This bill would lay critical groundwork to build an HIE network in California — by establishing a consistent source of funding, and compelling every health network and provider to participate.
AB 1131, as amended, Wood. Health information exchange. network.
Existing law makes legislative findings and declarations on health information technology, including that there is a need to promote secure electronic health data exchange among specified individuals, such as health care providers and consumers of health care, and that specified federal law provides unprecedented opportunity for California to develop a statewide health information technology infrastructure to improve the state’s health care system.
This bill would require, by January 1, 2023, health plans, hospitals, medical groups, testing laboratories, and nursing facilities, at a minimum, contribute to, access, exchange, and make available data through the network of health information exchanges for every person, as a condition of participation in a state health program, including Medi-Cal, Covered California, and CalPERS. The bill would also state the intent of the Legislature to enact legislation that would expand the use of clinical and administrative data and further build on the promise of health information exchange, including specified strategies for achieving these goals.Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law provides for the regulation of health insurers by the Department of Insurance. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would establish the statewide health information network (statewide HIN) governing board, an independent public entity not affiliated with an agency or department with specified membership, to provide the data infrastructure needed to meet California’s health care access, equity, affordability, public health, and quality goals, as specified. The bill would require the governing board to issue a request for proposals to select an operating entity with specified minimum capabilities to support the electronic exchange of health information between, and aggregate and integrate data from multiple sources within, the State of California, among other responsibilities. The bill would require the statewide HIN to take specified actions with respect to reporting on, and auditing the security and finances of, the health information network. The bill would require the statewide HIN to convene a health technology advisory committee with specified membership to advise the statewide HIN and set agendas, hold public meetings with stakeholders, and solicit external input on behalf of the statewide HIN.The bill would also require a health care entity, including a hospital, health system, skilled nursing facility, laboratory, physician practice, health care service plan, health insurer, and the State Department of Health Care Services, to submit specified data to the operating entity. The bill would authorize the statewide HIN to add additional health care entities or data to the list of entities required to submit data to the statewide HIN by adopting a subsequent regulation. The bill would also require a health care service plan, health insurer, and a health care provider to collect and submit health equity data to the operating entity.
Vote: majority Appropriation: no Fiscal Committee: yes Local Program: no
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
(a) It is the intent of the Legislature to accomplish both of the following goals:
(1) Expand the use of clinical and administrative data to better understand the health and social needs of individual patients in order to achieve high-quality, efficient, safe, and timely service delivery while improving outcomes.
(2) Further build on the promise of health information exchange by accelerating the utilization and integration of health information exchanges as part of a network that receives and integrates health data for all Californians. The building and operation of the network of exchanges would leverage existing investments in health information exchange and look for additional federal funding in alignment with federal interoperability rules.
(b) To achieve the goals set out in subdivision (a), it is the intent of the Legislature to enact legislation that would do all of the following:
(1) Enable the right access to health information at the right time resulting in improved health and outcomes for all Californians.
(2) Identify and overcome the barriers to exchanging health information between public programs, and with California providers and consumers.
(3) Engage consumers and their providers in managing medical, behavioral, and social services through appropriate, streamlined access to electronic health information.
Division 109.51 (commencing with Section 130260) is added to the Health and Safety Code, to read:
DIVISION 109.51. Health Information Exchange Network
By January 1, 2023, health plans, hospitals, medical groups, testing laboratories, and nursing facilities, at a minimum, shall contribute to, access, exchange, and make available data through the network of health information exchanges for every person, as a condition of participating in a state health program, including Medi-Cal, Covered California, and CalPERS.130260. For the purposes of this division, the following definitions shall apply:(a) “Certified EHR technology” means an electronic health record system that meets the certification requirements established by the federal Office of the National Coordinator for Health Information Technology. Certified electronic health record technologies are listed on the HealthIT.gov internet website.(b) “Clinic” means any individual, entity, or organization of a type required to be licensed pursuant to Chapter 1 (commencing with Section 1200) of Division 2, or exempt from licensure pursuant to Section 1206.(c) “Health care service plan” shall have the same meaning as in subdivision (f) of Section 1345, licensed by the Department of Managed Health Care.(d) ”Health insurer” means a private health insurer holding a valid outstanding certificate of authority from the Insurance Commissioner.(e) “Hospital” means a general acute care hospital, as defined in Section 1250.(f) “Physician” means a person licensed pursuant to the Medical Practice Act (Article 1 (commencing with Section 2000) of Chapter 5 of Division 2 of the Business and Professions Code).