HF 1322

1st Engrossment - 86th Legislature (2009 - 2010) Posted on 02/09/2010 01:48am

A bill for an act
relating to health; changing provisions for health information technology and
infrastructure; establishing an e-health advisory committee; changing electronic
health records provisions; changing electronic health record system revolving
account and loan program; modifying electronic prescribing provisions;
amending Minnesota Statutes 2008, sections 62J.495; 62J.496; 62J.497,
subdivisions 1, 2.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

Section 1.

Minnesota Statutes 2008, section 62J.495, is amended to read:

62J.495 HEALTH INFORMATION TECHNOLOGY AND
INFRASTRUCTURE.

Subdivision 1.

Implementation.

By January 1, 2015, all hospitals and health care
providers must have in place an interoperable electronic health records system within their
hospital system or clinical practice setting. The commissioner of health, in consultation
with the e-Health Information Technology and Infrastructure Advisory Committee,
shall develop a statewide plan to meet this goal, including uniform standards to be used
for the interoperable system for sharing and synchronizing patient data across systems.
The standards must be compatible with federal efforts. The uniform standards must be
developed by January 1, 2009, with a status report on the development of these standards
submitted to the legislature by January 15, 2008 and updated on an ongoing basis. The
commissioner shall include an update on standards development as part of an annual
report to the legislature.

Subd. 1a.

Definitions.

(a) "Certified electronic health record technology" means an
electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH
Act to meet the standards and implementation specifications adopted under section 3004
as applicable.

(b) "Commissioner" means the commissioner of health.

(c) "Electronic data intermediary" means any entity that provides the infrastructure to
connect computer systems or other electronic devices utilized by prescribing practitioners
with those used by pharmacies, health plans, third party administrators, and pharmacy
benefit manager in order to facilitate the secure transmission of electronic prescriptions,
refill authorization requests, communications, and other prescription-related information
between such entities.

(d) "HITECH Act" means the Health Information Technology for Economic and
Clinical Health Act in division A, title XIII and division B, title IV of the American
Recovery and Reinvestment Act of 2009, including federal regulations adopted under
that act.

(e) "Interoperable electronic health record" means an electronic health record that
securely exchanges health information with another electronic health record system that
meets national requirements for certification under the HITECH Act.

(f) "Qualified electronic health record" means an electronic record of health-related
information on an individual that includes patient demographic and clinical health
information and has the capacity to:

(1) provide clinical decision support;

(2) support physician order entry;

(3) capture and query information relevant to health care quality; and

(4) exchange electronic health information with, and integrate such information
from, other sources.

Subd. 2.

E-Health Information Technology and Infrastructure Advisory
Committee.

(a) The commissioner shall establish a an e-Health Information Technology
and Infrastructure Advisory Committee governed by section 15.059 to advise the
commissioner on the following matters:

(1) assessment of the adoption and effective use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;

(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for administrative clinical data exchange, clinical support programs, patient privacy
requirements, and maintenance of the security and confidentiality of individual patient
data;

(3) recommendations for encouraging use of innovative health care applications
using information technology and systems to improve patient care and reduce the cost
of care, including applications relating to disease management and personal health
management that enable remote monitoring of patients' conditions, especially those with
chronic conditions; and

(4) other related issues as requested by the commissioner.

(b) The members of the e-Health Information Technology and Infrastructure
Advisory Committee shall include the commissioners, or commissioners' designees, of
health, human services, administration, and commerce and additional members to be
appointed by the commissioner to include persons representing Minnesota's local public
health agencies, licensed hospitals and other licensed facilities and providers, private
purchasers, the medical and nursing professions, health insurers and health plans, the
state quality improvement organization, academic and research institutions, consumer
advisory organizations with an interest and expertise in health information technology, and
other stakeholders as identified by the Health Information Technology and Infrastructure
Advisory Committee commissioner to fulfill the requirements of section 3013, paragraph
(g) of the HITECH Act.

