Texas 2009 - 81st Regular

Texas House Bill HB1218 Compare Versions

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1	1	H.B. No. 1218
2	2
3	3
4	4	AN ACT
5	5	relating to programs to exchange certain health information between
6	6	the Health and Human Services Commission and certain health care
7	7	entities and facilities.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Chapter 531, Government Code, is amended by
10	10	adding Subchapter V to read as follows:
11	11	SUBCHAPTER V. HEALTH INFORMATION EXCHANGE SYSTEMS
12	12	Sec. 531.901. DEFINITIONS. In this subchapter:
13	13	(1) "Electronic health record" means an electronic
14	14	record of aggregated health-related information concerning a
15	15	person that conforms to nationally recognized interoperability
16	16	standards and that can be created, managed, and consulted by
17	17	authorized health care providers across two or more health care
18	18	organizations.
19	19	(2) "Electronic medical record" means an electronic
20	20	record of health-related information concerning a person that can
21	21	be created, gathered, managed, and consulted by authorized
22	22	clinicians and staff within a single health care organization.
23	23	(3) "Health information exchange system" means a
24	24	health information exchange system created under this subchapter
25	25	that moves health-related information among entities according to
26	26	nationally recognized standards.
27	27	(4) "Local or regional health information exchange"
28	28	means a health information exchange operating in this state that
29	29	securely exchanges electronic health information, including
30	30	information for patients receiving services under the child health
31	31	plan or Medicaid program, among hospitals, clinics, physicians'
32	32	offices, and other health care providers that are not owned by a
33	33	single entity or included in a single operational unit or network.
34	34	Sec. 531.902. ELECTRONIC HEALTH INFORMATION EXCHANGE PILOT
35	35	PROJECT. (a) The commission shall establish a pilot project in at
36	36	least one urban area of this state to determine the feasibility,
37	37	costs, and benefits of exchanging secure electronic health
38	38	information between the commission and local or regional health
39	39	information exchanges. The pilot project must include the
40	40	participation of at least two local or regional health information
41	41	exchanges.
42	42	(b) A local or regional health information exchange
43	43	selected for the pilot project under this section must possess a
44	44	functioning health information exchange database that exchanges
45	45	secure electronic health information among hospitals, clinics,
46	46	physicians' offices, and other health care providers that are not
47	47	each owned by a single entity or included in a single operational
48	48	unit or network. The information exchanged by the local or regional
49	49	health information exchange must include health information for
50	50	patients receiving services from state and federal health and human
51	51	services programs administered by the commission.
52	52	(c) In developing the pilot project under this section, the
53	53	commission shall:
54	54	(1) establish specific written guidelines, in
55	55	conjunction with the health information exchanges participating in
56	56	the pilot project, to:
57	57	(A) ensure that information exchanged through
58	58	the pilot project is used only for the patient's benefit; and
59	59	(B) specify which health care providers will use
60	60	which data elements obtained from the commission and for what
61	61	purposes, including purposes related to reducing costs, improving
62	62	access, and improving quality of care for patients; and
63	63	(2) ensure compliance with all state and federal laws
64	64	and rules related to the transmission of health information,
65	65	including state privacy laws and the Health Insurance Portability
66	66	and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
67	67	rules adopted under that Act.
68	68	(d) The commission and the health information exchanges
69	69	participating in the pilot project shall at a minimum exchange a
70	70	patient's medication history under the pilot project. If the
71	71	executive commissioner determines that there will be no significant
72	72	cost to the state, the commission shall apply for and actively
73	73	pursue any waiver from the federal Centers for Medicare and
74	74	Medicaid Services that may be necessary for the pilot project and
75	75	shall actively pursue a waiver to use an electronic alternative to
76	76	the requirement for handwritten certification of certain drugs
77	77	under 42 C.F.R. Section 447.152. The pilot project may include
78	78	additional health care information, either at the inception of the
79	79	project or as part of a subsequent expansion of the scope of the
80	80	project.
