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ENGROSSED HOUSE
BILL NO. 1688 By: McEntire of the House
and
Haste of the Senate
An Act relating to health information; creating the
Oklahoma Health Care Transparency Initiati ve Act of
2023; amending Section 1, Chapter 250, O.S.L. 2022
(63 O.S. Supp. 2022, Section 1 -132.1), which relates
to the Office of the State Coordinator for Health
Information Exchange ; broadening powers and duties of
the Office; amending 63 O.S. 2021, Sec tion 1-133, as
amended by Section 2, Chapter 250, O.S.L. 2022 (63
O.S. Supp. 2022, Section 1 -133), which relates to
state-designated entity for health information
exchange; modifying time p eriod of certain
requirement; modifying a nd adding certain exemptio ns;
stating legislative intent and purpose of act;
defining terms; creating the Oklahoma Health Care
Transparency Initiative ; providing for governance and
administration of the initiative; directing
implementation of sustainabilit y plan; requiring
submitting entity to submit certain information to
state-designated entity; allowing voluntary
submission of certain information by certain health
benefit plan, person, or entity; mandating complian ce
with certain requirements; providing for
confidentiality, privac y, and security of ce rtain
data; listing circumstances under whic h certain data
may be made available ; prohibiting certain use or
disclosure of data; authorizing certain penalties;
providing for certain remittance or mitigation o f
penalties; specifying all owed use of certain f unds;
requiring submission of public health data for
integration into the initiative; requiring assignment
of unique identifier; amending 51 O.S. 2021, Section
24A.3, as last amended by Section 1, Chapter 402 ,
O.S.L. 2022 (51 O.S. Supp . 2022, Section 24A.3 ),
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which relates to the Oklahoma Open Records Act;
modifying certain definition ; providing for
codification; and declaring an emergency .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statute s as Section 1-134.1 of Title 63, unless
there is created a duplication in numbering, reads as follows:
Sections 4 through 10 of this act shall be known and may be
cited as the "Oklahoma Health Care Transparency Ini tiative Act of
2023".
SECTION 2. AMENDATORY Section 1, Chapter 250, O.S.L.
2022 (63 O.S. Supp. 2022, Section 1 -132.1), is amended to read as
follows:
Section 1-132.1 A. There is hereby created the O ffice of the
State Coordinator for Health Information Exchange within the
Oklahoma Health Care Authority.
B. The Office shall have the power and duty to oversee:
1. Oversee the state-designated entity for health information
exchange, as described under pursuant to Section 1-133 of Title 63
of the Oklahoma Statutes this title; and
2. For the purpose of implementing the Oklahoma Health Care
Transparency Initiative Act of 2023:
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a. collect, validate, analyze, and present health data,
including claims data,
b. assess penalties for noncomplia nce with the Oklahoma
Health Care Transparency Initiative Act of 2023,
c. establish policies and procedures necessary for the
administration and oversight of the Oklahoma Health
Care Transparency Initiative including p rocedures for
the collection, processing, storag e, analysis, use,
and release of data,
d. identify and explore the key health care issues,
questions, and problems that may be improved through
more transparent information including, but not
limited to, data required to be disclosed to patients
related to provider relationships or affiliations with
payers and providers, financial interests in health
care businesses, and payments or items of any value
given to providers from pharmaceutical or medical
device manufacturers or agents thereof , and
e. provide a biennial report to the Legislature on the
operations of the Oklahoma Health Care Transparency
Initiative.
C. The Office shall consist of the State Coordinator for Hea lth
Information Exchange, who shall be ap pointed by and serve at the
pleasure of the Administr ator of the Authority, and such other
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employees of the Authority as the Administrator may assign to the
Office.
SECTION 3. AMENDATORY 63 O.S. 2021, Section 1 -133, as
amended by Section 2, Chapter 250, O.S.L. 2022 (63 O.S. Supp. 20 22,
Section 1-133), is amended to read as follows:
Section 1-133. A. As used in this section:
1. "Health information exchange " means the electronic movement
of health-related information among organiz ations according to
nationally recognized standards f or purposes including, but not
limited to, payment, treatment, and administration; and
2. "Health information exchange organization " means an entity
whose primary business activity is health information exchange and
which is governed by its stakeholders.
