This bill would ensure the state leads on health IT efforts, ensure the state matches valuable federal dollars, and insist on resource sharing — but could go further to build necessary statewide infrastructure, and ensure universal participation.

Introduced by Senator Caballero (Coauthors: Senators Becker and Eggman)

February 10, 2021

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An act to amend Section 130255 of, and to add Sections 130256 and 130257 to, the Health and Safety Code, and to add Article 1.55 (commencing with Section 14046.9) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to health information technology.

LEGISLATIVE COUNSEL’S DIGEST

SB 371, as amended, Caballero. Health information technology.

Existing law establishes the California Health and Human Services Agency (CHHSA), which includes departments charged with the administration of health, social, and other human services. Existing law authorizes CHHSA to apply for federal health information technology and exchange funding. If CHHSA applies for and receives that funding through the federal American Recovery and Reinvestment Act of 2009, existing law requires those funds to be deposited in the California Health Information Technology and Exchange Fund for use, upon appropriation by the Legislature, for purposes related to health information technology and exchange.

This bill would require any federal funds CHHSA receives for health information technology and exchange to be deposited in the California Health Information Technology and Exchange Fund. The bill would authorize CHHSA to use the fund to provide grants to health care providers to implement or expand health information technology and to contract for direct data exchange technical assistance for safety net providers. The bill would require a health information organization to be connected to the California Trusted Exchange Network and to a qualified national network. The bill would also require a health care provider, health system, health care service plan, or health insurer that engages in health information exchange to comply with specified federal standards.

This bill would create the position of Deputy Secretary for Health Information Technology within CHHSA to serve as a single point of contact for health information technology programs that interact with the state government and to coordinate with specified federal agencies. The bill would require the deputy secretary to establish and appoint specified members to the California Health Information Technology Advisory Committee, which would provide information and advice to CHHSA on health information technology issues. On or before July 1, 2022, the bill would require the deputy secretary, in consultation with the advisory committee, to develop a plan to use federal funding to promote data exchange. The bill would also require the deputy secretary, in consultation with the advisory committee, to annually submit a report to the Legislature and the Secretary of California Health and Human Services.

Existing law provides for the Medi-Cal program, administered by the State Department of Health Care Services and 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. Existing law requires the department to make incentive payments to Medi-Cal providers for the implementation and use of electronic health record systems.

This bill would require the department to apply for federal funding made available through the Coronavirus Aid, Relief, and Economic Security Act of 2020, American Rescue Plan Act of 2021 2021, or the Medicaid Information Technology Architecture program. The bill would authorize specific uses for any funding received, including creating a unified state health information exchange gateway to improve the bidirectional exchange of data between state sources and health care providers.

DIGEST KEY

Vote: majority   Appropriation: no   Fiscal Committee: yes   Local Program: no  

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THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

SECTION 1.

 The Legislature finds and declares all of the following:

(a) California needs to enhance its robust health care data exchange to achieve greater care coordination and to continue moving the health care system toward equitable value-based care.

(b) Physicians and other health care providers use many different technologies to exchange data, including regional, national, and electronic health record vendor health information exchange networks, regional health information organizations, Direct Exchange messaging, and application programming interfaces. The goal of promoting data exchange is to leverage a the current national “network of networks” approach, utilizing existing technology standards to facilitate the seamless flow of data between providers, regardless of the technology they utilize. utilize, while protecting the privacy of individual patients and their data both when stored and while exchanged.

(c) The State of California can play a significant role in the promotion of data exchange as a convener and a facilitator, bringing together stakeholders to promote efficiency efficiency, privacy, security, and fairness and to share resources. The state can also pursue and facilitate the flow of federal funding to support data exchange.

