H395: HIE Deadline Extension & Patient Protection. Latest Version



AN ACT EXEMPTING AMBULATORY SURGICAL CENTERS FROM THE REQUIREMENT TO SUBMIT DEMOGRAPHIC AND CLINICAL DATA, EXTENDING FOR CERTAIN PROVIDERS AND ENTITIES THE DEADLINES for mandatory participation in the statewide health information exchange network known as nc healthconnex, and instituting reforms to protect patients.

The General Assembly of North Carolina enacts:

SECTION 1.  G.S. 90‑414.4(a) reads as rewritten:

§ 90‑414.4.  Required participation in HIE Network for some providers.

(a)        Findings. – The General Assembly makes the following findings:

(1)        That controlling escalating health care costs of the Medicaid program and other State‑funded health care services is of significant importance to the State, its taxpayers, its Medicaid recipients, and other recipients of State‑funded health care services.

(2)        That the State and covered entities in North Carolina need timely access to certain demographic and clinical information pertaining to services rendered to Medicaid and other State‑funded health care program beneficiaries and paid for with Medicaid or other State‑funded health care funds in order to assess performance, improve health care outcomes, pinpoint medical expense trends, identify beneficiary health risks, and evaluate how the State is spending money on Medicaid and other State‑funded health care services. The Department of Information Technology, the Department of State Treasurer, State Health Plan Division, and the Department of Health and Human Services, Division of Health Benefits, have an affirmative duty to facilitate and support participation by covered entities in the statewide health information exchange network.

(3)        That making demographic and clinical information available to the State and covered entities in North Carolina by secure electronic means as set forth in subsection (b) of this section will improve care coordination within and across health systems, increase care quality for such beneficiaries, enable more effective population health management, reduce duplication of medical services, augment syndromic surveillance, allow more accurate measurement of care services and outcomes, increase strategic knowledge about the health of the population, and facilitate health care cost containment.

SECTION 2.  G.S. 90‑414.4(a1) reads as rewritten:

(a1)    Mandatory Connection to HIE Network. – Notwithstanding the voluntary nature of the HIE Network under G.S. 90‑414.2, the following providers and entities shall be connected to the HIE Network and begin submitting data through the HIE Network pertaining to services rendered to Medicaid beneficiaries and to other State‑funded health care program beneficiaries and paid for with Medicaid or other State‑funded health care funds in accordance with the following time line:



(2)        Except as provided in subdivisions (3), (4), and (5) of this subsection, all other providers of Medicaid and State‑funded health care services and their affiliated entities shall begin submitting demographic and clinical data by October 1, 2021.January 1, 2023.



(4)        The following entities shall begin submitting demographic and clinical data by June 1, 2021:January 1, 2023:

a.         Ambulatory surgical centers as defined in G.S. 131E‑146.

b.         Dentists licensed under Article 2 of Chapter 90 of the General Statutes.

c.         Licensed physicians whose primary area of practice is psychiatry.

d.         The State Laboratory of Public Health operated by the Department of Health and Human Services.

(5)        The following entities shall begin submitting claims data by June 1, 2021:January 1, 2023:

a.         Pharmacies registered with the North Carolina Board of Pharmacy under Article 4A of Chapter 90 of the General Statutes.

b.         State health care facilities operated under the jurisdiction of the Secretary of the Department of Health and Human Services, including State psychiatric hospitals, developmental centers, alcohol and drug treatment centers, neuro‑medical treatment centers, and residential programs for children such as the Wright School and the Whitaker Psychiatric Residential Treatment Facility.