B. The State of Oklahoma:
1. Shall designate a health information exchange organization
as the state-designated entity for health information exchange;
2. Shall establish a transition plan to ensure c ontinued
operation of the health information exchange ; and
3. May temporarily serve as the state-designated entity as part
of the transition plan described in paragraph 2 of this subsection.
C. Beginning July 1, 2023, all 1. All health care providers as
defined by the rules promulgated by the Oklahoma Hea lth Care
Authority Board and who are licensed by and located in this state
shall report data to and utilize the state -designated entity. The
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Office of the State Coordinator for Health Information Exchan ge
shall begin implementation of this requirement on or before July 1,
2023.
2. The Office of the State Coordinator for Health Information
Exchange may, as provided by rules promulgated by the Board, allow
exemptions from the requirement provided by paragraph 1 of this
subsection on the basis of :
a. financial hardship,
b. size of the practice, or
c. technological capability of a,
d. type of health care provider , or
e. such other bases as may be provided by rules
promulgated by the Board.
D. 1. A person who participates in the services or information
provided by the state-designated entity shall not be liable in any
action for damages or costs of any nature that result solely from
the person's use or failure to use information or data from the
state-designated entity that was entered or retrieved under relev ant
state or federal privacy laws, rules, regulations, or policies
including, but not limited to, the Health Insurance Portability and
Accountability Act of 1996.
2. A person shall not be subject to ant itrust or unfair
competition liability based on parti cipation with the state-
designated entity as long as the participation provides an essential
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governmental function for the public health and safety and enjoys
state action immunity.
E. A person who prov ides information and data to the state -
designated entity retains a property right in the information or
data, but grants to the other participants or subscribers a
nonexclusive license to retrieve and use that information or data
under relevant state or fe deral privacy laws, rules, regulations, or
policies including, but not limited to, the Health Insurance
Portability and Accountability Act of 1996.
F. Patient-specific protected health information sha ll only be
disclosed in compliance with relevant state or federal privacy laws,
rules, regulations, or polic ies including, but not limited to, the
Health Insurance Portability and Accountability Act of 1996.
G. The Oklahoma Health Care Authority Board sha ll promulgate
rules to implement the provisions of this section.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.2 of Title 63, unless
there is created a duplication in numbering, rea ds as follows:
A. It is the intent of the Legislature to create and maintain
an informative source of healt h care information to support
consumers, researchers, and policymakers in health care decisions
within this state.
B. The purpose of the Oklahoma Hea lth Care Transparency
Initiative Act of 2023 is to:
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1. Create the Oklahoma Health Care Transparency Initiative;
2. Establish governance of the Oklahoma Health Care
Transparency Initiative;
3. Provide authority to collect health care information from
insurance carriers and other entities; and
4. Establish appropriate methods for collecting, maintaining,
and reporting health care information including privacy and security
safeguards.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.3 of Title 63, unless
there is created a duplication in numbering, reads as follows:
As used in the Oklahoma Health Care Transparency Initiative Act
of 2023:
1. "Board" means the Oklahoma Health Care Authority Board;
2. "Claims data" means information included in an
institutional, professional, or pharmacy claim or equivalent
information transaction for a covered individual including the
amount paid to a provider of hea lth care services plus any amount
owed by the covered individual;
3. "Covered individual" means a natural person who is a
resident of this state and is eligible to receive medical, dental,
or pharmaceutical benefits under any policy, contract, certificate,
evidence of coverage, rider, binder, or endorsement that provides
for or describes coverage;
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4. "Direct personal identifiers " means information relating to
a covered individual that contains primary or obvious identifiers,
such as the individual 's name, street address, email address,
telephone number, or Social Security number. Direct personal
identifiers shall not include geographic or demographic informatio n
that would not allow the identification of a covered individual;
5. "Enrollment data" means demographic information and other
identifying information relating to covered individuals including
direct personal identifiers;
6. "Office" means the Office of the State Coordinator for
Health Information Exchange created under Section 1 -132.1 of Title
63 of the Oklahoma Statutes;
7. "Oklahoma Health Care Transparency Initiative " means an
initiative to create a database including ongoing all -payer claims
database projects that receive and store data from a submitting
entity relating to medical, dental, pha rmaceutical, and other
insurance claims information, unique identifiers, and geographic and
