H.B. No. 1218
AN ACT
relating to programs to exchange certain health information between
the Health and Human Services Commission and certain health care
entities and facilities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 531, Government Code, is amended by
adding Subchapter V to read as follows:
SUBCHAPTER V. HEALTH INFORMATION EXCHANGE SYSTEMS
Sec. 531.901. DEFINITIONS. In this subchapter:
(1) "Electronic health record" means an electronic
record of aggregated health-related information concerning a
person that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by
authorized health care providers across two or more health care
organizations.
(2) "Electronic medical record" means an electronic
record of health-related information concerning a person that can
be created, gathered, managed, and consulted by authorized
clinicians and staff within a single health care organization.
(3) "Health information exchange system" means a
health information exchange system created under this subchapter
that moves health-related information among entities according to
nationally recognized standards.
(4) "Local or regional health information exchange"
means a health information exchange operating in this state that
securely exchanges electronic health information, including
information for patients receiving services under the child health
plan or Medicaid program, among hospitals, clinics, physicians'
offices, and other health care providers that are not owned by a
single entity or included in a single operational unit or network.
Sec. 531.902. ELECTRONIC HEALTH INFORMATION EXCHANGE PILOT
PROJECT. (a) The commission shall establish a pilot project in at
least one urban area of this state to determine the feasibility,
costs, and benefits of exchanging secure electronic health
information between the commission and local or regional health
information exchanges. The pilot project must include the
participation of at least two local or regional health information
exchanges.
(b) A local or regional health information exchange
selected for the pilot project under this section must possess a
functioning health information exchange database that exchanges
secure electronic health information among hospitals, clinics,
physicians' offices, and other health care providers that are not
each owned by a single entity or included in a single operational
unit or network. The information exchanged by the local or regional
health information exchange must include health information for
patients receiving services from state and federal health and human
services programs administered by the commission.
(c) In developing the pilot project under this section, the
commission shall:
(1) establish specific written guidelines, in
conjunction with the health information exchanges participating in
the pilot project, to:
(A) ensure that information exchanged through
the pilot project is used only for the patient's benefit; and
(B) specify which health care providers will use
which data elements obtained from the commission and for what
purposes, including purposes related to reducing costs, improving
access, and improving quality of care for patients; and
(2) ensure compliance with all state and federal laws
and rules related to the transmission of health information,
including state privacy laws and the Health Insurance Portability
and Accountability Act of 1996 (42 U.S.C. Section 1320d et seq.) and
rules adopted under that Act.
(d) The commission and the health information exchanges
participating in the pilot project shall at a minimum exchange a
patient's medication history under the pilot project. If the
executive commissioner determines that there will be no significant
cost to the state, the commission shall apply for and actively
pursue any waiver from the federal Centers for Medicare and
Medicaid Services that may be necessary for the pilot project and
shall actively pursue a waiver to use an electronic alternative to
the requirement for handwritten certification of certain drugs
under 42 C.F.R. Section 447.152. The pilot project may include
additional health care information, either at the inception of the
project or as part of a subsequent expansion of the scope of the
project.
(e) The pilot project shall initially use the method of
secure transmission that is available at the time implementation of
the pilot project begins, and subsequently move toward full
interoperability in conjunction with the health information
exchange system under Section 531.903.
(f) The commission may accept gifts, grants, and donations
from any public or private source for the operation of the pilot
project.
Sec. 531.903. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM. (a) The commission shall develop an electronic health
information exchange system to improve the quality, safety, and
efficiency of health care services provided under the child health
plan and Medicaid programs. In developing the system, the
commission shall ensure that:
(1) the confidentiality of patients' health
information is protected and the privacy of those patients is
maintained in accordance with applicable federal and state law,
including:
(A) Section 1902(a)(7), Social Security Act (42
U.S.C. Section 1396a(a)(7));
(B) the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191);
(C) Chapter 552, Government Code;
(D) Subchapter G, Chapter 241, Health and Safety
Code;
(E) Section 12.003, Human Resources Code; and
(F) federal and state rules and regulations,
including:
(i) 42 C.F.R. Part 431, Subpart F; and
(ii) 45 C.F.R. Part 164;
(2) appropriate information technology systems used
by the commission and health and human services agencies are
interoperable;
(3) the system and external information technology
systems are interoperable in receiving and exchanging appropriate
electronic health information as necessary to enhance:
(A) the comprehensive nature of the information
contained in electronic health records; and
(B) health care provider efficiency by
supporting integration of the information into the electronic
health record used by health care providers;
(4) the system and other health information systems
not described by Subdivision (3) and data warehousing initiatives
are interoperable; and
(5) the system has the elements described by
Subsection (b).
