PRIOR PRINTER'S NOS. 1955, 2092

PRINTER'S NO.  2196

  

THE GENERAL ASSEMBLY OF PENNSYLVANIA

  

SENATE BILL

 

No.

8

Session of

2012

  

  

INTRODUCED BY FOLMER, SCARNATI, PILEGGI, FARNESE, M. WHITE, GORDNER, BOSCOLA, D. WHITE, VANCE, ERICKSON, TARTAGLIONE, BLAKE, STACK, BRUBAKER AND PIPPY, FEBRUARY 13, 2012

  

  

SENATOR CORMAN, APPROPRIATIONS, RE-REPORTED AS AMENDED, MAY 21, 2012   

  

  

  

AN ACT

  

1

Establishing the Pennsylvania eHealth Partnership Authority and

2

the Pennsylvania eHealth Partnership Fund; providing for

3

consent and confidentiality of health information; and

4

establishing civil immunity under certain circumstances.

5

The General Assembly of the Commonwealth of Pennsylvania

6

hereby enacts as follows:

7

CHAPTER 1

8

PRELIMINARY PROVISIONS

9

Section 101.  Short title.

10

This act shall be known and may be cited as the Pennsylvania

11

eHealth Information Technology Act.

12

Section 102.  Definitions.

13

The following words and phrases when used in this act shall

14

have the meanings given to them in this section unless the

15

context clearly indicates otherwise:

16

"Authority."  The Pennsylvania eHealth Partnership Authority.

17

"Board."  The board of directors of the Pennsylvania eHealth

18

Partnership Authority.

 


1

"Electronic health record."  An electronic record of health-

2

related information relating to an individual that is created,

3

gathered, managed and consulted by authorized health care

<--

4

providers.

5

"Fund."  The Pennsylvania eHealth Partnership Fund.

6

"Health care provider."  A provider of services as defined

<--

7

under section 1861(u) of the Social Security Act (49 Stat. 620,

8

42 U.S.C. § 301 et seq.), a provider of medical or health

9

services as defined under section 1861(s) of the Social Security

10

Act (42 U.S.C. § 301 et seq.) and any other person or

11

organization who furnishes, bills or is paid for health care in

12

the normal course of business and is licensed by the

13

Commonwealth to provide health care or professional clinical

14

services.

15

"Health information."  Any information, whether oral or

16

recorded, in any form or medium that is created or received by a

17

health care provider, health plan, public health authority,

18

employer, life insurer, school or university or health care

19

clearing house and relates to any of the following:

20

(1)  The past, present or future physical or mental

21

health condition of an individual.

22

(2)  The past, present or future payment for the

23

provision of health care to an individual as defined under

24

section 1171(4) of the Health Insurance Portability and

25

Accountability Act of 1996 (Public Law 104-191, 110 Stat.

26

1936).

27

"Health information exchange."  The electronic movement of

28

health information among health information exchange systems

29

according to Federal laws and standards.

30

"Health information exchange systems."  An information

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1

technology infrastructure with an interoperable system that

2

connects health care providers to ensure the secure digital

3

exchange of health information among approved participants who

4

are engaged in the care of a patient.

5

"Health care provider."  A person licensed by the

<--

6

Commonwealth to provide health care or professional clinical

7

services. The term includes:

8

(1)  A "health care practitioner," as defined in section

9

103 of the act of July 19, 1979 (P.L.130, No.48), known as

10

the Health Care Facilities Act.

11

(2)  A "health care provider," as defined in section 103

12

of the Health Care Facilities Act.

13

(3)  A life or health insurer or other payer.

14

(4)  A public health authority.

15

(5)  A pharmacy.

16

(6)  A laboratory.

17

(7)  A person that provides items or services described

18

in section 1861(s) of the Social Security Act (49 Stat. 620,

19

42 U.S.C. § 1395x(s)).

20

(8)  A "provider of services," as defined in section

21

1861(u) of the Social Security Act (42 U.S.C. § 1395x(u)).

22

"Health information."  Information, whether oral or recorded,

23

in any form or medium, that is created or received by a health

24

care provider relating to the following:

25

(1)  The past, present or future physical or mental

26

health or medical condition of an individual.

27

(2)  The past, present or future payment for the

28

provision of health care to an individual.

29

"Health information exchange."  A Statewide interoperable

30

system established under this act that electronically moves and

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1

exchanges health information between approved participating

2

health care providers or health information organizations in a

3

manner that ensures the secure exchange of health information to

4

provide care to patients.