81	81	(e) The pilot project shall initially use the method of
82	82	secure transmission that is available at the time implementation of
83	83	the pilot project begins, and subsequently move toward full
84	84	interoperability in conjunction with the health information
85	85	exchange system under Section 531.903.
86	86	(f) The commission may accept gifts, grants, and donations
87	87	from any public or private source for the operation of the pilot
88	88	project.
89	89	Sec. 531.903. ELECTRONIC HEALTH INFORMATION EXCHANGE
90	90	SYSTEM. (a) The commission shall develop an electronic health
91	91	information exchange system to improve the quality, safety, and
92	92	efficiency of health care services provided under the child health
93	93	plan and Medicaid programs. In developing the system, the
94	94	commission shall ensure that:
95	95	(1) the confidentiality of patients' health
96	96	information is protected and the privacy of those patients is
97	97	maintained in accordance with applicable federal and state law,
98	98	including:
99	99	(A) Section 1902(a)(7), Social Security Act (42
100	100	U.S.C. Section 1396a(a)(7));
101	101	(B) the Health Insurance Portability and
102	102	Accountability Act of 1996 (Pub. L. No. 104-191);
103	103	(C) Chapter 552, Government Code;
104	104	(D) Subchapter G, Chapter 241, Health and Safety
105	105	Code;
106	106	(E) Section 12.003, Human Resources Code; and
107	107	(F) federal and state rules and regulations,
108	108	including:
109	109	(i) 42 C.F.R. Part 431, Subpart F; and
110	110	(ii) 45 C.F.R. Part 164;
111	111	(2) appropriate information technology systems used
112	112	by the commission and health and human services agencies are
113	113	interoperable;
114	114	(3) the system and external information technology
115	115	systems are interoperable in receiving and exchanging appropriate
116	116	electronic health information as necessary to enhance:
117	117	(A) the comprehensive nature of the information
118	118	contained in electronic health records; and
119	119	(B) health care provider efficiency by
120	120	supporting integration of the information into the electronic
121	121	health record used by health care providers;
122	122	(4) the system and other health information systems
123	123	not described by Subdivision (3) and data warehousing initiatives
124	124	are interoperable; and
125	125	(5) the system has the elements described by
126	126	Subsection (b).
127	127	(b) The health information exchange system must include the
128	128	following elements:
129	129	(1) an authentication process that uses multiple forms
130	130	of identity verification before allowing access to information
131	131	systems and data;
132	132	(2) a formal process for establishing data-sharing
133	133	agreements within the community of participating providers in
134	134	accordance with the Health Insurance Portability and
135	135	Accountability Act of 1996 (Pub. L. No. 104-191) and the American
136	136	Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5);
137	137	(3) a method by which the commission may open or
138	138	restrict access to the system during a declared state emergency;
139	139	(4) the capability of appropriately and securely
140	140	sharing health information with state and federal emergency
141	141	responders;
142	142	(5) compatibility with the Nationwide Health
143	143	Information Network (NHIN) and other national health information
144	144	technology initiatives coordinated by the Office of the National
145	145	Coordinator for Health Information Technology;
146	146	(6) technology that allows for patient identification
147	147	across multiple systems; and
148	148	(7) the capability of allowing a health care provider
149	149	to access the system if the provider has technology that meets
150	150	current national standards.
151	151	(c) The commission shall implement the health information
152	152	exchange system in stages as described by Sections 531.905 through
153	153	531.908, except that the commission may deviate from those stages
154	154	if technological advances make a deviation advisable or more
155	155	efficient.
156	156	(d) The health information exchange system must be
157	157	developed in accordance with the Medicaid Information Technology
158	158	Architecture (MITA) initiative of the Center for Medicaid and State
159	159	Operations and conform to other standards required under federal
160	160	law.