(d) Improving data exchange exchange, while preserving individual patient privacy, will bridge the digital divide in health care. This will involve expanding broadband access and exchange infrastructure in rural and underserved communities, providing funding and technical assistance to safety net health care providers, providers and community-based organizations providing social health services, and modernizing the state’s public health information infrastructure to improve reporting of, and access to, public health data. Attempts to improve data exchange or reporting of, and access to, public health data shall take into account privacy implications, including the privacy of sensitive health data and other private and sensitive data protected by Section 1 of Article I of the California Constitution, and the extent that private or commercial entities use public health data for non-public-health purposes, such as advertising and marketing.

(e) The COVID-19 pandemic has exposed real impediments in how public health data is shared among providers, laboratories, and state and local public health agencies. Removing these barriers barriers, while protecting patient privacy, should be an important goal to improve the state’s public health infrastructure.

(f) The COVID-19 pandemic has also demonstrated the critical need to improve the availability of, and access to, telehealth services throughout the state.

(g) The federal government is making substantial funding available in response to the COVID-19 pandemic to update the state’s public health infrastructure, creating an opportunity for California to make needed improvements.

(h) The federal Office of the National Coordinator for Health Information Technology’s 21st Century Cures Act Final Rule and Rule, the federal Centers for Medicare and Medicaid’s Interoperability and Patient Access Final Rule Rule, and Office for Civil Rights revisions to HIPAA privacy, security guidance, and rules will provide a policy framework and requirement for the use of new methods of and standards used in health information exchange, driven by patient access and control of their own data. These rules will also require providers, health care service plans, health insurers, health information organizations, and all other actors to make all patient data available at the point of care. California should build on this federal framework to facilitate access, exchange, and use of health data across the state.

SEC. 2.

 Section 130255 of the Health and Safety Code is amended to read:

130255.

 (a) If the California Health and Human Services Agency receives funds made available for health information technology and exchange, as outlined in subdivision (a) of Section 130251, the California Health Information Technology and Exchange Fund is hereby created in the State Treasury.

(b) All moneys in the California Health Information Technology and Exchange Fund shall be available, upon appropriation by the Legislature, for purposes related to health information technology and exchange.

(c) The California Health Information Technology and Exchange Fund shall consist of, but is not limited to, federal funds made available for health information technology and exchange. Notwithstanding Section 16305.7 of the Government Code, any interest and dividends earned on deposits in the fund shall be retained in the fund for purposes of this division.

(d) It is the intent of the Legislature that the activities associated with health information exchange be funded solely through the following:

(1) Federal funds, including funding made available through the Coronavirus Aid, Relief, and Economic Security Act of 2020 and the American Rescue Plan Act of 2021, Medicaid Information Technology Architecture funding, demonstration projects organized under the Center for Medicare and Medicaid Innovation, and telehealth and broadband funding made available through the Federal Communications Commission.

(2) Private contributions identified by the state or any relevant advisory panel convened by the California Health and Human Services Agency.

(3) Funds generated by the self-sustaining funding mechanism to be established by the California Health and Human Services Agency or one of its departments, or the state-designated entity.

(e) If funds are available, upon appropriation by the Legislature, the California Health and Human Services Agency may utilize the California Health Information Technology and Exchange Fund for both of the following:

(1) To provide grants to small physician or dental practices, community health centers, critical access hospitals, and other safety net providers as well as social service entities and community-based organizations addressing social health needs, to help them implement or expand their use of health information technology and connect to qualified health information networks and exchanges.

(2) To contract with experienced organizations to provide direct data exchange technical assistance to safety net providers. providers and community-based organizations providing social health services.

SEC. 3.

 Section 130256 is added to the Health and Safety Code, to read:

130256.

 (a) The position of Deputy Secretary for Health Information Technology is established within the California Health and Human Services Agency. The deputy secretary shall be appointed by the Governor and confirmed by the Senate.

(b) (1) The deputy secretary shall serve as a single point of contact for internal and external stakeholders for health information technology programs that interact with the state government.

(2) The deputy secretary shall coordinate state interaction with both of the following:

(A) The federal Office of the National Coordinator for Health Information Technology.

