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SF 2974

4th Engrossment - 86th Legislature (2009 - 2010) Posted on 05/11/2010 07:56am

KEY: stricken = removed, old language.
underscored = added, new language.

Current Version - 4th Engrossment

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A bill for an act
relating to health; amending provisions for electronic health record technology;
providing for administrative penalties; defining significant disruption to
normal operations; appropriating money; amending Minnesota Statutes 2009
Supplement, sections 62J.495, subdivisions 1a, 3, by adding a subdivision;
62J.497, subdivisions 4, 5; proposing coding for new law in Minnesota Statutes,
chapter 62J.

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

Section 1.

Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 1a,
is amended to read:


Subd. 1a.

Definitions.

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

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

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

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

(e) "Interoperable electronic health record" means an electronic health record that
securely exchanges health information with another electronic health record system that
meetsnew text begin requirements specified in subdivision 3, andnew text end national requirements for certification
under the HITECH Act.

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

(1) provide clinical decision support;

(2) support physician order entry;

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

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

Sec. 2.

Minnesota Statutes 2009 Supplement, section 62J.495, subdivision 3, is
amended to read:


Subd. 3.

Interoperable electronic health record requirements.

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

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

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

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

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

new text begin (e) The electronic health record system must be connected to a state-certified
health information organization either directly or through a connection facilitated by a
state-certified health data intermediary as defined in section 62J.498.
new text end

deleted text begin (e)deleted text endnew text begin (f)new text end A health care provider who is a prescriber or dispenser of legend drugs must
have an electronic health record system that meets the requirements of section 62J.497.

Sec. 3.

Minnesota Statutes 2009 Supplement, section 62J.495, is amended by adding a
subdivision to read:


new text begin Subd. 6. new text end

new text begin State agency information system. new text end

new text begin Development of state agency
information systems necessary to implement this section is subject to the authority of the
Office of Enterprise Technology in chapter 16E, including, but not limited to:
new text end

new text begin (1) evaluation and approval of the system as specified in section 16E.03, subdivisions
3 and 4;
new text end

new text begin (2) review of the system to ensure compliance with security policies, guidelines, and
standards as specified in section 16E.03, subdivision 7; and
new text end

new text begin (3) assurance that the system complies with accessibility standards developed under
section 16E.03, subdivision 9.
new text end

Sec. 4.

Minnesota Statutes 2009 Supplement, section 62J.497, subdivision 4, is
amended to read:


Subd. 4.

Development and use of uniform formulary exception form.

(a) The
commissioner of health, in consultation with the Minnesota Administrative Uniformity
Committee, shall develop by July 1, 2009, a uniform formulary exception form that allows
health care providers to request exceptions from group purchaser formularies using a
uniform form. Upon development of the form, all health care providers must submit
requests for formulary exceptions using the uniform form, and all group purchasers must
accept this form from health care providers.

(b) No later than January 1, 2011, the uniform formulary exception form must be
accessible and submitted by health care providers, and accepted and processed by group
purchasers, through secure electronic transmissions. deleted text beginFacsimile shall not be considered
secure electronic transmissions.
deleted text end

Sec. 5.

Minnesota Statutes 2009 Supplement, section 62J.497, subdivision 5, is
amended to read:


Subd. 5.

Electronic drug prior authorization standardization and transmission.

(a) The commissioner of health, in consultation with the Minnesota e-Health Advisory
Committee and the Minnesota Administrative Uniformity Committee, shall, by February
15, 2010, identify an outline on how best to standardize drug prior authorization request
transactions between providers and group purchasers with the goal of maximizing
administrative simplification and efficiency in preparation for electronic transmissions.

(b) new text beginBy January 1, 2014, the Minnesota Administrative Uniformity Committee shall
develop the standard companion guide by which providers and group purchasers will
exchange standard drug authorization requests using electronic data interchange standards,
if available, with the goal of alignment with standards that are or will potentially be used
nationally.
new text end

new text begin (c) new text endNo later than January 1, deleted text begin2011deleted text endnew text begin 2015new text end, drug prior authorization requests must be
accessible and submitted by health care providers, and accepted by group purchasers,
electronically through secure electronic transmissions. Facsimile shall not be considered
electronic transmission.

