1.1 	A bill for an act
1.2 	relating to health; amending provisions for electronic health record technology; 
1.3 	providing for administrative penalties; appropriating money;amending 
1.4 	Minnesota Statutes 2009 Supplement, sections 62J.495, subdivisions 1a, 3; 
1.5 	62J.497, subdivisions 4, 5; proposing coding for new law in Minnesota Statutes, 
1.6 	chapter 62J.
1.7 	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:

1.8 	Section 1. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a, 
1.9 	is amended to read:
1.10 		Subd. 1a.Definitions. (a) "Certified electronic health record technology" means an 
1.11 	electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH 
1.12 	Act to meet the standards and implementation specifications adopted under section 3004 
1.13 	as applicable.
1.14 	(b) "Commissioner" means the commissioner of health.
1.15 	(c) "Pharmaceutical electronic data intermediary" means any entity that provides 
1.16 	the infrastructure to connect computer systems or other electronic devices utilized 
1.17 	by prescribing practitioners with those used by pharmacies, health plans, third-party 
1.18 	administrators, and pharmacy benefit managers in order to facilitate the secure 
1.19 	transmission of electronic prescriptions, refill authorization requests, communications, 
1.20 	and other prescription-related information between such entities.
1.21 	(d) "HITECH Act" means the Health Information Technology for Economic and 
1.22 	Clinical Health Act in division A, title XIII and division B, title IV of the American 
1.23 	Recovery and Reinvestment Act of 2009, including federal regulations adopted under 
1.24 	that act.
2.1 	(e) "Interoperable electronic health record" means an electronic health record that 
2.2 	securely exchanges health information with another electronic health record system that 
2.3 	meets requirements specified in subdivision 3, and national requirements for certification 
2.4 	under the HITECH Act.
2.5 	(f) "Qualified electronic health record" means an electronic record of health-related 
2.6 	information on an individual that includes patient demographic and clinical health 
2.7 	information and has the capacity to:
2.8 	(1) provide clinical decision support;
2.9 	(2) support physician order entry;
2.10 	(3) capture and query information relevant to health care quality; and
2.11 	(4) exchange electronic health information with, and integrate such information 
2.12 	from, other sources.

2.13 	Sec. 2. Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is 
2.14 	amended to read:
2.15 		Subd. 3.Interoperable electronic health record requirements.  To meet the 
2.16 	requirements of subdivision 1, hospitals and health care providers must meet the following 
2.17 	criteria when implementing an interoperable electronic health records system within their 
2.18 	hospital system or clinical practice setting.
2.19 	(a) The electronic health record must be a qualified electronic health record.
2.20 	(b) The electronic health record must be certified by the Office of the National 
2.21 	Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and 
2.22 	health care providers only if a certified electronic health record product for the provider's 
2.23 	particular practice setting is available. This criterion shall be considered met if a hospital 
2.24 	or health care provider is using an electronic health records system that has been certified 
2.25 	within the last three years, even if a more current version of the system has been certified 
2.26 	within the three-year period.
2.27 	(c) The electronic health record must meet the standards established according to 
2.28 	section 3004 of the HITECH Act as applicable.
2.29 	(d) The electronic health record must have the ability to generate information on 
2.30 	clinical quality measures and other measures reported under sections 4101, 4102, and 
2.31 	4201 of the HITECH Act.
2.32 	(e) The electronic health record system must be connected to a state-certified 
2.33 	health information organization either directly or through a connection facilitated by a 
2.34 	state-certified health data intermediary as defined in section 62J.498.
3.1 	(e) (f) A health care provider who is a prescriber or dispenser of legend drugs must 
3.2 	have an electronic health record system that meets the requirements of section 62J.497.

3.3 	Sec. 3. Minnesota Statutes 2009 Supplement, section 62J.497, subdivision 4, is 
3.4 	amended to read:
3.5 		Subd. 4.Development and use of uniform formulary exception form. (a) The 
3.6 	commissioner of health, in consultation with the Minnesota Administrative Uniformity 
3.7 	Committee, shall develop by July 1, 2009, a uniform formulary exception form that allows 
3.8 	health care providers to request exceptions from group purchaser formularies using a 
3.9 	uniform form. Upon development of the form, all health care providers must submit 
3.10 	requests for formulary exceptions using the uniform form, and all group purchasers must 
3.11 	accept this form from health care providers.
3.12 	(b) No later than January 1, 2011, the uniform formulary exception form must be 
3.13 	accessible and submitted by health care providers, and accepted and processed by group 
3.14 	purchasers, through secure electronic transmissions. Facsimile shall not be considered 
3.15 	secure electronic transmissions.

