HF 3279

1st Committee Engrossment - 86th Legislature (2009 - 2010)

Posted on 03/19/2013 07:29 p.m.

1.1A bill for an act 1.2relating to health; amending provisions for electronic health record technology; 1.3providing for administrative penalties; appropriating money;amending 1.4Minnesota Statutes 2009 Supplement, section 62J.495, subdivisions 1a, 3; 1.5proposing coding for new law in Minnesota Statutes, chapter 62J. 1.6BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 1.7    Section 1. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a, 1.8is amended to read: 1.9    Subd. 1a. Definitions. (a) "Certified electronic health record technology" means an 1.10electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH 1.11Act to meet the standards and implementation specifications adopted under section 3004 1.12as applicable. 1.13(b) "Commissioner" means the commissioner of health. 1.14(c) "Pharmaceutical electronic data intermediary" means any entity that provides 1.15the infrastructure to connect computer systems or other electronic devices utilized 1.16by prescribing practitioners with those used by pharmacies, health plans, third-party 1.17administrators, and pharmacy benefit managers in order to facilitate the secure 1.18transmission of electronic prescriptions, refill authorization requests, communications, 1.19and other prescription-related information between such entities. 1.20(d) "HITECH Act" means the Health Information Technology for Economic and 1.21Clinical Health Act in division A, title XIII and division B, title IV of the American 1.22Recovery and Reinvestment Act of 2009, including federal regulations adopted under 1.23that act. 1.24(e) "Interoperable electronic health record" means an electronic health record that 1.25securely exchanges health information with another electronic health record system that 2.1meets new text begin requirements specified in subdivision 3, and new text end national requirements for certification 2.2under the HITECH Act. 2.3(f) "Qualified electronic health record" means an electronic record of health-related 2.4information on an individual that includes patient demographic and clinical health 2.5information and has the capacity to: 2.6(1) provide clinical decision support; 2.7(2) support physician order entry; 2.8(3) capture and query information relevant to health care quality; and 2.9(4) exchange electronic health information with, and integrate such information 2.10from, other sources. 2.11    Sec. 2. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is 2.12amended to read: 2.13    Subd. 3. Interoperable electronic health record requirements. To meet the 2.14requirements of subdivision 1, hospitals and health care providers must meet the following 2.15criteria when implementing an interoperable electronic health records system within their 2.16hospital system or clinical practice setting. 2.17(a) The electronic health record must be a qualified electronic health record. 2.18    (b) The electronic health record must be certified by the Office of the National 2.19Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and 2.20health care providers only if a certified electronic health record product for the provider's 2.21particular practice setting is available. This criterion shall be considered met if a hospital 2.22or health care provider is using an electronic health records system that has been certified 2.23within the last three years, even if a more current version of the system has been certified 2.24within the three-year period. 2.25(c) The electronic health record must meet the standards established according to 2.26section 3004 of the HITECH Act as applicable. 2.27(d) The electronic health record must have the ability to generate information on 2.28clinical quality measures and other measures reported under sections 4101, 4102, and 2.294201 of the HITECH Act. 2.30 new text begin (e) The electronic health record system must be connected to a state-certified new text end 2.31 new text begin health information organization either directly or through a connection facilitated by a new text end 2.32 new text begin state-certified health data intermediary as defined in section 62J.498. new text end 2.33    (e) new text begin (f) new text end A health care provider who is a prescriber or dispenser of legend drugs must 2.34have an electronic health record system that meets the requirements of section 62J.497. 3.1    Sec. 3. new text begin [62J.498] HEALTH INFORMATION EXCHANGE. new text end 3.2     new text begin Subdivision 1. new text end new text begin Definitions. new text end new text begin The following definitions apply to sections 62J.498 to new text end 3.3 new text begin 62J.4982: new text end 3.4 new text begin (a) "Clinical transaction" means any meaningful use transaction that is not covered new text end 3.5 new text begin by section 62J.536. new text end 3.6 new text begin (b) "Commissioner" means the commissioner of health. new text end 3.7 new text begin (c) "Direct health information exchange" means the electronic transmission of new text end 3.8 new text begin health-related information through a direct connection between the electronic health new text end 3.9 new text begin record systems of health care providers without the use of a health data intermediary. new text end 3.10 new text begin (d) "Health care provider" or "provider" means a health care provider or provider as new text end 3.11 new text begin defined in section 62J.03, subdivision 8. new text end 3.12 new text begin (e) "Health data intermediary" means an entity that provides the infrastructure to new text end 3.13 new text begin connect computer systems or other electronic devices used by health care providers, new text end 3.14 new text begin laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit new text end 3.15 new text begin managers to facilitate the secure transmission of health information, including new text end 3.16 new text begin pharmaceutical electronic data intermediaries as defined in section 62J.495. This does not new text end 3.17 new text begin include health care providers engaged in direct health information exchange. new text end 3.18 new text begin (f) "Health information exchange" means the electronic transmission of new text end 3.19 new text begin health-related information between organizations according to nationally recognized new text end 3.20 new text begin standards. new text end 3.21 new text begin (g) "Health information exchange service provider" means a health data intermediary new text end 3.22 new text begin or health information organization that has been issued a certificate of authority by the new text end 3.23 new text begin commissioner under section 62J.4981. new text end 3.24 new text begin (h) "Health information organization" means an organization that oversees, governs, new text end 3.25 new text begin and facilitates the exchange of health-related information among organizations according new text end 3.26 new text begin to nationally recognized standards. new text end 3.27 new text begin (i) "HITECH Act" means the Health Information Technology for