demographic information for covered individuals as permitted in the
Oklahoma Health Care Transparency Initiative Act of 2023, and
provider files, for the purposes of the Okl ahoma Health Care
Transparency Initiative Act of 2023;
8. "Protected health information " means health information as
protected by the Health Insurance Porta bility and Accountability Act
of 1996, Pub. L. No. 104-191;
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9. "Provider" means an individual or entity licensed by the
state to provide health care services;
10. "State-designated entity for health information exchange"
or "state-designated entity" means the health information exchange
organization designated by the State of Oklahoma as the state-
designated entity for health information exchange under Section 1-
133 of Title 63 of the Oklahoma Statutes;
11. a. "Submitting entity" means:
(1) an entity that provides health or dental
insurance or a health or dental benefit plan in
the state including but not limited to an
insurance company, medical services plan, managed
care organization, hospital plan, hos pital
medical service corporation, health maintenanc e
organization, or fraternal benefit society,
provided that the entity has covered individuals
and the entity had at least two thousand (2,000)
covered individuals in the previous calendar
year,
(2) a health benefit plan offered or administered by
or on behalf of the state or an agency or
instrumentality of the state in cluding but not
limited to benefits administered by a managed
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care organization, notwithstanding the number of
covered individuals in the p revious year,
(3) a health benefit plan offered or a dministered by
or on behalf of the federal government with the
agreement of the federal government,
(4) the Workers' Compensation Commission,
(5) any other entity providing a plan of health
insurance or health benefits subject to state
insurance regulation , or a third-party
administrator; provided, that the entity has
covered individuals and the entity had at least
two thousand (2,000) covered individuals in the
previous calendar year,
(6) a health benefit plan subject to the Employee
Retirement Income Secu rity Act of 1974, Pub. L .
No. 93-406, and that is fully insured,
(7) a risk-based provider organization licensed by
the Insurance Department, and
(8) any entity that contracts with the Department of
Corrections to provide medical, dental, or
pharmaceutical care to inmates.
b. A submitting entity shall not include:
(1) an entity that provides health insurance or a
health benefit plan that is accident -only,
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specified disease, hospital indemnity, long -term
care, disability income, or other supplemental
benefit coverage,
(2) an employee of a welfare benefit plan as defined
by federal law that is also a trust established
pursuant to collective bargaining subject to the
Labor Management Relations Act of 1947, Pub. L.
No. 80-101,
(3) a health benefit plan subject t o the Employee
Retirement Income Security Act of 1974, Pub. L.
No. 93-406, that is self-funded,
(4) a Medicare supplemental policy as defined by 42
C.F.R., Section 403.205, or
(5) a pharmacy benefits mana ger; and
12. "Unique identifier" means any identifier that is guaranteed
to be unique among all identifiers for covered individuals but does
not include direct personal identifiers.
SECTION 6. NEW LAW A new section of law to be cod ified
in the Oklahoma Statutes as Section 1-134.4 of Title 63, unless
there is created a duplication in numbering, reads as follows:
A. Beginning July 1, 2024 , there is hereby created the Oklahoma
Health Care Transparency Initiative, which shall be govern ed by the
Office of the State Coordinator for Health Information Exchange .
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B. The Office shall be the administrator of the Oklahoma Health
Care Transparency Initiative and shall, in collaboration with the
state-designated entity for health information exc hange, develop and
implement a sustainability plan subject to data use and disclo sure
requirements of the Oklahoma Health Care Transparency Initiative Act
of 2023 and any rules promulgated by the Oklahoma Health Care
Authority Board under the Oklahoma Health Care Transparency
Initiative Act of 2023.
SECTION 7. NEW LAW A new secti on of law to be codified
in the Oklahoma Statutes as Section 1 -134.5 of Title 63, unless
there is created a duplication in numbering, reads as follows:
A. No later than July 1, 2024, and thereafter in a frequ ency
specified in rules promulgated by the Okla homa Health Care Authority
Board, a submitting entity shall submit claims data, unique
identifiers, and geographic and demographic information for covered
individuals as permitted in the Oklahoma Health Care Transparency
Initiative Act of 2023, and provider files t o the state-designated
entity for health information exchange in accordance with standards
and procedures promulgated by the Board.
B. 1. A health benefit plan, person, o r entity excluded from
the definition of submitting entity as provided by Section 5 of this
act shall not be subject to the requirements of subsection A of this
section, but may voluntarily submit claims data, unique identifiers,
and geographic and demogra phic information for covered individuals
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as permitted in the Oklahoma Health Care Transparency Initiative Act
of 2023, and provider files to the state-designated entity in
accordance with standards and procedures promulgated by the Board.
