BILL ANALYSIS Ó
SENATE JUDICIARY COMMITTEE
Senator Hannah-Beth Jackson, Chair
2015-2016 Regular Session
SB 980 (Nielsen)
Version: February 10, 2016
Hearing Date: April 19, 2016
Fiscal: Yes
Urgency: No
NR
SUBJECT
Veterans' homes
DESCRIPTION
Existing law provides for the establishment and operation of
veterans' homes at various sites, and provides for the
administration of these homes. This bill would revise and
recast those provisions. This bill would specify which veterans'
homes are administered by the Department of Veterans Affairs and
would require the Secretary of Veterans Affairs to implement a
statewide electronic medical record system for veterans' homes
by January 1, 2018. This bill would make other conforming
changes.
BACKGROUND
The State of California, acknowledging the service and
sacrifices California veterans have made, established veterans'
homes to help provide for the state's aged or disabled veterans.
The Veterans Homes Division provides rehabilitative,
residential medical care, and other services in a homelike
environment for eligible veterans and their spouses. Eight
homes in California currently serve over 2,000 veterans.
Seeking to ensure that California's veterans receive quality
care, this bill would update laws, policies, and procedures
governing the homes, and would require the Secretary of
Veteran's Affairs (secretary) to implement an electronic medical
record system for standardized use in the homes. The use of
electronic health records has been on the rise since 2009 when
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the President signed the American Recovery and Reinvestment Act
which included the establishment of the Office of the National
Coordinator for Health Information Technology to facilitate and
expand the use of health information technology pursuant to
national standards. Using electronic health record systems is
intended to reduce medical errors and increase patient
accessibility to personal medical information. However,
according to Privacy Rights Clearing House, 1,263 data breaches
involving medical and healthcare providers have been made public
since 2005. Those breaches involved over 45 million records.
Accordingly, both the state and federal governments continue to
enact measures to ensure the protection of patient medical
information, and closely monitor legislation involving
electronic health records.
CHANGES TO EXISTING LAW
Existing law , the California Constitution, provides that all
people have inalienable rights, including the right to pursue
and obtain privacy. (Cal. Const. art. I, Sec. 1.)
Existing federal law , the Health Insurance Portability and
Accountability Act (HIPAA), specifies privacy protections for
patients' protected health information and generally provides
that a covered entity, as defined (health plan, health care
provider, and health care clearing house), may not use or
disclose protected health information except as specified or as
authorized by the patient in writing. (45 C.F.R. Sec. 164.500
et seq.)
Existing law prohibits, under the State Confidentiality of
Medical Information Act (CMIA), providers of health care, health
care service plans, or contractors, as defined, from sharing
medical information without the patient's written authorization,
subject to certain exceptions. (Civ. Code Sec. 56 et seq.)
This bill would update outdated terminology and references
within the Military and Veterans Code governing state veterans'
homes.
This bill would require the Secretary of Veterans Affairs
(secretary) to adopt uniform statewide policies and procedures,
by regulation, for the operation of the veterans' home system,
and would specifically require:
the Department of Veterans Affairs to establish a
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quality of care assessment team;
the secretary to adopt criteria for admission, as
specified;
the secretary to annually report to the veterans policy
committees of the Legislature;
that fees and charges be established by the Secretary;
and
that a resident spouse who continues residency after a
veteran spouse's death to continue to pay all applicable
fees and comply with all department regulations.
This bill would require the Secretary to implement a statewide
electronic health record system, and would specify that the
usage of the electronic medical record system shall be
standardized in all homes.
COMMENT
1.Stated need for the bill
According to the author:
CalVet should have a standardized electronic system of medical
records that reflects the emerging industry standard. The
veterans home system has exploded from three homes to eight
homes in the last several years and has become more
challenging in terms of guaranteeing quality of care. In
general, CalVet has lagged behind other state departments in
promulgating regulations that codify its policies and
procedures. Major portions of the Military and Veterans Code
are outdated and still include archaic and irrelevant terms
and references. This includes numerous provisions within the
areas of the Military and Veterans Code that govern state
veterans homes.
