Hawaii 2024 Regular Session

Hawaii House Bill HB517 Compare Versions

Only one version of the bill is available at this time.

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1	1	HOUSE OF REPRESENTATIVES H.B. NO. 517 THIRTY-SECOND LEGISLATURE, 2023 H.D. 1 STATE OF HAWAII A BILL FOR AN ACT RELATING TO HEALTH DATA SHARING. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	HOUSE OF REPRESENTATIVES H.B. NO. 517
4	4	THIRTY-SECOND LEGISLATURE, 2023 H.D. 1
5	5	STATE OF HAWAII
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9	9	H.B. NO.
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13	13	THIRTY-SECOND LEGISLATURE, 2023
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15	15	H.D. 1
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	RELATING TO HEALTH DATA SHARING.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that the ability to securely and efficiently exchange patient health information electronically has become vitally important to improve health outcomes, reduce health care costs, and connect health care providers together to enhance care coordination. Furthermore, the legislature finds that health equity and access continue to be a challenge for Hawaii, especially for Native Hawaiians and Pacific Islanders, as social and economic factors distinct from medical care are powerful predictors of health outcomes and disease burden throughout a person's life. From a population health perspective, this means that evidence-based policies that affect the broader conditions in which people are born, grow, and live can exert a powerful influence on health and well-being. From an operational perspective, data-driven efforts to better coordinate human and social supports with the medical and health care sectors provide opportunities to deliver services that are more client centered, efficient, effective, and tailored. The legislature also finds that the federal Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology continue to move toward interoperability and mandated standards-based health data sharing to help improve health information exchange and patient care. To be truly successful in moving toward value-based care as a way to improve outcomes, lower costs, and improve health equity, payers and providers need access to timely, actionable data. The purpose of this Act is to: (1) Establish a Hawaii health data exchange framework that will accelerate and expand the exchange of health information among health care entities and government agencies in Hawaii to create greater health equity, address health care disparities, and improve health outcomes in the State's communities; and (2) Establish a working group to assist the department of health with developing the Hawaii health data exchange framework. SECTION 2. For purposes of this Act, "health information" includes, for hospitals, clinics, and physician practices, all electronic health information as defined under title 45 Code of Federal Regulations section 171.102 and held by the entity. "Health information" means, at a minimum, the data required to be shared under the Centers for Medicare and Medicaid Services Interoperability and Patient Access regulations for public programs as contained in United States Department of Health and Human Services final rule CMS-9115-F, 85 Federal Register 25510. SECTION 3. (a) On or before September 1, 2030, there is established within the department of health a Hawaii health data exchange framework that shall: (1) Include a single data sharing agreement and common set of policies and procedures that shall leverage and advance national standards for information exchange and data content, and that shall govern and require the exchange of health information among health care entities and government agencies in the State in real time; (2) Be technology agnostic and not an information technology system or single repository of data; (3) Be designed to enable and require real-time access to, or exchange of, health information among health care providers and payers through any health information exchange network, health information organization, or technology that adheres to specified standards and policies; and (4) Align with state and federal data requirements, including the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) and other applicable state and federal privacy laws related to the sharing of data among and between providers, payers, and the government, while also streamlining and reducing reporting burden. (b) On or before September 1, 2030, the department of health shall work with necessary state agencies and stakeholders as needed to encourage the inclusion of public and private health entities, to the extent possible, as part of the Hawaii health data exchange framework to assist public and private entities to connect through uniform standards and policies. It is the intent of the legislature that all state and county public health agencies will exchange electronic health information in real time with participating health care entities to protect and improve the health and well-being of the community. (c) On or before September 1, 2030, and in alignment with existing federal standards and policies, the following health care organizations shall execute the Hawaii health data exchange framework data sharing agreement pursuant to subsection (a): (1) General acute care hospitals; (2) Physician organizations and medical groups; (3) Nursing facilities, including skilled nursing facilities; (4) Health care service plans and accident and health or sickness insurance providers, including without limitation, those governed under title 24 of the Hawaii Revised Statutes, as well as any entity contracted with the State to provide medicaid managed care services; (5) Clinical laboratories that are regulated by the department of health; and (6) Acute psychiatric hospitals. (d) Except as provided in subsection (e), on or before September 1, 2032, the entities listed in subsection (b) shall exchange health information, or provide access to health information, to and from each other, and beginning on January 31, 2034, to and from the entities listed in subsection (e), in real time as specified by the department of health pursuant to the Hawaii health data exchange framework data sharing agreement for treatment, payment, or health care operations. (e) On January 31, 2034, the following entities shall exchange health information, or provide access to health information, to and from each other and to and from the