(g) “Statewide HIN” collectively refers to the governing board of the statewide HIN (“governing board”) and the operating entity selected to operate the statewide HIN (“operating entity”).130260.1. (a) There is hereby established in state government the statewide health information network (HIN) governing board (“governing board”), an independent public entity not affiliated with an agency or department.(b) (1) The statewide HIN shall be governed by a governing board consisting of the following five members that are residents of California:(A) Two members that shall be appointed by the Governor.(B) One member that shall be appointed by the Senate Committee on Rules.(C) One member that shall be appointed by the Speaker of the Assembly.(D) The Secretary of California Health and Human Services or the secretary’s designee, who shall serve as a voting, ex officio member of the governing board.(2) Members of the governing board, other than an ex officio member, shall be appointed for a term of four years, except that the initial appointment by the Senate Committee on Rules shall be for a term of five years, and the initial appointment by the Speaker of the Assembly shall be for a term of two years. A member of the governing board may continue to serve until the appointment and qualification of the member’s successor. A vacancy shall be filled by appointment for the unexpired term.(3) Appointments by the Governor shall be subject to confirmation by the Senate.(4) The governing board shall elect a chairperson on an annual basis.(c) The statewide HIN shall provide the data infrastructure needed to meet California’s health care access, equity, affordability, public health, and quality goals. The statewide HIN shall do all of the following:(1) Enable participating health care providers, health care service plans, and health insurers to access health information, tools, and analysis from the statewide HIN for treatment, payment, and operations activities for their patients, in accordance with state and federal law.(2) Aggregate encounter and clinical information needed to support the successful operation of the Medi-Cal program.(3) Collect and analyze data for the purposes of informing the Legislature, the California Health and Human Services Agency, the public, and health care organizations as to the cost of, access to, equity of, and quality of health care in California, including sharing information as allowable with the Healthcare Payments Database.(4) Be authorized as a state public health authority, enabling the statewide HIN to collect, report, and analyze aggregated public health data.(d) The statewide HIN shall issue a request for proposals to select an entity (“operating entity”) to operate the statewide HIN, meeting the following minimum capabilities:(1) The ability to support the electronic exchange of health information between, and aggregate and integrate data from multiple sources within, the State of California, including hospitals, health systems, skilled nursing facilities, physicians, laboratories, and health care service plans and health insurers in as near real time as possible.(2) The ability to develop and maintain a statewide master patient index to facilitate patient matching for the purposes of locating or routing records for all Californians.(3) The ability to protect patient data through rigorous privacy and security policies and controls, and an agreement not to sell or commercialize aggregated and deidentified data.(4) The ability to support data submission to, and develop reports based on data from, local and state public health authorities.(5) The ability to analyze data and produce reports and dashboards to support participant needs and state action, including identifying emerging trends and health disparities.(6) The ability to provide payers with data required to provide complete claims histories to enrollees, regardless of the line of business, in a manner consistent with federal law.(7) The ability to provide a patient with the ability to obtain data from the entity, to correct data maintained by the entity, and to prevent data from being shared in accordance’s with the patient’s choice, except where sharing is otherwise required by law.(8) The ability to establish and maintain an open technology platform, including selection and management of all needed technology vendors, provision of standards-based application programming interfaces (APIs), and commitment to allowing sharing and reuse, without charge, of any technology developed in the course of the contract.(9) Subject to governing board approval, the ability to develop data-sharing requirements and policies and negotiate and execute data-sharing and participation agreements with providers, health care service plans, and health insurers.(e) The statewide HIN contract or agreement entered into with the operating entity is subject to renewal every four years.(f) The statewide HIN shall submit an annual report to the California Health and Human Services Agency and the Legislature.(g) At least annually, the statewide HIN shall engage an independent firm to provide audit services that review and test privacy and security controls.(h) At least annually, the statewide HIN shall conduct an independent financial audit, meeting all necessary state and federal requirements.130260.2. (a) All the data described in subdivision (b) shall be shared in its entirety with the statewide HIN, except as prohibited by state and federal law.(b) A health care entity is required to share the following data with the operating entity:(1) By _____, a hospital, a health system, and a skilled nursing facility using certified electronic health record technology shall share encounter data.(2) By _____, a hospital, a health system, and a laboratory shall share laboratory data.(3) By _____, a hospital, a health system, and a physician practice of 10 or more physicians using certified electronic health record technology shall share clinical summaries.(4) By _____, a health care service plan and a health insurer shall share eligibility files and medical and pharmacy claims and encounters.(5) By _____, the State Department of Health Care Services shall share Medi-Cal fee-for-service claims, including for pharmacy and vaccination services.(c) (1) The statewide HIN shall have the authority to add additional health care entities and health care information to the list of data required to be shared pursuant to subdivision (b) through the adoption of a regulation pursuant to the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code).