Economic and new text end 3.28 new text begin Clinical Health Act as defined in section 62J.495. new text end 3.29 new text begin (j) "Major participating entity" means: new text end 3.30 new text begin (1) a participating entity that receives compensation for services that is greater new text end 3.31 new text begin than 30 percent of the health information organization's gross annual revenues from the new text end 3.32 new text begin health information exchange service provider; new text end 3.33 new text begin (2) a participating entity providing administrative, financial, or management services new text end 3.34 new text begin to the health information organization, if the total payment for all services provided by the new text end 3.35 new text begin participating entity exceeds three percent of the gross revenue of the health information new text end 3.36 new text begin organization; and new text end 4.1 new text begin (3) a participating entity that nominates or appoints 30 percent or more of the board new text end 4.2 new text begin of directors of the health information organization. new text end 4.3 new text begin (k) "Meaningful use" means use of certified electronic health record technology that new text end 4.4 new text begin includes e-prescribing, and is connected in a manner that provides for the electronic new text end 4.5 new text begin exchange of health information and used for the submission of clinical quality measures new text end 4.6 new text begin as established by the Center for Medicare and Medicaid Services and the Minnesota new text end 4.7 new text begin Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH new text end 4.8 new text begin Act. new text end 4.9 new text begin (l) "Meaningful use transaction" means an electronic transaction that a health care new text end 4.10 new text begin provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare new text end 4.11 new text begin penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act. new text end 4.12 new text begin (m) "Participating entity" means any of the following persons, health care providers, new text end 4.13 new text begin companies, or other organizations with which a health information organization or health new text end 4.14 new text begin data intermediary has contracts or other agreements for the provision of health information new text end 4.15 new text begin exchange service providers: new text end 4.16 new text begin (1) a health care facility licensed under sections 144.50 to 144.56, a nursing home new text end 4.17 new text begin licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise new text end 4.18 new text begin licensed under the laws of this state or registered with the commissioner; new text end 4.19 new text begin (2) a health care provider, and any other health care professional otherwise licensed new text end 4.20 new text begin under the laws of this state or registered with the commissioner; new text end 4.21 new text begin (3) a group, professional corporation, or other organization that provides the new text end 4.22 new text begin services of individuals or entities identified in clause (2), including but not limited to a new text end 4.23 new text begin medical clinic, a medical group, a home health care agency, an urgent care center, and new text end 4.24 new text begin an emergent care center; new text end 4.25 new text begin (4) a health plan as defined in section 62A.011, subdivision 3; and new text end 4.26 new text begin (5) a state agency as defined in section 13.02, subdivision 17. new text end 4.27 new text begin (n) "Reciprocal agreement" means an arrangement in which two or more health new text end 4.28 new text begin information exchange service providers agree to share in-kind services and resources to new text end 4.29 new text begin allow for the pass-through of meaningful use transactions. new text end 4.30 new text begin (o) "State-certified health data intermediary" means a health data intermediary that: new text end 4.31 new text begin (1) provides a subset of the meaningful use transaction capabilities necessary for new text end 4.32 new text begin hospitals and providers to achieve meaningful use of electronic health records; new text end 4.33 new text begin (2) is not exclusively engaged in the exchange of meaningful use transactions new text end 4.34 new text begin covered by section 62J.536; and new text end 4.35 new text begin (3) has been issued a certificate of authority to operate in Minnesota. new text end 5.1 new text begin (p) "State-certified health information organization" means a nonprofit health new text end 5.2 new text begin information organization that provides transaction capabilities necessary to fully support new text end 5.3 new text begin clinical transactions required for meaningful use of electronic health records that has been new text end 5.4 new text begin issued a certificate of authority to operate in Minnesota. new text end 5.5     new text begin Subd. 2. new text end new text begin Health information exchange oversight. new text end new text begin (a) The commissioner shall new text end 5.6 new text begin protect the public interest on matters pertaining to health information exchange. The new text end 5.7 new text begin commissioner shall: new text end 5.8 new text begin (1) review and act on applications from health data intermediaries and health new text end 5.9 new text begin information organizations for certificates of authority to operate in Minnesota; new text end 5.10 new text begin (2) provide ongoing monitoring to ensure compliance with criteria established under new text end 5.11 new text begin sections 62J.498 to 62J.4982; new text end 5.12 new text begin (3) respond to public complaints related to health information exchange services; new text end 5.13 new text begin (4) take enforcement actions as necessary, including the imposition of fines, new text end 5.14 new text begin suspension, or revocation of certificates of authority as outlined in section 62J.4982; new text end 5.15 new text begin (5) provide a biannual report on the status of health information exchange services new text end 5.16 new text begin that includes but is not limited to: new text end 5.17 new text begin (i) recommendations on actions necessary to ensure that health information exchange new text end 5.18 new text begin services are adequate to meet the needs of Minnesota citizens and providers statewide; new text end 5.19 new text begin (ii) recommendations on enforcement actions to ensure that health information new text end 5.20 new text begin exchange service providers act in the public interest without causing disruption in health new text end 5.21 new text begin information exchange services; new text end 5.22 new text begin (iii) recommendations on updates to criteria for obtaining certificates of authority new text end 5.23 new text begin under this section; and new text end 5.24 new text begin (iv) recommendations on standard operating procedures for health information new text end 5.25 new text begin exchange, including but not limited to the management of consumer