161	161	Sec. 531.904. ELECTRONIC HEALTH INFORMATION EXCHANGE
162	162	SYSTEM ADVISORY COMMITTEE. (a) The commission shall establish the
163	163	Electronic Health Information Exchange System Advisory Committee
164	164	to assist the commission in the performance of the commission's
165	165	duties under this subchapter.
166	166	(b) The executive commissioner shall appoint to the
167	167	advisory committee at least 12 and not more than 16 members who have
168	168	an interest in health information technology and who have
169	169	experience in serving persons receiving health care through the
170	170	child health plan and Medicaid programs.
171	171	(c) The advisory committee must include the following
172	172	members:
173	173	(1) Medicaid providers;
174	174	(2) child health plan program providers;
175	175	(3) fee-for-service providers;
176	176	(4) at least one representative of the Texas Health
177	177	Services Authority established under Chapter 182, Health and Safety
178	178	Code;
179	179	(5) at least one representative of each health and
180	180	human services agency;
181	181	(6) at least one representative of a major provider
182	182	association;
183	183	(7) at least one representative of a health care
184	184	facility;
185	185	(8) at least one representative of a managed care
186	186	organization;
187	187	(9) at least one representative of the pharmaceutical
188	188	industry;
189	189	(10) at least one representative of Medicaid
190	190	recipients and child health plan enrollees;
191	191	(11) at least one representative of a local or
192	192	regional health information exchange; and
193	193	(12) at least one representative who is skilled in
194	194	pediatric medical informatics.
195	195	(d) The members of the advisory committee must represent the
196	196	geographic and cultural diversity of the state.
197	197	(e) The executive commissioner shall appoint the presiding
198	198	officer of the advisory committee.
199	199	(f) The advisory committee shall advise the commission on
200	200	issues regarding the development and implementation of the
201	201	electronic health information exchange system, including any issue
202	202	specified by the commission and the following specific issues:
203	203	(1) data to be included in an electronic health
204	204	record;
205	205	(2) presentation of data;
206	206	(3) useful measures for quality of service and patient
207	207	health outcomes;
208	208	(4) federal and state laws regarding privacy and
209	209	management of private patient information;
210	210	(5) incentives for increasing health care provider
211	211	adoption and usage of an electronic health record and the health
212	212	information exchange system; and
213	213	(6) data exchange with local or regional health
214	214	information exchanges to enhance:
215	215	(A) the comprehensive nature of the information
216	216	contained in electronic health records; and
217	217	(B) health care provider efficiency by
218	218	supporting integration of the information into the electronic
219	219	health record used by health care providers.
220	220	(g) The advisory committee shall collaborate with the Texas
221	221	Health Services Authority to ensure that the health information
222	222	exchange system is interoperable with, and not an impediment to,
223	223	the electronic health information infrastructure that the
224	224	authority assists in developing.
225	225	Sec. 531.905. ELECTRONIC HEALTH INFORMATION EXCHANGE
226	226	SYSTEM STAGE ONE: ELECTRONIC HEALTH RECORD. (a) In stage one of
227	227	implementing the health information exchange system, the
228	228	commission shall develop and establish an electronic health record
229	229	for each person who receives medical assistance under the Medicaid
230	230	program. The electronic health record must be available through a
231	231	browser-based format.
232	232	(b) The commission shall consult and collaborate with, and
233	233	accept recommendations from, physicians and other stakeholders to
234	234	ensure that electronic health records established under this
235	235	section support health information exchange with electronic
236	236	medical records systems in use by physicians in the public and
237	237	private sectors.
238	238	(c) The executive commissioner shall adopt rules specifying
239	239	the information required to be included in the electronic health
240	240	record. The required information may include, as appropriate:
241	241	(1) the name and address of each of the person's health
242	242	care providers;
243	243	(2) a record of each visit to a health care provider,
244	244	including diagnoses, procedures performed, and laboratory test
245	245	results;
246	246	(3) an immunization record;
247	247	(4) a prescription history;
248	248	(5) a list of due and overdue Texas Health Steps
249	249	medical and dental checkup appointments; and
250	250	(6) any other available health history that health
251	251	care providers who provide care for the person determine is
252	252	important.