3.16 	Sec. 4. Minnesota Statutes 2009 Supplement, section 62J.497, subdivision 5, is 
3.17 	amended to read:
3.18 		Subd. 5.Electronic drug prior authorization standardization and transmission.
 3.19 	(a) The commissioner of health, in consultation with the Minnesota e-Health Advisory 
3.20 	Committee and the Minnesota Administrative Uniformity Committee, shall, by February 
3.21 	15, 2010, identify an outline on how best to standardize drug prior authorization request 
3.22 	transactions between providers and group purchasers with the goal of maximizing 
3.23 	administrative simplification and efficiency in preparation for electronic transmissions.
3.24 	(b) By January 1, 2014, the Minnesota Administrative Uniformity Committee shall 
3.25 	develop the standard companion guide by which providers and group purchasers will 
3.26 	exchange standard drug authorization requests using electronic data interchange standards, 
3.27 	if available, with the goal of alignment with standards that are or will potentially be used 
3.28 	nationally.
3.29 	(c) No later than January 1, 2011 2015, drug prior authorization requests must be 
3.30 	accessible and submitted by health care providers, and accepted by group purchasers, 
3.31 	electronically through secure electronic transmissions. Facsimile shall not be considered 
3.32 	electronic transmission.

3.33 	Sec. 5. [62J.498] HEALTH INFORMATION EXCHANGE.
4.1 		Subdivision 1. Definitions.  The following definitions apply to sections 62J.498 to 
4.2 	62J.4982:
4.3 	(a) "Clinical transaction" means any meaningful use transaction that is not covered 
4.4 	by section 62J.536.
4.5 	(b) "Commissioner" means the commissioner of health.
4.6 	(c) "Direct health information exchange" means the electronic transmission of 
4.7 	health-related information through a direct connection between the electronic health 
4.8 	record systems of health care providers without the use of a health data intermediary.
4.9 	(d) "Health care provider" or "provider" means a health care provider or provider as 
4.10 	defined in section 62J.03, subdivision 8.
4.11 	(e) "Health data intermediary" means an entity that provides the infrastructure to 
4.12 	connect computer systems or other electronic devices used by health care providers, 
4.13 	laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit 
4.14 	managers to facilitate the secure transmission of health information, including 
4.15 	pharmaceutical electronic data intermediaries as defined in section 62J.495. This does not 
4.16 	include health care providers engaged in direct health information exchange.
4.17 	(f) "Health information exchange" means the electronic transmission of 
4.18 	health-related information between organizations according to nationally recognized 
4.19 	standards.
4.20 	(g) "Health information exchange service provider" means a health data intermediary 
4.21 	or health information organization that has been issued a certificate of authority by the 
4.22 	commissioner under section 62J.4981.
4.23 	(h) "Health information organization" means an organization that oversees, governs, 
4.24 	and facilitates the exchange of health-related information among organizations according 
4.25 	to nationally recognized standards.
4.26 	(i) "HITECH Act" means the Health Information Technology for Economic and 
4.27 	Clinical Health Act as defined in section 62J.495.
4.28 	(j) "Major participating entity" means:
4.29 	(1) a participating entity that receives compensation for services that is greater 
4.30 	than 30 percent of the health information organization's gross annual revenues from the 
4.31 	health information exchange service provider;
4.32 	(2) a participating entity providing administrative, financial, or management services 
4.33 	to the health information organization, if the total payment for all services provided by the 
4.34 	participating entity exceeds three percent of the gross revenue of the health information 
4.35 	organization; and
5.1 	(3) a participating entity that nominates or appoints 30 percent or more of the board 
5.2 	of directors of the health information organization.
5.3 	(k) "Meaningful use" means use of certified electronic health record technology that 
5.4 	includes e-prescribing, and is connected in a manner that provides for the electronic 
5.5 	exchange of health information and used for the submission of clinical quality measures 
5.6 	as established by the Center for Medicare and Medicaid Services and the Minnesota 
5.7 	Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH 
5.8 	Act.
5.9 	(l) "Meaningful use transaction" means an electronic transaction that a health care 
5.10 	provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare 
5.11 	penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
5.12 	(m) "Participating entity" means any of the following persons, health care providers, 
5.13 	companies, or other organizations with which a health information organization or health 
5.14 	data intermediary has contracts or other agreements for the provision of health information 
5.15 	exchange service providers: 
5.16 	(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home 
5.17 	licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise 
5.18 	licensed under the laws of this state or registered with the commissioner;
5.19 	(2) a health care provider, and any other health care professional otherwise licensed 
5.20 	under the laws of this state or registered with the commissioner;
5.21 	(3) a group, professional corporation, or other organization that provides the 
5.22 	services of individuals or entities identified in clause (2), including but not limited to a 
5.23 	medical clinic, a medical group, a home health care agency, an urgent care center, and 
5.24 	an emergent care center;
5.25 	(4) a health plan as defined in section 62A.011, subdivision 3; and
5.26 	(5) a state agency as defined in section 13.02, subdivision 17.