Sec. 6.

new text begin [62J.498] HEALTH INFORMATION EXCHANGE.
new text end

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
62J.4982:
new text end

new text begin (a) "Clinical transaction" means any meaningful use transaction that is not covered
by section 62J.536.
new text end

new text begin (b) "Commissioner" means the commissioner of health.
new text end

new text begin (c) "Direct health information exchange" means the electronic transmission of
health-related information through a direct connection between the electronic health
record systems of health care providers without the use of a health data intermediary.
new text end

new text begin (d) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.
new text end

new text begin (e) "Health data intermediary" means an entity that provides the infrastructure to
connect computer systems or other electronic devices used by health care providers,
laboratories, pharmacies, health plans, third-party administrators, or pharmacy benefit
managers to facilitate the secure transmission of health information, including
pharmaceutical electronic data intermediaries as defined in section 62J.495. This does not
include health care providers engaged in direct health information exchange.
new text end

new text begin (f) "Health information exchange" means the electronic transmission of
health-related information between organizations according to nationally recognized
standards.
new text end

new text begin (g) "Health information exchange service provider" means a health data intermediary
or health information organization that has been issued a certificate of authority by the
commissioner under section 62J.4981.
new text end

new text begin (h) "Health information organization" means an organization that oversees, governs,
and facilitates the exchange of health-related information among organizations according
to nationally recognized standards.
new text end

new text begin (i) "HITECH Act" means the Health Information Technology for Economic and
Clinical Health Act as defined in section 62J.495.
new text end

new text begin (j) "Major participating entity" means:
new text end

new text begin (1) a participating entity that receives compensation for services that is greater
than 30 percent of the health information organization's gross annual revenues from the
health information exchange service provider;
new text end

new text begin (2) a participating entity providing administrative, financial, or management services
to the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and
new text end

new text begin (3) a participating entity that nominates or appoints 30 percent or more of the board
of directors of the health information organization.
new text end

new text begin (k) "Meaningful use" means use of certified electronic health record technology that
includes e-prescribing, and is connected in a manner that provides for the electronic
exchange of health information and used for the submission of clinical quality measures
as established by the Center for Medicare and Medicaid Services and the Minnesota
Department of Human Services pursuant to sections 4101, 4102, and 4201 of the HITECH
Act.
new text end

new text begin (l) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
new text end

new text begin (m) "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization or health
data intermediary has contracts or other agreements for the provision of health information
exchange service providers:
new text end

new text begin (1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;
new text end

new text begin (2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;
new text end

new text begin (3) a group, professional corporation, or other organization that provides the
services of individuals or entities identified in clause (2), including but not limited to a
medical clinic, a medical group, a home health care agency, an urgent care center, and
an emergent care center;
new text end

new text begin (4) a health plan as defined in section 62A.011, subdivision 3; and
new text end

new text begin (5) a state agency as defined in section 13.02, subdivision 17.
new text end

new text begin (n) "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of meaningful use transactions.
new text end

new text begin (o) "State-certified health data intermediary" means a health data intermediary that:
new text end

new text begin (1) provides a subset of the meaningful use transaction capabilities necessary for
hospitals and providers to achieve meaningful use of electronic health records;
new text end

new text begin (2) is not exclusively engaged in the exchange of meaningful use transactions
covered by section 62J.536; and
new text end

new text begin (3) has been issued a certificate of authority to operate in Minnesota.
new text end

new text begin (p) "State-certified health information organization" means a nonprofit health
information organization that provides transaction capabilities necessary to fully support
clinical transactions required for meaningful use of electronic health records that has been
issued a certificate of authority to operate in Minnesota.
new text end