2. To the extent the exc luded health benefit plan, person, or
entity voluntarily submits data described in th is subsection to the
state-designated entity, the health benefit plan, person, or entity
shall comply with all requirements of the Oklahoma Health Care
Transparency Initiative Act of 2023, other than subsection A of this
section, including, but not limited to, compliance with applicable
state and federal data privacy and security law s.
C. Data submitted pursuant to this section shall be treated as
confidential and shall be exempt fr om disclosure as a record under
the Oklahoma Open Records Act as defined in Section 24A.3 of Title
51 of the Oklahoma Statutes and are not subject to subpoena except
to the extent provided in the Oklahoma Insurance Code.
D. The collection, storage, and re lease of data and other
information pursuant to this section is subject to applicable state
and federal data privacy and security law.
E. The Oklahoma Health Care Transparency Initiative Act of 2023
shall not be construed to supersede, limit, a mend, or abrogate any
data privacy or security law, rule, or policy.
SECTION 8. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.6 of Title 63, unless
there is created a duplication in numbering, reads as follows:
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A. Data in the Oklahoma Health Care Transparency Initiative
shall, to the extent authorize d by rules promulgated by the Oklahoma
Health Care Authority Board, be available:
1. When disclosed in a form and manner that ensures th e privacy
and security of protected health information as required by state
and federal laws, as a resource to insurers , employers, purchasers
of health care, researchers, state agencies, and health care
providers to allow for assessment of health care utilization,
expenditures, and performance in this state including , but not
limited to, as a resource for hospital community health needs
assessments; and
2. To state programs regarding health care quality and costs
for use in improving health care in the state, subject to rules
prescribed by the Board conforming to state and federal privacy laws
or limiting access to limited -use data sets.
B. Data in the Oklahoma Health Care Transparency Initiative
shall not be used to disclose trade secrets of submitting entitie s,
and shall be used or disclosed only in compliance with applicable
state and federal data privacy and security la w and in compliance
with the policies established by the Board or the state-designated
entity for health information exchange .
C. Notwithstanding any other section of law, the Oklahoma
Health Care Transparency Initiative shall not publicly disclose any
data that contains direct personal identifiers.
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SECTION 9. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.7 of Title 63, unless
there is created a duplication in numbering, reads as follows:
A. Except for state or federal agencies that are submitting
entities, a submitting entity that fails to submit data as required
by the Oklahoma Health Care Transparency Initiative Act of 2023 or
the rules promulgated by the Oklahoma Health Care Authority Board
may be subject to a penalty.
B. The Board shall adopt a schedule of penalties not to exceed
One Thousand Dollars ($1,000.00) per day for e ach day the violation
occurs, to be determined by the severity of the violation.
C. A penalty imposed under this section m ay be remitted or
mitigated upon such terms and conditions as the Board considers
proper and consistent with public health and safety.
D. A penalty remitted under this section shall be used to fund
operations of the Oklahoma Health Care Transparency Initiative.
SECTION 10. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.8 of Title 63, unless
there is created a duplication in numbering, reads as follows:
A. The State Department of Health shal l submit all public
health data and vital statistics data collected by the Department
pursuant to Title 63 of the Oklahoma Statutes to the state-
designated entity for health information exchange for integration
into the Oklahoma Health Care Transparency Initiative database
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created pursuant to Section 6 of this act including, but not limited
to, data collected regarding hospital discharge and emergency
department records for the uninsured, birth and death records, and
disease registry data.
B. The data submitted pursuant to subsection A of this sec tion
shall be assigned a unique identifier and may be used in accordance
with the purposes of the Oklahoma Health Care Transparency
Initiative and the rules promulgated pursuant to the Oklahoma Health
Care Transparency Initiative Act of 2023.
SECTION 11. AMENDATORY 51 O.S. 2021, Section 24A.3, as
last amended by Section 1, Chapter 402, O.S.L. 2022 (51 O.S. Supp.