preferences; new text end 5.26 new text begin (6) other duties necessary to protect the public interest. new text end 5.27 new text begin (b) As part of the application review process for certification under paragraph (a), new text end 5.28 new text begin prior to issuing a certificate of authority, the commissioner shall: new text end 5.29 new text begin (1) hold public hearings that provide an adequate opportunity for participating new text end 5.30 new text begin entities and consumers to provide feedback and recommendations on the application under new text end 5.31 new text begin consideration. The commissioner shall make all portions of the application classified new text end 5.32 new text begin as public data available to the public at least ten days in advance of the hearing. The new text end 5.33 new text begin applicant shall participate in the hearing by presenting an overview of their application new text end 5.34 new text begin and responding to questions from interested parties; new text end 5.35 new text begin (2) make available all feedback and recommendations from the hearing available to new text end 5.36 new text begin the public prior to issuing a certificate of authority; and new text end 6.1 new text begin (3) consult with hospitals, physicians, and other professionals eligible to receive new text end 6.2 new text begin meaningful use incentive payments or subject to penalties as established in the HITECH new text end 6.3 new text begin Act, and their respective statewide associations, prior to issuing a certificate of authority. new text end 6.4 new text begin (c)(1) When the commissioner is actively considering a suspension or revocation of new text end 6.5 new text begin a certificate of authority as described in section 62J.4982, subdivision 3, all investigatory new text end 6.6 new text begin data that are collected, created, or maintained related to the suspension or revocation new text end 6.7 new text begin are classified as confidential data on individuals and as protected nonpublic data in the new text end 6.8 new text begin case of data not on individuals. new text end 6.9 new text begin (2) The commissioner may disclose data classified as protected nonpublic or new text end 6.10 new text begin confidential under this paragraph if disclosing the data will protect the health or safety of new text end 6.11 new text begin patients. new text end 6.12 new text begin (d) After the commissioner makes a final determination regarding a suspension or new text end 6.13 new text begin revocation of a certificate of authority, all minutes, orders for hearing, findings of fact, new text end 6.14 new text begin conclusions of law, and the specification of the final disciplinary action, are classified new text end 6.15 new text begin as public data. new text end 6.16    Sec. 4. new text begin [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH new text end 6.17 new text begin INFORMATION EXCHANGE SERVICES. new text end 6.18     new text begin Subdivision 1. new text end new text begin Authority to require organizations to apply. new text end new text begin The commissioner new text end 6.19 new text begin shall require an entity providing health information exchange services to apply for a new text end 6.20 new text begin certificate of authority under this section. An applicant may continue to operate until new text end 6.21 new text begin the commissioner acts on the application. If the application is denied, the applicant is new text end 6.22 new text begin considered a health information organization whose certificate of authority has been new text end 6.23 new text begin revoked under section 62J.4982, subdivision 2, paragraph (d). new text end 6.24     new text begin Subd. 2. new text end new text begin Certificate of authority for health data intermediaries. new text end new text begin (a) A health new text end 6.25 new text begin data intermediary that provides health information exchange services for the transmission new text end 6.26 new text begin of one or more clinical transactions necessary for hospitals, providers, or eligible new text end 6.27 new text begin professionals to achieve meaningful use must be registered with the state and comply with new text end 6.28 new text begin requirements established in this section. new text end 6.29 new text begin (b) Notwithstanding any law to the contrary, any corporation organized to do so new text end 6.30 new text begin may apply to the commissioner for a certificate of authority to establish and operate as new text end 6.31 new text begin a health data intermediary in compliance with this section. No person shall establish or new text end 6.32 new text begin operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers new text end 6.33 new text begin to purchase or receive advance or periodic consideration in conjunction with a health new text end 6.34 new text begin data intermediary contract unless the organization has a certificate of authority or has an new text end 6.35 new text begin application under active consideration under this section. new text end 7.1 new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether new text end 7.2 new text begin the applicant for the certificate of authority has demonstrated that the applicant meets new text end 7.3 new text begin the following minimum criteria: new text end 7.4 new text begin (1) interoperate with at least one state-certified health information organization; new text end 7.5 new text begin (2) provide an option for Minnesota entities to connect to their services through at new text end 7.6 new text begin least one state-certified health information organization; new text end 7.7 new text begin (3) have a record locator service as defined in section 144.291, subdivision 2, new text end 7.8 new text begin paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8, new text end 7.9 new text begin when conducting meaningful use transactions; and new text end 7.10 new text begin (4) hold reciprocal agreements with at least one state-certified health information new text end 7.11 new text begin organization to enable access to record locator services to find patient data, and for the new text end 7.12 new text begin transmission and receipt of meaningful use transactions consistent with the format and new text end 7.13 new text begin content required by national standards established by Centers for Medicare and Medicaid new text end 7.14 new text begin Services. Reciprocal agreements must meet the requirements established in subdivision 5. new text end 7.15     new text begin Subd. 3. new text end new text begin Certificate of authority for health information organizations. new text end 7.16 new text begin (a) A health information organization that provides all electronic capabilities for the new text end 7.17 new text begin transmission of clinical transactions necessary for meaningful use of electronic health new text end 7.18 new text begin records must obtain a certificate of authority from the commissioner and demonstrate new text end 7.19 new text begin compliance with the criteria in paragraph (c). new text end 7.20 new text begin (b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do new text end 7.21 new text begin so may apply for a certificate of authority to establish and operate a health information new text end 7.22 new text begin organization under this section. No person shall establish or operate a health information new text end 7.23 new text begin organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive new text end 7.24 new text begin advance or periodic consideration in conjunction with a health information organization new text end 7.25 new text begin or health information contract unless the organization has a certificate of authority under new text end 7.26 new text begin this section. new text end 7.27 new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether new text end 7.28 new text begin the applicant for the certificate of authority has demonstrated that the applicant meets new text end 7.29 new text begin the following minimum criteria: new text end 7.30 new text begin (1) the entity is a legally established, nonprofit organization; new text end 7.31 new text begin (2) appropriate insurance, including liability insurance, for the operation of the new text end 7.32 new text begin health information organization is in place and sufficient to protect the interest of the new text end 7.33 new text begin public and participating entities; new text end 7.34 new text begin (3) strategic and operational plans clearly address how the organization will expand new text end 7.35 new text begin technical capacity of the health information organization to support providers in achieving new text end 7.36 new text begin meaningful use of electronic health records over time; new text end 8.1 new text begin (4) the entity addresses the parameters to be used with participating entities and new text end 8.2 new text begin other health information organizations for meaningful use transactions, compliance with new text end 8.3 new text begin Minnesota law, and interstate health information exchange in trust agreements; new text end 8.4 new text begin (5) the entity's board of directors is comprised of members that broadly represent the new text end 8.5 new text begin health information organization's participating entities and consumers; new text end 8.6 new text begin (6) the entity maintains a professional staff responsible to the board of directors with new text end 8.7 new text begin the capacity to ensure accountability to the organization's mission; new text end 8.8 new text begin (7) the organization is compliant with criteria established under the Health new text end 8.9 new text begin Information Exchange Accreditation Program of the Electronic Healthcare Network new text end 8.10 new text begin Accreditation Commission (EHNAC) or equivalent criteria established by the new text end 8.11 new text begin commissioner; new text end 8.12 new text begin (8) the entity maintains a record locator service as defined in section 144.291, new text end 8.13 new text begin subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293, new text end 8.14 new text begin subdivision 8, when conducting meaningful use transactions; new text end 8.15 new text begin (9) the organization demonstrates interoperability with all other state-certified health new text end 8.16 new text begin information organizations using nationally recognized standards; new text end 8.17 new text begin (10) the organization demonstrates compliance with all privacy and security new text end 8.18 new text begin requirements required by state and federal law; and new text end 8.19 new text begin (11) the organization uses financial policies and procedures consistent with generally new text end 8.20 new text begin accepted accounting principles and has an independent audit of the organization's new text end 8.21 new text begin financials on an annual basis. new text end 8.22 new text begin (d) Health information organizations that have obtained a certificate of authority new text end 8.23 new text begin must: new text end 8.24 new text begin (1) meet the requirements established for connecting to the Nationwide Health new text end 8.25 new text begin Information Network (NHIN) within the federally mandated timeline or within a time new text end 8.26 new text begin frame established by the commissioner and published in the State Register. If the state new text end 8.27 new text begin timeline for implementation varies from the federal timeline, the State Register notice new text end 8.28 new text begin shall include an explanation for the variation; new text end 8.29 new text begin (2) annually submit strategic and operational plans for review by the commissioner new text end 8.30 new text begin that address: new text end 8.31 new text begin (i) increasing adoption rates to include a sufficient number of participating entities to new text end 8.32 new text begin achieve financial sustainability; and new text end 8.33 new text begin (ii) progress in achieving objectives included in previously submitted strategic new text end 8.34 new text begin and operational plans across the following domains: business and technical operations, new text end 8.35 new text begin technical infrastructure, legal and policy issues, finance, and organizational governance; new text end 8.36 new text begin (3) develop and maintain a business plan that addresses: new text end 9.1 new text begin (i) plans for ensuring the necessary capacity to support meaningful use transactions; new text end 9.2 new text begin (ii) approach for attaining financial sustainability, including public and private new text end 9.3 new text begin financing strategies, and rate structures; new text end 9.4 new text begin (iii) rates of adoption, utilization, and transaction volume, and mechanisms to new text end 9.5 new text begin support health information exchange; and new text end 9.6 new text begin (iv) an explanation of methods employed to address the needs of community clinics, new text end 9.7 new text begin critical access hospitals, and free clinics in accessing health information exchange services; new text end 9.8 new text begin (4) annually submit a rate plan outlining fee structures for health information new text end 9.9 new text begin exchange services for approval by the commissioner. The commissioner shall approve the new text end 9.10 new text begin rate plan if it: new text end 9.11 new text begin (i) distributes costs equitably among users of health information services; new text end 9.12 new text begin (ii) provides predictable costs for participating entities; new text end 9.13 new text begin (iii) covers all costs associated with conducting the full range of meaningful use new text end 9.14 new text begin clinical transactions, including access to health information retrieved through other new text end 9.15 new text begin state-certified health information exchange service providers; and new text end 9.16 new text begin (iv) provides for a predictable revenue stream for the health information organization new text end 9.17 new text begin and generates sufficient resources to