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
protect the public interest on matters pertaining to health information exchange. The
commissioner shall:
new text end

new text begin (1) review and act on applications from health data intermediaries and health
information organizations for certificates of authority to operate in Minnesota;
new text end

new text begin (2) provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;
new text end

new text begin (3) respond to public complaints related to health information exchange services;
new text end

new text begin (4) take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;
new text end

new text begin (5) provide a biennial report on the status of health information exchange services
that includes but is not limited to:
new text end

new text begin (i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;
new text end

new text begin (ii) recommendations on enforcement actions to ensure that health information
exchange service providers act in the public interest without causing disruption in health
information exchange services;
new text end

new text begin (iii) recommendations on updates to criteria for obtaining certificates of authority
under this section; and
new text end

new text begin (iv) recommendations on standard operating procedures for health information
exchange, including but not limited to the management of consumer preferences;
new text end

new text begin (6) other duties necessary to protect the public interest.
new text end

new text begin (b) As part of the application review process for certification under paragraph (a),
prior to issuing a certificate of authority, the commissioner shall:
new text end

new text begin (1) hold public hearings that provide an adequate opportunity for participating
entities and consumers to provide feedback and recommendations on the application under
consideration. The commissioner shall make all portions of the application classified
as public data available to the public at least ten days in advance of the hearing. The
applicant shall participate in the hearing by presenting an overview of their application
and responding to questions from interested parties;
new text end

new text begin (2) make available all feedback and recommendations gathered at the hearing
available to the public prior to issuing a certificate of authority; and
new text end

new text begin (3) consult with hospitals, physicians, and other professionals eligible to receive
meaningful use incentive payments or subject to penalties as established in the HITECH
Act, and their respective statewide associations, prior to issuing a certificate of authority.
new text end

new text begin (c) When the commissioner is actively considering a suspension or revocation of a
certificate of authority as described in section 62J.4982, subdivision 3, all investigatory
data that are collected, created, or maintained related to the suspension or revocation
are classified as confidential data on individuals and as protected nonpublic data in the
case of data not on individuals.
new text end

new text begin (d) The commissioner may disclose data classified as protected nonpublic or
confidential under paragraph (c) if disclosing the data will protect the health or safety of
patients.
new text end

new text begin (e) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified
as public data.
new text end

Sec. 7.

new text begin [62J.4981] CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.
new text end

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
shall require an entity providing health information exchange services to apply for a
certificate of authority under this section. An applicant may continue to operate until
the commissioner acts on the application. If the application is denied, the applicant is
considered a health information organization whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).
new text end

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
data intermediary that provides health information exchange services for the transmission
of one or more clinical transactions necessary for hospitals, providers, or eligible
professionals to achieve meaningful use must be registered with the state and comply with
requirements established in this section.
new text end

new text begin (b) Notwithstanding any law to the contrary, any corporation organized to do so
may apply to the commissioner for a certificate of authority to establish and operate as
a health data intermediary in compliance with this section. No person shall establish or
operate a health data intermediary in this state, nor sell or offer to sell, or solicit offers
to purchase or receive advance or periodic consideration in conjunction with a health
data intermediary contract unless the organization has a certificate of authority or has an
application under active consideration under this section.
new text end

new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether
the applicant for the certificate of authority has demonstrated that the applicant meets
the following minimum criteria:
new text end

new text begin (1) interoperate with at least one state-certified health information organization;
new text end

new text begin (2) provide an option for Minnesota entities to connect to their services through at
least one state-certified health information organization;
new text end

new text begin (3) have a record locator service as defined in section 144.291, subdivision 2,
paragraph (i), that is compliant with the requirements of section 144.293, subdivision 8,
when conducting meaningful use transactions; and
new text end

new text begin (4) hold reciprocal agreements with at least one state-certified health information
organization to enable access to record locator services to find patient data, and for the
transmission and receipt of meaningful use transactions consistent with the format and
content required by national standards established by Centers for Medicare and Medicaid
Services. Reciprocal agreements must meet the requirements established in subdivision 5.
new text end