(B) The Federal Communications Commission regarding availability and implementation of broadband internet services for telehealth and health information exchange in California.

(c) (1) As soon as practicable after appointment, the deputy secretary shall establish and convene the California Health Information Technology Advisory Committee. Members of the advisory committee shall be appointed by the deputy secretary for three-year terms. Terms of the members shall be staggered such that no more than one-third of the advisory committee seats become open in any one year.

(2) The advisory committee shall be composed of health care stakeholders and experts, including representatives of all of the following:

(3) The advisory committee shall provide information and advice to the California Health and Human Services Agency on health information technology issues, including all of the following:

(4) The advisory committee shall select a chair from among its members.

(5) Advisory committee members shall serve without compensation, but shall receive reimbursement for their actual and necessary expenses incurred in connection with the performance of their duties.

(6) The advisory committee shall meet at least quarterly and shall provide regular updates to the deputy secretary regarding their work.

(d) On or before July 1, 2022, the deputy secretary, in consultation with the advisory committee, shall present to the Secretary of California Health and Human Services a plan for utilizing federal Medicaid Information Technology Architecture funding, Federal Communications Commission rural broadband funds, and other sources of federal funding to promote data exchange. The plan shall identify sites of care in California without broadband or internet coverage.

(e) At least annually, the deputy secretary, in consultation with the advisory committee, shall submit to the Secretary of California Health and Human Services and the Legislature a report describing the state of health information exchange, telehealth services, and broadband internet services among all health care providers in California. The report shall be submitted in compliance with Section 9795 of the Government Code.

(f) For purposes of this section:

(1) “Advisory committee” means the California Health Information Technology Advisory Committee established pursuant to subdivision (c).

(2) “Deputy secretary” means the Deputy Secretary for Health Information Technology appointed pursuant to subdivision (a).

(3) “Health information technology” involves the use of information technology to capture, process, store, and exchange health information in an electronic environment. Health information technology includes electronic health records, health information exchange, personal health records and applications, and telehealth.

SEC. 4.

 Section 130257 is added to the Health and Safety Code, to read:

130257.

 (a) A health information organization shall be connected to the California Trusted Exchange Network (CTEN) and, either through the CTEN or independently, to a qualified national network to facilitate bidirectional exchange of patient data across networks.

(b) A health care provider, health system, health care service plan, or health insurer that engages in health information exchange shall do so in accordance with the Interoperability Standards Advisory published and maintained by the federal Office of the National Coordinator for Health Information Technology.

SEC. 5.

 Article 1.55 (commencing with Section 14046.9) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:

Article  1.55. Information Technology

14046.9.

 The department shall apply to the federal government for funding made available through the Coronavirus Aid, Relief, and Economic Security Act of 2020, the American Rescue Plan Act of 2021 2021, or the Medicaid Information Technology Architecture (MITA) program. Funds received through MITA shall be used for all of the following purposes:

(a) Creating a unified state health information exchange gateway, which shall use an application programming interface to facilitate bidirectional communication between dataholders within the state government and health information organizations, national data exchange networks, direct interfaces with electronic health record systems, and mobile health applications. applications, other provider and payer organizations, and community-based organizations providing social health services.

The primary purpose of the unified state health information exchange gateway shall be to improve the bidirectional exchange of data between state sources and health care providers, including the Medi-Cal program, the California Reportable Disease Information Exchange, the California Immunization Registry, and the Controlled Substance Utilization Review and Evaluation System.

(b) Providing shared services to promote data exchange, in consultation with the California Health Information Technology Advisory Committee established pursuant to Section 130256 of the Health and Safety Code.

(c) Supporting efforts by qualified health information organizations to expand their service territories into geographic regions not currently served by a regional health information organization.

(d) Providing technical assistance and support to health care providers, including small physician and dental practices, community health centers, public and critical access hospitals, and other safety net providers. providers, and community-based organizations providing social health services.