253	253	(d) Information under Subsection (c) may be added to any
254	254	existing electronic health record or health information technology
255	255	and may be exchanged with local and regional health information
256	256	exchanges.
257	257	(e) The commission shall make an electronic health record
258	258	for a patient available to the patient through the Internet.
259	259	Sec. 531.9051. ELECTRONIC HEALTH INFORMATION EXCHANGE
260	260	SYSTEM STAGE ONE: ENCOUNTER DATA. In stage one of implementing the
261	261	health information exchange system, the commission shall require
262	262	for purposes of the implementation each managed care organization
263	263	with which the commission contracts under Chapter 533 for the
264	264	provision of Medicaid managed care services or Chapter 62, Health
265	265	and Safety Code, for the provision of child health plan program
266	266	services to submit to the commission complete and accurate
267	267	encounter data not later than the 30th day after the last day of the
268	268	month in which the managed care organization adjudicated the claim.
269	269	Sec. 531.906. ELECTRONIC HEALTH INFORMATION EXCHANGE
270	270	SYSTEM STAGE ONE: ELECTRONIC PRESCRIBING. (a) In stage one of
271	271	implementing the health information exchange system, the
272	272	commission shall support and coordinate electronic prescribing
273	273	tools used by health care providers and health care facilities
274	274	under the child health plan and Medicaid programs.
275	275	(b) The commission shall consult and collaborate with, and
276	276	accept recommendations from, physicians and other stakeholders to
277	277	ensure that the electronic prescribing tools described by
278	278	Subsection (a):
279	279	(1) are integrated with existing electronic
280	280	prescribing systems otherwise in use in the public and private
281	281	sectors; and
282	282	(2) to the extent feasible:
283	283	(A) provide current payer formulary information
284	284	at the time a health care provider writes a prescription; and
285	285	(B) support the electronic transmission of a
286	286	prescription.
287	287	(c) The commission may take any reasonable action to comply
288	288	with this section, including establishing information exchanges
289	289	with national electronic prescribing networks or providing health
290	290	care providers with access to an Internet-based prescribing tool
291	291	developed by the commission.
292	292	(d) The commission shall apply for and actively pursue any
293	293	waiver to the child health plan program or the state Medicaid plan
294	294	from the federal Centers for Medicare and Medicaid Services or any
295	295	other federal agency as necessary to remove an identified
296	296	impediment to supporting and implementing electronic prescribing
297	297	tools under this section, including the requirement for handwritten
298	298	certification of certain drugs under 42 C.F.R. Section 447.512. If
299	299	the commission, with assistance from the Legislative Budget Board,
300	300	determines that the implementation of operational modifications in
301	301	accordance with a waiver obtained as required by this subsection
302	302	has resulted in cost increases in the child health plan or Medicaid
303	303	program, the commission shall take the necessary actions to reverse
304	304	the operational modifications.
305	305	Sec. 531.907. ELECTRONIC HEALTH INFORMATION EXCHANGE
306	306	SYSTEM STAGE TWO: EXPANSION. (a) Based on the recommendations of
307	307	the advisory committee established under Section 531.904 and
308	308	feedback provided by interested parties, the commission in stage
309	309	two of implementing the health information exchange system may
310	310	expand the system by:
311	311	(1) providing an electronic health record for each
312	312	child enrolled in the child health plan program;
313	313	(2) including state laboratory results information in
314	314	an electronic health record, including the results of newborn
315	315	screenings and tests conducted under the Texas Health Steps
316	316	program, based on the system developed for the health passport
317	317	under Section 266.006, Family Code;
318	318	(3) improving data-gathering capabilities for an
319	319	electronic health record so that the record may include basic
320	320	health and clinical information in addition to available claims
321	321	information, as determined by the executive commissioner;
322	322	(4) using evidence-based technology tools to create a
323	323	unique health profile to alert health care providers regarding the
324	324	need for additional care, education, counseling, or health
325	325	management activities for specific patients; and
326	326	(5) continuing to enhance the electronic health record
327	327	created under Section 531.905 as technology becomes available and
328	328	interoperability capabilities improve.