entities subject to subsection (d), in real time as specified by the department of health pursuant to the Hawaii health data exchange framework data sharing agreement for treatment, payment, or health care operations: (1) Physician practices of fewer than physicians; (2) Rehabilitation hospitals; (3) Critical access hospitals; (4) Rural general acute care hospitals with fewer than acute care beds; (5) Acute psychiatric hospitals operated by the State; and (6) Any nonprofit clinic with fewer than health care providers. (f) The department of health shall work with experienced health entities and partners represented in the working group established pursuant to section 4 of this Act to provide technical assistance to the entities outlined in subsections (b) and (c). (g) On or before September 1, 2024, the department of health shall develop in consultation with the working group established pursuant to section 4 of this Act a strategy for unique, secure digital identities capable of supporting master patient indices to be implemented by private and public organizations in the State. SECTION 4. (a) The department of health shall convene a working group no later than September 1, 2023, to advise on legislation developing and implementing the Hawaii health data exchange framework. (b) The working group shall consist of the following members, or their designee: (1) The director of health; (2) The administrator of the med-QUEST division of the department of human services; (3) The insurance commissioner of the department of commerce and consumer affairs' insurance division; (4) The administrator of the Hawaii employer-union health benefits trust fund; (5) A representative of the house of representatives, to be appointed by the speaker of the house of representatives; and (6) A representative of the senate, to be appointed by the president of the senate. (c) The members of the working group listed in subsection (b) shall invite a representative from each of the following entities to be a member of the working group: (1) Hawaii Health Information Exchange; (2) Hawaii Medical Association; and (3) Healthcare Association of Hawaii. (d) The majority of working group members may invite any other person deemed necessary to be a member of the working group. (e) The working group shall provide information and advice to the department of health on health information issues, including: (1) Identifying which health information, at a minimum, should be shared for specified purposes between the entities represented in the working group and those that will be required to execute the Hawaii health data exchange framework data sharing agreement; (2) Identifying gaps in the life cycle of health information with proposed solutions, including gaps in any of the following: (A) Health information creation, including the use of national standards in clinical documentation, health plan records, and social services data; (B) Translation, mapping, controlled vocabularies, coding, and data classification; (C) Storage, maintenance, and management of health information; and (D) Linking, sharing, exchanging, and providing access to health information; (3) Identifying ways to incorporate data related to social determinants of health, such as housing and food insecurity, into shared health information; (4) Identifying ways to incorporate data related to underserved or underrepresented populations, including but not limited to data regarding sexual orientation, gender identity, and racial and ethnic minorities; (5) Identifying ways to incorporate relevant data on behavioral health and substance use disorder conditions; (6) Addressing the privacy, security, and equity risks of expanding care coordination, health information exchange, access, and telehealth in a dynamic technological and entrepreneurial environment in which data and network security are under constant threat of attack; (7) Developing policies and procedures consistent with national standards and federally adopted standards in the exchange of health information and ensuring that health information sharing broadly implements national frameworks and agreements consistent with federal rules and programs; (8) Developing definitions of complete clinical, administrative, and claims data consistent with federal policies and national standards; (9) Identifying how all payers will be required to provide enrollees with electronic access to enrollees' health information, consistent with rules applicable to federal payer programs; (10) Assessing governance structures to help guide policy decisions and general oversight; and (11) Identifying federal, state, private, or philanthropic sources of funding that could support data access and exchange. (f) The working group shall select a chairperson from among its members. (g) The working group shall hold public meetings with stakeholders, solicit input, and set its own meeting agendas. (h) The members of the working group shall serve without compensation but shall be reimbursed for any actual and necessary expenses, including travel expenses, incurred in connection with their duties as members of the working group. (i) The working group shall submit an update based on the input from members on the issues identified in subsection (e), including any recommendations, to the legislature no later than twenty days prior to the convening of the regular session of 2024. (j) For purposes of implementing this Act, including but not limited to hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the working group and department of health may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Any contract executed pursuant to this Act shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the working group shall ensure transparency when executing the contract. (k) All actions to implement the Hawaii health data exchange framework, including the adoption or development of any data sharing agreement, requirements, policies and procedures, guidelines, subgrantee contract provisions, or reporting requirements, shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the working group shall ensure transparency. The department of health shall release program notices that detail the requirements of the Hawaii health data exchange framework. SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the purposes of this Act. The sums appropriated shall be expended by the department of health for the purposes of this Act. SECTION 6. This Act shall take effect on June 30, 3000.
