.................... moves to amend H.F. No. 384, the first engrossment, as follows:
Delete everything after the enacting clause and insert:
"Section 1. Minnesota Statutes 2008, section 62J.495, is amended to read:
1.462J.495 HEALTH INFORMATION TECHNOLOGY AND
Subdivision 1. Implementation.
By January 1, 2015, all hospitals and health care
providers must have in place an interoperable electronic health records system within their
hospital system or clinical practice setting. The commissioner of health, in consultation
with the e-
Information Technology and Infrastructure
shall develop a statewide plan to meet this goal, including uniform standards to be used
for the interoperable system for sharing and synchronizing patient data across systems.
The standards must be compatible with federal efforts. The uniform standards must be
developed by January 1, 2009,
with a status report on the development of these standards
1.14 submitted to the legislature by January 15, 2008 and updated on an ongoing basis. The
1.15commissioner shall include an update on standards development as part of an annual
1.16report to the legislature
1.17 Subd. 1a. Definitions. (a) "Certified electronic health record technology" means an
1.18electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH
1.19Act to meet the standards and implementation specifications adopted under section 3004
1.21(b) "Commissioner" means the commissioner of health.
1.22(c) "Electronic data intermediary" means any entity that provides the infrastructure to
1.23connect computer systems or other electronic devices utilized by prescribing practitioners
1.24with those used by pharmacies, health plans, third party administrators, and pharmacy
1.25benefit manager in order to facilitate the secure transmission of electronic prescriptions,
2.1refill authorization requests, communications, and other prescription-related information
2.2between such entities.
2.3(d) "HITECH Act" means the Health Information Technology for Economic and
2.4Clinical Health Act in division A, title XIII and division B, title IV of the American
2.5Recovery and Reinvestment Act of 2009, including federal regulations adopted under
2.7(e) "Interoperable electronic health record" means an electronic health record that
2.8securely exchanges health information with another electronic health record system that
2.9meets national requirements for certification under the HITECH Act.
2.10(f) "Qualified electronic health record" means an electronic record of health-related
2.11information on an individual that includes patient demographic and clinical health
2.12information and has the capacity to:
2.13(1) provide clinical decision support;
2.14(2) support physician order entry;
2.15(3) capture and query information relevant to health care quality; and
2.16(4) exchange electronic health information with, and integrate such information
2.17from, other sources.
Subd. 2. E-Health
Information Technology and Infrastructure Advisory
(a) The commissioner shall establish
a an e-
2.20 and Infrastructure
Advisory Committee governed by section
to advise the
commissioner on the following matters:
(1) assessment of the adoption and effective
use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;
(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
data exchange, clinical support programs, patient privacy
requirements, and maintenance of the security and confidentiality of individual patient
(3) recommendations for encouraging use of innovative health care applications
using information technology and systems to improve patient care and reduce the cost
of care, including applications relating to disease management and personal health
management that enable remote monitoring of patients' conditions, especially those with
chronic conditions; and
(4) other related issues as requested by the commissioner.
(b) The members of the e-
Information Technology and Infrastructure
Advisory Committee shall include the commissioners, or commissioners' designees, of
health, human services, administration, and commerce and additional members to be
appointed by the commissioner to include persons representing Minnesota's local public
health agencies, licensed hospitals and other licensed facilities and providers, private
purchasers, the medical and nursing professions, health insurers and health plans, the
state quality improvement organization, academic and research institutions, consumer
advisory organizations with an interest and expertise in health information technology, and
other stakeholders as identified by the
Health Information Technology and Infrastructure
3.8 Advisory Committee commissioner to fulfill the requirements of section 3013, paragraph
3.9(g) of the HITECH Act
(c) The commissioner shall prepare and issue an annual report not later than January
30 of each year outlining progress to date in implementing a statewide health information
infrastructure and recommending
future projects action on policy and necessary resources
3.13to continue the promotion of adoption and effective use of health information technology
(d) Notwithstanding section
, this subdivision expires June 30, 2015.
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.
3.19(a) The electronic health record must be a qualified electronic health record.
(b) The electronic health record must be certified by the
3.21 for Healthcare Information Technology, or its successor Office of the National Coordinator
3.22pursuant to the HITECH Act
. This criterion only applies to hospitals and health care
whose practice setting is a practice setting covered by the Certification
3.24 Commission for Healthcare Information Technology certifications only if a certified
3.25electronic 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.
3.29(c) The electronic health record must meet the standards established according to
3.30section 3004 of the HITECH Act as applicable.