5

"Health information organization."  An information technology

6

infrastructure with an interoperable system that is established

7

by a health care provider or that connects participating health

8

care providers to ensure the secure digital exchange of health

9

information among participants engaged in the care of the

10

patient.

11

"Health information technology."  Hardware, software,

12

integrated technologies or related licenses, intellectual

13

property, upgrades or packaged solutions sold as services that

14

are designed for or support the use by health care entities or

15

patients for the electronic creation, maintenance, access or

16

exchange of health information as defined under section 3000(5)

<--

17

of the American Recovery and Reinvestment Act of 2009 (Public

18

Law 111-5, 123 Stat. 115).

19

"Interoperability."  The ability of different operating and

20

software systems to employ federally recognized standards to

21

exchange data securely, accurately, effectively and in a manner

22

that maintains and preserves the clinical purpose of the data.

23

"Participant."  A person or entity which has been approved by

24

the Pennsylvania eHealth Partnership Authority to send and

25

receive health information using the health information exchange

<--

26

system.

<--

27

"Payer."  An entity that contracts or offers to contract to

28

provide, deliver, pay or reimburse any of the costs of health

29

care services, including an employer, a health care plan, the

30

Federal Government, the Commonwealth, a municipality, a labor

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1

union or an entity licensed under any of the following:

2

(1)  The act of May 17, 1921 (P.L.682, No.284), known as

3

The Insurance Company Law of 1921.

4

(2)  The act of December 29, 1972 (P.L.1701, No.364),

5

known as the Health Maintenance Organization Act.

6

(3)  40 Pa.C.S. Ch. 61 (relating to hospital plan

7

corporations).

8

(4)  40 Pa.C.S. Ch. 63 (relating to professional health

9

services plan corporations).

10

"Protected health information."  Personally identifying

<--

11

health information that is any of the following:

12

(1)  Transmitted or maintained by electronic or other

13

form of medium.

14

(2)  Maintained in electronic media.

15

CHAPTER 3

16

PENNSYLVANIA EHEALTH

17

PARTNERSHIP AUTHORITY

18

Section 301.  Scope of chapter.

19

This chapter relates to the Pennsylvania eHealth Partnership

20

Authority.

21

Section 302.  Pennsylvania eHealth Partnership Authority.

22

(a)  Establishment.--There is hereby established a body

23

corporate and politic to be known as the Pennsylvania eHealth

24

Partnership Authority, which shall be an independent agency of

25

the Commonwealth. The powers and duties of the authority shall

26

be vested in and exercised by a board of directors.

27

(b)  Composition.--The board shall consist of 15 members, who

<--

28

must be residents of this Commonwealth, with two additional, ex

29

officio nonvoting members selected by members of the advisory

30

council, composed and appointed as follows:

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1

(1)  The Secretary of Health or a designee, who shall be

2

an employee of the Department of Health designated in writing

3

prior to service.

4

(2)  The Secretary of Public Welfare or a designee, who

5

shall be an employee of the Department of Public Welfare

6

designated in writing prior to service.

7

(3)  One representative of the health care community

8

focused on an unserved or underserved rural or urban patient

9

population, who shall be appointed by the Governor from a

10

list of individuals submitted for consideration by both the

11

Pennsylvania Area Health Education Center and the Association

12

of Community Health Centers.

13

(4)  One physician or nurse who is a resident of this

<--

14

Commonwealth appointed by the Governor from lists of

15

individuals submitted by the Pennsylvania Medical Society,

16

the Pennsylvania Osteopathic Medical Association, the

17

Pennsylvania Academy of Family Physicians and the

18

Pennsylvania State Nurses Association. At least one name on

19

each list shall include an individual residing in an unserved

20

or underserved rural patient population area and an

21

individual in an unserved or underserved urban patient

22

population area.

23

(5)  One hospital representative who is a resident of

<--

24

this Commonwealth appointed by the Governor from a list of

25

individuals submitted by the Hospital and Healthsystem

26

Association of Pennsylvania. At least one name on this list

27

shall include an individual residing in an unserved or

28

underserved rural or urban patient population area.

29

(6)  One insurance representative who is a resident of

<--

30

this Commonwealth appointed by the Governor from lists of

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1

individuals submitted by the Blue Cross and Blue Shield plans

2

and the Insurance Federation of Pennsylvania.

3

(7)  One representative of an assisted living residence,

4

personal care home, long-term care nursing facility or, 

<--

5

continuing care facility or behavioral or mental health

<--

6

facility who shall be appointed by the Governor.

