
�	Centers for Medicare and Medicaid Services; and
�	�������������(2)��subject to Subsection (b), an event included in
�	the list of adverse events identified by the National Quality Forum
�	that is not included under Subdivision (1).
�	�������(b)��The executive commissioner may exclude an adverse event
�	described by Subsection (a)(2) from the reporting requirement of
�	Subsection (a) if the executive commissioner, in consultation with
�	the advisory panel, determines that the adverse event is not an
�	appropriate indicator of a preventable adverse event.
�	�������(g)��Subsections (a), (b), and (g), Section 98.106, Health
�	and Safety Code, as added by Chapter 359 (S.B. 288), Acts of the
�	80th Legislature, Regular Session, 2007, are amended to read as
�	follows:
�	�������(a)��The department shall compile and make available to the
�	public a summary, by health care facility, of:
�	�������������(1)��the infections reported by facilities under
�	Sections 98.103 and 98.104; and
�	�������������(2)��the preventable adverse events reported by
�	facilities under Section 98.1045.
�	�������(b)��Information included in the [The] departmental summary
�	with respect to infections reported by facilities under Sections
�	98.103 and 98.104 must be risk adjusted and include a comparison of
�	the risk-adjusted infection rates for each health care facility in
�	this state that is required to submit a report under Sections 98.103
�	and 98.104.
�	�������(g)��The department shall make the departmental summary
�	available on an Internet website administered by the department and
�	may make the summary available through other formats accessible to
�	the public. The website must contain a statement informing the
�	public of the option to report suspected health care-associated
�	infections and preventable adverse events to the department.
�	�������(h)��Section 98.108, Health and Safety Code, as added by
�	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
�	Session, 2007, is amended to read as follows:
�	�������Sec.�98.108.��FREQUENCY OF REPORTING. In consultation with
�	the advisory panel, the executive commissioner by rule shall
�	establish the frequency of reporting by health care facilities
�	required under Sections 98.103, [and] 98.104, and 98.1045.
�	Facilities may not be required to report more frequently than
�	quarterly.
�	�������(i)��Section 98.109, Health and Safety Code, as added by
�	Chapter 359 (S.B. 288), Acts of the 80th Legislature, Regular
�	Session, 2007, is amended by adding Subsection (b-1) and amending
�	Subsection (e) to read as follows:
�	�������(b-1)��A state employee or officer may not be examined in a
�	civil, criminal, or special proceeding, or any other proceeding,
�	regarding the existence or contents of information or materials
�	obtained, compiled, or reported by the department under this
�	chapter.
�	�������(e)��A department summary or disclosure may not contain
�	information identifying a [facility] patient, employee,
�	contractor, volunteer, consultant, health care professional,
�	student, or trainee in connection with a specific [infection]
�	incident.
�	�������(j)��Sections 98.110 and 98.111, Health and Safety Code, as
�	added by Chapter 359 (S.B. 288), Acts of the 80th Legislature,
�	Regular Session, 2007, are amended to read as follows:
�	�������Sec.�98.110.��DISCLOSURE AMONG CERTAIN AGENCIES [WITHIN
�	DEPARTMENT]. Notwithstanding any other law, the department may
�	disclose information reported by health care facilities under
�	Section 98.103, [or] 98.104, or 98.1045 to other programs within
�	the department, to the Health and Human Services Commission, and to
�	other health and human services agencies, as defined by Section
�	531.001, Government Code, for public health research or analysis
�	purposes only, provided that the research or analysis relates to
�	health care-associated infections or preventable adverse events.
�	The privilege and confidentiality provisions contained in this
�	chapter apply to such disclosures.
�	�������Sec.�98.111.��CIVIL ACTION. Published infection rates or
�	preventable adverse events may not be used in a civil action to
�	establish a standard of care applicable to a health care facility.
�	�������(k)��As soon as possible after the effective date of this
�	Act, the commissioner of state health services shall appoint two
�	additional members to the advisory panel who meet the
�	qualifications prescribed by Subdivision (4), Subsection (a),
�	Section 98.052, Health and Safety Code, as amended by this section.
�	�������(l)��Not later than February 1, 2010, the executive
�	commissioner of the Health and Human Services Commission shall
�	adopt rules and procedures necessary to implement the reporting of
�	health care-associated preventable adverse events as required
�	under Chapter 98, Health and Safety Code, as amended by this
�	section.
�	�������SECTION�3.��(a)��Subchapter B, Chapter 32, Human Resources
�	Code, is amended by adding Section 32.0312 to read as follows:
�	�������Sec.�32.0312.��REIMBURSEMENT FOR SERVICES ASSOCIATED WITH
�	PREVENTABLE ADVERSE EVENTS. The executive commissioner of the
�	Health and Human Services Commission shall adopt rules regarding
�	the denial or reduction of reimbursement under the medical
�	assistance program for preventable adverse events that occur in a
�	hospital setting. In adopting the rules, the executive
�	commissioner:
�	�������������(1)��shall ensure that the commission imposes the same
�	reimbursement denials or reductions for preventable adverse events
�	as the Medicare program imposes for the same types of health
�	care-associated adverse conditions and the same types of health
�	care providers and facilities under a policy adopted by the federal
�	Centers for Medicare and Medicaid Services;
�	�������������(2)��shall consult an advisory committee on health care
�	quality, if established by the executive commissioner, to obtain
�	the advice of that committee regarding denial or reduction of
�	reimbursement claims for any other preventable adverse events that
�	cause patient death or serious disability in health care settings,
�	including events on the list of adverse events identified by the
�	National Quality Forum; and
�	�������������(3)��may allow the commission to impose reimbursement
�	denials or reductions for preventable adverse events described by
�	Subdivision (2).
�	�������(b)��Not later than September 1, 2010, the executive
�	commissioner of the Health and Human Services Commission shall
�	adopt the rules required by Section 32.0312, Human Resources Code,
�	as added by this section.
�	�������(c)��Rules adopted by the executive commissioner of the
�	Health and Human Services Commission under Section 32.0312, Human
�	Resources Code, as added by this section, may apply only to a
�	preventable adverse event occurring on or after the effective date
�	of the rules.
�	�������SECTION�4.��This Act takes effect September 1, 2009.
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�	______________________________	______________________________
�	���President of the Senate	Speaker of the House�����
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�	�������I hereby certify that S.B.�No.�203 passed the Senate on
�	April�16,�2009, by the following vote: Yeas�31, Nays�0; and that
�	the Senate concurred in House amendment on May�29,�2009, by the
�	following vote: Yeas�31, Nays�0.
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�	______________________________
�	Secretary of the Senate����
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�	�������I hereby certify that S.B.�No.�203 passed the House, with
�	amendment, on May�27,�2009, by the following vote: Yeas�148,
�	Nays�0, one present not voting.
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�	______________________________
�	Chief Clerk of the House���
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�	Approved:
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�	______________________________�
�	������������Date
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�	______________________________�
�	����������Governor