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SENATE FLOOR VERSION
April 12, 2023
COMMITTEE SUBSTITUTE
FOR ENGROSSED
HOUSE BILL NO. 1688 By: McEntire of the House
and
Haste of the Senate
[ health information - Office of the State
Coordinator for Healt h Information Exchange - powers
and duties - state-designated entity - time period -
exemptions - Oklahoma Health Care Transparency
Initiative - voluntary submission - requirements -
public health data - penalties - proceeds - funds -
Oklahoma Open Records Act -
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 Statutes as Section 1 -134.1 of Title 63, unless
there is created a duplication in numbering, reads as follows:
Sections 4 through 7 of this act shall be known and may be cited
as the “Oklahoma Health Care Transparency Initiative Act of 2023 ”.
SECTION 2. AMENDATORY S ection 1, Chapter 250, O.S.L.
2022 (63 O.S. Supp. 2022, Section 1 -132.1), is amended to read as
follows:
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Section 1-132.1 A. There is hereby created the Office of the
State Coordinator for Health Information Exchange within the
Oklahoma Health Care Author ity.
B. The Office shall have the power and duty to oversee:
1. Oversee the state-designated entity for health information
exchange, as described under Section 1-133 of Title 63 of the
Oklahoma Statutes this title; and
2. Oversee the Oklahoma Health Care Transparency Initiati ve.
C. The Office shall consist of the Sta te Coordinator for Health
Information Exchange, who shall be appointed by and serve at the
pleasure of the Administrator of the Authority, and such other
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. 2022,
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 organizations according to
nationally recognized standards for 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.
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B. The State of Oklahoma:
1. Shall designate a h ealth information exchange organization
as the state-designated entity for health informat ion exchange;
2. Shall establish a transition plan to ensure continued
operation of the health information exchange; and
3. May temporarily serve as the state -designated entity as part
of the transition plan des cribed 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 Health Care
Authority Board and who are licensed by a nd located in this state
shall report data to a nd utilize the state-designated entity. The
Office of the State Coordinator for Health Information Exchange
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.
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D. 1. A person who participates in the services or information
provided by the state -designated entity shall not be lia ble in any
action for damages or costs of any n ature 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 relevant
state or federal privacy laws, rules, regulati ons, or policies
including, but not limited to, the Health Insurance Portability and
Accountability Act of 1996.
2. A person shall not be subject to antitrust or unfair
competition liability based on participation with the state -
designated entity as long as the participation provides an essential
governmental function for the public health and safety and enjoys
state action immunity.
E. A person who provides 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 retri eve and use that information or data
under relevant state or federal 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 informa tion shall only be
disclosed in compliance with relevant state or federal privacy laws,
rules, regulations, or policies including, but not limited to, the
Health Insurance Portability and Accountability Act of 199 6.
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G. The Oklahoma Health Care Authority B oard shall 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, unle ss
there is created a duplication in number ing, 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 health 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 endors ement that provides
for or describes coverage;
4. “Direct personal identifiers” means information re lating 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 information
that would not allow the identification of a covered individual;
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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, pharmaceutical, and other
insurance claims information, unique identifiers, and geographic and
demographic information for covered individuals as permi tted in the
Oklahoma Health Care Transparency Initiative Act of 2023, and
provider files, for the purpose of implementing the Oklahoma Health
Care Transparency Initiative Act of 2023;
8. “Protected health informa tion” means health information as
protected by the Health Insurance Portability and Accountability Act
of 1996, Pub. L. No. 104 -191;
9. “Provider” means an individual or entity licen sed 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 -
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designated entity for health information exchange under Section 1 -
133 of Title 63 of th e 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, hospital
medical service corporation, health maintenance
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 cal endar
year,
(2) a health benefit plan offer ed or administered by
or on behalf of the state or an agency or
instrumentality of the state including but not
limited to benefits administered by a managed
care organization, notwithstanding the number of
covered individuals in the previous year,
(3) a health benefit plan offered or administered by
or on behalf of the federal government with the
agreement of the federal government,
(4) the Workers’ Compensation Commission,
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(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 E mployee
Retirement Income Security 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 th e Department of
Corrections to provide medi cal, 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,
specified disease, hospital in demnity, 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
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Labor Management Relat ions Act of 1947, Pub. L.
No. 80-101,
(3) a health benefit plan subject to 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 manager; 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 5. NEW LAW A new sec tion 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:
A. Beginning July 1, 2024, there is hereby created the Oklahoma
Health Care Transparency Initiative . The initiative shall be
governed by the state-designated entity for health information
exchange and overseen by the Office of the State Coordinator for
Health Information Exchange.
B. Beginning on a date determined by the Oklahoma Health Care
Authority Board, and thereafter in a frequency specifi ed in rules
promulgated by the 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
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Transparency Initiative Act of 2023, and provider files to the
state-designated entity for health information exchange in
accordance with standards and procedures promulgated by the Board.
The Office shall begin implementation of the requirements of this
subsection on or before July 1, 2024.
C. 1. A health benefit plan, person, or entity excluded from
the definition of submitting entity as provided by Section 4 of this
act shall not be subject to the requirements of subsection B of this
section, but may voluntarily submit claims data, unique ident ifiers,
and geographic and demographic information for covered individuals
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 promulgat ed by the Board.
2. To the extent the excluded health benefit plan, person, or
entity voluntarily submits data described in this subsection to the
state-designated entity, the health benefit plan, person, or enti ty
shall comply with all requirements of the Oklahoma Health Care
Transparency Initiative Act of 2023, other than subsection B of this
section, including, but not limited to, compliance with applicable
state and federal data privacy and security laws.