2022, Section 24A.3), is amended to read as follows:
Section 24A.3 As used in the Oklahoma Open Records Act:
1. "Record" means all documents including, but not limited to,
any book, paper, photograph, microfilm, data files created by or
used with computer software, computer tape, disk, record, sound
recording, film recording, video record or other material regardless
of physical form or characteristic, created by, received by, under
the authority of, or coming into the custody, control or possession
of public officials, public bodies or their representatives in
connection with the transacti on of public business, the expenditure
of public funds or the administering of public property. "Record"
does not mean:
a. computer software,
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b. nongovernment personal effects,
c. unless public disclosure is required by other laws or
regulations, vehicle movement records of the Oklahoma
Transportation Authority obtained in c onnection with
the Authority's electronic toll collection system,
d. personal financial information, credit reports or
other financial data obtained by or submitted to a
public body for the purpose of evaluating credit
worthiness, obtaining a license, perm it or for the
purpose of becoming qualified to contract with a
public body,
e. any digital audio/video recordings of the toll
collection and safeguarding activities of the Oklahoma
Transportation Authority,
f. any personal information provided by a guest a t any
facility owned or operated by the Oklahoma Tourism and
Recreation Department to obtain any service at the
facility or by a purchaser of a product sold by or
through the Oklahoma T ourism and Recreation
Department,
g. a Department of Defense Form 214 ( DD Form 214) filed
with a county clerk including any DD Form 214 filed
before July 1, 2002,
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h. except as provided for in Section 2 -110 of Title 47 of
the Oklahoma Statutes,
(1) any record in connection with a Motor Vehicle
Report issued by the Department o f Public Safety,
as prescribed in Section 6 -117 of Title 47 of the
Oklahoma Statutes, or
(2) personal information within driver records, as
defined by the Driver 's Privacy Protection Ac t,
18 United States Code, Sections 2721 thro ugh
2725, which are stored and maintained by the
Department of Public Safety, or
i. any portion of any document or information provided to
an agency or entity of the state or a political
subdivision to obtain lic ensure under the laws of this
state or a political subdivision that con tains an
applicant's personal address, personal phone number,
personal electronic mail address or other contact
information. Provided, however, lists of persons
licensed, the existence of a license of a person, or a
business or commercial address, or othe r business or
commercial information disclosable under state law
submitted with an application for licensure shall be
public record, or
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j. data submitted under the Oklahoma Health Care
Transparency Initiative Act of 2023;
2. "Public body" shall include, but not be limited to, any
office, department, board, bureau, commission, agen cy, trusteeship,
authority, council, committee, trust or any entity created by a
trust, county, city, villag e, town, township, district, school
district, fair board, court, executi ve office, advisory group, task
force, study group or any subdivision thereo f, supported in whole or
in part by public funds or entrusted with the expenditure of public
funds or administering or operating public property, and all
committees, or subcommitte es thereof. Except for the records
required by Section 24A.4 of this title, "public body" does not mean
judges, justices, the Council on Judicial Complaints, the
Legislature or legisl ators. "Public body" shall not include an
organization that is exempt f rom federal income tax under Section
501(c)(3) of the Internal Revenue Code of 19 86, as amended, and
whose sole beneficiary is a college or university , or an affiliated
entity of the college or university, that is a member of The
Oklahoma State System of H igher Education. Such organization shall
not receive direct appropriations from the Oklahoma Legislature.
The following persons shall not be eligible to serve as a voting
member of the governing board of the organization:
a. a member, officer, or employe e of the Oklahoma State
Regents for Higher Education,
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b. a member of the board of regents or other governing
board of the college or university that is the sole
beneficiary of the orga nization, or
c. an officer or employee of the college or university
that is the sole beneficiary of the organization;
3. "Public office" means the physical location where public
bodies conduct business or keep records;
4. "Public official" means any official or employee of a ny
public body as defined herein; and
5. "Law enforcement agency" means any public body charged with
enforcing state or local crimi nal laws and initiating criminal
prosecutions including, but not limited to, police departments,
county sheriffs, the Depart ment of Public Safety, the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control, the Alcoholic
Beverage Laws Enforcement C ommission, and the Oklahoma State Bureau
of Investigation.
SECTION 12. It being immediately necessary for th e preservation
of the public peace, health or safet y, an emergency is hereby
declared to exist, by reason whereof this act shall tak e effect and
be in full force from and after its passage and approval.
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Passed the House of Representati ves the 22nd day of March, 2023.
Presiding Officer of the House
of Representatives
Passed the Senate the ____ day of __________, 2023.
Presiding Officer of the Senate