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Amend HB 1218 (Senate committee printing) by adding the
following appropriately numbered SECTION to the bill and
renumbering subsequent SECTIONS of the bill accordingly:
SECTION ____. (a) Chapter 531, Government Code, is amended
by adding Subchapter V to read as follows:
SUBCHAPTER V. ELECTRONIC HEALTH INFORMATION EXCHANGE PROGRAM
Sec. 531.901. DEFINITIONS. In this subchapter:
(1) "Electronic health record" means an electronic
record of aggregated health-related information concerning a
person that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by
authorized health care providers across two or more health care
organizations.
(2) "Electronic medical record" means an electronic
record of health-related information concerning a person that can
be created, gathered, managed, and consulted by authorized
clinicians and staff within a single health care organization.
(3) "Health information exchange system" means the
electronic health information exchange system created under this
subchapter that electronically moves health-related information
among entities according to nationally recognized standards.
(4) "Local or regional health information exchange"
means a health information exchange operating in this state that
securely exchanges electronic health information, including
information for patients receiving services under the child health
plan or Medicaid program, among hospitals, clinics, physicians'
offices, and other health care providers that are not owned by a
single entity or included in a single operational unit or network.
Sec. 531.902. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM. (a) The commission shall develop an electronic health
information exchange system to improve the quality, safety, and
efficiency of health care services provided under the child health
plan and Medicaid programs. In developing the system, the
commission shall ensure that:
(1) the confidentiality of patients' health
information is protected and the privacy of those patients is
maintained in accordance with applicable federal and state law,
including:
(A) Section 1902(a)(7), Social Security Act (42
U.S.C. Section 1396a(a)(7));
(B) the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191);
(C) Chapter 552, Government Code;
(D) Subchapter G, Chapter 241, Health and Safety
Code;
(E) Section 12.003, Human Resources Code; and
(F) federal and state rules and regulations,
including:
(i) 42 C.F.R. Part 431, Subpart F; and
(ii) 45 C.F.R. Part 164;
(2) appropriate information technology systems used
by the commission and health and human services agencies are
interoperable;
(3) the system and external information technology
systems are interoperable in receiving and exchanging appropriate
electronic health information as necessary to enhance:
(A) the comprehensive nature of the information
contained in electronic health records; and
(B) health care provider efficiency by
supporting integration of the information into the electronic
health record used by health care providers;
(4) the system and other health information systems
not described by Subdivision (3) and data warehousing initiatives
are interoperable; and
(5) the system has the elements described by
Subsection (b).
(b) The health information exchange system must include the
following elements:
(1) an authentication process that uses multiple forms
of identity verification before allowing access to information
systems and data;
(2) a formal process for establishing data-sharing
agreements within the community of participating providers in
accordance with the Health Insurance Portability and
Accountability Act of 1996 (Pub. L. No. 104-191) and the American
Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5);
(3) a method by which the commission may open or
restrict access to the system during a declared state emergency;
(4) the capability of appropriately and securely
sharing health information with state and federal emergency
responders;
(5) compatibility with the Nationwide Health
Information Network (NHIN) and other national health information
technology initiatives coordinated by the Office of the National
Coordinator for Health Information Technology;
(6) an electronic master patient index or similar
technology that allows for patient identification across multiple
systems; and
(7) the capability of allowing a health care provider
to access the system if the provider has technology that meets
current national standards.
(c) The commission shall implement the health information
exchange system in stages as described by this subchapter, except
that the commission may deviate from those stages if technological
advances make a deviation advisable or more efficient.
(d) The health information exchange system must be
developed in accordance with the Medicaid Information Technology
Architecture (MITA) initiative of the Center for Medicaid and State
Operations and conform to other standards required under federal
law.
Sec. 531.903. ELECTRONIC HEALTH INFORMATION EXCHANGE
SYSTEM ADVISORY COMMITTEE. (a) The commission shall establish the
Electronic Health Information Exchange System Advisory Committee
to assist the commission in the performance of the commission's
duties under this subchapter.
(b) The executive commissioner shall appoint to the
advisory committee at least 12 and not more than 16 members who have
an interest in health information technology and who have
experience in serving persons receiving health care through the
child health plan and Medicaid programs.