(b) The health information exchange system must include the
following elements:
(1) an authentication process that uses multiple forms
of identity verification before allowing access to information
systems and data;
(2) a formal process for establishing data-sharing
agreements within the community of participating providers in
accordance with the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191) and the American
Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5);
(3) a method by which the commission may open or
restrict access to the system during a declared state emergency;
(4) the capability of appropriately and securely
sharing health information with state and federal emergency
responders;
(5) compatibility with the Nationwide Health
Information Network (NHIN) and other national health information
technology initiatives coordinated by the Office of the National
Coordinator for Health Information Technology;
(6) technology that allows for patient identification
across multiple systems; and
(7) the capability of allowing a health care provider
to access the system if the provider has technology that meets
current national standards.
(c) The commission shall implement the health information
exchange system in stages as described by Sections 531.905 through
531.908, except that the commission may deviate from those stages
if technological advances make a deviation advisable or more
efficient.
(d) The health information exchange system must be
developed in accordance with the Medicaid Information Technology
Architecture (MITA) initiative of the Center for Medicaid and State
Operations and conform to other standards required under federal
law.
Sec. 531.904. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM ADVISORY COMMITTEE. (a) The commission shall establish the
Electronic Health Information Exchange System Advisory Committee
to assist the commission in the performance of the commission's
duties under this subchapter.
(b) The executive commissioner shall appoint to the
advisory committee at least 12 and not more than 16 members who have
an interest in health information technology and who have
experience in serving persons receiving health care through the
child health plan and Medicaid programs.
(c) The advisory committee must include the following
members:
(1) Medicaid providers;
(2) child health plan program providers;
(3) fee-for-service providers;
(4) at least one representative of the Texas Health
Services Authority established under Chapter 182, Health and Safety
Code;
(5) at least one representative of each health and
human services agency;
(6) at least one representative of a major provider
association;
(7) at least one representative of a health care
facility;
(8) at least one representative of a managed care
organization;
(9) at least one representative of the pharmaceutical
industry;
(10) at least one representative of Medicaid
recipients and child health plan enrollees;
(11) at least one representative of a local or
regional health information exchange; and
(12) at least one representative who is skilled in
pediatric medical informatics.
(d) The members of the advisory committee must represent the
geographic and cultural diversity of the state.
(e) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(f) The advisory committee shall advise the commission on
issues regarding the development and implementation of the
electronic health information exchange system, including any issue
specified by the commission and the following specific issues:
(1) data to be included in an electronic health
record;
(2) presentation of data;
(3) useful measures for quality of service and patient
health outcomes;
(4) federal and state laws regarding privacy and
management of private patient information;
(5) incentives for increasing health care provider
adoption and usage of an electronic health record and the health
information exchange system; and
(6) data exchange with local or regional health
information exchanges to enhance:
(A) the comprehensive nature of the information
contained in electronic health records; and
(B) health care provider efficiency by
supporting integration of the information into the electronic
health record used by health care providers.
(g) The advisory committee shall collaborate with the Texas
Health Services Authority to ensure that the health information
exchange system is interoperable with, and not an impediment to,
the electronic health information infrastructure that the
authority assists in developing.
Sec. 531.905. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM STAGE ONE: ELECTRONIC HEALTH RECORD. (a) In stage one of
implementing the health information exchange system, the
commission shall develop and establish an electronic health record
for each person who receives medical assistance under the Medicaid
program. The electronic health record must be available through a
browser-based format.