7

(8)  Two consumer representatives of this Commonwealth's

<--

8

consumers appointed by the Governor who are not primarily

9

involved in providing health care or health care insurance.

10

At least one of these individuals shall have expertise in

11

health care or health care information technology or the

12

laboratory industry.

13

(9)  Three representatives from established health

14

information exchange systems organizations appointed by the

<--

15

President pro tempore of the Senate, in consultation with the

16

Majority Leader and the Minority Leader of the Senate, each

17

of whom shall recommend one person. At least one of these

18

representatives shall be from the private information

19

technology sector with knowledge about security issues.

20

(10)  Three representatives from established health

21

information exchange systems organizations appointed by the

<--

22

Speaker of the House of Representatives, in consultation with

23

the Majority Leader and the Minority Leader of the House of

24

Representatives, each of whom shall recommend one person. At

25

least one of these representatives shall be from the private

26

information technology sector with knowledge about security

27

issues.

28

(c)  Terms.--Except a member as specified in subsection (b)

29

(1) or (2), a member of the board shall serve for a term of

30

three years after completion of the initial terms designated in

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1

subsection (g) and may not be eligible to serve more than two

2

full consecutive three-year terms. A member shall remain on the

3

board until the member's replacement is appointed and,

4

notwithstanding any other provision of this act, all terms end

5

at the expiration of the authority.

6

(d)  Quorum.--A majority of the appointed members of the

7

board shall constitute a quorum. Action may be taken by the

8

board at a meeting upon a vote of a quorum of its members

9

present in person or through electronic means if authorized by

10

the bylaws of the board.

11

(e)  Meetings.--The board shall meet at the call of the

12

chairperson or as may be provided in the bylaws of the board.

13

The board shall hold meetings at least quarterly, which shall be

14

subject to the requirements of 65 Pa.C.S. Ch. 7 (relating to

15

open meetings). Meetings of the board may be held anywhere

16

within this Commonwealth.

17

(f)  Chairperson.--The Governor shall appoint a chairperson

18

from among the authority members.

19

(g)  Initial appointment and vacancy.--

20

(1)  A member appointed under subsection (b)(3), (4) or

21

(5) shall be appointed to an initial term of two years with

22

the option for reappointment to two additional three-year

23

terms.

24

(2)  A member appointed under subsection (b)(6) or (7)

25

shall be appointed to an initial term of one year with the

26

option for reappointment to two additional three-year terms.

27

(3)  A member appointed under subsection (b)(8) shall be

28

appointed to an initial term of three years with the option

29

for reappointment to one additional three-year term.

30

(4)  A member appointed under subsection (b)(9) or (10)

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1

shall be appointed to an initial term that coincides with the

2

appointing members' terms with the option for reappointment

3

to two additional three-year terms.

4

(h)  Formation.--The board shall be formed within 90 days of

5

the effective date of this act.

6

Section 303.  Powers and duties.

7

(a)  General rule.--The board shall:

8

(1)  Adopt bylaws necessary to establish the authority

<--

9

and carry out the provisions of this act, to operate, develop

<--

10

and maintain the health information exchange system in

11

compliance with Federal and State law and to develop policies

12

and procedures to govern the exchange of health care

13

information.

14

(2)  Establish a system to provide for the exchange of

<--

15

electronic health information that Develop, establish and

<--

16

maintain a health information exchange that complies with

17

Federal and State law and that:

18

(i)  Promotes efficient and effective communication

19

among multiple health care providers, including

<--

20

hospitals, physicians, payers, employers, pharmacies,

21

laboratories and other health care entities and

22

practitioners.

23

(ii)  Creates efficiencies and promotes accuracy in

<--

24

the delivery of health care.

25

(iii)  Supports the ability to improve community

26

health status.

27

(3)  Employ individuals as necessary to carry out the

28

purposes of this act. Individuals employed by the authority

29

shall be considered employees of the Commonwealth for the

30

purposes of 71 Pa.C.S. Pt. XXV (relating to retirement for

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1

State employees and officers).

2

(4)  Establish Adopt all of the following:

<--

3

(i)  Policies and procedures to govern the electronic

<--

4

exchange of health information in accordance with this

5

act.

6

(i) (ii)  Rules, responsibilities and obligations for

<--

7

organizations and individuals to become and remain

8

participants in the health information exchange.

<--

9

(ii) (iii)  Policies and procedures for organizations

<--

10

and individuals to be suspended and disengaged as

11

participants in the health information exchange.