maintain operating costs and develop technical new text end 9.18 new text begin infrastructure necessary to serve the public interest; new text end 9.19 new text begin (5) enter into reciprocal agreements with all other state-certified health information new text end 9.20 new text begin organizations to enable access to record locator services to find patient data, and new text end 9.21 new text begin transmission and receipt of meaningful use transactions consistent with the format and new text end 9.22 new text begin content required by national standards established by Centers for Medicare and Medicaid new text end 9.23 new text begin Services. Reciprocal agreements must meet the requirements in subdivision 5; and new text end 9.24 new text begin (6) comply with additional requirements for the certification or recertification of new text end 9.25 new text begin health information organizations that may be established by the commissioner. new text end 9.26     new text begin Subd. 4. new text end new text begin Application for certificate of authority for health information exchange new text end 9.27 new text begin service providers. new text end new text begin (a) Each application for a certificate of authority shall be in a form new text end 9.28 new text begin prescribed by the commissioner and verified by an officer or authorized representative of new text end 9.29 new text begin the applicant. Each application shall include the following: new text end 9.30 new text begin (1) a copy of the basic organizational document, if any, of the applicant and of new text end 9.31 new text begin each major participating entity, such as the articles of incorporation, or other applicable new text end 9.32 new text begin documents, and all amendments to it; new text end 9.33 new text begin (2) a list of the names, addresses, and official positions of the following: new text end 9.34 new text begin (i) all members of the board of directors, and the principal officers and, if applicable, new text end 9.35 new text begin shareholders of the applicant organization; and new text end 10.1 new text begin (ii) all members of the board of directors, and the principal officers of each major new text end 10.2 new text begin participating entity and, if applicable, each shareholder beneficially owning more than ten new text end 10.3 new text begin percent of any voting stock of the major participating entity; new text end 10.4 new text begin (3) the name and address of each participating entity and the agreed-upon duration new text end 10.5 new text begin of each contract or agreement if applicable; new text end 10.6 new text begin (4) a copy of each standard agreement or contract intended to bind the participating new text end 10.7 new text begin entities and the health information organization. Contractual provisions shall be consistent new text end 10.8 new text begin with the purposes of this section, in regard to the services to be performed under the new text end 10.9 new text begin standard agreement or contract, the manner in which payment for services is determined, new text end 10.10 new text begin the nature and extent of responsibilities to be retained by the health information new text end 10.11 new text begin organization, and contractual termination provisions; new text end 10.12 new text begin (5) a copy of each contract intended to bind major participating entities and the new text end 10.13 new text begin health information organization. Contract information filed with the commissioner under new text end 10.14 new text begin this section shall be nonpublic as defined in section 13.02, subdivision 9; new text end 10.15 new text begin (6) a statement generally describing the health information organization, its health new text end 10.16 new text begin information exchange contracts, facilities, and personnel, including a statement describing new text end 10.17 new text begin the manner in which the applicant proposes to provide participants with comprehensive new text end 10.18 new text begin health information exchange services; new text end 10.19 new text begin (7) financial statements showing the applicant's assets, liabilities, and sources new text end 10.20 new text begin of financial support, including a copy of the applicant's most recent certified financial new text end 10.21 new text begin statement; new text end 10.22 new text begin (8) strategic and operational plans that specifically address how the organization new text end 10.23 new text begin will expand technical capacity of the health information organization to support providers new text end 10.24 new text begin in achieving meaningful use of electronic health records over time, a description of new text end 10.25 new text begin the proposed method of marketing the services, a schedule of proposed charges, and a new text end 10.26 new text begin financial plan that includes a three-year projection of the expenses and income and other new text end 10.27 new text begin sources of future capital; new text end 10.28 new text begin (9) a statement reasonably describing the geographic area or areas to be served and new text end 10.29 new text begin the type or types of participants to be served; new text end 10.30 new text begin (10) a description of the complaint procedures to be used as required under this new text end 10.31 new text begin section; new text end 10.32 new text begin (11) a description of the mechanism by which participating entities will have an new text end 10.33 new text begin opportunity to participate in matters of policy and operation; new text end 10.34 new text begin (12) a copy of any pertinent agreements between the health information organization new text end 10.35 new text begin and insurers, including liability insurers, demonstrating coverage is in place; new text end 11.1 new text begin (13) a copy of the conflict of interest policy that applies to all members of the board new text end 11.2 new text begin of directors and the principal officers of the health information organization; and new text end 11.3 new text begin (14) other information as the commissioner may reasonably require to be provided. new text end 11.4 new text begin (b) Thirty days after the receipt of the application for a certificate of authority, new text end 11.5 new text begin the commissioner shall determine whether or not the application submitted meets the new text end 11.6 new text begin requirements for completion in paragraph (a), and notify the applicant of any further new text end 11.7 new text begin information required for the application to be processed. new text end 11.8 new text begin (c) Ninety days after the receipt of a complete application for a certificate of new text end 11.9 new text begin authority, the commissioner shall issue a certificate of authority to the applicant if the new text end 11.10 new text begin commissioner determines that the applicant meets the minimum criteria requirements new text end 11.11 new text begin of subdivision 2 for health data intermediaries or subdivision 3 for health information new text end 11.12 new text begin organizations. If