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Second Substitute H.B. 47

Senator Peter C. Knudson proposes the following substitute bill:


             1     
STANDARDS FOR ELECTRONIC EXCHANGE OF

             2     
CLINICAL HEALTH INFORMATION

             3     
2008 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Chief Sponsor: Ronda Rudd Menlove

             6     
Senate Sponsor: Peter C. Knudson

             7     
             8      LONG TITLE
             9      General Description:
             10          This bill adds to the duties of the Department of Health.
             11      Highlighted Provisions:
             12          This bill:
             13          .    authorizes the Department of Health to adopt standards for the electronic exchange
             14      of clinical health information;
             15          .    defines terms;
             16          .    authorizes the department to require individuals who elect to participate in an
             17      electronic exchange of clinical health information to use the standards adopted by
             18      the department;
             19          .    requires the department to report to the Legislature's Health and Human Services
             20      Interim Committee concerning the adoption of the standards for the secure
             21      electronic exchange of clinical health information; and
             22          .    coordinates rulemaking authority between the Department of Health and the
             23      Insurance Department.
             24      Monies Appropriated in this Bill:
             25          None


             26      Other Special Clauses:
             27          None
             28      Utah Code Sections Affected:
             29      AMENDS:
             30          31A-22-614.5, as enacted by Laws of Utah 1993, Chapter 255
             31      ENACTS:
             32          26-1-37, Utah Code Annotated 1953
             33     
             34      Be it enacted by the Legislature of the state of Utah:
             35          Section 1. Section 26-1-37 is enacted to read:
             36          26-1-37. Duty to establish standards for the exchange of electronic health
             37      information exchange.
             38          (1) For purposes of this section:
             39          (a) "Affiliate" means an organization that directly or indirectly through one or more
             40      intermediaries controls, is controlled by, or is under common control with another
             41      organization.
             42          (b) "Clinical health information" shall be defined by the department by administrative
             43      rule adopted in accordance with Subsection (2).
             44          (c) "Electronic exchange":
             45          (i) includes:
             46          (A) the electronic transmission of clinical health data via Internet or extranet; and
             47          (B) physically moving clinical health information from one location to another using
             48      magnetic tape, disk, or compact disc media; and
             49          (ii) does not include exchange of information by telephone or fax.
             50          (d) "Health care provider" means a licensing classification that:
             51          (i) is either:
             52          (A) licensed under Title 58, Occupations and Professions, to provide health care; or
             53          (B) licensed under Chapter 21, Health Care Facility Licensing and Inspection Act.
             54          (e) "Health care system" shall include:
             55          (i) affiliated health care providers;
             56          (ii) affiliated third party payers; and


             57          (iii) other arrangement between organizations or providers as described by the
             58      department by administrative rule.
             59          (f) "Third party payer" means:
             60          (i) all insurers offering health insurance who are subject to Section 31A-22-614.5 ; and
             61          (ii) the state Medicaid program.
             62          (2) (a) In addition to the duties listed in Section 26-1-30 , the department shall, in
             63      accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act:
             64          (i) define:
             65          (A) "clinical health information" subject to this section; and
             66          (B) health system arrangements between providers or organizations as described in
             67      Subsection (1)(d)(iii); and
             68          (ii) adopt standards for the electronic exchange of clinical health information between
             69      health care providers and third party payers that are in compliance with 45 CFR Parts 160, 162,
             70      and 164, Health Insurance Reform: Security Standards.
             71          (b) The department shall coordinate its rule making authority under the provisions of
             72      this section with the rule making authority of the Department of Insurance under Section
             73      31A-22-614.5 . The department shall establish procedures for developing the rules adopted
             74      under this section, which ensure that the Department of Insurance is given the opportunity to
             75      comment on proposed rules.
             76          (3) (a) Except as provided in Subsection (3)(b), a health care provider or third party
             77      payer in Utah is required to use the standards adopted by the department under the provisions
             78      of Subsection (2) if the health care provider or third party payer elects to engage in an
             79      electronic exchange of clinical health information with another health care provider, third party
             80      payer, or health care recipient.
             81          (b) A health care provider or third party payer is not required to use the standards
             82      adopted by the department under the provisions of Subsection (2) if the health care provider or
             83      third party payer engage in the secure electronic exchange of clinical health information within
             84      a particular health care system.
             85          (4) Nothing in this section shall limit the number of networks eligible to engage in the
             86      electronic data interchange of clinical health information using the standards adopted by the
             87      department under Subsection (2)(a)(ii).


             88          (5) The department shall report on the use of the standards for the electronic exchange
             89      of clinical health information to the legislative Health and Human Services Interim Committee
             90      no later than October 15, 2008 and no later than every October 15th thereafter. The report shall
             91      include publicly available information concerning the costs and savings for the department,
             92      third party payers, and health care providers associated with the standards for the secure
             93      electronic exchange of clinical health records.
             94          Section 2. Section 31A-22-614.5 is amended to read:
             95           31A-22-614.5. Uniform claims processing.
             96          (1) Beginning July 1, 1993, all insurers offering health insurance shall use a uniform
             97      claim form and uniform billing and claim codes.
             98          (2) The uniform claim forms and billing codes shall be adopted and approved by the
             99      commissioner in accordance with Title 63, Chapter 46a, Utah Administrative Rulemaking Act.
             100      The commissioner shall consult with the director of the Division of Health Care Financing, the
             101      National Uniform Claim Form Task Force, and the National Uniform Billing Committee when
             102      adopting the uniform claims and billing codes.
             103          (3) (a) (i) Beginning July 1, 1995, all insurers shall offer compatible systems of
             104      electronic billing approved by the commissioner in accordance with Title 63, Chapter 46a,
             105      Utah Administrative Rulemaking Act.
             106          (ii) The systems approved by the commissioner may include monitoring and
             107      disseminating information concerning eligibility and coverage of individuals.
             108          (iii) The commissioner shall coordinate the administrative rules adopted under the
             109      provisions of this section with the administrative rules adopted by the Department of Health for
             110      the implementation of the standards for the secure electronic exchange of clinical health
             111      information under Section 26-1-37 . The department shall establish procedures for developing
             112      the rules adopted under this section, which ensure that the Department of Health is given the
             113      opportunity to comment on proposed rules.
             114          (b) The commissioner shall regulate any fees charged by insurers to the providers for:
             115          (i) uniform claim forms [or];
             116          (ii) electronic billing[.]; or
             117          (iii) the secure electronic exchange of clinical health information permitted by Section
             118      26-1-37 .


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