new text begin Subd. 3. new text end

new text begin Certificate of authority for health information organizations.
new text end

new text begin (a) A health information organization that provides all electronic capabilities for the
transmission of clinical transactions necessary for meaningful use of electronic health
records must obtain a certificate of authority from the commissioner and demonstrate
compliance with the criteria in paragraph (c).
new text end

new text begin (b) Notwithstanding any law to the contrary, a nonprofit corporation organized to do
so may apply for a certificate of authority to establish and operate a health information
organization under this section. No person shall establish or operate a health information
organization in this state, nor sell or offer to sell, or solicit offers to purchase or receive
advance or periodic consideration in conjunction with a health information organization
or health information contract unless the organization has a certificate of authority under
this section.
new text end

new text begin (c) In issuing the certificate of authority, the commissioner shall determine whether
the applicant for the certificate of authority has demonstrated that the applicant meets
the following minimum criteria:
new text end

new text begin (1) the entity is a legally established, nonprofit organization;
new text end

new text begin (2) appropriate insurance, including liability insurance, for the operation of the
health information organization is in place and sufficient to protect the interest of the
public and participating entities;
new text end

new text begin (3) strategic and operational plans clearly address how the organization will expand
technical capacity of the health information organization to support providers in achieving
meaningful use of electronic health records over time;
new text end

new text begin (4) the entity addresses the parameters to be used with participating entities and
other health information organizations for meaningful use transactions, compliance with
Minnesota law, and interstate health information exchange in trust agreements;
new text end

new text begin (5) the entity's board of directors is composed of members that broadly represent the
health information organization's participating entities and consumers;
new text end

new text begin (6) the entity maintains a professional staff responsible to the board of directors with
the capacity to ensure accountability to the organization's mission;
new text end

new text begin (7) the organization is compliant with criteria established under the Health
Information Exchange Accreditation Program of the Electronic Healthcare Network
Accreditation Commission (EHNAC) or equivalent criteria established by the
commissioner;
new text end

new text begin (8) the entity maintains a record locator service as defined in section 144.291,
subdivision 2, paragraph (i), that is compliant with the requirements of section 144.293,
subdivision 8, when conducting meaningful use transactions;
new text end

new text begin (9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;
new text end

new text begin (10) the organization demonstrates compliance with all privacy and security
requirements required by state and federal law; and
new text end

new text begin (11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's
financials on an annual basis.
new text end

new text begin (d) Health information organizations that have obtained a certificate of authority
must:
new text end

new text begin (1) meet the requirements established for connecting to the Nationwide Health
Information Network (NHIN) within the federally mandated timeline or within a time
frame established by the commissioner and published in the State Register. If the state
timeline for implementation varies from the federal timeline, the State Register notice
shall include an explanation for the variation;
new text end

new text begin (2) annually submit strategic and operational plans for review by the commissioner
that address:
new text end

new text begin (i) increasing adoption rates to include a sufficient number of participating entities to
achieve financial sustainability; and
new text end

new text begin (ii) progress in achieving objectives included in previously submitted strategic
and operational plans across the following domains: business and technical operations,
technical infrastructure, legal and policy issues, finance, and organizational governance;
new text end

new text begin (3) develop and maintain a business plan that addresses:
new text end

new text begin (i) plans for ensuring the necessary capacity to support meaningful use transactions;
new text end

new text begin (ii) approach for attaining financial sustainability, including public and private
financing strategies, and rate structures;
new text end

new text begin (iii) rates of adoption, utilization, and transaction volume, and mechanisms to
support health information exchange; and
new text end

new text begin (iv) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;
new text end

new text begin (4) annually submit a rate plan to the commissioner outlining fee structures for health
information exchange services for approval by the commissioner. The commissioner
shall approve the rate plan if it:
new text end