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49	49	SECTION 1. The legislature finds that the ability to securely and efficiently exchange patient health information electronically has become vitally important to improve health outcomes, reduce health care costs, and connect health care providers together to enhance care coordination.
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51	51	Furthermore, the legislature finds that health equity and access continue to be a challenge for Hawaii, especially for Native Hawaiians and Pacific Islanders, as social and economic factors distinct from medical care are powerful predictors of health outcomes and disease burden throughout a person's life. From a population health perspective, this means that evidence-based policies that affect the broader conditions in which people are born, grow, and live can exert a powerful influence on health and well-being. From an operational perspective, data-driven efforts to better coordinate human and social supports with the medical and health care sectors provide opportunities to deliver services that are more client centered, efficient, effective, and tailored.
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53	53	The legislature also finds that the federal Centers for Medicare and Medicaid Services and Office of the National Coordinator for Health Information Technology continue to move toward interoperability and mandated standards-based health data sharing to help improve health information exchange and patient care. To be truly successful in moving toward value-based care as a way to improve outcomes, lower costs, and improve health equity, payers and providers need access to timely, actionable data.
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55	55	The purpose of this Act is to:
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57	57	(1) Establish a Hawaii health data exchange framework that will accelerate and expand the exchange of health information among health care entities and government agencies in Hawaii to create greater health equity, address health care disparities, and improve health outcomes in the State's communities; and
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59	59	(2) Establish a working group to assist the department of health with developing the Hawaii health data exchange framework.
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61	61	SECTION 2. For purposes of this Act, "health information" includes, for hospitals, clinics, and physician practices, all electronic health information as defined under title 45 Code of Federal Regulations section 171.102 and held by the entity. "Health information" means, at a minimum, the data required to be shared under the Centers for Medicare and Medicaid Services Interoperability and Patient Access regulations for public programs as contained in United States Department of Health and Human Services final rule CMS-9115-F, 85 Federal Register 25510.
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63	63	SECTION 3. (a) On or before September 1, 2030, there is established within the department of health a Hawaii health data exchange framework that shall:
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65	65	(1) Include a single data sharing agreement and common set of policies and procedures that shall leverage and advance national standards for information exchange and data content, and that shall govern and require the exchange of health information among health care entities and government agencies in the State in real time;
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67	67	(2) Be technology agnostic and not an information technology system or single repository of data;
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69	69	(3) Be designed to enable and require real-time access to, or exchange of, health information among health care providers and payers through any health information exchange network, health information organization, or technology that adheres to specified standards and policies; and
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71	71	(4) Align with state and federal data requirements, including the federal Health Insurance Portability and Accountability Act of 1996 (P.L. 104-191) and other applicable state and federal privacy laws related to the sharing of data among and between providers, payers, and the government, while also streamlining and reducing reporting burden.
