BILL ANALYSIS
AB 278
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB 278 (Monning)
As Amended August 17, 2010
Majority vote
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|ASSEMBLY: | |(May 18, 2009) |SENATE: |23-12|(August 19, |
| | | | | |2010) |
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(vote not relevant)
Original Committee Reference: REV. & TAX.
SUMMARY : Permits the California Office of Health Information
Integrity (CalOHII) to establish and administer up to four
demonstration projects annually to evaluate potential solutions
to facilitate health information exchange that promote quality
of care, respect the privacy of personal health information, and
enhance the trust of stakeholders.
The Senate amendments delete the Assembly approved version of
this bill and instead:
1)Authorize CalOHII to establish and administer up to four
demonstration projects a year, as defined, to evaluate
potential solutions to facilitate health information exchange
(HIE) that promote quality of care, respect the privacy and
security of personal health information, and enhance the trust
of the stakeholders.
2)Authorize health care entities, as defined, to submit an
application to CalOHII to be approved as a demonstration
project participant, as defined.
3)For purposes of this bill define the following:
a) "Demonstration project" means a project approved and
administered by CalOHII in accordance to specified
provisions;
b) "Demonstration project participant" means a health care
entity that is approved by CalOHII to participate in a
demonstration project;
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c) "Governmental authority" means any municipal, county,
state, or other governmental entity that has jurisdiction
and control over the provision of, or payment for, medical
services or that routinely receives medical information to
complete its designated governmental function;
d) "Meaningful use" means the term as defined in the Health
Information Technology for Economic and Clinical Health
(HITECH) Act, and in regulations promulgated under the
HITECH Act; and,
e) "State Cooperative Agreement" means the grant agreement
between the federal government and the state, in which the
federal government awarded the state with grant money
pursuant to the HITECH Act.
4)Require CalOHII, upon receiving a demonstration project
application, to assist applicants in soliciting federal funds
for the demonstration project and work with applicants to
define the scope of the demonstration project.
5)Authorize the Director of CalOHII to approve demonstration
projects to test for, but not limited to policies and
practices related to patient consent, information, and
notification, new technologies and applications that enable
the transmission of protected health information, as
specified; and implementation issues, if any, encountered by
small solo health care providers as a result of exchanging
electronic health information.
6)Require that the selection of demonstration projects be based
on, but not limited to, the following criteria:
a) Areas critical to building consumer trust and confidence
in the HIE system;
b) Projects that help support the exchange of information
critical to meeting the federal meaningful use provisions,
as defined; and,
c) Areas recommended by the California HIE consumer and
industry stakeholder advisory process.
7)Require CalOHII to engage with stakeholders to evaluate issues
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identified by the demonstration projects, comment upon
proposed regulations, and discuss HIE solutions.
8)Require CalOHII to work collaboratively with approved
demonstration project participants to identify a set of common
data elements that will be used to collect, analyze, and
measure performance.
9)Authorize the Director of CalOHII to adopt regulations to
ensure all approved HIE service participants, as defined, and
demonstration project participants follow rules, and work
within parameters, as defined by the office, that are
consistent for the exchange of information.
10)Exempt adoption of, and changes to, such regulations from
provisions in existing law related to procedures for public
participation, the review of proposed regulations by the
Office of Administrative Law, and filing and publication
requirements that specify an effective date that is 30 days
after the date of filing with the Secretary of State.
11)Require the Director of CalOHII to file any regulation
adopted pursuant to this bill with the Office of
Administrative Law, for filing with the Secretary of State and
publication in the California Code of Regulations. Requires
such filings to cite the appropriate section of this bill and
any other applicable state or federal laws.
12)Require CalOHII, prior to adopting a regulation or changing
an existing regulation pursuant to this bill, to adopt the
standards requiring CalOHII to:
a) Post the proposed regulation on its website at least 45
days prior to adoption;
b) Accept public comments for at least 30 days after the
proposed regulation has been posted online; and,
c) Hold a hearing prior to adoption of the regulation if a
member of the public requests a public hearing during the
30-day review period.
13)Specify that any regulation adopted shall become effective on
the date it is filed with the Secretary of State unless the
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director prescribes a later date in the regulation, or in a
written instrument filed with the regulation.
14)Require regulations adopted to expire upon repeal of the
authorizing statute.
15)Require CalOHII to receive reports from demonstration project
participants on the outcome of the demonstration project no
later than 60 days after the end of the project.
16)Require CalOHII to review the results of the demonstration
projects and report to the Joint Legislative Budget Committee,
the Senate Committee on Appropriations, the Senate Committee
on Budget and Fiscal Review, the Senate Committee on Health,
the Assembly Committee on Appropriations, the Assembly
Committee on Budget, and the Assembly Committee on Health,
within six months after the end of the project.
17)Specify that demonstration projects carried out utilizing
federal grant funds may be subject to federal auditing
requirements.
18)Require costs associated with the support, assistance and
evaluation of approved demonstration projects to be funded
exclusively by federal funds or other non-General Fund
sources.
19)Repeal the provisions of the bill on the date the Director of
CalOHII executes a declaration stating that the grant period
for the State Cooperative Grant Agreement for HIE has ended.
20)Make various legislative findings and declarations.
AS PASSED BY THE ASSEMBLY , this bill deleted an erroneous
reference in Revenue and Taxation Code (R&TC) Section 18639 to
non-existing Title 15 of the Internal Revenue Code (IRC).
FISCAL EFFECT : According to Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Demonstration project $360 $360 $360Special*
procurement, administration,
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and oversight
* California Health Information Technology and Exchange Fund
(federal HITECH funds)
COMMENTS : According to the author, current state privacy laws,
while extensive, are problematic when it comes to electronic
HIE. For example, current state law does not specifically
address widespread HIE, which results in ambiguity of some state
rules in an electronic environment. Additionally, the current
health privacy framework is built upon an interaction of state
and federal requirements, and it is not easily determined which
requirements apply. Last of all, no agency or office at the
state level is authorized to establish requirements, or
interpret California medical privacy law, when it is applied to
health information exchanged electronically.
The author points out that the imminent implementation of
widespread HIE systems has raised many new issues among
stakeholders with strong and often opposing viewpoints. While
these issues generate strong and often opposing viewpoints,
there is growing consensus on two points: 1) electronic HIE is
such a new area that it raises new privacy issues on which there
is very little empirical information that can alter the debate;
and, 2) demonstration projects can provide valuable new insights
into these complex issues and can help lead to resolution on
issues.
This bill was substantially amended in the Senate and the
Assembly-approved version of this bill was deleted. This bill,
as amended in the Senate, is inconsistent with Assembly actions.
Analysis Prepared by : Martin Radosevich / HEALTH / (916)
319-2097
FN: 0006286