S.B. No. 203

	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.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	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.
	______________________________
	Secretary of the Senate
	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.
	______________________________
	Chief Clerk of the House
	Approved:
	______________________________
	Date
	______________________________
	Governor