the commissioner determines that the applicant is not qualified, the new text end 11.13 new text begin commissioner shall notify the applicant and specify the reasons for disqualification. new text end 11.14 new text begin (d) Upon being granted a certificate of authority to operate as a health information new text end 11.15 new text begin organization, the organization must operate in compliance with the provisions of this new text end 11.16 new text begin section. Noncompliance may result in the imposition of a fine or the suspension or new text end 11.17 new text begin revocation of the certificate of authority according to section 62J.4982. new text end 11.18     new text begin Subd. 5. new text end new text begin Reciprocal agreements between health information exchange entities. new text end 11.19 new text begin (a) Reciprocal agreements between two health information organizations or between a new text end 11.20 new text begin health information organization and a health data intermediary must include a fair and new text end 11.21 new text begin equitable model for charges between the entities that: new text end 11.22 new text begin (1) does not impede the secure transmission of transactions necessary to achieve new text end 11.23 new text begin meaningful use; new text end 11.24 new text begin (2) does not charge a fee for the exchange of meaningful use transactions transmitted new text end 11.25 new text begin according to nationally recognized standards where no additional value-added service new text end 11.26 new text begin is rendered to the sending or receiving health information organization or health data new text end 11.27 new text begin intermediary either directly or on behalf of the client; new text end 11.28 new text begin (3) is consistent with fair market value and proportionately reflects the value-added new text end 11.29 new text begin services accessed as a result of the agreement; and new text end 11.30 new text begin (4) prevents health care stakeholders from being charged multiple times for the new text end 11.31 new text begin same service. new text end 11.32 new text begin (b) Reciprocal agreements must include comparable quality of service standards that new text end 11.33 new text begin ensure equitable levels of services. new text end 11.34 new text begin (c) Reciprocal agreements are subject to review and approval by the commissioner. new text end 12.1 new text begin (d) Nothing in this section precludes a state-certified health information organization new text end 12.2 new text begin or state-certified health data intermediary from entering into contractual agreements for new text end 12.3 new text begin the provision of value-added services beyond meaningful use. new text end 12.4 new text begin (e) The commissioner of human services or health, when providing access to data or new text end 12.5 new text begin services through a certified health information organization, must offer the same data or new text end 12.6 new text begin services directly through any certified health information organization at the same pricing, new text end 12.7 new text begin if the health information organization pays for all connection costs to the state data or new text end 12.8 new text begin service. For all external connectivity to the respective agencies through existing or future new text end 12.9 new text begin information exchange implementations, the respective agency shall establish the required new text end 12.10 new text begin connectivity methods as well as protocol standards to be utilized. new text end 12.11     new text begin Subd. 6. new text end new text begin State participation in health information exchange. new text end new text begin A state agency new text end 12.12 new text begin that connects to a health information exchange service provider for the purpose of new text end 12.13 new text begin exchanging meaningful use transactions must ensure that the contracted health information new text end 12.14 new text begin exchange service provider has reciprocal agreements in place as required by this section. new text end 12.15 new text begin The reciprocal agreements must provide equal access to information supplied by the new text end 12.16 new text begin agency and necessary for meaningful use by the participating entities of the other health new text end 12.17 new text begin information service providers. new text end 12.18    Sec. 5. new text begin [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE. new text end 12.19     new text begin Subdivision 1. new text end new text begin Penalties and enforcement. new text end new text begin (a) The commissioner may, for any new text end 12.20 new text begin violation of statute or rule applicable to a health information exchange service provider, new text end 12.21 new text begin levy an administrative penalty in an amount up to $25,000 for each violation. In new text end 12.22 new text begin determining the level of an administrative penalty, the commissioner shall consider the new text end 12.23 new text begin following factors: new text end 12.24 new text begin (1) the number of participating entities affected by the violation; new text end 12.25 new text begin (2) the effect of the violation on participating entities' access to health information new text end 12.26 new text begin exchange services; new text end 12.27 new text begin (3) if only one participating entity is affected, the effect of the violation on the new text end 12.28 new text begin patients of that entity; new text end 12.29 new text begin (4) whether the violation is an isolated incident or part of a pattern of violations; new text end 12.30 new text begin (5) the economic benefits derived by the health information organization or a health new text end 12.31 new text begin data intermediary by virtue of the violation; new text end 12.32 new text begin (6) whether the violation hindered or facilitated an individual's ability to obtain new text end 12.33 new text begin health care; new text end 12.34 new text begin (7) whether the violation was intentional; new text end 13.1 new text begin (8) whether the violation was beyond the direct control of the health information new text end 13.2 new text begin exchange service provider; new text end 13.3 new text begin (9) any history of prior compliance with the provisions of this section, including new text end 13.4 new text begin violations; new text end 13.5 new text begin (10) whether and to what extent the health information exchange service provider new text end 13.6 new text begin attempted to correct previous violations; new text end 13.7 new text begin (11) how the health information exchange service provider responded to technical new text end 13.8 new text begin assistance from the commissioner provided in the context of a compliance effort; and new text end 13.9 new text begin (12) the financial condition of the health information exchange service provider new text end 13.10 new text begin including, but not limited to, whether the health information exchange service provider new text end 13.11 new text begin had financial