329	329	(b) In expanding the system, the commission shall consult
330	330	and collaborate with, and accept recommendations from, physicians
331	331	and other stakeholders to ensure that electronic health records
332	332	provided under this section support health information exchange
333	333	with electronic medical records systems in use by physicians in the
334	334	public and private sectors.
335	335	Sec. 531.908. ELECTRONIC HEALTH INFORMATION EXCHANGE
336	336	SYSTEM STAGE THREE: EXPANSION. In stage three of implementing the
337	337	health information exchange system, the commission may expand the
338	338	system by:
339	339	(1) developing evidence-based benchmarking tools that
340	340	can be used by health care providers to evaluate their own
341	341	performances on health care outcomes and overall quality of care as
342	342	compared to aggregated performance data regarding peers; and
343	343	(2) expanding the system to include state agencies,
344	344	additional health care providers, laboratories, diagnostic
345	345	facilities, hospitals, and medical offices.
346	346	Sec. 531.909. INCENTIVES. The commission and the advisory
347	347	committee established under Section 531.904 shall develop
348	348	strategies to encourage health care providers to use the health
349	349	information exchange system, including incentives, education, and
350	350	outreach tools to increase usage.
351	351	Sec. 531.910. REPORTS. (a) The commission shall provide an
352	352	initial report to the Senate Committee on Health and Human Services
353	353	or its successor, the House Committee on Human Services or its
354	354	successor, and the House Committee on Public Health or its
355	355	successor regarding the health information exchange system not
356	356	later than January 1, 2011, and shall provide a subsequent report to
357	357	those committees not later than January 1, 2013. Each report must:
358	358	(1) describe the status of the implementation of the
359	359	system;
360	360	(2) specify utilization rates for each health
361	361	information technology implemented as a component of the system;
362	362	and
363	363	(3) identify goals for utilization rates described by
364	364	Subdivision (2) and actions the commission intends to take to
365	365	increase utilization rates.
366	366	(b) This section expires September 2, 2013.
367	367	Sec. 531.911. RULES. The executive commissioner may adopt
368	368	rules to implement Sections 531.903 through 531.910.
369	369	Sec. 531.912. QUALITY OF CARE HEALTH INFORMATION EXCHANGE
370	370	WITH CERTAIN NURSING FACILITIES. (a) In this section, "nursing
371	371	facility" means a convalescent or nursing home or related
372	372	institution licensed under Chapter 242, Health and Safety Code,
373	373	that provides long-term care services, as defined by Section
374	374	22.0011, Human Resources Code, to medical assistance recipients.
375	375	(b) If feasible, the executive commissioner by rule shall
376	376	establish a quality of care health information exchange with
377	377	nursing facilities that choose to participate in a program designed
378	378	to improve the quality of care and services provided to medical
379	379	assistance recipients. Subject to Subsection (f), the program may
380	380	provide incentive payments in accordance with this section to
381	381	encourage facilities to participate in the program.
382	382	(c) In establishing a quality of care health information
383	383	exchange program under this section, the executive commissioner
384	384	shall, subject to Subsection (d), exchange information with
385	385	participating nursing facilities regarding performance measures.
386	386	The performance measures:
387	387	(1) must be:
388	388	(A) recognized by the executive commissioner as
389	389	valid indicators of the overall quality of care received by medical
390	390	assistance recipients; and
391	391	(B) designed to encourage and reward
392	392	evidence-based practices among nursing facilities; and
393	393	(2) may include measures of:
394	394	(A) quality of life;
395	395	(B) direct-care staff retention and turnover;
396	396	(C) recipient satisfaction;
397	397	(D) employee satisfaction and engagement;
398	398	(E) the incidence of preventable acute care
399	399	emergency room services use;
400	400	(F) regulatory compliance;
401	401	(G) level of person-centered care; and
402	402	(H) level of occupancy or of facility
403	403	utilization.
404	404	(d) The executive commissioner shall maximize the use of
405	405	available information technology and limit the number of
406	406	performance measures adopted under Subsection (c) to achieve
407	407	administrative cost efficiency and avoid an unreasonable
408	408	administrative burden on participating nursing facilities.
409	409	(e) The executive commissioner may:
410	410	(1) determine the amount of any incentive payment
411	411	under the program; and
412	412	(2) enter into a contract with a qualified person, as
413	413	determined by the executive commissioner, for the following
414	414	services related to the program:
415	415	(A) data collection;
416	416	(B) data analysis; and
417	417	(C) technical support.
418	418	(f) The commission may make incentive payments under the
419	419	program only if money is specifically appropriated for that
420	420	purpose.
421	421	Sec. 531.913. HOSPITAL HEALTH INFORMATION EXCHANGE. (a)
422	422	In this section, "potentially preventable readmission" means a
423	423	return hospitalization of a person within a period specified by the
424	424	commission that results from deficiencies in the care or treatment
425	425	provided to the person during a previous hospital stay or from
426	426	deficiencies in post-hospital discharge follow-up. The term does
427	427	not include a hospital readmission necessitated by the occurrence
428	428	of unrelated events after the discharge. The term includes the
429	429	readmission of a person to a hospital for:
430	430	(1) the same condition or procedure for which the
431	431	person was previously admitted;
432	432	(2) an infection or other complication resulting from
433	433	care previously provided;
434	434	(3) a condition or procedure that indicates that a
435	435	surgical intervention performed during a previous admission was
436	436	unsuccessful in achieving the anticipated outcome; or
437	437	(4) another condition or procedure of a similar
438	438	nature, as determined by the executive commissioner.
439	439	(b) The executive commissioner shall adopt rules for
440	440	identifying potentially preventable readmissions of Medicaid
441	441	recipients and the commission shall exchange data with hospitals on
442	442	present-on-admission indicators for purposes of this section.
443	443	(c) The commission shall establish a health information
444	444	exchange program to exchange confidential information with each
445	445	hospital in this state regarding the hospital's performance with
446	446	respect to potentially preventable readmissions. A hospital shall
447	447	distribute the information received from the commission to health
448	448	care providers providing services at the hospital.
449	449	SECTION 2. Subchapter B, Chapter 62, Health and Safety
450	450	Code, is amended by adding Section 62.060 to read as follows:
451	451	Sec. 62.060. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
452	452	In this section, "health information technology" means information
453	453	technology used to improve the quality, safety, or efficiency of
454	454	clinical practice, including the core functionalities of an
455	455	electronic health record, an electronic medical record, a
456	456	computerized health care provider order entry, electronic
457	457	prescribing, and clinical decision support technology.
458	458	(b) The commission shall ensure that any health information
459	459	technology used by the commission or any entity acting on behalf of
460	460	the commission in the child health plan program conforms to
461	461	standards required under federal law.
462	462	SECTION 3. Section 32.060(a), Human Resources Code, as
463	463	added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th
464	464	Legislature, Regular Session, 2003, is amended to read as follows:
465	465	(a) The following are not admissible as evidence in a civil
466	466	action:
467	467	(1) any finding by the department that an institution
468	468	licensed under Chapter 242, Health and Safety Code, has violated a
469	469	standard for participation in the medical assistance program under
470	470	this chapter; [or]
471	471	(2) the fact of the assessment of a monetary penalty
472	472	against an institution under Section 32.021 or the payment of the
473	473	penalty by an institution; or
474	474	(3) any information exchanged between the department
475	475	and a nursing facility under Section 531.912, Government Code.