<--

12

(5)  Make, execute and deliver contracts, grants and

13

other instruments.

14

(6)  Apply for, solicit, receive, establish priorities

15

for, allocate, disburse, contract for, administer and expend

16

funds consistent with the purposes of this act.

17

(7)  Apply for, accept and administer grants and loans to

18

carry out the purpose of the authority.

19

(8)  Accept funds from both public and private sources,

20

consistent with Federal and State law.

21

(9)  Develop and maintain a directory of health care

22

provider's contact information to enable participants to

23

share health information electronically.

24

(10)  Develop criteria for interoperability and approve 

<--

25

the approval of participants in the health information

<--

26

exchange.

27

(11)  Assure that security standards and procedures to

<--

28

protect confidentiality of electronic health records are

29

adopted and properly implemented.

30

(11)  Develop and maintain standards to ensure

<--

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1

interoperability.

2

(12)  Establish and collect fees adopted by the

3

authority. Fees may include transaction fees, subscription

4

fees or other fees or donations, to cover costs of

5

implementation and operation of the exchange or for other

6

services provided by the authority. Receipt of services

7

provided by or through the authority may be conditioned on

8

payment of fees. Participation in the exchange by any health

9

care provider, payer, consumer or any other person is

10

voluntary.

11

(13)  Establish advisory groups with a diverse membership

12

representing interested and affected groups and individuals,

13

two of which shall be selected by other members of the group

14

to serve as nonvoting members of the board or the authority.

15

(14)  Develop and conduct public information programs to

16

educate and inform consumers and patients about health

17

information.

18

(15)  Submit an annual report to the Governor, the

19

President pro tempore of the Senate and the Speaker of the

20

House of Representatives for distribution to appropriate

21

legislative committees on the activities of the authority for

22

the year, including a summary of the receipts and

23

expenditures, a list of contracts and a summary of any

24

reportable security breaches that occurred and corrective

25

actions that were taken.

26

(16)  Work with the Federal Government and other

<--

27

governmental entities to achieve interoperability.

28

(16)  Develop and maintain:

<--

29

(i)  a registry of patients choosing to opt out of

30

the health information exchange; and

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1

(ii)  procedures to reenroll into the health

2

information exchange.

3

(17)  Perform all other activities in furtherance of the

4

purposes of this act.

5

(b)  Audit.--

6

(1)  The accounts and books of the authority shall be

7

examined and audited annually by an independent certified

8

public accounting firm. The audit shall be public

9

information.

10

(2)  The authority shall, by December 31 of each year,

11

file a copy of the audit of the preceding Commonwealth fiscal

12

year required under paragraph (1) with the Secretary of the

13

Senate and the Chief Clerk of the House of Representatives.

14

(c)  Publication.--The authority shall annually submit a

15

financial statement to the Legislative Reference Bureau for

16

publication in the Pennsylvania Bulletin.

17

(d)  Expiration.--The authority shall expire five years after

18

the effective date of this chapter. One year prior to the

19

expiration, the Legislative Budget and Finance Committee shall

20

evaluate the management, viability and performance of the health

21

information exchange and shall provide a report to the

22

Communications and Technology Committee of the Senate and the

23

Health Committee of the House of Representatives and the Human

24

Services Committee of the House of Representatives. The report

25

shall include recommendations as to reauthorization of the

26

authority, dissolution of the authority or assumption of the

27

authority's responsibilities and assets by another entity.

28

CHAPTER 5

29

PENNSYLVANIA EHEALTH PARTNERSHIP FUND

30

Section 501.  Establishment.

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1

There is established a separate fund in the State Treasury to

2

be known as the Pennsylvania eHealth Partnership Fund. The fund

3

shall be administered by the authority.

4

Section 502.  Funds.

5

All moneys deposited into the fund shall be held for the

6

purposes of the authority and may not be considered a part of

7

the General Fund, but shall be used only to effectuate the

8

purposes of this act as determined by the authority. All

9

interest earned from the investment or deposit of moneys

10

accumulated in the fund shall be deposited in the account fund 

<--

11

for the same use.

12

CHAPTER 7

13

CONSENT AND CONFIDENTIALITY

14

OF HEALTH INFORMATION

15

Section 701.  Consent and confidentiality of health information.

16

(a)  Construction.--Nothing in this act shall be construed to 

<--

17

(a)  Construction.--

<--

18

(1)  Nothing in this act shall be construed to prohibit a

19

health care provider from obtaining and storing a patient's

20

medical health records in electronic form or exchanging

<--

21

health information with another health care provider in

<--

22

accordance with Federal or State law. Federal law or State

<--

23

law other than this act.

24

(2)  Nothing in this act shall supersede or limit any

25

other law which requires additional consent to the release of

26

health information or otherwise establishes greater

27

restrictions or limitations on the release of health

28

information.

29

(b)  Consent.--The authority shall promulgate a consent form

30

including notice of a patient's right ability to decline to

<--

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1

allow exchange of the patient's electronic health information in

2

the health information exchange system. The notice shall

<--

3

include, at a minimum and in plain language, the following

4

information:

5

(1)  Definition of a health information exchange.

6

(2)  Explanation of the benefits of participation in the

7

health information exchange system.

<--

8

(3)  Explanation of the limits of the patient's right 

<--

9

ability to decline the release or exchange of the patient's

<--

10

electronic health information with the health information

<--

11

exchange system to the health information exchange.

<--

12

(4)  Explanation of the manner in which the electronic 

<--

13

health information exchange system will address privacy

<--

14

issues. and, where practicable, an opportunity to consent to

<--

15

exchange of that health information on the electronic health

16

information exchange system.

17

(c)  Notice to patients.--Upon implementation of the notice

18

of a patient's right to decline, a patient shall be provided

19

with the form by a health care provider. If a patient chooses to

20

execute a denial of release, the notice shall be signed, dated

21

and witnessed by the patient, or the patient's representative.

22

Copies of the executed form shall be kept by the provider and

23

delivered to the patient within five business days of the

24

provider's receipt of the executed form.

<--

25

(5)  Explanation of the manner in which an individual may

26

decline to participate in the health information exchange.

27

(c)  Opt-out registry.--

28

(1)  In order to decline participation in the health

29

information exchange, a patient must sign and date a form

30

declining participation. If appropriate, the signature must

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1

be witnessed by the patient's representative. Copies of the

2

completed form shall be sent by the provider within five

3

business days to the authority to be included in an opt-out

4

registry.

5

(2)  After receipt of the form, the authority shall

6

within five business days notify health information

7

organizations that the patient has not authorized the release

8

of the health information.

9

(3)  Once the patient is included in the opt-out

10

registry, the authority shall notify the patient. The

11

notification shall include a copy of the completed form

12

signed by the patient or electronic notification to the

13

patient.

14

(4)  The patient alone shall decide to opt out of a

15

health information exchange.

16

(d)  Disclosure.--

17

(1)  The authority shall retain only the personally

<--

18

identifying health information necessary for the operation of

<--

19

the health exchange information system information exchange.

<--

20

The authority may not disclose, without prior written patient 

<--

21

consent of the patient, any personally identifying health

<--

22

information that the authority or its employees, agents or

<--

23

contractors retain, or to which the authority or its agents

24

or contractors have access or any other electronic health

<--

25

records maintained or accessible by the authority under this

26

act, to any person who is not an authorized employee, agent

27

or contractor of the authority, except as required by law.

28

(2)  Disclosures permitted by and between Sharing health

<--

29

information among participants in the health information

30

exchange system may shall not be considered disclosures made

<--

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1

by the authority a disclosure under paragraph (1).

<--

2

(3)  Violations of this subsection:

3

(i)  shall subject employees, agents and contractors

4

to administrative discipline, including discharge and

5

suspension; and

6

(ii)  shall subject contractors to monetary penalties

7

or contract revocation or suspension.

8

(e)  Construction.--Nothing in this act may be construed to

9

alter a proprietary interest held by any participant in any

10

record, data or information released, accepted or exchanged 

<--

11

included in the health information exchange system, except

<--

12

insofar as the paperwork approved by the authority may require

13

participants to license those interests by contract in order to

14

allow for the free flow of information.

15

CHAPTER 40

16

MISCELLANEOUS PROVISIONS

17

Section 4001.  Nonapplicability.

18

(1)  Nothing in this act shall constitute a waiver of

<--

19

sovereign immunity.

20

(1)  This act is subject to 1 Pa.C.S. § 2310 (relating to

<--

21

sovereign immunity reaffirmed; specific waiver).

22

(2)  The authority shall be subject to the act of

23

February 14, 2008 (P.L.6, No.3), known as the Right-to-Know

24

Law. Health information or personally identifying information

25

shall not be considered a public record for purposes of the

26

Right-to-Know Law.

27

(3)  The authority may not be subject to legal process

<--

28

related to lawsuits to which the authority is not a party.

29

Section 4002.  Effective date.

30

This act shall take effect immediately.

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