80R10575 MCK-D

By: Delisi H.B. No. 3472

A BILL TO BE ENTITLED

AN ACT

relating to the promotion of an electronic health record system for health care programs or health insurance plans administered by the State of Texas.

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

SECTION 1. Subtitle I, Title 8, Insurance Code, is amended by adding Chapter 1654 to read as follows: CHAPTER 1654. TEXAS HEALTH INSURANCE ELECTRONIC HEALTH RECORDS

Sec. 1654.001. PURPOSE. The purpose of this chapter is to:

(1) ensure that health care programs or health insurance plans sponsored or administered by the state promote quality and efficient health care through the use of health information technology;

(2) facilitate the transparency of health care quality and price in a manner that promotes better incentives for program beneficiaries, enrollees, and providers;

(3) enable the secure, electronic exchange of health information among beneficiaries, enrollees, providers, and health plans; and

(4) foster a robust and competitive market for the state and its plan members.

Sec. 1654.002. DEFINITIONS. In this chapter:

(1) "Agency" means the state agency that administers, sponsors, or funds, either partially or completely, a state health care program or health insurance plan.

(2) "Electronic health record" means electronically originated and maintained health information that may be derived from multiple sources regarding the health status of an individual and includes the following core functionalities:

(A) a patient health information or data entry function to aid with medical and nursing diagnosis, medication lists, allergy recognition, demographics, clinical narratives, and test results;

(B) a results management function that may include computerized laboratory test results, diagnostic imaging reports, interventional radiology reports, and automated displays of past and present medical or laboratory test results;

(C) a computerized physician order entry of medication, care orders, and ancillary services;

(D) a clinical decision support that may include electronic reminders and prompts to improve prevention, diagnosis, and management;

(E) electronic communication and connectivity that allows online communication between health care providers;

(F) patient support and education functions; and

(G) public health monitoring, reporting, and management functions that link with local, state, or national public health agencies.

(3) "Health information technology" means information technology used to improve the quality, safety, and efficiency of clinical practice, including the core functionalities of an electronic health record, computerized physician order entry, electronic prescribing, and clinical decision support technology.

(4) "Interoperability" means the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings and the ability to exchange data so that the clinical or operational purpose and meaning of the data are preserved without being altered. The term may include connectivity domains that create electronic links among health care providers, hospitals or hospital systems, health care institutions, health plans, health care clearinghouses, or other entities as defined by privacy rules of the Administrative Simplification subtitle of the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) contained in 45 C.F.R. Part 160 and 45 C.F.R. Part 164, Subparts A and E.

(5) "Recognized interoperability standards" means interoperability standards that are recognized by the Certification Commission for Healthcare Information Technology or other federally approved certification standards.

(6) "State health care program or health insurance plan" means health benefits coverage provided by or through an agency of this state in accordance with Chapter 1551, 1575, 1579, or 1601, the child health plan program, the medical assistance program under Chapter 32, Human Resources Code, the Medicaid managed care program, or any other plan that:

(A) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:

(i) an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage that is offered by:

(a) an insurer;

(b) a group hospital service corporation operating under Chapter 842;

(c) a fraternal benefit society operating under Chapter 885;

(d) a stipulated premium company operating under Chapter 884; or

(e) a health maintenance organization operating under Chapter 843; and

(ii) to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:

(a) a multiple employer welfare arrangement as defined by Section 3 of that Act and operating under Chapter 846; or

(b) an analogous benefit arrangement;

(B) is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or

(C) is offered by any other entity that:

(i) is not authorized under this code or another insurance law of this state; and

(ii) contracts directly for health care services on a risk-sharing basis, including a capitation basis.

Sec. 1654.003. ELECTRONIC HEALTH RECORDS. The agency that administers or sponsors a state health care program or health insurance plan may:

(1) request that any health care provider, health care program, health care plan, insurer, or health care clearinghouse submit to the agency information regarding the adoption of or future plans to adopt the core functionalities of an electronic health record, as necessary, to achieve sufficient interoperability to allow for the exchange of health information or data among those entities as part of any new contract or agreement formed between the agency and the health care provider, health care program, health care plan, insurer, or health care clearinghouse;

(2) require that any contract for health information technology, including the core functionalities of an electronic medical record, use the Certification Commission for Healthcare Information Technology or other federally approved certification standards;

(3) require a health care provider, health care program, health care plan, insurer, or health care clearinghouse that enters into an agreement to provide electronic health records or other medical information technology services to the beneficiaries of a state health care program or health insurance plan to comply with federal and state laws governing the privacy health information or data;

(4) consider as an evaluation factor when evaluating new contract awards or extensions of existing contracts a vendor's efforts to provide incentives to providers that promote and enhance or serve to promote and enhance the integration of electronic health records or other medical information technology in a collaborative manner within its provider network and with consumers;

(5) negotiate with existing vendors, if opportunities for additional value-added services would offer a suitable benefit to the agency and to the patients served, to provide electronic health records or other health information technology to promote the greater integration of electronic health records or other health information technology in a collaborative patient-centered manner within their provider networks and with consumers;

(6) develop objective standards for evaluating the relative value to the state of electronic health records or other health information technology proposals, including enhancements in care for the recipients of health care services, improvements in the ability of medical providers to provide higher levels of care, and any return on state investment reasonably expected to be gained through the better coordination and quality of medical services;

(7) enter into contracts for electronic health records and other health information technology in which the value to the agency, the health care system, health care provider, and the general public is clearly established and for which sufficient funding exists within existing resources budgeted for the delivery of those services; and

(8) include within the agency biennial legislative appropriation request value-based recommendations for the expansion of electronic health records and medical information technology initiatives that require an appropriation.

SECTION 2. This Act takes effect September 1, 2007.