3.31(d) The electronic health record must have the ability to generate information on
3.32clinical quality measures and other measures reported under sections 4101, 4102, and
3.334201 of the HITECH Act.
A health care provider who is a prescriber or dispenser of
3.35 substances legend drugs
must have an electronic health record system that meets the
requirements of section
4.1 Subd. 4. Coordination with national HIT activities. (a) The commissioner,
4.2in consultation with the e-Health Advisory Committee, shall update the statewide
4.3implementation plan required under subdivision 2 and released June 2008, to be consistent
4.4with the updated Federal HIT Strategic Plan released by the Office of the National
4.5Coordinator in accordance with section 3001 of the HITECH Act. The statewide plan
4.6shall meet the requirements for a plan required under section 3013 of the HITECH Act.
4.7(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
4.8work to ensure coordination between state, regional, and national efforts to support and
4.9accelerate efforts to effectively use health information technology to improve the quality
4.10and coordination of health care and continuity of patient care among health care providers,
4.11to reduce medical errors, to improve population health, to reduce health disparities, and
4.12to reduce chronic disease. The commissioner's coordination efforts shall include but not
4.13be limited to:
4.14(1) assisting in the development and support of health information technology
4.15regional extension centers established under section 3012(c) of the HITECH Act to
4.16provide technical assistance and disseminate best practices; and
4.17(2) providing supplemental information to the best practices gathered by regional
4.18centers to ensure that the information is relayed in a meaningful way to the Minnesota
4.19health care community.
4.20(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
4.21monitor national activity related to health information technology and shall coordinate
4.22statewide input on policy development. The commissioner shall coordinate statewide
4.23responses to proposed federal regulations in order to ensure that the needs of the
4.24Minnesota health care community are adequately and efficiently addressed in the proposed
4.25regulations. The commissioner's responses may include, but are not limited to:
4.26(1) reviewing and evaluating any standard, implementation specification, or
4.27certification criteria proposed by the national HIT standards committee;
4.28(2) reviewing and evaluating policy proposed by the national HIT policy
4.29committee relating to the implementation of a nationwide health information technology
4.31(3) monitoring and responding to activity related to the development of quality
4.32measures and other measures as required by section 4101 of the HITECH Act. Any
4.33response related to quality measures shall consider and address the quality efforts required
4.34under chapter 62U; and
5.1(4) monitoring and responding to national activity related to privacy, security, and
5.2data stewardship of electronic health information and individually identifiable health
5.4(d) To the extent that the state is either required or allowed to apply, or designate an
5.5entity to apply for or carry out activities and programs under section 3013 of the HITECH
5.6Act, the commissioner of health, in consultation with the e-Health Advisory Committee
5.7and the commissioner of human services, shall be the lead applicant or sole designating
5.8authority. The commissioner shall make such designations consistent with the goals and
5.9objectives of sections 62J.495 to 62J.497, and sections 62J.50 to 62J.61.
5.10(e) The commissioner of human services shall apply for funding necessary to
5.11administer the incentive payments to providers authorized under title IV of the American
5.12Recovery and Reinvestment Act.
5.13(f) The commissioner shall include in the report to the legislature information on the
5.14activities of this subdivision and provide recommendations on any relevant policy changes
5.15that should be considered in Minnesota.
5.16 Subd. 5. Collection of data for assessment and eligibility determination. (a) The
5.17commissioner of health, in consultation with the commissioner of human services, may
5.18require providers, dispensers, group purchasers, and electronic data intermediaries to
5.19submit data in a form and manner specified by the commissioner to assess the status of
5.20adoption, effective use, and interoperability of electronic health records for the purpose of:
5.21(1) demonstrating Minnesota's progress on goals established by the Office of the
5.22National Coordinator to accelerate the adoption and effective use of health information
5.23technology established under the HITECH Act;
5.24(2) assisting the Center for Medicare and Medicaid Services and Department of
5.25Human Services in determining eligibility of health care professionals and hospitals
5.26to receive federal incentives for the adoption and effective use of health information
5.27technology under the HITECH Act or other federal incentive programs;
5.28(3) assisting the Office of the National Coordinator in completing required
5.29assessments of the impact of the implementation and effective use of health information
5.30technology in achieving goals identified in the national strategic plan, and completing
5.31studies required by the HITECH Act;
5.32(4) providing the data necessary to assist the Office of the National Coordinator in
5.33conducting evaluations of regional extension centers as required by the HITECH Act; and
5.34(5) other purposes as necessary to support the implementation of the HITECH Act.