(c) The commissioner shall prepare and issue an annual report not later than January
30 of each year outlining progress to date in implementing a statewide health information
infrastructure and recommending future projects action on policy and necessary resources
to continue the promotion of adoption and effective use of health information technology.

(d) Notwithstanding section 15.059, this subdivision expires June 30, 2015.

Subd. 3.

Interoperable electronic health record requirements.

(a) To meet the
requirements of subdivision 1, hospitals and health care providers must meet the following
criteria when implementing an interoperable electronic health records system within their
hospital system or clinical practice setting.

(a) The electronic health record must be a qualified electronic health record.

(b) The electronic health record must be certified by the Certification Commission
for Healthcare Information Technology, or its successor Office of the National Coordinator
pursuant to the HITECH Act. This criterion only applies to hospitals and health care
providers whose practice setting is a practice setting covered by the Certification
Commission for Healthcare Information Technology certifications only if a certified
electronic health record product for the provider's particular practice setting is available.
This criterion shall be considered met if a hospital or health care provider is using an
electronic health records system that has been certified within the last three years, even if a
more current version of the system has been certified within the three-year period.

(c) The electronic health record must meet the standards established according to
section 3004 of the HITECH Act as applicable.

(d) The electronic health record must have the ability to generate information on
clinical quality measures and other measures reported under sections 4101, 4102, and
4201 of the HITECH Act.

(c) (e) A health care provider who is a prescriber or dispenser of controlled
substances legend drugs must have an electronic health record system that meets the
requirements of section 62J.497.

Subd. 4.

Coordination with national HIT activities.

(a) The commissioner,
in consultation with the e-Health Advisory Committee, shall update the statewide
implementation plan required under subdivision 2 and released June 2008, to be consistent
with the updated Federal HIT Strategic Plan released by the Office of the National
Coordinator in accordance with section 3001 of the HITECH Act. The statewide plan
shall meet the requirements for a plan required under section 3013 of the HITECH Act.

(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
work to ensure coordination between state, regional, and national efforts to support and
accelerate efforts to effectively use health information technology to improve the quality
and coordination of health care and continuity of patient care among health care providers,
to reduce medical errors, to improve population health, to reduce health disparities, and
to reduce chronic disease. The commissioner's coordination efforts shall include but not
be limited to:

(1) assisting in the development and support of health information technology
regional extension centers established under section 3012(c) of the HITECH Act to
provide technical assistance and disseminate best practices; and

(2) providing supplemental information to the best practices gathered by regional
centers to ensure that the information is relayed in a meaningful way to the Minnesota
health care community.

(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
monitor national activity related to health information technology and shall coordinate
statewide input on policy development. The commissioner shall coordinate statewide
responses to proposed federal regulations in order to ensure that the needs of the
Minnesota health care community are adequately and efficiently addressed in the proposed
regulations. The commissioner's responses may include, but are not limited to:

(1) reviewing and evaluating any standard, implementation specification, or
certification criteria proposed by the national HIT standards committee;

(2) reviewing and evaluating policy proposed by the national HIT policy
committee relating to the implementation of a nationwide health information technology
infrastructure;

(3) monitoring and responding to activity related to the development of quality
measures and other measures as required by section 4101 of the HITECH Act. Any
response related to quality measures shall consider and address the quality efforts required
under chapter 62U; and

(4) monitoring and responding to national activity related to privacy, security, and
data stewardship of electronic health information and individually identifiable health
information.

(d) To the extent that the state is either required or allowed to apply, or designate an
entity to apply for or carry out activities and programs under section 3013 of the HITECH
Act, the commissioner of health, in consultation with the e-Health Advisory Committee
and the commissioner of human services, shall be the lead applicant or sole designating
authority. The commissioner shall make such designations consistent with the goals and
objectives of sections 62J.495 to 62J.497, and sections 62J.50 to 62J.61.

(e) The commissioner of human services shall apply for funding necessary to
administer the incentive payments to providers authorized under title IV of the American
Recovery and Reinvestment Act.

(f) The commissioner shall include in the report to the legislature information on the
activities of this subdivision and provide recommendations on any relevant policy changes
that should be considered in Minnesota.

Subd. 5.

Collection of data for assessment and eligibility determination.

(a) The
commissioner of health, in consultation with the commissioner of human services, may
require providers, dispensers, group purchasers, and electronic data intermediaries to
submit data in a form and manner specified by the commissioner to assess the status of
adoption, effective use, and interoperability of electronic health records for the purpose of:

(1) demonstrating Minnesota's progress on goals established by the Office of the
National Coordinator to accelerate the adoption and effective use of health information
technology established under the HITECH Act;

(2) assisting the Center for Medicare and Medicaid Services and Department of
Human Services in determining eligibility of health care professionals and hospitals
to receive federal incentives for the adoption and effective use of health information
technology under the HITECH Act or other federal incentive programs;

(3) assisting the Office of the National Coordinator in completing required
assessments of the impact of the implementation and effective use of health information
technology in achieving goals identified in the national strategic plan, and completing
studies required by the HITECH Act;

(4) providing the data necessary to assist the Office of the National Coordinator in
conducting evaluations of regional extension centers as required by the HITECH Act; and

(5) other purposes as necessary to support the implementation of the HITECH Act.

(b) The commissioner shall coordinate with the commissioner of human services
and other state agencies in the collection of data required under this section to:

(1) avoid duplicative reporting requirements;

(2) maximize efficiencies in the development of reports on state activities as
required by HITECH; and

(3) determine health professional and hospital eligibility for incentives available
under the HITECH Act.

Subd. 6.

Data classification.

(a) Data collected on providers, dispensers, group
purchasers, and electronic data intermediaries under this section are private data on
individuals or nonpublic data, as defined in section 13.02. Notwithstanding the definition
of summary data in section 13.02, subdivision 19, summary data prepared under this
subdivision may be derived from nonpublic data.

(b) The commissioner shall not collect data or publish analyses that identify, or
could potentially identify, individual patients.

Sec. 2.

Minnesota Statutes 2008, section 62J.496, is amended to read:

62J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
ACCOUNT AND LOAN PROGRAM.

Subdivision 1.

Account establishment.

(a) An account is established to: provide
loans to eligible borrowers to assist in financing the installation or support of an
interoperable health record system. The system must provide for the interoperable
exchange of health care information between the applicant and, at a minimum, a hospital
system, pharmacy, and a health care clinic or other physician group.

(1) finance the purchase of certified electronic health records or qualified electronic
health records as defined in section 62J.495, subdivision 1a;

(2) enhance the utilization of electronic health record technology, which may include
costs associated with upgrading the technology to meet the criteria necessary to be a
certified electronic health record or a qualified electronic health record;

(3) train personnel in the use of electronic health record technology; and

(4) improve the secure electronic exchange of health information.

(b) Amounts deposited in the account, including any grant funds obtained through
federal or other sources, loan repayments, and interest earned on the amounts shall be
used only for awarding loans or loan guarantees, as a source of reserve and security for
leveraged loans, or for the administration of the account.

(c) The commissioner may accept contributions to the account from private sector
entities subject to the following provisions:

(1) the contributing entity may not specify the recipient or recipients of any loan
issued under this subdivision;

(2) the commissioner shall make public the identity of any private contributor to the
loan fund, as well as the amount of the contribution provided; and

(3) the commissioner may issue letters of commendation or make other awards that
have no financial value to any such entity.

(d) The commissioner may use the loan funds to reimburse private sector entities
for any contribution made to the loan fund. Reimbursement to private entities may not
exceed the principle amount contributed to the loan fund.

(e) The commissioner may use funds deposited in the account to guarantee, or
purchase insurance for, a local obligation if the guarantee or purchase would improve
credit market access or reduce the interest rate applicable to the obligation involved.

(f) The commissioner may use funds deposited in the account as a source of revenue
or security for the payment of principal and interest on revenue or bonds issued by the
state if the proceeds of the sale of the bonds will be deposited into the loan fund.

Subd. 2.

Eligibility.

(a) "Eligible borrower" means one of the following:

(1) federally qualified health centers;

(1) (2) community clinics, as defined under section 145.9268;

(2) (3) hospitals eligible for rural hospital capital improvement grants, as defined
in section 144.148;

(3) physician clinics located in a community with a population of less than 50,000
according to United States Census Bureau statistics and outside the seven-county
metropolitan area;

(4) individual or small group physician practices that are focused primarily on
primary care;

(4) (5) nursing facilities licensed under sections 144A.01 to 144A.27; and

(5) (6) other providers of health or health care services approved by the
commissioner for which interoperable electronic health record capability would improve
quality of care, patient safety, or community health.

(b) The commissioner shall administer the loan fund to prioritize support and
assistance to:

(1) critical access hospitals;

(2) federally qualified health centers;

(3) entities that serve uninsured, underinsured, and medically underserved
individuals, regardless of whether such area is urban or rural; and

(4) individual or small group practices that are primarily focused on primary care.

(b) To be eligible for a loan under this section, the (c) An eligible applicant must
submit a loan application to the commissioner of health on forms prescribed by the
commissioner. The application must include, at a minimum:

(1) the amount of the loan requested and a description of the purpose or project
for which the loan proceeds will be used;

(2) a quote from a vendor;

(3) a description of the health care entities and other groups participating in the
project;

(4) evidence of financial stability and a demonstrated ability to repay the loan; and

(5) a description of how the system to be financed interconnects interoperates or
plans in the future to interconnect interoperate with other health care entities and provider
groups located in the same geographical area;

(6) a plan on how the certified electronic health record technology will be maintained
and supported over time; and

(7) any other requirements for applications included or developed pursuant to
section 3014 of the HITECH Act.

Subd. 3.

Loans.

(a) The commissioner of health may make a no interest, or low
interest, loan to a provider or provider group who is eligible under subdivision 2 on a
first-come, first-served basis provided that the applicant is able to comply with this section
consistent with the priorities established in subdivision 2. The total accumulative loan
principal must not exceed $1,500,000 $3,000,000 per loan. The interest rate for each
loan, if imposed, shall not exceed the current market interest rate. The commissioner of
health has discretion over the size, interest rate, and number of loans made. Nothing in
this section shall require the commissioner to make a loan to an eligible borrower under
subdivision 2.

(b) The commissioner of health may prescribe forms and establish an application
process and, notwithstanding section 16A.1283, may impose a reasonable nonrefundable
application fee to cover the cost of administering the loan program. Any application
fees imposed and collected under the electronic health records system revolving account
and loan program in this section are appropriated to the commissioner of health for the
duration of the loan program. The commissioner may apply for and use all federal funds
available through the HITECH Act to administer the loan program.

(c) For loans approved prior to July 1, 2009, the borrower must begin repaying the
principal no later than two years from the date of the loan. Loans must be amortized no
later than six years from the date of the loan.

(d) For loans granted on January 1, 2010, or thereafter, the borrower must begin
repaying the principle no later than one year from the date of the loan. Loans must be
amortized no later than six years after the date of the loan.

(d) Repayments (e) All repayments and interest paid on each loan must be credited
to the account.

(f) The loan agreement shall include the assurances that borrower meets requirements
included or developed pursuant to section 3014 of the HITECH Act. The requirements
shall include, but are not limited to:

(1) submitting reports on quality measures in compliance with regulations adopted
by the federal government;

(2) demonstrating that any certified electronic health record technology purchased,
improved, or otherwise financially supported by this loan program is used to exchange
health information in a manner that, in accordance with law and standards applicable to
the exchange of information, improves the quality of health care;

(3) including a plan on how the borrower intends to maintain and support the
certified electronic health record technology over time and the resources expected to be
used to maintain and support the technology purchased with the loan; and

(4) complying with other requirements the secretary may require to use loans funds
under the HITECH Act.