(2) The statewide HIN shall establish a formal process for a health care entity subject to the information-sharing requirements in subdivision (b), or promulgated pursuant to paragraph (1), to request an extension of the timeline to meet the information-sharing requirements based on financial duress or other hardship criteria.(3) Any rules and regulations necessary for implementing this division may be adopted as emergency regulations in accordance with the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code) until January 1, 2024, or if there is a state of emergency declared that necessitates urgent action. The adoption of emergency regulations pursuant to this section shall be deemed to be an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare.(4) Except for a regulation adopted pursuant to a state of emergency, any rule or regulation adopted pursuant to this section shall be discussed by the governing board during at least one properly noticed governing board meeting prior to the governing board meeting at which the governing board adopts the rule or regulation.(d) An organization providing publicly funded health insurance coverage in California, including Medi-Cal, Covered California, and CalPERS, shall use available mechanisms that may include contracting terms, quality improvement programs, financial incentives, and default enrollment to incentivize timely data sharing by a health care entity subject to the data-sharing requirements in subdivision (b), or promulgated pursuant to paragraph (1) of subdivision (c).(e) A health care entity subject to the data-sharing requirements in subdivision (b), or promulgated pursuant to paragraph (1) of subdivision (c), may share the required data directly with the operating entity or select a designee, including a regional health information organization or a commercial company, to do so on its behalf, if that regional health information organization or commercial company furnishes the data required to be submitted to the statewide HIN in a form, manner, and timeframe required by the statewide HIN.(f) To ensure data quality and integrity, a health care entity subject to the data-sharing requirements in subdivision (b), or promulgated pursuant to paragraph (1) of subdivision (c), or the health care entity’s designee shall comply with data formatting and transmission standards, protocols, and other specifications required by the statewide HIN, which shall engage in best efforts to follow national standards.(g) A health care entity providing services in California may access the data and tools of the designated operating entity for purposes permitted under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), including treatment, payment, operations, and patient access for the entity’s patients and members, after signing an operating entity participation agreement and agreeing to operating entity policies, as approved by the statewide HIN. A participating health care entity or the health care entity’s designee shall comply with all privacy, data security, and information-blocking requirements under state and federal law.130260.3. (a) By _____, the statewide HIN shall convene a health technology advisory committee to do both of the following:(1) Advise the statewide HIN regarding processes for establishing statewide information sharing to accomplish all of the following:(A) Improving health, protecting the public health, and increasing affordability.(B) Addressing health equity, metrics for measuring success, and opportunities to reduce administrative costs for payers, providers, and consumers.(C) Ensure data security and consumer privacy.(D) Ensure collection and use of data relevant to social determinants of health.(E) Ensure collection and use of data relevant for behavioral health and substance use disorder treatment.(F) Ensure implementation and enforcement of the data-sharing requirements of this division.(2) Subject to the provisions of the Bagley-Keene Open Meeting Act (Article 9 (commencing with Section 11120) of Chapter 1 of Part 1 of Division 3 of Title 2 of the Government Code), set agendas, hold public meetings with stakeholders, and solicit external input.(b) The advisory committee shall not have decisionmaking authority related to the administration of the data-sharing activities required by this division.(c) The advisory committee shall consist of no fewer than 11 but no more than 14 members, composed of health care stakeholders and experts, including, but not limited to, representatives of all of the following:(1) Consumers.(2) Covered California.(3) Department of Insurance.(4) Department of Managed Health Care.(5) Health care service plans and health insurers.(6) Health information exchange organizations.(7) Hospitals.(8) Organized labor.(9) Physicians, including small practices.(10) Privacy and security experts.(11) Public Employees’ Retirement System (CalPERS).(12) State Department of Health Care Services.(13) State Department of Public Health.(d) Members of the advisory committee shall select a chairperson among the membership.(e) Members of the advisory committee shall serve without compensation but shall receive reimbursement for actual and necessary expenses incurred in connection with the performance of their duties.(f) Members of the advisory committee shall not be represented on the governing board of the statewide HIN or be employed by, or receive financial compensation from, the statewide HIN.130260.4. (a) By _____, a health care service plan, a health insurer, and a health care provider shall collect and submit to the operating entity race and ethnicity data on the health care service plan’s, health insurer’s, or health care provider’s enrollees, insurers, or patients.(b) The statewide HIN shall maintain information submitted pursuant to subdivision (a) in the master patient index and shall utilize the information to identify, track, and address health care disparities. The operating entity shall have the ability to measure, track, and report on a range of standard access, quality, and outcome measurers that are stratified by race and ethnicity.(c) (1) The operating entity shall produce an annual equity report on both of the following:(A) The Agency for Healthcare Research and Quality’s Quality Indicators, including measures of access, quality, and outcomes.(B) The National Committee for Quality Assurance Healthcare Effectiveness Data and Information Set by race and ethnicity.(2) The annual equity report shall be disaggregated by provider and region.