(c) The advisory committee must include the following
members:
(1) Medicaid providers;
(2) child health plan program providers;
(3) fee-for-service providers;
(4) at least one representative of the Texas Health
Services Authority established under Chapter 182, Health and Safety
Code;
(5) at least one representative of each health and
human services agency;
(6) at least one representative of a major provider
association;
(7) at least one representative of a health care
facility;
(8) at least one representative of a managed care
organization;
(9) at least one representative of the pharmaceutical
industry;
(10) at least one representative of Medicaid
recipients and child health plan enrollees;
(11) at least one representative of a local or
regional health information exchange; and
(12) at least one representative who is skilled in
pediatric medical informatics.
(d) The members of the advisory committee must represent the
geographic and cultural diversity of the state.
(e) The executive commissioner shall appoint the presiding
officer of the advisory committee.
(f) The advisory committee shall advise the commission on
issues regarding the development and implementation of the
electronic health information exchange system, including any issue
specified by the commission and the following specific issues:
(1) data to be included in an electronic health
record;
(2) presentation of data;
(3) useful measures for quality of service and patient
health outcomes;
(4) federal and state laws regarding privacy and
management of private patient information;
(5) incentives for increasing health care provider
adoption and usage of an electronic health record and the health
information exchange system; and
(6) data exchange with local or regional health
information exchanges to enhance:
(A) the comprehensive nature of the information
contained in electronic health records; and
(B) health care provider efficiency by
supporting integration of the information into the electronic
health record used by health care providers.
(g) The advisory committee shall collaborate with the Texas
Health Services Authority to ensure that the health information
exchange system is interoperable with, and not an impediment to,
the electronic health information infrastructure that the
authority assists in developing.
Sec. 531.904. STAGE ONE: ELECTRONIC HEALTH RECORD. (a) In
stage one of implementing the health information exchange system,
the commission shall develop and establish an electronic health
record for each person who receives medical assistance under the
Medicaid program. The electronic health record must be available
through a browser-based format.
(b) The commission shall consult and collaborate with, and
accept recommendations from, physicians and other stakeholders to
ensure that electronic health records established under this
section support health information exchange with electronic
medical records systems in use by physicians in the public and
private sectors in a manner that:
(1) allows those physicians to exclusively use their
own electronic medical records systems; and
(2) does not require the purchase of a new electronic
medical records system.
(c) The executive commissioner shall adopt rules specifying
the information required to be included in the electronic health
record. The required information may include, as appropriate:
(1) the name and address of each of the person's health
care providers;
(2) a record of each visit to a health care provider,
including diagnoses, procedures performed, and laboratory test
results;
(3) an immunization record;
(4) a prescription history;
(5) a list of due and overdue Texas Health Steps
medical and dental checkup appointments; and
(6) any other available health history that health
care providers who provide care for the person determine is
important.
(d) Information under Subsection (c) may be added to any
existing electronic health record or health information technology
and may be exchanged with local and regional health information
exchanges.
(e) The commission shall make an electronic health record
for a patient available to the patient through the Internet.
Sec. 531.9041. STAGE ONE: ENCOUNTER DATA. In stage one of
implementing the health information exchange system, the
commission shall require for purposes of the implementation each
managed care organization with which the commission contracts under
Chapter 533 for the provision of Medicaid managed care services or
Chapter 62, Health and Safety Code, for the provision of child
health plan program services to submit to the commission complete
and accurate encounter data not later than the 30th day after the
last day of the month in which the managed care organization
adjudicated the claim.
Sec. 531.905. STAGE ONE: ELECTRONIC PRESCRIBING. (a) In
stage one of implementing the health information exchange system,
the commission shall support and coordinate electronic prescribing
tools used by health care providers and health care facilities
under the child health plan and Medicaid programs.
(b) The commission shall consult and collaborate with, and
accept recommendations from, physicians and other stakeholders to
ensure that the electronic prescribing tools described by
Subsection (a):
(1) are integrated with existing electronic
prescribing systems otherwise in use in the public and private
sectors; and
(2) to the extent feasible:
(A) provide current payer formulary information
at the time a health care provider writes a prescription; and
(B) support the electronic transmission of a
prescription.
(c) The commission may take any reasonable action to comply
with this section, including establishing information exchanges
with national electronic prescribing networks or providing health
care providers with access to an Internet-based prescribing tool
developed by the commission.
(d) The commission shall apply for and actively pursue any
waiver to the child health plan program or the state Medicaid plan
from the federal Centers for Medicare and Medicaid Services or any
other federal agency as necessary to remove an identified
impediment to supporting and implementing electronic prescribing
tools under this section, including the requirement for handwritten
certification of certain drugs under 42 C.F.R. Section 447.512. If
the commission with assistance from the Legislative Budget Board
determines that the implementation of operational modifications in
accordance with a waiver obtained as required by this subsection
has resulted in cost increases in the child health plan or Medicaid
program, the commission shall take the necessary actions to reverse
the operational modifications.