difficulties that affected its ability to comply or whether the imposition of an new text end 13.12 new text begin administrative monetary penalty would jeopardize the ability of the health information new text end 13.13 new text begin exchange service provider to continue to deliver health information exchange services. new text end 13.14 new text begin Reasonable notice in writing to the health information exchange service provider new text end 13.15 new text begin shall be given of the intent to levy the penalty and the reasons for them. A health new text end 13.16 new text begin information exchange service provider may have 15 days within which to contest whether new text end 13.17 new text begin the finding of facts constitute a violation of sections 62J.4981 and 62J.4982, according to new text end 13.18 new text begin the contested case and judicial review provisions of sections 14.57 to 14.69. new text end 13.19 new text begin (b) If the commissioner has reason to believe that a violation of section 62J.4981 or new text end 13.20 new text begin 62J.4982 has occurred or is likely, the commissioner may confer with the persons involved new text end 13.21 new text begin before commencing action under subdivision 2. The commissioner may notify the health new text end 13.22 new text begin information exchange service provider and the representatives, or other persons who new text end 13.23 new text begin appear to be involved in the suspected violation, to arrange a voluntary conference with new text end 13.24 new text begin the alleged violators or their authorized representatives. The purpose of the conference is new text end 13.25 new text begin to attempt to learn the facts about the suspected violation and, if it appears that a violation new text end 13.26 new text begin has occurred or is threatened, to find a way to correct or prevent it. The conference is new text end 13.27 new text begin not governed by any formal procedural requirements, and may be conducted as the new text end 13.28 new text begin commissioner considers appropriate. new text end 13.29 new text begin (c) The commissioner may issue an order directing a health information exchange new text end 13.30 new text begin service provider or a representative of a health information exchange service provider to new text end 13.31 new text begin cease and desist from engaging in any act or practice in violation of sections 62J.4981 new text end 13.32 new text begin and 62J.4982. new text end 13.33 new text begin (d) Within 20 days after service of the order to cease and desist, a health information new text end 13.34 new text begin exchange service provider may contest whether the finding of facts constitutes a violation new text end 13.35 new text begin of sections 62J.4981 and 62J.4982 according to the contested case and judicial review new text end 13.36 new text begin provisions of sections 14.57 to 14.69. new text end 14.1 new text begin (e) In the event of noncompliance with a cease and desist order issued under this new text end 14.2 new text begin subdivision, the commissioner may institute a proceeding to obtain injunctive relief or new text end 14.3 new text begin other appropriate relief in Ramsey County District Court. new text end 14.4     new text begin Subd. 2. new text end new text begin Suspension or revocation of certificates of authority. new text end new text begin (a) The new text end 14.5 new text begin commissioner may suspend or revoke a certificate of authority issued to a health new text end 14.6 new text begin data intermediary or health information organization under section 62J.4981 if the new text end 14.7 new text begin commissioner finds that: new text end 14.8 new text begin (1) the health information exchange service provider is operating significantly new text end 14.9 new text begin in contravention of its basic organizational document, or in a manner contrary to that new text end 14.10 new text begin described in and reasonably inferred from any other information submitted under section new text end 14.11 new text begin 62J.4981, unless amendments to the submissions have been filed with and approved by new text end 14.12 new text begin the commissioner; new text end 14.13 new text begin (2) the health information exchange service provider is unable to fulfill its new text end 14.14 new text begin obligations to furnish comprehensive health information exchange services as required new text end 14.15 new text begin under its health information exchange contract; new text end 14.16 new text begin (3) the health information exchange service provider is no longer financially solvent new text end 14.17 new text begin or may not reasonably be expected to meet its obligations to participating entities; new text end 14.18 new text begin (4) the health information exchange service provider has failed to implement the new text end 14.19 new text begin complaint system in a manner designed to reasonably resolve valid complaints; new text end 14.20 new text begin (5) the health information exchange service provider, or any person acting with its new text end 14.21 new text begin sanction, has advertised or merchandised its services in an untrue, misleading, deceptive, new text end 14.22 new text begin or unfair manner; new text end 14.23 new text begin (6) the continued operation of the health information exchange service provider new text end 14.24 new text begin would be hazardous to its participating entities or the patients served by the participating new text end 14.25 new text begin entities; or new text end 14.26 new text begin (7) the health information exchange service provider has otherwise failed to new text end 14.27 new text begin substantially comply with section 62J.4981 or with any other statute or administrative new text end 14.28 new text begin rule applicable to health information exchange service providers, or has submitted false new text end 14.29 new text begin information in any report required under sections 62J.498 to 62J.4982. new text end 14.30 new text begin (b) A certificate of authority shall be suspended or revoked only after meeting the new text end 14.31 new text begin requirements of subdivision 3. new text end 14.32 new text begin (c) If the certificate of authority of a health information exchange service provider is new text end 14.33 new text begin suspended, the health information exchange service provider shall not, during the period new text end 14.34 new text begin of suspension, enroll any additional participating entities, and shall not engage in any new text end 14.35 new text begin advertising or solicitation. new text end 15.1 new text begin (d) If the certificate of authority of a health information exchange service provider is new text end 15.2 new text begin revoked, the organization shall proceed, immediately following the effective date of the new text end 15.3 new text begin order of revocation, to wind up its affairs, and shall conduct no further business except as new text end 15.4 new text begin necessary to the orderly conclusion of the affairs of the organization. The organization new