(b) The commission shall consult and collaborate with, and
accept recommendations from, physicians and other stakeholders to
ensure that electronic health records established under this
section support health information exchange with electronic
medical records systems in use by physicians in the public and
private sectors.
(c) The executive commissioner shall adopt rules specifying
the information required to be included in the electronic health
record. The required information may include, as appropriate:
(1) the name and address of each of the person's health
care providers;
(2) a record of each visit to a health care provider,
including diagnoses, procedures performed, and laboratory test
results;
(3) an immunization record;
(4) a prescription history;
(5) a list of due and overdue Texas Health Steps
medical and dental checkup appointments; and
(6) any other available health history that health
care providers who provide care for the person determine is
important.
(d) Information under Subsection (c) may be added to any
existing electronic health record or health information technology
and may be exchanged with local and regional health information
exchanges.
(e) The commission shall make an electronic health record
for a patient available to the patient through the Internet.
Sec. 531.9051. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM STAGE ONE: ENCOUNTER DATA. In stage one of implementing the
health information exchange system, the commission shall require
for purposes of the implementation each managed care organization
with which the commission contracts under Chapter 533 for the
provision of Medicaid managed care services or Chapter 62, Health
and Safety Code, for the provision of child health plan program
services to submit to the commission complete and accurate
encounter data not later than the 30th day after the last day of the
month in which the managed care organization adjudicated the claim.
Sec. 531.906. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM STAGE ONE: ELECTRONIC PRESCRIBING. (a) In stage one of
implementing the health information exchange system, the
commission shall support and coordinate electronic prescribing
tools used by health care providers and health care facilities
under the child health plan and Medicaid programs.
(b) The commission shall consult and collaborate with, and
accept recommendations from, physicians and other stakeholders to
ensure that the electronic prescribing tools described by
Subsection (a):
(1) are integrated with existing electronic
prescribing systems otherwise in use in the public and private
sectors; and
(2) to the extent feasible:
(A) provide current payer formulary information
at the time a health care provider writes a prescription; and
(B) support the electronic transmission of a
prescription.
(c) The commission may take any reasonable action to comply
with this section, including establishing information exchanges
with national electronic prescribing networks or providing health
care providers with access to an Internet-based prescribing tool
developed by the commission.
(d) The commission shall apply for and actively pursue any
waiver to the child health plan program or the state Medicaid plan
from the federal Centers for Medicare and Medicaid Services or any
other federal agency as necessary to remove an identified
impediment to supporting and implementing electronic prescribing
tools under this section, including the requirement for handwritten
certification of certain drugs under 42 C.F.R. Section 447.512. If
the commission, with assistance from the Legislative Budget Board,
determines that the implementation of operational modifications in
accordance with a waiver obtained as required by this subsection
has resulted in cost increases in the child health plan or Medicaid
program, the commission shall take the necessary actions to reverse
the operational modifications.
Sec. 531.907. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM STAGE TWO: EXPANSION. (a) Based on the recommendations of
the advisory committee established under Section 531.904 and
feedback provided by interested parties, the commission in stage
two of implementing the health information exchange system may
expand the system by:
(1) providing an electronic health record for each
child enrolled in the child health plan program;
(2) including state laboratory results information in
an electronic health record, including the results of newborn
screenings and tests conducted under the Texas Health Steps
program, based on the system developed for the health passport
under Section 266.006, Family Code;
(3) improving data-gathering capabilities for an
electronic health record so that the record may include basic
health and clinical information in addition to available claims
information, as determined by the executive commissioner;
(4) using evidence-based technology tools to create a
unique health profile to alert health care providers regarding the
need for additional care, education, counseling, or health
management activities for specific patients; and
(5) continuing to enhance the electronic health record
created under Section 531.905 as technology becomes available and
interoperability capabilities improve.
(b) In expanding the system, the commission shall consult
and collaborate with, and accept recommendations from, physicians
and other stakeholders to ensure that electronic health records
provided under this section support health information exchange
with electronic medical records systems in use by physicians in the
public and private sectors.