D. 1. The State Department of Health shall su bmit all public
health data and vital statistics data collected by the Department
under Title 63 of the Oklahoma Statutes to the state -designated
entity for integration into t he Oklahoma Health Care Transparency
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Initiative database created under this section 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.
2. The data submitted under paragraph 1 of this subsection
shall be assigned a unique identifier and may be used in accordance
with the Oklahoma Health Care Transparency Initiative Act of 2023
and the rules promulgated under the Oklahoma Health Care
Transparency Initiative Act of 2023.
SECTION 6. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1 -134.4 of Title 63, unless
there is created a duplication in numbering, reads as follows:
A. Data and other information submitted under Section 5 of this
act shall be treated as con fidential and shall be exempt from
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 p rovided in the
Oklahoma Insurance Code.
B. Data and other information submitted under Section 5 of this
act may only be collected, stored, used, disclosed, or released in
compliance with applicable state and federal data privacy and
security law, rules promulgated by the Oklahoma Health Care
Authority Board, and data governance policies established by the
state-designated entity for health information exchange.
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C. Data and other information in the Oklahoma Health Care
Transparency Initiative shall, to the extent authorized by rules
promulgated by the Board, be available:
1. When disclosed in a form and manner that ensures the privacy
and security of protected health information as required by state
and federal laws, as a resource to insurers, employers, p urchasers
of health care, researchers, stat e 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 need s
assessments; and
2. To state programs re garding 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.
D. Data and other information in the Oklahoma Health Care
Transparency Initiative shall not be used to disclose trade secrets
of submitting entities .
E. Notwithstanding any other section of law, the Oklah oma
Health Care Transparency Initiative shall n ot publicly disclose any
data or other information that contains direct personal identifiers.
F. The Oklahoma Health Care Transparency Initiative Act of 2023
shall not be construed to supersede, limit, amend, or abrogate any
data privacy or security law, rule, or policy.
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SECTION 7. NEW LAW A new section 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, read s as follows:
A. Except for state or federal a gencies 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 C are Authority Board
may be subject to a fine assessed by the Insurance Department.
B. The Insurance Commissioner shall adopt a schedule of fines
not to exceed One Thousand Dollars ($1,000.00) per day for each day
the violation occurs, to be determined by the severity of the
violation.
C. A fine assessed under this section may be remitted or
mitigated upon such terms and conditions as the Insurance
Commissioner considers proper and consistent with public health and
safety.
D. Of the proceeds from fines remitted under this section , the
Insurance Department shall retain a portion of such proceed s
necessary to cover the cost to the Department of admi nistering the
assessment and collection of such fines, and the Department shall
remit the remainder of the proceeds to the Oklahoma Health Care
Authority. The Authority may only use proceeds from fine s assessed
under this section to fund operations of the Oklahoma Health Care
Transparency Initiative.
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SECTION 8. AMENDATORY 51 O.S. 2021, Section 24A.3, as
amended by Section 1, Chapter 4 02, 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 custo dy, control or possession
of public officials, public bodies or their representatives in
connection with the transaction of public business, the expendit ure
of public funds or the administering of public property. “Record”
does not mean:
a. computer software,
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 connection with
the Authority’s electronic toll collection system,
d. personal financial information, credit re ports or
other financial data obtained by or submitted to a
public body for the purpose of evaluating credit
worthiness, obtaining a license, permit or for the
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purpose of becoming qualified to contract with a
public body,
e. any digital audio/video recordi ngs of the toll
collection and safeguarding activities of the Oklahoma
Transportation Authority,
f. any personal information provided by a guest at any
facility owned or operated by the Oklahoma Tourism and
Recreation Department to obtain any service at th e
facility or by a purchaser of a product sold by or
through the Oklahoma Tourism and Recreation
Department,
g. a Department of Defense Form 214 (DD Form 214) filed
with a county clerk including any DD Form 214 fi led
before July 1, 2002,
h. except as provided for in Section 2-110 of Title 47 of
the Oklahoma Statutes ,:
(1) any record in connection with a Motor Vehic le
Report issued by the Department of 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 Act,
18 United States Code, Sections 2721 through
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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 licensure under the laws of this
state or a political subdivision that contains an
applicant’s personal address, personal phone number,
personal electronic mail address or other conta ct
information. Provided, however, lists of persons
licensed, the existence of a license of a person, or a
business or commercial address, or other business or
commercial information disclosable under state law
submitted with an application for licensure shall be
public record, or
j. data or other information submitted to the state-
designated entity for health inf ormation exchange
under Section 1-133 of Title 63 of the Oklahoma
Statutes or 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, agency, trusteeship,
authority, council, committee, trust or any entity created by a
trust, county, city, village, town, township, district, school
district, fair board, court, executive office, advisory group, task
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force, study group or any subdivision thereof, 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 subcommittees 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 legislators. “Public body” shall not include an
organization that is exempt from federal income tax under Section
501(c)(3) of the Internal Revenue Code of 1986, 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 Higher 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 employee of the Oklahoma State
Regents for Higher Education,
b. a member of the board of regents or other governing
board of the college or university that is the sole
beneficiary of the organization, or
c. an officer or employ ee 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;
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4. “Public official” means any official or employee of any
public body as defined herein; and
5. “Law enforcement agency ” means any public body charged with
enforcing state or local criminal laws and initiating criminal
prosecutions including, but not limited to, police departments,
county sheriffs, the Department of Public Safety, the Oklahoma State
Bureau of Narcotics and Dangerous Drugs Control, the Alcoholic
Beverage Laws Enforcement Commission, and the Oklahoma State Bureau
of Investigation.
SECTION 9. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
COMMITTEE REPORT BY: COMMITTEE ON AP PROPRIATIONS
April 12, 2023 - DO PASS AS AMENDED BY CS