text end 15.5 new text begin shall engage in no further advertising or solicitation. The commissioner may, by written new text end 15.6 new text begin order, permit further operation of the organization as the commissioner finds to be in the new text end 15.7 new text begin best interest of participating entities, to the end that participating entities will be given the new text end 15.8 new text begin greatest practical opportunity to access continuing health information exchange services. new text end 15.9     new text begin Subd. 3. new text end new text begin Denial, suspension, and revocation; administrative procedures. new text end new text begin (a) new text end 15.10 new text begin When the commissioner has cause to believe that grounds for the denial, suspension, new text end 15.11 new text begin or revocation of a certificate of authority exists, the commissioner shall notify the new text end 15.12 new text begin health information exchange service provider in writing stating the grounds for denial, new text end 15.13 new text begin suspension, or revocation and setting a time within 20 days for a hearing on the matter. new text end 15.14 new text begin (b) After a hearing before the commissioner at which the health information new text end 15.15 new text begin exchange service provider may respond to the grounds for denial, suspension, or new text end 15.16 new text begin revocation, or upon the failure of the health information exchange service provider to new text end 15.17 new text begin appear at the hearing, the commissioner shall take action as deemed necessary and shall new text end 15.18 new text begin issue written findings that shall be mailed to the health information exchange service new text end 15.19 new text begin provider. new text end 15.20 new text begin (c) If suspension, revocation, or an administrative penalty is proposed according new text end 15.21 new text begin to this section, the commissioner must deliver, or send by certified mail with return new text end 15.22 new text begin receipt requested, to the health information exchange service provider written notice of new text end 15.23 new text begin the commissioner's intent to impose a penalty. This notice of proposed determination new text end 15.24 new text begin must include: new text end 15.25 new text begin (1) a reference to the statutory basis for the penalty; new text end 15.26 new text begin (2) a description of the findings of fact regarding the violations with respect to new text end 15.27 new text begin which the penalty is proposed; new text end 15.28 new text begin (3) the nature and/or amount of the proposed penalty; new text end 15.29 new text begin (4) any circumstances described in subdivision 1, paragraph (a), that were considered new text end 15.30 new text begin in determining the amount of the proposed penalty; new text end 15.31 new text begin (5) instructions for responding to the notice, including a statement of the health new text end 15.32 new text begin information exchange service provider's right to a contested case proceeding and a new text end 15.33 new text begin statement that failure to request a contested case proceeding within 30 calendar days new text end 15.34 new text begin permits the imposition of the proposed penalty; and new text end 15.35 new text begin (6) the address to which the contested case proceeding request must be sent. new text end 16.1     new text begin Subd. 4. new text end new text begin Coordination. new text end new text begin (a) The commissioner shall, to the extent possible, seek new text end 16.2 new text begin the advice of the Minnesota e-Health Advisory Committee, in the review and update of new text end 16.3 new text begin criteria for the certification and recertification of health information exchange service new text end 16.4 new text begin providers when implementing sections 62J.498 to 62J.4982. new text end 16.5 new text begin (b) By January 1, 2011, the commissioner shall report to the governor and the chairs new text end 16.6 new text begin of the senate and house of representatives committees having jurisdiction over health new text end 16.7 new text begin information policy issues on the status of health information exchange in Minnesota, and new text end 16.8 new text begin provide recommendations on further action necessary to facilitate the secure electronic new text end 16.9 new text begin movement of health information among health providers that will enable Minnesota new text end 16.10 new text begin providers and hospitals to meet meaningful use exchange requirements. new text end 16.11     new text begin Subd. 5. new text end new text begin Fees and monetary penalties. new text end new text begin (a) Every health information exchange new text end 16.12 new text begin service provider subject to sections 62J.4981 and 62J.4982 shall be assessed fees as new text end 16.13 new text begin follows: new text end 16.14 new text begin (1) filing an application for certificate of authority to operate as a health information new text end 16.15 new text begin organization, $10,500; new text end 16.16 new text begin (2) filing an application for certificate of authority to operate as a health data new text end 16.17 new text begin intermediary, $7,000; new text end 16.18 new text begin (3) annual health information organization certificate fee, $14,000; new text end 16.19 new text begin (4) annual health data intermediary certificate fee, $7,000; and new text end 16.20 new text begin (5) fees for other filings, as specified by rule. new text end 16.21 new text begin (b) Administrative monetary penalties imposed under this subdivision shall be new text end 16.22 new text begin deposited into a revolving fund and are appropriated to the commissioner for the purposes new text end 16.23 new text begin of sections 62J.498 to 62J.4982. new text end 16.24    Sec. 6. new text begin APPLICATION PROCESS FOR HEALTH INFORMATION new text end 16.25 new text begin EXCHANGE. new text end 16.26 new text begin To the extent that the commissioner of health applies for additional federal funding new text end 16.27 new text begin to support the commissioner's responsibilities of developing and maintaining state level new text end 16.28 new text begin health information exchange under section 3013 of the HITECH Act, the commissioner of new text end 16.29 new text begin health shall ensure that applications are made through an open process that provides health new text end 16.30 new text begin information exchange service providers equal opportunity to receive funding. new text end 16.31    Sec. 7. new text begin APPROPRIATION; HEALTH INFORMATION EXCHANGE new text end 16.32 new text begin OVERSIGHT. new text end 16.33 new text begin $104,000 in fiscal year 2011 is appropriated from the state government special new text end 16.34 new text begin revenue fund to the commissioner of health for the duties required under sections 62J.498 new text end 17.1 new text begin to 62J.4982. Base funding shall be $97,000 in fiscal year 2012 and $97,000 in fiscal new text end 17.2 new text begin year 2013. new text end