Sec. 531.908. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM STAGE THREE: EXPANSION. In stage three of implementing the
health information exchange system, the commission may expand the
system by:
(1) developing evidence-based benchmarking tools that
can be used by health care providers to evaluate their own
performances on health care outcomes and overall quality of care as
compared to aggregated performance data regarding peers; and
(2) expanding the system to include state agencies,
additional health care providers, laboratories, diagnostic
facilities, hospitals, and medical offices.
Sec. 531.909. INCENTIVES. The commission and the advisory
committee established under Section 531.904 shall develop
strategies to encourage health care providers to use the health
information exchange system, including incentives, education, and
outreach tools to increase usage.
Sec. 531.910. REPORTS. (a) The commission shall provide an
initial report to the Senate Committee on Health and Human Services
or its successor, the House Committee on Human Services or its
successor, and the House Committee on Public Health or its
successor regarding the health information exchange system not
later than January 1, 2011, and shall provide a subsequent report to
those committees not later than January 1, 2013. Each report must:
(1) describe the status of the implementation of the
system;
(2) specify utilization rates for each health
information technology implemented as a component of the system;
and
(3) identify goals for utilization rates described by
Subdivision (2) and actions the commission intends to take to
increase utilization rates.
(b) This section expires September 2, 2013.
Sec. 531.911. RULES. The executive commissioner may adopt
rules to implement Sections 531.903 through 531.910.
Sec. 531.912. QUALITY OF CARE HEALTH INFORMATION EXCHANGE
WITH CERTAIN NURSING FACILITIES. (a) In this section, "nursing
facility" means a convalescent or nursing home or related
institution licensed under Chapter 242, Health and Safety Code,
that provides long-term care services, as defined by Section
22.0011, Human Resources Code, to medical assistance recipients.
(b) If feasible, the executive commissioner by rule shall
establish a quality of care health information exchange with
nursing facilities that choose to participate in a program designed
to improve the quality of care and services provided to medical
assistance recipients. Subject to Subsection (f), the program may
provide incentive payments in accordance with this section to
encourage facilities to participate in the program.
(c) In establishing a quality of care health information
exchange program under this section, the executive commissioner
shall, subject to Subsection (d), exchange information with
participating nursing facilities regarding performance measures.
The performance measures:
(1) must be:
(A) recognized by the executive commissioner as
valid indicators of the overall quality of care received by medical
assistance recipients; and
(B) designed to encourage and reward
evidence-based practices among nursing facilities; and
(2) may include measures of:
(A) quality of life;
(B) direct-care staff retention and turnover;
(C) recipient satisfaction;
(D) employee satisfaction and engagement;
(E) the incidence of preventable acute care
emergency room services use;
(F) regulatory compliance;
(G) level of person-centered care; and
(H) level of occupancy or of facility
utilization.
(d) The executive commissioner shall maximize the use of
available information technology and limit the number of
performance measures adopted under Subsection (c) to achieve
administrative cost efficiency and avoid an unreasonable
administrative burden on participating nursing facilities.
(e) The executive commissioner may:
(1) determine the amount of any incentive payment
under the program; and
(2) enter into a contract with a qualified person, as
determined by the executive commissioner, for the following
services related to the program:
(A) data collection;
(B) data analysis; and
(C) technical support.
(f) The commission may make incentive payments under the
program only if money is specifically appropriated for that
purpose.
Sec. 531.913. HOSPITAL HEALTH INFORMATION EXCHANGE. (a)
In this section, "potentially preventable readmission" means a
return hospitalization of a person within a period specified by the
commission that results from deficiencies in the care or treatment
provided to the person during a previous hospital stay or from
deficiencies in post-hospital discharge follow-up. The term does
not include a hospital readmission necessitated by the occurrence
of unrelated events after the discharge. The term includes the
readmission of a person to a hospital for:
(1) the same condition or procedure for which the
person was previously admitted;
(2) an infection or other complication resulting from
care previously provided;
(3) a condition or procedure that indicates that a
surgical intervention performed during a previous admission was
unsuccessful in achieving the anticipated outcome; or
(4) another condition or procedure of a similar
nature, as determined by the executive commissioner.
(b) The executive commissioner shall adopt rules for
identifying potentially preventable readmissions of Medicaid
recipients and the commission shall exchange data with hospitals on
present-on-admission indicators for purposes of this section.