SECTION 3.  G.S. 90‑414.4(a2) reads as rewritten:

(a2)    Extensions of Time for Establishing Connection to the HIE Network. – The Department of Information Technology, in consultation with the Department of Health and Human Services and the State Health Plan for Teachers and State Employees, may establish a process to grant limited extensions of the time for providers and entities to connect to the HIE Network and begin submitting data as required by this section upon the request of a provider or entity that demonstrates an ongoing good‑faith effort to take necessary steps to establish such connection and begin data submission as required by this section. The process for granting an extension of time must include a presentation by the provider or entity to the Department of Information Technology, the Department of Health and Human Services, and the State Health Plan for Teachers and State Employees on the expected time line for connecting to the HIE Network and commencing data submission as required by this section. Neither the Department of Information Technology, the Department of Health and Human Services, nor the State Health Plan for Teachers and State Employees shall grant an extension of time (i) to any provider or entity that fails to provide this information to both Departments, and the State Health Plan for Teachers and State Employees, (ii) that would result in the provider or entity connecting to the HIE Network and commencing data submission as required by this section later than October 1, 2021, or (iii) that would result in any provider or entity specified in subdivisions (4) and (5) of subsection (a1) of this section connecting to the HIE Network and commencing data submission as required by this section later than June 1, 2022. January 1, 2023. The Department of Information Technology shall consult with the Department of Health and Human Services and the State Health Plan for Teachers and State Employees to review and decide upon a request for an extension of time under this section within 30 days after receiving a request for an extension.

SECTION 4.  G.S. 90‑414.4(b) reads as rewritten:

(b)      Mandatory Submission of Demographic and Clinical Data. – Notwithstanding the voluntary nature of the HIE Network under G.S. 90‑414.2 and, except as otherwise provided in subsection (c) of this section, as a condition of receiving State funds, including Medicaid funds, the following entities shall submit at least twice daily, through the HIE network, demographic and clinical information pertaining to services rendered to Medicaid and other State‑funded health care program beneficiaries and paid for with Medicaid or other State‑funded health care funds, solely for the purposes set forth in subsection (a) of this section:

(1)        Each hospital, as defined in G.S. 131E‑176(13) that has an electronic health record system.

(2)        Each Medicaid provider.provider, unless the provider is an ambulatory surgical center, as defined in G.S. 131E‑146.

(3)        Each provider that receives State funds for the provision of health services.services, unless the provider is an ambulatory surgical center, as defined in G.S. 131E‑146.

(4)        Each local management entity/managed care organization, as defined in G.S. 122C‑3.

SECTION 5.  G.S. 90‑414.4 is amended by adding a new subsection to read:

(b1)    Any provider or entity whose receipt of State funds is negatively impacted by a failure to connect to the HIE Network and submit required data in compliance with this Article shall not balance bill for any services rendered to State‑funded health care program beneficiaries, and those beneficiaries shall not be responsible for improper charges.

SECTION 6.  G.S. 90‑414.6 reads as rewritten:

§ 90‑414.6.  State ownership of HIE Network data.

Any data pertaining to services rendered to Medicaid and other State‑funded health care program beneficiaries submitted through and stored by the HIE Network pursuant to G.S. 90‑414.4 or any other provision of this Article shall be and will remain the sole property of the State. Any data or product derived from the aggregated, de‑identified data submitted to and stored by the HIE Network pursuant to G.S. 90‑414.4 or any other provision of this Article, shall be and will remain the sole property of the State. The Authority shall not allow data it receives pursuant to G.S. 90‑414.4 or any other provision of this Article to be used or disclosed by or to any person or entity for commercial purposes or for any other purpose other than those set forth in G.S. 90‑414.4(a) or G.S. 90‑414.2. To the extent the Authority receives requests for electronic health information as the term is defined in 45 C.F.R. § 171.102, or other medical records from an individual, an individual's personal representative, or an individual or entity purporting to act on an individual's behalf, the Authority (i) shall not fulfill the request and (ii) shall make available to the requester and the public, via the Authority's website, educational materials about how to access such information from other sources.

SECTION 7.  On or before December 1, 2022, the NC HIE Advisory Board shall submit to the Joint Legislative Oversight Committee on Health and Human Services recommendations regarding appropriate features or actions to support enforcement of the Statewide Health Information Exchange Act contained in Article 29B of Chapter 90 of the General Statutes.

SECTION 8.  This act is effective when it becomes law.