new text begin (i) distributes costs equitably among users of health information services;
new text end

new text begin (ii) provides predictable costs for participating entities;
new text end

new text begin (iii) covers all costs associated with conducting the full range of meaningful use
clinical transactions, including access to health information retrieved through other
state-certified health information exchange service providers; and
new text end

new text begin (iv) provides for a predictable revenue stream for the health information organization
and generates sufficient resources to maintain operating costs and develop technical
infrastructure necessary to serve the public interest;
new text end

new text begin (5) enter into reciprocal agreements with all other state-certified health information
organizations to enable access to record locator services to find patient data, and
transmission and receipt of meaningful use transactions consistent with the format and
content required by national standards established by Centers for Medicare and Medicaid
Services. Reciprocal agreements must meet the requirements in subdivision 5; and
new text end

new text begin (6) comply with additional requirements for the certification or recertification of
health information organizations that may be established by the commissioner.
new text end

new text begin Subd. 4. new text end

new text begin Application for certificate of authority for health information exchange
service providers.
new text end

new text begin (a) Each application for a certificate of authority shall be in a form
prescribed by the commissioner and verified by an officer or authorized representative of
the applicant. Each application shall include the following:
new text end

new text begin (1) a copy of the basic organizational document, if any, of the applicant and of
each major participating entity, such as the articles of incorporation, or other applicable
documents, and all amendments to it;
new text end

new text begin (2) a list of the names, addresses, and official positions of the following:
new text end

new text begin (i) all members of the board of directors, and the principal officers and, if applicable,
shareholders of the applicant organization; and
new text end

new text begin (ii) all members of the board of directors, and the principal officers of each major
participating entity and, if applicable, each shareholder beneficially owning more than ten
percent of any voting stock of the major participating entity;
new text end

new text begin (3) the name and address of each participating entity and the agreed-upon duration
of each contract or agreement if applicable;
new text end

new text begin (4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information organization. Contractual provisions shall be consistent
with the purposes of this section, in regard to the services to be performed under the
standard agreement or contract, the manner in which payment for services is determined,
the nature and extent of responsibilities to be retained by the health information
organization, and contractual termination provisions;
new text end

new text begin (5) a copy of each contract intended to bind major participating entities and the
health information organization. Contract information filed with the commissioner under
this section shall be nonpublic as defined in section 13.02, subdivision 9;
new text end

new text begin (6) a statement generally describing the health information organization, its health
information exchange contracts, facilities, and personnel, including a statement describing
the manner in which the applicant proposes to provide participants with comprehensive
health information exchange services;
new text end

new text begin (7) financial statements showing the applicant's assets, liabilities, and sources
of financial support, including a copy of the applicant's most recent certified financial
statement;
new text end

new text begin (8) strategic and operational plans that specifically address how the organization
will expand technical capacity of the health information organization to support providers
in achieving meaningful use of electronic health records over time, a description of
the proposed method of marketing the services, a schedule of proposed charges, and a
financial plan that includes a three-year projection of the expenses and income and other
sources of future capital;
new text end

new text begin (9) a statement reasonably describing the geographic area or areas to be served and
the type or types of participants to be served;
new text end

new text begin (10) a description of the complaint procedures to be used as required under this
section;
new text end

new text begin (11) a description of the mechanism by which participating entities will have an
opportunity to participate in matters of policy and operation;
new text end

new text begin (12) a copy of any pertinent agreements between the health information organization
and insurers, including liability insurers, demonstrating coverage is in place;
new text end

new text begin (13) a copy of the conflict of interest policy that applies to all members of the board
of directors and the principal officers of the health information organization; and
new text end

new text begin (14) other information as the commissioner may reasonably require to be provided.
new text end

new text begin (b) Within 30 days after the receipt of the application for a certificate of authority,
the commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.
new text end

new text begin (c) Within 90 days after the receipt of a complete application for a certificate of
authority, the commissioner shall issue a certificate of authority to the applicant if the
commissioner determines that the applicant meets the minimum criteria requirements
of subdivision 2 for health data intermediaries or subdivision 3 for health information
organizations. If the commissioner determines that the applicant is not qualified, the
commissioner shall notify the applicant and specify the reasons for disqualification.
new text end

new text begin (d) Upon being granted a certificate of authority to operate as a health information
organization, the organization must operate in compliance with the provisions of this
section. Noncompliance may result in the imposition of a fine or the suspension or
revocation of the certificate of authority according to section 62J.4982.
new text end

new text begin Subd. 5. new text end

new text begin Reciprocal agreements between health information exchange entities.
new text end

new text begin (a) Reciprocal agreements between two health information organizations or between a
health information organization and a health data intermediary must include a fair and
equitable model for charges between the entities that:
new text end

new text begin (1) does not impede the secure transmission of transactions necessary to achieve
meaningful use;
new text end

new text begin (2) does not charge a fee for the exchange of meaningful use transactions transmitted
according to nationally recognized standards where no additional value-added service
is rendered to the sending or receiving health information organization or health data
intermediary either directly or on behalf of the client;
new text end

new text begin (3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and
new text end

new text begin (4) prevents health care stakeholders from being charged multiple times for the
same service.
new text end

new text begin (b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.
new text end

new text begin (c) Reciprocal agreements are subject to review and approval by the commissioner.
new text end

new text begin (d) Nothing in this section precludes a state-certified health information organization
or state-certified health data intermediary from entering into contractual agreements for
the provision of value-added services beyond meaningful use.
new text end

new text begin (e) The commissioner of human services or health, when providing access to data or
services through a certified health information organization, must offer the same data or
services directly through any certified health information organization at the same pricing,
if the health information organization pays for all connection costs to the state data or
service. For all external connectivity to the respective agencies through existing or future
information exchange implementations, the respective agency shall establish the required
connectivity methods as well as protocol standards to be utilized.
new text end

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 that
connects to a health information exchange service provider for the purpose of exchanging
meaningful use transactions must ensure that the contracted health information exchange
service provider has reciprocal agreements in place as required by this section. The
reciprocal agreements must provide equal access to information supplied by the agency as
necessary for meaningful use by the participating entities of the other health information
service providers.
new text end

Sec. 8.

new text begin [62J.4982] ENFORCEMENT AUTHORITY; COMPLIANCE.
new text end

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
violation of statute or rule applicable to a health information exchange service provider,
levy an administrative penalty in an amount up to $25,000 for each violation. In
determining the level of an administrative penalty, the commissioner shall consider the
following factors:
new text end

new text begin (1) the number of participating entities affected by the violation;
new text end

new text begin (2) the effect of the violation on participating entities' access to health information
exchange services;
new text end

new text begin (3) if only one participating entity is affected, the effect of the violation on the
patients of that entity;
new text end

new text begin (4) whether the violation is an isolated incident or part of a pattern of violations;
new text end

new text begin (5) the economic benefits derived by the health information organization or a health
data intermediary by virtue of the violation;
new text end

new text begin (6) whether the violation hindered or facilitated an individual's ability to obtain
health care;
new text end

new text begin (7) whether the violation was intentional;
new text end

new text begin (8) whether the violation was beyond the direct control of the health information
exchange service provider;
new text end

new text begin (9) any history of prior compliance with the provisions of this section, including
violations;
new text end

new text begin (10) whether and to what extent the health information exchange service provider
attempted to correct previous violations;
new text end

new text begin (11) how the health information exchange service provider responded to technical
assistance from the commissioner provided in the context of a compliance effort; and
new text end

new text begin (12) the financial condition of the health information exchange service provider
including, but not limited to, whether the health information exchange service provider
had financial difficulties that affected its ability to comply or whether the imposition of an
administrative monetary penalty would jeopardize the ability of the health information
exchange service provider to continue to deliver health information exchange services.
new text end

new text begin The commissioner shall give reasonable notice in writing to the health information
exchange service provider of the intent to levy the penalty and the reasons for them.
A health information exchange service provider may have 15 days within which to
contest whether the facts found constitute a violation of sections 62J.4981 and 62J.4982,
according to the contested case and judicial review provisions of sections 14.57 to 14.69.
new text end

new text begin (b) If the commissioner has reason to believe that a violation of section 62J.4981 or
62J.4982 has occurred or is likely, the commissioner may confer with the persons involved
before commencing action under subdivision 2. The commissioner may notify the health
information exchange service provider and the representatives, or other persons who
appear to be involved in the suspected violation, to arrange a voluntary conference with
the alleged violators or their authorized representatives. The purpose of the conference is
to attempt to learn the facts about the suspected violation and, if it appears that a violation
has occurred or is threatened, to find a way to correct or prevent it. The conference is
not governed by any formal procedural requirements, and may be conducted as the
commissioner considers appropriate.
new text end

new text begin (c) The commissioner may issue an order directing a health information exchange
service provider or a representative of a health information exchange service provider to
cease and desist from engaging in any act or practice in violation of sections 62J.4981
and 62J.4982.
new text end

new text begin (d) Within 20 days after service of the order to cease and desist, a health information
exchange service provider may contest whether the facts found constitute a violation
of sections 62J.4981 and 62J.4982 according to the contested case and judicial review
provisions of sections 14.57 to 14.69.
new text end

new text begin (e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or
other appropriate relief in Ramsey County District Court.
new text end

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
commissioner may suspend or revoke a certificate of authority issued to a health
data intermediary or health information organization under section 62J.4981 if the
commissioner finds that:
new text end

new text begin (1) the health information exchange service provider is operating significantly
in contravention of its basic organizational document, or in a manner contrary to that
described in and reasonably inferred from any other information submitted under section
62J.4981, unless amendments to the submissions have been filed with and approved by
the commissioner;
new text end

new text begin (2) the health information exchange service provider is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;
new text end

new text begin (3) the health information exchange service provider is no longer financially solvent
or may not reasonably be expected to meet its obligations to participating entities;
new text end

new text begin (4) the health information exchange service provider has failed to implement the
complaint system in a manner designed to reasonably resolve valid complaints;
new text end

new text begin (5) the health information exchange service provider, or any person acting with its
sanction, has advertised or merchandised its services in an untrue, misleading, deceptive,
or unfair manner;
new text end

new text begin (6) the continued operation of the health information exchange service provider
would be hazardous to its participating entities or the patients served by the participating
entities; or
new text end

new text begin (7) the health information exchange service provider has otherwise failed to
substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.
new text end

new text begin (b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.
new text end

new text begin (c) If the certificate of authority of a health information exchange service provider is
suspended, the health information exchange service provider shall not, during the period
of suspension, enroll any additional participating entities, and shall not engage in any
advertising or solicitation.
new text end

new text begin (d) If the certificate of authority of a health information exchange service provider is
revoked, the organization shall proceed, immediately following the effective date of the
order of revocation, to wind up its affairs, and shall conduct no further business except as
necessary to the orderly conclusion of the affairs of the organization. The organization
shall engage in no further advertising or solicitation. The commissioner may, by written
order, permit further operation of the organization as the commissioner finds to be in the
best interest of participating entities, to the end that participating entities will be given the
greatest practical opportunity to access continuing health information exchange services.
new text end

new text begin Subd. 3. new text end

new text begin Denial, suspension, and revocation; administrative procedures. new text end

new text begin (a)
When the commissioner has cause to believe that grounds for the denial, suspension,
or revocation of a certificate of authority exist, the commissioner shall notify the
health information exchange service provider in writing stating the grounds for denial,
suspension, or revocation and setting a time within 20 days for a hearing on the matter.
new text end

new text begin (b) After a hearing before the commissioner at which the health information
exchange service provider may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information exchange service provider to
appear at the hearing, the commissioner shall take action as deemed necessary and shall
issue written findings and mail them to the health information exchange service provider.
new text end

new text begin (c) If suspension, revocation, or administrative penalty is proposed according
to this section, the commissioner must deliver, or send by certified mail with return
receipt requested, to the health information exchange service provider written notice of
the commissioner's intent to impose a penalty. This notice of proposed determination
must include:
new text end

new text begin (1) a reference to the statutory basis for the penalty;
new text end

new text begin (2) a description of the findings of fact regarding the violations with respect to
which the penalty is proposed;
new text end

new text begin (3) the nature and amount of the proposed penalty;
new text end

new text begin (4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;
new text end

new text begin (5) instructions for responding to the notice, including a statement of the health
information exchange service provider's right to a contested case proceeding and a
statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and
new text end

new text begin (6) the address to which the contested case proceeding request must be sent.
new text end

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
the advice of the Minnesota e-Health Advisory Committee, in the review and update of
criteria for the certification and recertification of health information exchange service
providers when implementing sections 62J.498 to 62J.4982.
new text end

new text begin (b) By January 1, 2011, the commissioner shall report to the governor and the chairs
of the senate and house of representatives committees having jurisdiction over health
information policy issues on the status of health information exchange in Minnesota, and
provide recommendations on further action necessary to facilitate the secure electronic
movement of health information among health providers that will enable Minnesota
providers and hospitals to meet meaningful use exchange requirements.
new text end

new text begin Subd. 5. new text end

new text begin Fees and monetary penalties. new text end

new text begin (a) The commissioner shall assess fees
on every health information exchange service provider subject to sections 62J.4981 and
62J.4982 as follows:
new text end

new text begin (1) filing an application for certificate of authority to operate as a health information
organization, $10,500;
new text end

new text begin (2) filing an application for certificate of authority to operate as a health data
intermediary, $7,000;
new text end

new text begin (3) annual health information organization certificate fee, $14,000;
new text end

new text begin (4) annual health data intermediary certificate fee, $7,000; and
new text end

new text begin (5) fees for other filings, as specified by rule.
new text end

new text begin (b) Administrative monetary penalties imposed under this subdivision shall
be credited to an account in the special revenue fund and are appropriated to the
commissioner for the purposes of sections 62J.498 to 62J.4982.
new text end

Sec. 9. new text beginFEDERAL FUNDING.
new text end

new text begin To the extent that the commissioner of health applies for additional federal funding
to support the commissioner's responsibilities of developing and maintaining state-level
health information exchange under section 3013 of the HITECH Act, the commissioner of
health shall ensure that applications are made through an open process that provides health
information exchange service providers equal opportunity to receive funding.
new text end

Sec. 10. new text beginNONSUBMISSION OF HEALTH CARE CLAIM BY
CLEARINGHOUSE; SIGNIFICANT DISRUPTION.
new text end

new text begin A situation shall be considered a significant disruption to normal operations that
materially affects the provider's or facility's ability to conduct business in a normal manner
and to submit claims on a timely basis under Minnesota Statutes, section 62Q.75, if:
new text end

new text begin (1) a clearinghouse loses, or otherwise does not submit, a health care claim as
required by Minnesota Statutes, section 62J.536; and
new text end

new text begin (2) the provider or facility can substantiate that it submitted a complete claim to the
clearinghouse within provisions stated in contract or six months of the date of service,
whichever is less.
new text end

new text begin This section expires January 1, 2012.
new text end

Sec. 11. new text beginAPPROPRIATION; HEALTH INFORMATION EXCHANGE
OVERSIGHT.
new text end

new text begin $104,000 in fiscal year 2011 is appropriated from the state government special
revenue fund to the commissioner of health for the duties required under Minnesota
Statutes, sections 62J.498 to 62J.4982. Base funding shall be $97,000 in fiscal year 2012
and $97,000 in fiscal year 2013.
new text end