(c) The commission shall establish a health information
exchange program to exchange confidential information with each
hospital in this state regarding the hospital's performance with
respect to potentially preventable readmissions. A hospital shall
distribute the information received from the commission to health
care providers providing services at the hospital.
SECTION 2. Subchapter B, Chapter 62, Health and Safety
Code, is amended by adding Section 62.060 to read as follows:
Sec. 62.060. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
In this section, "health information technology" means information
technology used to improve the quality, safety, or efficiency of
clinical practice, including the core functionalities of an
electronic health record, an electronic medical record, a
computerized health care provider order entry, electronic
prescribing, and clinical decision support technology.
(b) The commission shall ensure that any health information
technology used by the commission or any entity acting on behalf of
the commission in the child health plan program conforms to
standards required under federal law.
SECTION 3. Section 32.060(a), Human Resources Code, as
added by Section 16.01, Chapter 204 (H.B. 4), Acts of the 78th
Legislature, Regular Session, 2003, is amended to read as follows:
(a) The following are not admissible as evidence in a civil
action:
(1) any finding by the department that an institution
licensed under Chapter 242, Health and Safety Code, has violated a
standard for participation in the medical assistance program under
this chapter; [or]
(2) the fact of the assessment of a monetary penalty
against an institution under Section 32.021 or the payment of the
penalty by an institution; or
(3) any information exchanged between the department
and a nursing facility under Section 531.912, Government Code.
SECTION 4. Subchapter B, Chapter 32, Human Resources Code,
is amended by adding Section 32.073 to read as follows:
Sec. 32.073. HEALTH INFORMATION TECHNOLOGY STANDARDS. (a)
In this section, "health information technology" means information
technology used to improve the quality, safety, or efficiency of
clinical practice, including the core functionalities of an
electronic health record, an electronic medical record, a
computerized health care provider order entry, electronic
prescribing, and clinical decision support technology.
(b) The Health and Human Services Commission shall ensure
that any health information technology used by the commission or
any entity acting on behalf of the commission in the medical
assistance program conforms to standards required under federal
law.
SECTION 5. The Health and Human Services Commission shall
begin implementing the pilot project established under Section
531.902, Government Code, as added by this Act, as soon as feasible
after September 1, 2009, but not later than the 60th day after the
effective date of this Act.
SECTION 6. Not later than January 1, 2011, the Health and
Human Services Commission shall:
(1) assess, in conjunction with the health information
exchanges selected for participation in the pilot project
established under Section 531.902, Government Code, as added by
this Act, the benefits to the state, patients, and health care
providers of exchanging secure health information with local or
regional health information exchanges;
(2) include, as part of the assessment required by
Subdivision (1) of this section, a return on investment analysis
for the guidelines developed under Section 531.902(c)(1),
Government Code, as added by this Act; and
(3) report the commission's findings to the standing
committees of the senate and house of representatives having
primary jurisdiction over health and human services issues.
SECTION 7. As soon as practicable after the effective date
of this Act, the executive commissioner of the Health and Human
Services Commission shall:
(1) adopt rules to implement the health information
exchange systems required by Subchapter V, Chapter 531, Government
Code, as added by this Act; and
(2) appoint the members of the Electronic Health
Information Exchange System Advisory Committee established under
Section 531.904, Government Code, as added by this Act.
SECTION 8. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 9. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1218 was passed by the House on May
12, 2009, by the following vote: Yeas 140, Nays 1, 1 present, not
voting; that the House refused to concur in Senate amendments to
H.B. No. 1218 on May 29, 2009, and requested the appointment of a
conference committee to consider the differences between the two
houses; and that the House adopted the conference committee report
on H.B. No. 1218 on May 31, 2009, by the following vote: Yeas 140,
Nays 0, 1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1218 was passed by the Senate, with
amendments, on May 26, 2009, by the following vote: Yeas 28, Nays
2; at the request of the House, the Senate appointed a conference
committee to consider the differences between the two houses; and
that the Senate adopted the conference committee report on H.B. No.
1218 on May 31, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor