Minnesota Law and Health Information Exchange

Oversight Activities

James I. Golden, PhDState Government Health IT Coordinator

Director, Health Policy DivisionMinnesota Department of Health

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Developing the Minnesota Approach

• October 2009 - January 2010: MN e-Health Advisory Committee convened a public workgroup to develop recommendations on health information exchange

• 30-day public comment period to seek additional public input

• Recommendations became the basis of legislation to establish a mechanism to oversee HIE activities in Minnesota

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New Minnesota Law Governing HIE

• May 13, 2010, Chapter 336 (SF 2974) signed into law

• Establishes certification requirements and oversight for organizations conducting Health Information Exchange in Minnesota

• Effective July 1, 2010, all organizations that provide HIE services for clinical meaningful use transactions must apply for a certificate of authority to operate in Minnesota

(M.S., § 62J.498 - 62J.4982)

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Mechanism for State Certification and Oversight of HIE

Minnesota 2010 Session Law, Chapter 336

• Establishes oversight by Commissioner of Health to protect the public interest on matters pertaining to health information exchange

– Transparent public hearing process with on-going input by Minnesota consumers & stakeholders

• Allows open, free market for provision of HIE services

– Allows for multiple HIOs to be certified and operate in the state

• Requires State certificate of authority to operate– Health Information Organizations (HIO)– Health Data Intermediaries (HDI)

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Health Information Organization

• Health Information Organization (HIO)Health information organization means an organization that oversees, governs, and/or facilitates the exchange of health-related information among organizations according to nationally recognized standards.

• An entity must apply for a Certificate of Authority to operate as an HIO if it provides all electronic capabilities for the transmission of clinical transactions necessary for meaningful use.

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Health Data Intermediary

• Health Data Intermediary (HDI)Health data intermediaries are entities that provide the infrastructure necessary to connect computer systems or other electronic devices utilized by health care providers, laboratories, pharmacies, health plans, third-party administrators or pharmacy benefit managers in order to facilitate the secure transmission of health information.

• A health data intermediary that provides HIE services for the transmission of one or more clinical meaningful use transactions must apply for a Certificate of Authority

• An HDI does not include health care providers engaged in direct health information exchange.

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State Certification and Oversight of HIE

• Establishes common ground rules for HIE service providers– Requires connection & interoperability across HIOs and HDIs

– Ensures that organizations engaged in HIE are adhering to nationally recognized standards

– Requires that organizations maintain strategic and operational plans that support health care providers in achieving meaningful use

• Verifies financial sustainability of HIE service providers– Schedule of proposed charges and a financial plan, including a three-year

projection of the expenses and income and other sources of future capital

– HIOs must submit a rate plan outlining fee structures for health information exchange services.

– Rate review & approval

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State Certification and Oversight of HIE

• Protects Consumer – Ensures that health information follows the patient across the full

continuum of care

– Provides public hearings to give consumers an opportunity to provide feedback and recommendations on applications

– HIOs and HDIs must demonstrate compliance with state and federal privacy laws

– Ensures that HIOs and HDIs have adequate insurance

– Requires a description of complaint procedures

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State Certification and Oversight of HIE

• Protects Providers– Prevents the fragmentation from a lack of interoperability or cooperation

between HIE service providers

– Strategic and operational plans that address how the HIE service provider will expand technical capacity to support providers in achieving meaningful use

– Maintain a business plan that addresses the needs of community clinics, critical access hospitals, and free clinics in accessing HIE services

– Description of the mechanism by which providers will have an opportunity to participate in matters of policy and operation

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Reciprocal Agreements

• HIOs and HDIs must enter into agreements with each other that: – Permit access to each other’s Record Locator Service – do not impede the secure transmission of transactions necessary to achieve

meaningful use– do not charge a fee for the exchange of meaningful use transactions

transmitted according to nationally recognized standards– are consistent with fair market value and proportionately reflect the value-

added services accessed as a result of the agreement– prevent health care stakeholders from being charged multiple times for the

same service.– include comparable quality of service standards

• Reciprocal agreements are subject to review and approval by the Commissioner of Health

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Minnesota HIE Application Process

• Applicants must complete an application demonstrating compliance with requirements

• Completed applications are posted on website for 10 days

• There is a public hearing for stakeholders to ask questions and comment on applications

• A review panel will help direct the public hearing

• Five-day period after the hearing to submit additional comments

www.health.state.mn.us/divs/hpsc/ohit/certificate.html

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Compliance and Enforcement Authority

• Minnesota law authorizes the Commissioner of Health to take enforcement action if entity fails to comply with requirements

– Arrange a voluntary conference to find a way to correct or prevent violations

– Issue an order to “cease and desist” from engaging in any act or practice in violation of law

– Assess monetary penalty up to $25,000 per violation

– Suspend or revoke entity’s Certificate of Authority

Financing HIE Oversight

HIE Service Provider Type

One-Time Application Fee

Annual Certification Fee

HIO $10,500 $14,000

HDI $7,000 $7,000

HIE Service Provider Application & Certification Fees

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HIE Service Provider Application Process

See Website: www.health.state.mn.us/divs/hpsc/ohit/certificate.html

• Instructions and Guidance for Applicants

• Application Form and Checklist

• Glossary of Key Terms

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For More Information

Donna Watz, JDMinnesota Department of Health Office of Health Information Technologydonna.watz@state.mn.us 651-201-3598

James Golden, PhDMinnesota Department of Health Health Policy Division james.golden@state.mn.us 651-201-4819