Sec. 531.906. STAGE TWO: EXPANSION. (a) Based on the
recommendations of the advisory committee established under
Section 531.903 and feedback provided by interested parties, the
commission in stage two of implementing the health information
exchange system may expand the system by:
(1) providing an electronic health record for each
child enrolled in the child health plan program;
(2) including state laboratory results information in
an electronic health record, including the results of newborn
screenings and tests conducted under the Texas Health Steps
program, based on the system developed for the health passport
under Section 266.006, Family Code;
(3) improving data-gathering capabilities for an
electronic health record so that the record may include basic
health and clinical information in addition to available claims
information, as determined by the executive commissioner;
(4) using evidence-based technology tools to create a
unique health profile to alert health care providers regarding the
need for additional care, education, counseling, or health
management activities for specific patients; and
(5) continuing to enhance the electronic health record
created under Section 531.904 as technology becomes available and
interoperability capabilities improve.
(b) In expanding the system, the commission shall consult
and collaborate with, and accept recommendations from, physicians
and other stakeholders to ensure that electronic health records
provided under this section support health information exchange
with electronic medical records systems in use by physicians in the
public and private sectors in a manner that:
(1) allows those physicians to exclusively use their
own electronic medical records systems; and
(2) does not require the purchase of a new electronic
medical records system.
Sec. 531.907. STAGE THREE: EXPANSION. In stage three of
implementing the health information exchange system, the
commission may expand the system by:
(1) developing evidence-based benchmarking tools that
can be used by health care providers to evaluate their own
performances on health care outcomes and overall quality of care as
compared to aggregated performance data regarding peers; and
(2) expanding the system to include state agencies,
additional health care providers, laboratories, diagnostic
facilities, hospitals, and medical offices.
Sec. 531.908. INCENTIVES. The commission and the advisory
committee established under Section 531.903 shall develop
strategies to encourage health care providers to use the health
information exchange system, including incentives, education, and
outreach tools to increase usage.
Sec. 531.909. REPORTS. (a) The commission shall provide
an initial report to the Senate Committee on Health and Human
Services or its successor, the House Committee on Human Services or
its successor, and the House Committee on Public Health or its
successor regarding the health information exchange system not
later than January 1, 2011, and shall provide a subsequent report to
those committees not later than January 1, 2013. Each report must:
(1) describe the status of the implementation of the
system;
(2) specify utilization rates for each health
information technology implemented as a component of the system;
and
(3) identify goals for utilization rates described by
Subdivision (2) and actions the commission intends to take to
increase utilization rates.
(b) This section expires September 2, 2013.
Sec. 531.910. RULES. The executive commissioner may adopt
rules to implement this subchapter.
(b) Subchapter B, Chapter 62, Health and Safety Code, is
amended by adding Section 62.060 to read as follows:
Sec. 62.060. HEALTH INFORMATION TECHNOLOGY STANDARDS.
(a) In this section, "health information technology" means
information technology used to improve the quality, safety, or
efficiency of clinical practice, including the core
functionalities of an electronic health record, an electronic
medical record, a computerized health care provider order entry,
electronic prescribing, and clinical decision support technology.
(b) The commission shall ensure that any health information
technology used by the commission or any entity acting on behalf of
the commission in the child health plan program conforms to
standards required under federal law.
(c) Subchapter B, Chapter 32, Human Resources Code, is
amended by adding Section 32.073 to read as follows:
Sec. 32.073. HEALTH INFORMATION TECHNOLOGY STANDARDS.
(a) In this section, "health information technology" means
information technology used to improve the quality, safety, or
efficiency of clinical practice, including the core
functionalities of an electronic health record, an electronic
medical record, a computerized health care provider order entry,
electronic prescribing, and clinical decision support technology.
(b) The Health and Human Services Commission shall ensure
that any health information technology used by the commission or
any entity acting on behalf of the commission in the medical
assistance program conforms to standards required under federal
law.
(d) As soon as practicable after the effective date of this
Act, the executive commissioner of the Health and Human Services
Commission shall adopt rules to implement the electronic health
record and electronic prescribing system required by Subchapter V,
Chapter 531, Government Code, as added by this section.
(e) The executive commissioner of the Health and Human
Services Commission shall appoint the members of the Electronic
Health Information Exchange System Advisory Committee established
under Section 531.903, Government Code, as added by this section,
as soon as practicable after the effective date of this Act.