2.Protecting patient privacy and integrity of information when
using electronic medical records
The federal Health Insurance Portability and Accountability Act
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(HIPAA), enacted in 1996, guarantees privacy protection for
individuals with regard to specific health information (Pub.L.
104-191, 110 Stat. 1936). Generally, protected health
information (PHI) is any information held by a covered entity
which concerns health status, provision of health care, or
payment for health care that can be connected to an individual.
HIPAA privacy regulations require health care providers and
organizations to develop and follow procedures that ensure the
confidentiality and security of PHI when it is transferred,
received, handled, or shared. HIPAA further requires reasonable
efforts when using, disclosing, or requesting PHI, to limit
disclosure of that information to the minimum amount necessary
to accomplish the intended purpose. California's
Confidentiality of Medical Information Act (CMIA) also protects
PHI and restricts the disclosure of medical information by
health care providers, and health care service plans, as
specified. (Civ. Code Sec. 56 et seq.)
The Legislature has considered a number of bills aimed at
ensuring patient privacy and the accuracy of information within
electronic health records, including ensuring that electronic
conveyance of laboratory test results are protected (see AB
2253, Pan, Ch. 698, Stats. 2012), clarifying that businesses
that offer electronic medical records through mobile
applications are subject to CMIA requirements (see AB 658, Ch.
296, Stats. 2013), and ensuring that there is a record of any
changes to an electronic record (SB 850, Leno, Ch. 714, Stats.
2011). When considering a state-wide electronic registry for
Physician Orders for Life Sustaining Treatment (POLST), this
Committee also required that a patient be able to review a POLST
form for accuracy and make any necessary amendments prior to the
form being available to authorized users.
This bill would require an electronic medical record system for
individuals living in veterans' homes in California. Of the
veteran population, Dr. Stephen Hunt, national director of the
U.S. Department of Veterans Affairs Post Deployment Integrative
Care Initiative said "folks returning from combat have a
constellation of health concerns, including physical issues,
psychological issues and psychosocial issues concerning things
like work and family." Clearly, the wounds of war can go far
beyond what meets the eye. From mental health issues to pain and
illness that persist long after they have left the battlefield,
veterans face a multitude of health troubles more frequent among
them than the general population. (Salamon, After the Battle: 7
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Health Problems Facing Veterans, Live Science (2010)
[as of
4/12/2016].)
Given the unique needs of the veteran population, and how
information held in a medical record may affect anything from
medical treatment, to mental health treatment, to employment
prospects, privacy and accuracy with regard to veteran patient
information are of the utmost importance. Accordingly, the
following amendments would ensure that the protections the
Legislature has enacted with regard to electronic medical
records in general, will also protect veterans receiving their
care from the Department of Veterans Affairs.
Author's amendments:
Ensure that the medical record system implemented by the
secretary, and all transactions made pursuant to that system,
comply with the Confidentiality of Medical Information Act
(Part 2.6 (commencing with Section 56) of Division 1 of the
Civil Code), Chapter 1 (commencing with Section 123100) of
Part 1 of Division 106 of the Health and Safety Code, the
Information Practices Act (Chapter 1 (commencing with Section
1798) of Title 1.8 of Part 4 of Division 3 of the Civil
Code), the federal Health Insurance Portability and
Accountability Act of 1996 (HIPAA) (Public Law 104-191), the
federal Health Information Technology for Clinical Health Act
(HITECH) (Public Law 111-005), and the corresponding
implementing regulations relating to privacy and security in
Parts 160 and 164 of Title 45 of the Code of Federal
Regulations.
Support : California Council of Chapters; California State
Commanders Veteran Council; California Long-Term Care Ombudsman
Association; Military Officers Association of America-California
Council of Chapters; Veterans of Foreign Wars-Department of
California; Vietnam Veterans of America-California State Council
Opposition : None Known
HISTORY
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Source : AMVETS-Department of California; California Association
of County Veterans Service Officers
Related Pending Legislation : None Known
Prior Legislation : None Known
Prior Vote : Senate Committee on Veterans Affairs (Ayes 4, Noes
0)
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