5.27 	(n) "Reciprocal agreement" means an arrangement in which two or more health 
5.28 	information exchange service providers agree to share in-kind services and resources to 
5.29 	allow for the pass-through of meaningful use transactions.
5.30 	(o) "State-certified health data intermediary" means a health data intermediary that:
5.31 	(1) provides a subset of the meaningful use transaction capabilities necessary for 
5.32 	hospitals and providers to achieve meaningful use of electronic health records;
5.33 	(2) is not exclusively engaged in the exchange of meaningful use transactions 
5.34 	covered by section 62J.536; and
5.35 	(3) has been issued a certificate of authority to operate in Minnesota.
6.1 	(p) "State-certified health information organization" means a nonprofit health 
6.2 	information organization that provides transaction capabilities necessary to fully support 
6.3 	clinical transactions required for meaningful use of electronic health records that has been 
6.4 	issued a certificate of authority to operate in Minnesota.
6.5 		Subd. 2. Health information exchange oversight.  (a) The commissioner shall 
6.6 	protect the public interest on matters pertaining to health information exchange. The 
6.7 	commissioner shall:
6.8 	(1) review and act on applications from health data intermediaries and health 
6.9 	information organizations for certificates of authority to operate in Minnesota;
6.10 	(2) provide ongoing monitoring to ensure compliance with criteria established under 
6.11 	sections 62J.498 to 62J.4982;
6.12 	(3) respond to public complaints related to health information exchange services;
6.13 	(4) take enforcement actions as necessary, including the imposition of fines, 
6.14 	suspension, or revocation of certificates of authority as outlined in section 62J.4982;
6.15 	(5) provide a biannual report on the status of health information exchange services 
6.16 	that includes but is not limited to:
6.17 	(i) recommendations on actions necessary to ensure that health information exchange 
6.18 	services are adequate to meet the needs of Minnesota citizens and providers statewide;
6.19 	(ii) recommendations on enforcement actions to ensure that health information 
6.20 	exchange service providers act in the public interest without causing disruption in health 
6.21 	information exchange services;
6.22 	(iii) recommendations on updates to criteria for obtaining certificates of authority 
6.23 	under this section; and
6.24 	(iv) recommendations on standard operating procedures for health information 
6.25 	exchange, including but not limited to the management of consumer preferences;
6.26 	(6) other duties necessary to protect the public interest.
6.27 	(b) As part of the application review process for certification under paragraph (a), 
6.28 	prior to issuing a certificate of authority, the commissioner shall:
6.29 	(1) hold public hearings that provide an adequate opportunity for participating 
6.30 	entities and consumers to provide feedback and recommendations on the application under 
6.31 	consideration. The commissioner shall make all portions of the application classified 
6.32 	as public data available to the public at least ten days in advance of the hearing. The 
6.33 	applicant shall participate in the hearing by presenting an overview of their application 
6.34 	and responding to questions from interested parties;
6.35 	(2) make available all feedback and recommendations gathered at the hearing 
6.36 	available to the public prior to issuing a certificate of authority; and
7.1 	(3) consult with hospitals, physicians, and other professionals eligible to receive 
7.2 	meaningful use incentive payments or subject to penalties as established in the HITECH 
7.3 	Act, and their respective statewide associations, prior to issuing a certificate of authority.
7.4 	(c) When the commissioner is actively considering a suspension or revocation of a 
7.5 	certificate of authority as described in section 62J.4982, subdivision 3, all investigatory 
7.6 	data that are collected, created, or maintained related to the suspension or revocation 
7.7 	are classified as confidential data on individuals and as protected nonpublic data in the 
7.8 	case of data not on individuals.
7.9 	(d) The commissioner may disclose data classified as protected nonpublic or 
7.10 	confidential under paragraph (c) if disclosing the data will protect the health or safety of 
7.11 	patients.
7.12 	(e) After the commissioner makes a final determination regarding a suspension or 
7.13 	revocation of a certificate of authority, all minutes, orders for hearing, findings of fact, 
7.14 	conclusions of law, and the specification of the final disciplinary action, are classified 
7.15 	as public data.

7.16 	Sec. 6. [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH 
7.17 	INFORMATION EXCHANGE SERVICES.
7.18 		Subdivision 1. Authority to require organizations to apply.  The commissioner 
7.19 	shall require an entity providing health information exchange services to apply for a 
7.20 	certificate of authority under this section. An applicant may continue to operate until 
7.21 	the commissioner acts on the application. If the application is denied, the applicant is 
7.22 	considered a health information organization whose certificate of authority has been 
7.23 	revoked under section 62J.4982, subdivision 2, paragraph (d).
7.24 		Subd. 2. Certificate of authority for health data intermediaries.  (a) A health 
7.25 	data intermediary that provides health information exchange services for the transmission 
7.26 	of one or more clinical transactions necessary for hospitals, providers, or eligible 
7.27 	professionals to achieve meaningful use must be registered with the state and comply with 
7.28 	requirements established in this section.
7.29 	(b) Notwithstanding any law to the contrary, any corporation organized to do so 
7.30 	may apply to the commissioner for a certificate of authority to establish and operate as 
7.31 	a health data intermediary in compliance with this section. No person shall establish or 
7.32 	operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers 
7.33 	to purchase or receive advance or periodic consideration in conjunction with a health 
7.34 	data intermediary contract unless the organization has a certificate of authority or has an 
7.35 	application under active consideration under this section.
8.1 	(c) In issuing the certificate of authority, the commissioner shall determine whether 
8.2 	the applicant for the certificate of authority has demonstrated that the applicant meets 
8.3 	the following minimum criteria:
8.4 	(1) interoperate with at least one state-certified health information organization;
8.5 	(2) provide an option for Minnesota entities to connect to their services through at 
8.6 	least one state-certified health information organization;
8.7 	(3) have a record locator service as defined in section 144.291, subdivision 2, 
8.8 	paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8, 
8.9 	when conducting meaningful use transactions; and
8.10 	(4) hold reciprocal agreements with at least one state-certified health information 
8.11 	organization to enable access to record locator services to find patient data, and for the 
8.12 	transmission and receipt of meaningful use transactions consistent with the format and 
8.13 	content required by national standards established by Centers for Medicare and Medicaid 
8.14 	Services. Reciprocal agreements must meet the requirements established in subdivision 5.
8.15 		Subd. 3. Certificate of authority for health information organizations.
 8.16 	 (a) A health information organization that provides all electronic capabilities for the 
8.17 	transmission of clinical transactions necessary for meaningful use of electronic health 
8.18 	records must obtain a certificate of authority from the commissioner and demonstrate 
8.19 	compliance with the criteria in paragraph (c).
8.20 	(b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do 
8.21 	so may apply for a certificate of authority to establish and operate a health information 
8.22 	organization under this section. No person shall establish or operate a health information 
8.23 	organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive 
8.24 	advance or periodic consideration in conjunction with a health information organization 
8.25 	or health information contract unless the organization has a certificate of authority under 
8.26 	this section.
8.27 	(c) In issuing the certificate of authority, the commissioner shall determine whether 
8.28 	the applicant for the certificate of authority has demonstrated that the applicant meets 
8.29 	the following minimum criteria:
8.30 	(1) the entity is a legally established, nonprofit organization;
8.31 	(2) appropriate insurance, including liability insurance, for the operation of the 
8.32 	health information organization is in place and sufficient to protect the interest of the 
8.33 	public and participating entities;
8.34 	(3) strategic and operational plans clearly address how the organization will expand 
8.35 	technical capacity of the health information organization to support providers in achieving 
8.36 	meaningful use of electronic health records over time;
9.1 	(4) the entity addresses the parameters to be used with participating entities and 
9.2 	other health information organizations for meaningful use transactions, compliance with 
9.3 	Minnesota law, and interstate health information exchange in trust agreements;
9.4 	(5) the entity's board of directors is comprised of members that broadly represent the 
9.5 	health information organization's participating entities and consumers;
9.6 	(6) the entity maintains a professional staff responsible to the board of directors with 
9.7 	the capacity to ensure accountability to the organization's mission;
9.8 	(7) the organization is compliant with criteria established under the Health 
9.9 	Information Exchange Accreditation Program of the Electronic Healthcare Network 
9.10 	Accreditation Commission (EHNAC) or equivalent criteria established by the 
9.11 	commissioner;
9.12 	(8) the entity maintains a record locator service as defined in section 144.291, 
9.13 	subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293, 
9.14 	subdivision 8, when conducting meaningful use transactions;
9.15 	(9) the organization demonstrates interoperability with all other state-certified health 
9.16 	information organizations using nationally recognized standards;
9.17 	(10) the organization demonstrates compliance with all privacy and security 
9.18 	requirements required by state and federal law; and
9.19 	(11) the organization uses financial policies and procedures consistent with generally 
9.20 	accepted accounting principles and has an independent audit of the organization's 
9.21 	financials on an annual basis.
9.22 	(d) Health information organizations that have obtained a certificate of authority 
9.23 	must:
9.24 	(1) meet the requirements established for connecting to the Nationwide Health 
9.25 	Information Network (NHIN) within the federally mandated timeline or within a time 
9.26 	frame established by the commissioner and published in the State Register. If the state 
9.27 	timeline for implementation varies from the federal timeline, the State Register notice 
9.28 	shall include an explanation for the variation;
9.29 	(2) annually submit strategic and operational plans for review by the commissioner 
9.30 	that address:
9.31 	(i) increasing adoption rates to include a sufficient number of participating entities to 
9.32 	achieve financial sustainability; and
9.33 	(ii) progress in achieving objectives included in previously submitted strategic 
9.34 	and operational plans across the following domains: business and technical operations, 
9.35 	technical infrastructure, legal and policy issues, finance, and organizational governance;
9.36 	(3) develop and maintain a business plan that addresses:
10.1 	(i) plans for ensuring the necessary capacity to support meaningful use transactions;
10.2 	(ii) approach for attaining financial sustainability, including public and private 
10.3 	financing strategies, and rate structures;
10.4 	(iii) rates of adoption, utilization, and transaction volume, and mechanisms to 
10.5 	support health information exchange; and
10.6 	(iv) an explanation of methods employed to address the needs of community clinics, 
10.7 	critical access hospitals, and free clinics in accessing health information exchange services;
10.8 	(4) annually submit a rate plan to the commissioner outlining fee structures for health 
10.9 	information exchange services for approval by the commissioner. The commissioner 
10.10 	shall approve the rate plan if it:
10.11 	(i) distributes costs equitably among users of health information services;
10.12 	(ii) provides predictable costs for participating entities;
10.13 	(iii) covers all costs associated with conducting the full range of meaningful use 
10.14 	clinical transactions, including access to health information retrieved through other 
10.15 	state-certified health information exchange service providers; and
10.16 	(iv) provides for a predictable revenue stream for the health information organization 
10.17 	and generates sufficient resources to maintain operating costs and develop technical 
10.18 	infrastructure necessary to serve the public interest;
10.19 	(5) enter into reciprocal agreements with all other state-certified health information 
10.20 	organizations to enable access to record locator services to find patient data, and 
10.21 	transmission and receipt of meaningful use transactions consistent with the format and 
10.22 	content required by national standards established by Centers for Medicare and Medicaid 
10.23 	Services. Reciprocal agreements must meet the requirements in subdivision 5; and
10.24 	(6) comply with additional requirements for the certification or recertification of 
10.25 	health information organizations that may be established by the commissioner. 
10.26 		Subd. 4. Application for certificate of authority for health information exchange 
10.27 	service providers. (a) Each application for a certificate of authority shall be in a form 
10.28 	prescribed by the commissioner and verified by an officer or authorized representative of 
10.29 	the applicant. Each application shall include the following:
10.30 	(1) a copy of the basic organizational document, if any, of the applicant and of 
10.31 	each major participating entity, such as the articles of incorporation, or other applicable 
10.32 	documents, and all amendments to it;
10.33 	(2) a list of the names, addresses, and official positions of the following:
10.34 	(i) all members of the board of directors, and the principal officers and, if applicable, 
10.35 	shareholders of the applicant organization; and
11.1 	(ii) all members of the board of directors, and the principal officers of each major 
11.2 	participating entity and, if applicable, each shareholder beneficially owning more than ten 
11.3 	percent of any voting stock of the major participating entity;
11.4 	(3) the name and address of each participating entity and the agreed-upon duration 
11.5 	of each contract or agreement if applicable;
11.6 	(4) a copy of each standard agreement or contract intended to bind the participating 
11.7 	entities and the health information organization. Contractual provisions shall be consistent 
11.8 	with the purposes of this section, in regard to the services to be performed under the 
11.9 	standard agreement or contract, the manner in which payment for services is determined, 
11.10 	the nature and extent of responsibilities to be retained by the health information 
11.11 	organization, and contractual termination provisions;
11.12 	(5) a copy of each contract intended to bind major participating entities and the 
11.13 	health information organization. Contract information filed with the commissioner under 
11.14 	this section shall be nonpublic as defined in section 13.02, subdivision 9;
11.15 	(6) a statement generally describing the health information organization, its health 
11.16 	information exchange contracts, facilities, and personnel, including a statement describing 
11.17 	the manner in which the applicant proposes to provide participants with comprehensive 
11.18 	health information exchange services;
11.19 	(7) financial statements showing the applicant's assets, liabilities, and sources 
11.20 	of financial support, including a copy of the applicant's most recent certified financial 
11.21 	statement;
11.22 	(8) strategic and operational plans that specifically address how the organization 
11.23 	will expand technical capacity of the health information organization to support providers 
11.24 	in achieving meaningful use of electronic health records over time, a description of 
11.25 	the proposed method of marketing the services, a schedule of proposed charges, and a 
11.26 	financial plan that includes a three-year projection of the expenses and income and other 
11.27 	sources of future capital;
11.28 	(9) a statement reasonably describing the geographic area or areas to be served and 
11.29 	the type or types of participants to be served;
11.30 	(10) a description of the complaint procedures to be used as required under this 
11.31 	section;
11.32 	(11) a description of the mechanism by which participating entities will have an 
11.33 	opportunity to participate in matters of policy and operation;
11.34 	(12) a copy of any pertinent agreements between the health information organization 
11.35 	and insurers, including liability insurers, demonstrating coverage is in place;
12.1 	(13) a copy of the conflict of interest policy that applies to all members of the board 
12.2 	of directors and the principal officers of the health information organization; and
12.3 	(14) other information as the commissioner may reasonably require to be provided.
12.4 	(b) Thirty days after the receipt of the application for a certificate of authority, 
12.5 	the commissioner shall determine whether or not the application submitted meets the 
12.6 	requirements for completion in paragraph (a), and notify the applicant of any further 
12.7 	information required for the application to be processed.
12.8 	(c) Ninety days after the receipt of a complete application for a certificate of 
12.9 	authority, the commissioner shall issue a certificate of authority to the applicant if the 
12.10 	commissioner determines that the applicant meets the minimum criteria requirements 
12.11 	of subdivision 2 for health data intermediaries or subdivision 3 for health information 
12.12 	organizations. If the commissioner determines that the applicant is not qualified, the 
12.13 	commissioner shall notify the applicant and specify the reasons for disqualification.
12.14 	(d) Upon being granted a certificate of authority to operate as a health information 
12.15 	organization, the organization must operate in compliance with the provisions of this 
12.16 	section. Noncompliance may result in the imposition of a fine or the suspension or 
12.17 	revocation of the certificate of authority according to section 62J.4982.
12.18 		Subd. 5. Reciprocal agreements between health information exchange entities.
 12.19 	(a) Reciprocal agreements between two health information organizations or between a 
12.20 	health information organization and a health data intermediary must include a fair and 
12.21 	equitable model for charges between the entities that:
12.22 	(1) does not impede the secure transmission of transactions necessary to achieve 
12.23 	meaningful use;
12.24 	(2) does not charge a fee for the exchange of meaningful use transactions transmitted 
12.25 	according to nationally recognized standards where no additional value-added service 
12.26 	is rendered to the sending or receiving health information organization or health data 
12.27 	intermediary either directly or on behalf of the client;
12.28 	(3) is consistent with fair market value and proportionately reflects the value-added 
12.29 	services accessed as a result of the agreement; and
12.30 	(4) prevents health care stakeholders from being charged multiple times for the 
12.31 	same service.
12.32 	(b) Reciprocal agreements must include comparable quality of service standards that 
12.33 	ensure equitable levels of services.
12.34 	(c) Reciprocal agreements are subject to review and approval by the commissioner.
13.1 	(d) Nothing in this section precludes a state-certified health information organization 
13.2 	or state-certified health data intermediary from entering into contractual agreements for 
13.3 	the provision of value-added services beyond meaningful use. 

13.4 	Sec. 7. [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE.
13.5 		Subdivision 1. Penalties and enforcement.  (a) The commissioner may, for any 
13.6 	violation of statute or rule applicable to a health information exchange service provider, 
13.7 	levy an administrative penalty in an amount up to $25,000 for each violation. In 
13.8 	determining the level of an administrative penalty, the commissioner shall consider the 
13.9 	following factors:
13.10 	(1) the number of participating entities affected by the violation;
13.11 	(2) the effect of the violation on participating entities' access to health information 
13.12 	exchange services;
13.13 	(3) if only one participating entity is affected, the effect of the violation on the 
13.14 	patients of that entity;
13.15 	(4) whether the violation is an isolated incident or part of a pattern of violations;
13.16 	(5) the economic benefits derived by the health information organization or a health 
13.17 	data intermediary by virtue of the violation;
13.18 	(6) whether the violation hindered or facilitated an individual's ability to obtain 
13.19 	health care;
13.20 	(7) whether the violation was intentional;
13.21 	(8) whether the violation was beyond the direct control of the health information 
13.22 	exchange service provider;
13.23 	(9) any history of prior compliance with the provisions of this section, including 
13.24 	violations;
13.25 	(10) whether and to what extent the health information exchange service provider 
13.26 	attempted to correct previous violations;
13.27 	(11) how the health information exchange service provider responded to technical 
13.28 	assistance from the commissioner provided in the context of a compliance effort; and
13.29 	(12) the financial condition of the health information exchange service provider 
13.30 	including, but not limited to, whether the health information exchange service provider 
13.31 	had financial difficulties that affected its ability to comply or whether the imposition of an 
13.32 	administrative monetary penalty would jeopardize the ability of the health information 
13.33 	exchange service provider to continue to deliver health information exchange services.
13.34 	Reasonable notice in writing to the health information exchange service provider 
13.35 	shall be given of the intent to levy the penalty and the reasons for them. A health 
14.1 	information exchange service provider may have 15 days within which to contest whether 
14.2 	the finding of facts constitute a violation of sections 62J.4981 and 62J.4982, according to 
14.3 	the contested case and judicial review provisions of sections 14.57 to 14.69.
14.4 	(b) If the commissioner has reason to believe that a violation of section 62J.4981 or 
14.5 	62J.4982 has occurred or is likely, the commissioner may confer with the persons involved 
14.6 	before commencing action under subdivision 2. The commissioner may notify the health 
14.7 	information exchange service provider and the representatives, or other persons who 
14.8 	appear to be involved in the suspected violation, to arrange a voluntary conference with 
14.9 	the alleged violators or their authorized representatives. The purpose of the conference is 
14.10 	to attempt to learn the facts about the suspected violation and, if it appears that a violation 
14.11 	has occurred or is threatened, to find a way to correct or prevent it. The conference is 
14.12 	not governed by any formal procedural requirements, and may be conducted as the 
14.13 	commissioner considers appropriate.
14.14 	(c) The commissioner may issue an order directing a health information exchange 
14.15 	service provider or a representative of a health information exchange service provider to 
14.16 	cease and desist from engaging in any act or practice in violation of sections 62J.4981 
14.17 	and 62J.4982.
14.18 	(d) Within 20 days after service of the order to cease and desist, a health information 
14.19 	exchange service provider may contest whether the finding of facts constitutes a violation 
14.20 	of sections 62J.4981 and 62J.4982 according to the contested case and judicial review 
14.21 	provisions of sections 14.57 to 14.69.
14.22 	(e) In the event of noncompliance with a cease and desist order issued under this 
14.23 	subdivision, the commissioner may institute a proceeding to obtain injunctive relief or 
14.24 	other appropriate relief in Ramsey County District Court.
14.25 		Subd. 2. Suspension or revocation of certificates of authority. (a) The 
14.26 	commissioner may suspend or revoke a certificate of authority issued to a health 
14.27 	data intermediary or health information organization under section 62J.4981 if the 
14.28 	commissioner finds that:
14.29 	(1) the health information exchange service provider is operating significantly 
14.30 	in contravention of its basic organizational document, or in a manner contrary to that 
14.31 	described in and reasonably inferred from any other information submitted under section 
14.32 	62J.4981, unless amendments to the submissions have been filed with and approved by 
14.33 	the commissioner;
14.34 	(2) the health information exchange service provider is unable to fulfill its 
14.35 	obligations to furnish comprehensive health information exchange services as required 
14.36 	under its health information exchange contract;
15.1 	(3) the health information exchange service provider is no longer financially solvent 
15.2 	or may not reasonably be expected to meet its obligations to participating entities;
15.3 	(4) the health information exchange service provider has failed to implement the 
15.4 	complaint system in a manner designed to reasonably resolve valid complaints;
15.5 	(5) the health information exchange service provider, or any person acting with its 
15.6 	sanction, has advertised or merchandised its services in an untrue, misleading, deceptive, 
15.7 	or unfair manner;
15.8 	(6) the continued operation of the health information exchange service provider 
15.9 	would be hazardous to its participating entities or the patients served by the participating 
15.10 	entities; or
15.11 	(7) the health information exchange service provider has otherwise failed to 
15.12 	substantially comply with section 62J.4981 or with any other statute or administrative 
15.13 	rule applicable to health information exchange service providers, or has submitted false 
15.14 	information in any report required under sections 62J.498 to 62J.4982.
15.15 	(b) A certificate of authority shall be suspended or revoked only after meeting the 
15.16 	requirements of subdivision 3.
15.17 	(c) If the certificate of authority of a health information exchange service provider is 
15.18 	suspended, the health information exchange service provider shall not, during the period 
15.19 	of suspension, enroll any additional participating entities, and shall not engage in any 
15.20 	advertising or solicitation.
15.21 	(d) If the certificate of authority of a health information exchange service provider is 
15.22 	revoked, the organization shall proceed, immediately following the effective date of the 
15.23 	order of revocation, to wind up its affairs, and shall conduct no further business except as 
15.24 	necessary to the orderly conclusion of the affairs of the organization. The organization 
15.25 	shall engage in no further advertising or solicitation. The commissioner may, by written 
15.26 	order, permit further operation of the organization as the commissioner finds to be in the 
15.27 	best interest of participating entities, to the end that participating entities will be given the 
15.28 	greatest practical opportunity to access continuing health information exchange services.
15.29 		Subd. 3. Denial, suspension, and revocation; administrative procedures.  (a) 
15.30 	When the commissioner has cause to believe that grounds for the denial, suspension, 
15.31 	or revocation of a certificate of authority exists, the commissioner shall notify the 
15.32 	health information exchange service provider in writing stating the grounds for denial, 
15.33 	suspension, or revocation and setting a time within 20 days for a hearing on the matter.
15.34 	(b) After a hearing before the commissioner at which the health information 
15.35 	exchange service provider may respond to the grounds for denial, suspension, or 
15.36 	revocation, or upon the failure of the health information exchange service provider to 
16.1 	appear at the hearing, the commissioner shall take action as deemed necessary and shall 
16.2 	issue written findings that shall be mailed to the health information exchange service 
16.3 	provider.
16.4 	(c) If suspension, revocation, or administrative penalty is proposed according 
16.5 	to this section, the commissioner must deliver, or send by certified mail with return 
16.6 	receipt requested, to the health information exchange service provider written notice of 
16.7 	the commissioner's intent to impose a penalty. This notice of proposed determination 
16.8 	must include:
16.9 	(1) a reference to the statutory basis for the penalty;
16.10 	(2) a description of the findings of fact regarding the violations with respect to 
16.11 	which the penalty is proposed;
16.12 	(3) the nature and/or amount of the proposed penalty;
16.13 	(4) any circumstances described in subdivision 1, paragraph (a), that were considered 
16.14 	in determining the amount of the proposed penalty;
16.15 	(5) instructions for responding to the notice, including a statement of the health 
16.16 	information exchange service provider's right to a contested case proceeding and a 
16.17 	statement that failure to request a contested case proceeding within 30 calendar days 
16.18 	permits the imposition of the proposed penalty; and
16.19 	(6) the address to which the contested case proceeding request must be sent.
16.20 		Subd. 4. Coordination. (a) The commissioner shall, to the extent possible, seek 
16.21 	the advice of the Minnesota e-Health Advisory Committee, in the review and update of 
16.22 	criteria for the certification and recertification of health information exchange service 
16.23 	providers when implementing sections 62J.498 to 62J.4982.
16.24 	(b) By January 1, 2011, the commissioner shall report to the governor and the chairs 
16.25 	of the senate and house of representatives committees having jurisdiction over health 
16.26 	information policy issues on the status of health information exchange in Minnesota, and 
16.27 	provide recommendations on further action necessary to facilitate the secure electronic 
16.28 	movement of health information among health providers that will enable Minnesota 
16.29 	providers and hospitals to meet meaningful use exchange requirements.
16.30 		Subd. 5. Fees and monetary penalties.  (a) Every health information exchange 
16.31 	service provider subject to sections 62J.4981 and 62J.4982 shall be assessed fees as 
16.32 	follows:
16.33 	(1) filing an application for certificate of authority to operate as a health information 
16.34 	organization, $15,000;
16.35 	(2) filing an application for certificate of authority to operate as a health data 
16.36 	intermediary, $10,000;
17.1 	(3) annual health information organization certificate fee, $20,000;
17.2 	(4) annual health data intermediary certificate fee, $10,000; and
17.3 	(5) fees for other filings, as specified by rule.
17.4 	(b) Administrative monetary penalties imposed under this subdivision shall be 
17.5 	deposited into a revolving fund and are appropriated to the commissioner for the purposes 
17.6 	of sections 62J.498 to 62J.4982.

17.7 	Sec. 8. APPROPRIATION; HEALTH INFORMATION EXCHANGE 
17.8 	OVERSIGHT.
 17.9 	$140,000 in fiscal year 2011 is appropriated from the state government special 
17.10 	revenue fund to the commissioner of health for the duties required under Minnesota 
17.11 	Statutes, sections 62J.498 to 62J.4982. Base funding shall be $135,000 in fiscal year 2012 
17.12 	and $130,000 in fiscal year 2013.