Subd. 4.

Data classification.

Data collected by the commissioner of health on the
application to determine eligibility under subdivision 2 and to monitor borrowers' default
risk or collect payments owed under subdivision 3 are (1) private data on individuals as
defined in section 13.02, subdivision 12; and (2) nonpublic data as defined in section
13.02, subdivision 9. The names of borrowers and the amounts of the loans granted
are public data.

Sec. 3.

Minnesota Statutes 2008, section 62J.497, subdivision 1, is amended to read:

Subdivision 1.

Definitions.

For the purposes of this section, the following terms
have the meanings given.

(a) "Backward compatible" means that the newer version of a data transmission
standard would retain, at a minimum, the full functionality of the versions previously
adopted, and would permit the successful completion of the applicable transactions with
entities that continue to use the older versions.

(a) (b) "Dispense" or "dispensing" has the meaning given in section 151.01,
subdivision 30. Dispensing does not include the direct administering of a controlled
substance to a patient by a licensed health care professional.

(b) (c) "Dispenser" means a person authorized by law to dispense a controlled
substance, pursuant to a valid prescription.

(c) (d) "Electronic media" has the meaning given under Code of Federal Regulations,
title 45, part 160.103.

(d) (e) "E-prescribing" means the transmission using electronic media of prescription
or prescription-related information between a prescriber, dispenser, pharmacy benefit
manager, or group purchaser, either directly or through an intermediary, including
an e-prescribing network. E-prescribing includes, but is not limited to, two-way
transmissions between the point of care and the dispenser and two-way transmissions
related to eligibility, formulary, and medication history information.

(e) (f) "Electronic prescription drug program" means a program that provides for
e-prescribing.

(f) (g) "Group purchaser" has the meaning given in section 62J.03, subdivision 6.

(g) (h) "HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.

(h) (i) "National Provider Identifier" or "NPI" means the identifier described under
Code of Federal Regulations, title 45, part 162.406.

(i) (j) "NCPDP" means the National Council for Prescription Drug Programs, Inc.

(j) (k) "NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.

(k) (l) "NCPDP SCRIPT Standard" means the National Council for Prescription
Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation
Guide Version 8, Release 1 (Version 8.1), October 2005, or the most recent standard
adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
regulations adopted under it. The standards shall be implemented according to the Centers
for Medicare and Medicaid Services schedule for compliance. Subsequently released
versions of the NCPDP SCRIPT Standard may be used, provided that the new version
of the standard is backward compatible to the current version adopted by the Centers for
Medicare and Medicaid Services.

(l) (m) "Pharmacy" has the meaning given in section 151.01, subdivision 2.

(m) (n) "Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section 152.12, subdivision 1.

(n) (o) "Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.

(o) (p) "Provider" or "health care provider" has the meaning given in section 62J.03,
subdivision 8.

Sec. 4.

Minnesota Statutes 2008, section 62J.497, subdivision 2, is amended to read:

Subd. 2.

Requirements for electronic prescribing.

(a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish and, maintain,
and use an electronic prescription drug program that complies. This program must comply
with the applicable standards in this section for transmitting, directly or through an
intermediary, prescriptions and prescription-related information using electronic media.

(b) Nothing in this section requires providers, group purchasers, prescribers, or
dispensers to conduct the transactions described in this section. If transactions described in
this section are conducted, they must be done electronically using the standards described
in this section. Nothing in this section requires providers, group purchasers, prescribers,
or dispensers to electronically conduct transactions that are expressly prohibited by other
sections or federal law.

(c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.

(d) Entities transmitting prescriptions or prescription-related information where the
prescriber is required by law to issue a prescription for a patient to a nonprescribing
provider that in turn forwards the prescription to a dispenser are exempt from the
requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or
prescription-related information.