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73	73	(b) On or before September 1, 2030, the department of health shall work with necessary state agencies and stakeholders as needed to encourage the inclusion of public and private health entities, to the extent possible, as part of the Hawaii health data exchange framework to assist public and private entities to connect through uniform standards and policies. It is the intent of the legislature that all state and county public health agencies will exchange electronic health information in real time with participating health care entities to protect and improve the health and well-being of the community.
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75	75	(c) On or before September 1, 2030, and in alignment with existing federal standards and policies, the following health care organizations shall execute the Hawaii health data exchange framework data sharing agreement pursuant to subsection (a):
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77	77	(1) General acute care hospitals;
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79	79	(2) Physician organizations and medical groups;
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81	81	(3) Nursing facilities, including skilled nursing facilities;
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83	83	(4) Health care service plans and accident and health or sickness insurance providers, including without limitation, those governed under title 24 of the Hawaii Revised Statutes, as well as any entity contracted with the State to provide medicaid managed care services;
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85	85	(5) Clinical laboratories that are regulated by the department of health; and
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87	87	(6) Acute psychiatric hospitals.
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89	89	(d) Except as provided in subsection (e), on or before September 1, 2032, the entities listed in subsection (b) shall exchange health information, or provide access to health information, to and from each other, and beginning on January 31, 2034, to and from the entities listed in subsection (e), in real time as specified by the department of health pursuant to the Hawaii health data exchange framework data sharing agreement for treatment, payment, or health care operations.
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91	91	(e) On January 31, 2034, the following entities shall exchange health information, or provide access to health information, to and from each other and to and from the entities subject to subsection (d), in real time as specified by the department of health pursuant to the Hawaii health data exchange framework data sharing agreement for treatment, payment, or health care operations:
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93	93	(1) Physician practices of fewer than physicians;
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95	95	(2) Rehabilitation hospitals;
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97	97	(3) Critical access hospitals;
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99	99	(4) Rural general acute care hospitals with fewer than acute care beds;
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101	101	(5) Acute psychiatric hospitals operated by the State; and
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103	103	(6) Any nonprofit clinic with fewer than health care providers.
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105	105	(f) The department of health shall work with experienced health entities and partners represented in the working group established pursuant to section 4 of this Act to provide technical assistance to the entities outlined in subsections (b) and (c).
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107	107	(g) On or before September 1, 2024, the department of health shall develop in consultation with the working group established pursuant to section 4 of this Act a strategy for unique, secure digital identities capable of supporting master patient indices to be implemented by private and public organizations in the State.
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109	109	SECTION 4. (a) The department of health shall convene a working group no later than September 1, 2023, to advise on legislation developing and implementing the Hawaii health data exchange framework.
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111	111	(b) The working group shall consist of the following members, or their designee:
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113	113	(1) The director of health;
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115	115	(2) The administrator of the med-QUEST division of the department of human services;
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117	117	(3) The insurance commissioner of the department of commerce and consumer affairs' insurance division;
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119	119	(4) The administrator of the Hawaii employer-union health benefits trust fund;
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121	121	(5) A representative of the house of representatives, to be appointed by the speaker of the house of representatives; and
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123	123	(6) A representative of the senate, to be appointed by the president of the senate.
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125	125	(c) The members of the working group listed in subsection (b) shall invite a representative from each of the following entities to be a member of the working group:
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127	127	(1) Hawaii Health Information Exchange;
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129	129	(2) Hawaii Medical Association; and
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131	131	(3) Healthcare Association of Hawaii.
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133	133	(d) The majority of working group members may invite any other person deemed necessary to be a member of the working group.