476	476	SECTION 4. Subchapter B, Chapter 32, Human Resources Code,
477	477	is amended by adding Section 32.073 to read as follows:
478	478	Sec. 32.073. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
479	479	In this section, "health information technology" means information
480	480	technology used to improve the quality, safety, or efficiency of
481	481	clinical practice, including the core functionalities of an
482	482	electronic health record, an electronic medical record, a
483	483	computerized health care provider order entry, electronic
484	484	prescribing, and clinical decision support technology.
485	485	(b) The Health and Human Services Commission shall ensure
486	486	that any health information technology used by the commission or
487	487	any entity acting on behalf of the commission in the medical
488	488	assistance program conforms to standards required under federal
489	489	law.
490	490	SECTION 5. The Health and Human Services Commission shall
491	491	begin implementing the pilot project established under Section
492	492	531.902, Government Code, as added by this Act, as soon as feasible
493	493	after September 1, 2009, but not later than the 60th day after the
494	494	effective date of this Act.
495	495	SECTION 6. Not later than January 1, 2011, the Health and
496	496	Human Services Commission shall:
497	497	(1) assess, in conjunction with the health information
498	498	exchanges selected for participation in the pilot project
499	499	established under Section 531.902, Government Code, as added by
500	500	this Act, the benefits to the state, patients, and health care
501	501	providers of exchanging secure health information with local or
502	502	regional health information exchanges;
503	503	(2) include, as part of the assessment required by
504	504	Subdivision (1) of this section, a return on investment analysis
505	505	for the guidelines developed under Section 531.902(c)(1),
506	506	Government Code, as added by this Act; and
507	507	(3) report the commission's findings to the standing
508	508	committees of the senate and house of representatives having
509	509	primary jurisdiction over health and human services issues.
510	510	SECTION 7. As soon as practicable after the effective date
511	511	of this Act, the executive commissioner of the Health and Human
512	512	Services Commission shall:
513	513	(1) adopt rules to implement the health information
514	514	exchange systems required by Subchapter V, Chapter 531, Government
515	515	Code, as added by this Act; and
516	516	(2) appoint the members of the Electronic Health
517	517	Information Exchange System Advisory Committee established under
518	518	Section 531.904, Government Code, as added by this Act.
519	519	SECTION 8. If before implementing any provision of this Act
520	520	a state agency determines that a waiver or authorization from a
521	521	federal agency is necessary for implementation of that provision,
522	522	the agency affected by the provision shall request the waiver or
523	523	authorization and may delay implementing that provision until the
524	524	waiver or authorization is granted.
525	525	SECTION 9. This Act takes effect September 1, 2009.
526	526	______________________________ ______________________________
527	527	President of the Senate Speaker of the House
528	528	I certify that H.B. No. 1218 was passed by the House on May
529	529	12, 2009, by the following vote: Yeas 140, Nays 1, 1 present, not
530	530	voting; that the House refused to concur in Senate amendments to
531	531	H.B. No. 1218 on May 29, 2009, and requested the appointment of a
532	532	conference committee to consider the differences between the two
533	533	houses; and that the House adopted the conference committee report
534	534	on H.B. No. 1218 on May 31, 2009, by the following vote: Yeas 140,
535	535	Nays 0, 1 present, not voting.
536	536	______________________________
537	537	Chief Clerk of the House
538	538	I certify that H.B. No. 1218 was passed by the Senate, with
539	539	amendments, on May 26, 2009, by the following vote: Yeas 28, Nays
540	540	2; at the request of the House, the Senate appointed a conference
541	541	committee to consider the differences between the two houses; and
542	542	that the Senate adopted the conference committee report on H.B. No.
543	543	1218 on May 31, 2009, by the following vote: Yeas 31, Nays 0.
544	544	______________________________
545	545	Secretary of the Senate
546	546	APPROVED: __________________
547	547	Date
548	548	__________________
549	549	Governor