5.35(b) The commissioner shall coordinate with the commissioner of human services
5.36and other state agencies in the collection of data required under this section to:
6.1(1) avoid duplicative reporting requirements;
6.2(2) maximize efficiencies in the development of reports on state activities as
6.3required by HITECH; and
6.4(3) determine health professional and hospital eligibility for incentives available
6.5under the HITECH Act.
6.6 Subd. 6. Data classification. (a) Data collected on providers, dispensers, group
6.7purchasers, and electronic data intermediaries under this section are private data on
6.8individuals or nonpublic data, as defined in section 13.02. Notwithstanding the definition
6.9of summary data in section 13.02, subdivision 19, summary data prepared under this
6.10subdivision may be derived from nonpublic data.
6.11(b) Nothing in this section authorizes the collection of individual patient data.
Sec. 2. Minnesota Statutes 2008, section 62J.496, is amended to read:
6.1362J.496 ELECTRONIC HEALTH RECORD SYSTEM REVOLVING
6.14ACCOUNT AND LOAN PROGRAM.
Subdivision 1. Account establishment. (a)
An account is established to:
6.16 loans to eligible borrowers to assist in financing the installation or support of an
6.17 interoperable health record system. The system must provide for the interoperable
6.18 exchange of health care information between the applicant and, at a minimum, a hospital
6.19 system, pharmacy, and a health care clinic or other physician group.
6.20(1) finance the purchase of certified electronic health records or qualified electronic
6.21health records as defined in section 62J.495, subdivision 1a;
6.22(2) enhance the utilization of electronic health record technology, which may include
6.23costs associated with upgrading the technology to meet the criteria necessary to be a
6.24certified electronic health record or a qualified electronic health record;
6.25(3) train personnel in the use of electronic health record technology; and
6.26(4) improve the secure electronic exchange of health information.
6.27(b) Amounts deposited in the account, including any grant funds obtained through
6.28federal or other sources, loan repayments, and interest earned on the amounts shall be
6.29used only for awarding loans or loan guarantees, as a source of reserve and security for
6.30leveraged loans, or for the administration of the account.
6.31(c) The commissioner may accept contributions to the account from private sector
6.32entities subject to the following provisions:
6.33(1) the contributing entity may not specify the recipient or recipients of any loan
6.34issued under this subdivision;
7.1(2) the commissioner shall make public the identity of any private contributor to the
7.2loan fund, as well as the amount of the contribution provided; and
7.3(3) the commissioner may issue letters of commendation or make other awards that
7.4have no financial value to any such entity.
7.5A contributing entity may not specify that the recipient or recipients of any loan use
7.6specific products or services, nor may the contributing entity imply that a contribution is
7.7an endorsement of any specific product or service.
7.8(d) The commissioner may use the loan funds to reimburse private sector entities
7.9for any contribution made to the loan fund. Reimbursement to private entities may not
7.10exceed the principle amount contributed to the loan fund.
7.11(e) The commissioner may use funds deposited in the account to guarantee, or
7.12purchase insurance for, a local obligation if the guarantee or purchase would improve
7.13credit market access or reduce the interest rate applicable to the obligation involved.
7.14(f) The commissioner may use funds deposited in the account as a source of revenue
7.15or security for the payment of principal and interest on revenue or bonds issued by the
7.16state if the proceeds of the sale of the bonds will be deposited into the loan fund.
Subd. 2. Eligibility.
(a) "Eligible borrower" means one of the following:
7.18(1) federally qualified health centers;
community clinics, as defined under section
hospitals eligible for rural hospital capital improvement grants, as defined
(3) physician clinics located in a community with a population of less than 50,000
7.23 according to United States Census Bureau statistics and outside the seven-county
7.24 metropolitan area;
7.25(4) individual or small group physician practices that are focused primarily on
7.27 (4) (5)
nursing facilities licensed under sections
7.28(6) local public health departments as defined in chapter 145A; and
7.29 (5) (7)
other providers of health or health care services approved by the
commissioner for which interoperable electronic health record capability would improve
quality of care, patient safety, or community health.
7.32 (b) The commissioner shall administer the loan fund to prioritize support and
7.34(1) critical access hospitals;
7.35(2) federally qualified health centers;
8.1(3) entities that serve uninsured, underinsured, and medically underserved
8.2individuals, regardless of whether such area is urban or rural; and
8.3(4) individual or small group practices that are primarily focused on primary care.
(b) To be eligible for a loan under this section, the (c) An eligible
submit a loan application to the commissioner of health on forms prescribed by the
commissioner. The application must include, at a minimum:
(1) the amount of the loan requested and a description of the purpose or project
for which the loan proceeds will be used;
(2) a quote from a vendor;
(3) a description of the health care entities and other groups participating in the
(4) evidence of financial stability and a demonstrated ability to repay the loan; and
(5) a description of how the system to be financed
plans in the future to
with other health care entities and provider
groups located in the same geographical area;
8.16(6) a plan on how the certified electronic health record technology will be maintained
8.17and supported over time; and
8.18(7) any other requirements for applications included or developed pursuant to
8.19section 3014 of the HITECH Act
Subd. 3. Loans.
(a) The commissioner of health may make a no interest, or low
loan to a provider or provider group who is eligible under subdivision 2
8.22 first-come, first-served basis provided that the applicant is able to comply with this section
8.23consistent with the priorities established in subdivision 2
. The total accumulative loan
principal must not exceed
per loan. The interest rate for each
8.25loan, if imposed, shall not exceed the current market interest rate.
The commissioner of
health has discretion over the size, interest rate,
and number of loans made. Nothing in
8.27this section shall require the commissioner to make a loan to an eligible borrower under
(b) The commissioner of health may prescribe forms and establish an application
process and, notwithstanding section
, may impose a reasonable nonrefundable
application fee to cover the cost of administering the loan program. Any application
fees imposed and collected under the electronic health records system revolving account
and loan program in this section are appropriated to the commissioner of health for the
duration of the loan program. The commissioner may apply for and use all federal funds
8.35available through the HITECH Act to administer the loan program.
(c) For loans approved prior to July 1, 2009,
the borrower must begin repaying the
principal no later than two years from the date of the loan. Loans must be amortized no
later than six years from the date of the loan.
9.4(d) For loans granted on January 1, 2010, or thereafter, the borrower must begin
9.5repaying the principle no later than one year from the date of the loan. Loans must be
9.6amortized no later than six years after the date of the loan.
(d) Repayments (e) All repayments and interest paid on each loan
must be credited
to the account.
9.9(f) The loan agreement shall include the assurances that borrower meets requirements
9.10included or developed pursuant to section 3014 of the HITECH Act. The requirements
9.11shall include, but are not limited to:
9.12(1) submitting reports on quality measures in compliance with regulations adopted
9.13by the federal government;
9.14(2) demonstrating that any certified electronic health record technology purchased,
9.15improved, or otherwise financially supported by this loan program is used to exchange
9.16health information in a manner that, in accordance with law and standards applicable to
9.17the exchange of information, improves the quality of health care;
9.18(3) including a plan on how the borrower intends to maintain and support the
9.19certified electronic health record technology over time and the resources expected to be
9.20used to maintain and support the technology purchased with the loan; and
9.21(4) complying with other requirements the secretary may require to use loans funds
9.22under the HITECH Act.
Subd. 4. Data classification.
Data collected by the commissioner of health on the
application to determine eligibility under subdivision 2 and to monitor borrowers' default
risk or collect payments owed under subdivision 3 are (1) private data on individuals as
defined in section
13.02, subdivision 12
; and (2) nonpublic data as defined in section
9.2713.02, subdivision 9
. The names of borrowers and the amounts of the loans granted
are public data.
Sec. 3. Minnesota Statutes 2008, section 62J.497, subdivision 1, is amended to read:
Subdivision 1. Definitions.
For the purposes of this section, the following terms
have the meanings given.
9.32(a) "Backward compatible" means that the newer version of a data transmission
9.33standard would retain, at a minimum, the full functionality of the versions previously
9.34adopted, and would permit the successful completion of the applicable transactions with
9.35entities that continue to use the older versions.
"Dispense" or "dispensing" has the meaning given in section
30. Dispensing does not include the direct administering of a controlled
substance to a patient by a licensed health care professional.
"Dispenser" means a person authorized by law to dispense a controlled
substance, pursuant to a valid prescription.
"Electronic media" has the meaning given under Code of Federal Regulations,
title 45, part
"E-prescribing" means the transmission using electronic media of prescription
or prescription-related information between a prescriber, dispenser, pharmacy benefit
manager, or group purchaser, either directly or through an intermediary, including
an e-prescribing network. E-prescribing includes, but is not limited to, two-way
transmissions between the point of care and the dispenser and two-way transmissions
10.13related to eligibility, formulary, and medication history information
"Electronic prescription drug program" means a program that provides for
"Group purchaser" has the meaning given in section
62J.03, subdivision 6
"HL7 messages" means a standard approved by the standards development
organization known as Health Level Seven.
"National Provider Identifier" or "NPI" means the identifier described under
Code of Federal Regulations, title 45, part
"NCPDP" means the National Council for Prescription Drug Programs, Inc.
"NCPDP Formulary and Benefits Standard" means the National Council for
Prescription Drug Programs Formulary and Benefits Standard, Implementation Guide,
Version 1, Release 0, October 2005.
"NCPDP SCRIPT Standard" means the National Council for Prescription
Drug Programs Prescriber/Pharmacist Interface SCRIPT Standard, Implementation
Guide Version 8, Release 1 (Version 8.1), October 2005, or the most recent standard
10.28adopted by the Centers for Medicare and Medicaid Services for e-prescribing under
10.29Medicare Part D as required by section 1860D-4(e)(4)(D) of the Social Security Act, and
10.30regulations adopted under it. The standards shall be implemented according to the Centers
10.31for Medicare and Medicaid Services schedule for compliance. Subsequently released
10.32versions of the NCPDP SCRIPT Standard may be used, provided that the new version
10.33of the standard is backward compatible to the current version adopted by the Centers for
10.34Medicare and Medicaid Services
"Pharmacy" has the meaning given in section
151.01, subdivision 2
"Prescriber" means a licensed health care professional who is authorized to
prescribe a controlled substance under section
152.12, subdivision 1
"Prescription-related information" means information regarding eligibility for
drug benefits, medication history, or related health or drug information.
"Provider" or "health care provider" has the meaning given in section
Sec. 4. Minnesota Statutes 2008, section 62J.497, subdivision 2, is amended to read:
Subd. 2. Requirements for electronic prescribing.
(a) Effective January 1, 2011,
all providers, group purchasers, prescribers, and dispensers must establish
an electronic prescription drug program
that complies. This program must comply
with the applicable standards in this section for transmitting, directly or through an
intermediary, prescriptions and prescription-related information using electronic media.
Nothing in this section requires providers, group purchasers, prescribers, or
11.14 dispensers to conduct the transactions described in this section.
If transactions described in
this section are conducted, they must be done electronically using the standards described
in this section. Nothing in this section requires providers, group purchasers, prescribers,
or dispensers to electronically conduct transactions that are expressly prohibited by other
sections or federal law.
(c) Providers, group purchasers, prescribers, and dispensers must use either HL7
messages or the NCPDP SCRIPT Standard to transmit prescriptions or prescription-related
information internally when the sender and the recipient are part of the same legal entity. If
an entity sends prescriptions outside the entity, it must use the NCPDP SCRIPT Standard
or other applicable standards required by this section. Any pharmacy within an entity
must be able to receive electronic prescription transmittals from outside the entity using
the adopted NCPDP SCRIPT Standard. This exemption does not supersede any Health
Insurance Portability and Accountability Act (HIPAA) requirement that may require the
use of a HIPAA transaction standard within an organization.
(d) Entities transmitting prescriptions or prescription-related information where the
11.29 prescriber is required by law to issue a prescription for a patient to a nonprescribing
11.30 provider that in turn forwards the prescription to a dispenser are exempt from the
11.31 requirement to use the NCPDP SCRIPT Standard when transmitting prescriptions or
11.32 prescription-related information.
Sec. 5. DEVELOPING TECHNOLOGY STANDARDS AND TOOLS.
11.34The commissioner of health, in consultation with the Minnesota Administrative
11.35Uniformity Committee and the commissioner of human services, shall study and make
12.1recommendations on the feasibility and barriers to simplifying health care administrative
12.2transactions through electronic data interchange. The study shall include:
12.3(1) recommendations regarding the feasibility and barriers to establishing a single,
12.4standardized system for all group purchasers for health care administrative transactions
12.5and notification, preauthorization, or service notification, and retroactive denial through
12.6electronic data interchange, identifying a range of potential technologies to accomplish
12.8(2) recommendations regarding the relationship of technologies to the e-prescribing
12.9requirements of Minnesota Statutes, section 62J.497;
12.10(3) recommendations for ensuring that any use of technologies by providers and
12.11group purchasers is consistent with national standards;
12.12(4) an analysis of the readiness of providers and group purchasers to implement
12.13appropriate technologies and comply with technology requirements already required by
12.15(5) recommendation for prioritizing the implementation of specific technologies in
12.16relation to provider and health plan efforts to meet the requirements of Minnesota Statutes,
12.17section 62J.536, to meet the administrative requirements of Minnesota Statutes, section
12.1862J.497, to meet federal requirements for transitioning from ICD-9 to ICD-10, and to
12.19comply with federal changes to the Code of Federal Regulations, title 45, part 162.
Renumber the sections in sequence and correct the internal references
Amend the title accordingly