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135	135	(e) The working group shall provide information and advice to the department of health on health information issues, including:
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137	137	(1) Identifying which health information, at a minimum, should be shared for specified purposes between the entities represented in the working group and those that will be required to execute the Hawaii health data exchange framework data sharing agreement;
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139	139	(2) Identifying gaps in the life cycle of health information with proposed solutions, including gaps in any of the following:
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141	141	(A) Health information creation, including the use of national standards in clinical documentation, health plan records, and social services data;
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143	143	(B) Translation, mapping, controlled vocabularies, coding, and data classification;
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145	145	(C) Storage, maintenance, and management of health information; and
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147	147	(D) Linking, sharing, exchanging, and providing access to health information;
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149	149	(3) Identifying ways to incorporate data related to social determinants of health, such as housing and food insecurity, into shared health information;
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151	151	(4) Identifying ways to incorporate data related to underserved or underrepresented populations, including but not limited to data regarding sexual orientation, gender identity, and racial and ethnic minorities;
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153	153	(5) Identifying ways to incorporate relevant data on behavioral health and substance use disorder conditions;
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155	155	(6) Addressing the privacy, security, and equity risks of expanding care coordination, health information exchange, access, and telehealth in a dynamic technological and entrepreneurial environment in which data and network security are under constant threat of attack;
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157	157	(7) Developing policies and procedures consistent with national standards and federally adopted standards in the exchange of health information and ensuring that health information sharing broadly implements national frameworks and agreements consistent with federal rules and programs;
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159	159	(8) Developing definitions of complete clinical, administrative, and claims data consistent with federal policies and national standards;
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161	161	(9) Identifying how all payers will be required to provide enrollees with electronic access to enrollees' health information, consistent with rules applicable to federal payer programs;
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163	163	(10) Assessing governance structures to help guide policy decisions and general oversight; and
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165	165	(11) Identifying federal, state, private, or philanthropic sources of funding that could support data access and exchange.
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167	167	(f) The working group shall select a chairperson from among its members.
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169	169	(g) The working group shall hold public meetings with stakeholders, solicit input, and set its own meeting agendas.
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171	171	(h) The members of the working group shall serve without compensation but shall be reimbursed for any actual and necessary expenses, including travel expenses, incurred in connection with their duties as members of the working group.
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173	173	(i) The working group shall submit an update based on the input from members on the issues identified in subsection (e), including any recommendations, to the legislature no later than twenty days prior to the convening of the regular session of 2024.
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175	175	(j) For purposes of implementing this Act, including but not limited to hiring staff and consultants, facilitating and conducting meetings, conducting research and analysis, and developing the required reports, the working group and department of health may enter into exclusive or nonexclusive contracts on a bid or negotiated basis. Any contract executed pursuant to this Act shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the working group shall ensure transparency when executing the contract.
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177	177	(k) All actions to implement the Hawaii health data exchange framework, including the adoption or development of any data sharing agreement, requirements, policies and procedures, guidelines, subgrantee contract provisions, or reporting requirements, shall be exempt from chapter 103D, Hawaii Revised Statutes; provided that the working group shall ensure transparency. The department of health shall release program notices that detail the requirements of the Hawaii health data exchange framework.
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179	179	SECTION 5. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2023-2024 and the same sum or so much thereof as may be necessary for fiscal year 2024-2025 for the purposes of this Act.
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181	181	The sums appropriated shall be expended by the department of health for the purposes of this Act.
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183	183	SECTION 6. This Act shall take effect on June 30, 3000.
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187	187	Report Title: Health Information; Hawaii Health Data Exchange Framework; Working Group; Appropriation Description: Establishes the Hawaii health data exchange framework. Establishes a working group to assist the department of health on legislation developing and implementing the framework. Requires certain health care organizations to execute a health data sharing agreement by 9/1/2032. Establishes deadlines for certain entities to begin sharing health information. Appropriates funds. Effective 6/30/3000. (HD1) The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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193	193	Report Title:
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195	195	Health Information; Hawaii Health Data Exchange Framework; Working Group; Appropriation
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199	199	Description:
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201	201	Establishes the Hawaii health data exchange framework. Establishes a working group to assist the department of health on legislation developing and implementing the framework. Requires certain health care organizations to execute a health data sharing agreement by 9/1/2032. Establishes deadlines for certain entities to begin sharing health information. Appropriates funds. Effective 6/30/3000. (HD1)
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209	209	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.