2016 -- H 7866

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LC005004

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- THE RHODE ISLAND HEALTH

INFORMATION EXCHANGE ACT OF 2008

     

     Introduced By: Representatives Coughlin, Solomon, Kazarian, Edwards, and Johnston

     Date Introduced: March 04, 2016

     Referred To: House Health, Education & Welfare

     (OHHS)

It is enacted by the General Assembly as follows:

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     SECTION 1. Sections 5-37.7-3, 5-37.7-4, 5-37.7-7 and 5-37.7-10 of the General Laws in

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Chapter 5-37.7 entitled "Rhode Island Health Information Exchange Act of 2008" are hereby

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amended to read as follows:

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     5-37.7-3. Definitions. -- As used in this chapter:

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      (a) "Agency" means the Rhode Island department of health.

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      (b) "Authorized representative" means:

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      (1) A person empowered by the patient participant to assert or to waive the

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confidentiality, or to disclose or authorize the disclosure of confidential information, as

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established by this chapter. That person is not, except by explicit authorization, empowered to

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waive confidentiality or to disclose or consent to the disclosure of confidential information; or

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      (2) A person appointed by the patient participant to make health care decisions on his or

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her behalf through a valid durable power of attorney for health care as set forth in Rhode Island

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general laws § 23-4.10-2; or

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      (3) A guardian or conservator, with authority to make health care decisions, if the patient

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participant is decisionally impaired; or

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      (4) Another legally appropriate medical decision maker temporarily if the patient

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participant is decisionally impaired and no health care agent, guardian or conservator is available;

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or

 

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      (5) If the patient participant is deceased, his or her personal representative or, in the

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absence of that representative, his or her heirs-at-law; or

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      (6) A parent with the authority to make health care decisions for the parent's child; or

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     (7) A person authorized by the patient participant or their authorized representative to

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access their confidential health care information form the HIE, including family members or other

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proxies as designated by the patient, to assist patient participant with the coordination of their

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care.

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      (c) "Authorization form" means the form described in § 5-37.7-7 of this chapter and by

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which a patient participant provides authorization for the RHIO to allow access to, review of,

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and/or disclosure of the patient participant's confidential health care information by electronic,

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written or other means.

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      (d) "Business associate" means a business associate as defined by HIPAA.

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      (e) "Confidential health care information" means all information relating to a patient

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participant's health care history, diagnosis, condition, treatment, or evaluation.

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      (f) "Coordination of care" means the process of coordinating, planning, monitoring,

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and/or sharing information relating to and assessing a care plan for treatment of a patient.

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      (g) "Data submitting partner" means an individual, organization or entity that has entered

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into a business associate agreement with the RHIO and submits patient participants' confidential

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health care information through the HIE.

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      (h) "Department of health" means the Rhode Island department of health.

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      (i) "Disclosure report" means a report generated by the HIE relating to the record of

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access to, review of and/or disclosure of a patient's confidential health care information received,

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accessed or held by the HIE.

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      (j) "Electronic mobilization" means the capability to move clinical information

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electronically between disparate health care information systems while maintaining the accuracy

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of the information being exchanged.

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      (k) "Emergency" means the sudden onset of a medical, mental or substance abuse or

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other condition manifesting itself by acute symptoms of severity (e.g. severe pain) where the

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absence of medical attention could reasonably be expected, by a prudent lay person, to result in

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placing the patient's health in serious jeopardy, serious impairment to bodily or mental functions,

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or serious dysfunction of any bodily organ or part.

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      (l) "Health care provider" means any person or entity licensed by this state to provide or

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lawfully providing health care services, including, but not limited to, a physician, hospital,

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intermediate care facility or other health care facility, dentist, nurse, optometrist, podiatrist,

 

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physical therapist, psychiatric social worker, pharmacist or psychologist, and any officer,

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employee, or agent of that provider acting in the course and scope of his or her employment or

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agency related to or supportive of health care services.

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      (m) "Health care services" means acts of diagnosis, treatment, medical evaluation,

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referral or counseling or any other acts that may be permissible under the health care licensing

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statutes of this state.

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      (n) "Health Information Exchange" or "HIE" means the technical system operated, or to

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be operated, by the RHIO under state authority allowing for the statewide electronic mobilization

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of confidential health care information, pursuant to this chapter.

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     (o) "Health plan" means an individual plan or a group plan that provides, or pays the cost

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of, health care services for patient participants.

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      (o)(p) "HIE Advisory Commission" means the advisory body established by the

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department of health in order to provide community input and policy recommendations regarding

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the use of the confidential health care information of the HIE.

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      (p)(q) "HIPAA" means the health insurance portability and accountability act of 1996, as

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amended.

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      (q)(r) "Participant" means a patient participant, a patient participant's authorized

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representative, a provider participant, a data submitting partner, the regional health information

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organization and the department of health, that has agreed to authorize, submit, access and/or

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disclose confidential health care information via the HIE in accordance with this chapter.

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      (r)(s) "Participation" means a patient participant's authorization, submission, access

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and/or disclosure of confidential health care information via the HIE in accordance with this

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chapter.

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      (s)(t) "Patient participant" means a person who receives health care services from a

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provider participant and has agreed to participate in the HIE through the mechanisms established

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in this chapter.

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      (t)(u) "Provider participant" means a pharmacy, laboratory, or health care provider, or

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health plan who is providing health care services to or pays for the cost of health care services for

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a patient participant and/or is submitting or accessing health care information through the HIE

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and has executed an electronic and/or written agreement regarding disclosure, access, receipt,

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retention or release of confidential health care information to the HIE;

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      (u)(v) "Regional health information organization" or "RHIO" means the organization

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designated as the RHIO by the state to provide administrative and operational support to the HIE.

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     5-37.7-4. Participation in the health information exchange. -- (a) There shall be

 

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established a statewide HIE under state authority to allow for the electronic mobilization of

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confidential health care information in Rhode Island. Confidential health care information may

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only be accessed, released or transferred from the HIE in accordance with this chapter.

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      (b) The state of Rhode Island has an interest in encouraging participation in the HIE by

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all interested parties, including, but not limited to, health care providers, patients, health plans,

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entities submitting information to the HIE, entities obtaining information from the HIE and the

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RHIO. The Rhode Island department of health is also considered a participant for public health

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purposes.

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      (c) Patients and health care providers shall have the choice to participate in the HIE, as

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defined by regulations in accordance with § 5-37.7-3, provided, however, that provider

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participants must continue to maintain their own medical record meeting the documentation and

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other standards imposed by otherwise applicable law.

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      (d) Participation in the HIE shall have no impact on the content of or use or disclosure of

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confidential health care information of patient participants that is held in locations other than the

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HIE. Nothing in this chapter shall be construed to limit, change or otherwise affect entities' rights

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to exchange confidential health care information in accordance with other applicable laws.

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      (e) The state of Rhode Island hereby imposes on the HIE and the RHIO as a matter of

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state law, the obligation to maintain, and abide by the terms of, HIPAA complaint business

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associate agreements, including, without limitation, the obligations to use appropriate safeguards

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to prevent use or disclosure of confidential health care information in accordance with HIPAA

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and this chapter, not to use or disclose confidential health care information other than as

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permitted by HIPAA and this chapter, or to make any amendment to a confidential health care

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record that a provider participant so directs and to respond to a request by a patient participant to

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make an amendment to the patient participant's confidential health care record.

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     5-37.7-7. Disclosure. -- (a) (1) Except as provided in subsection (b) of this section, a

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patient participant's confidential health care information may only be accessed, released or

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transferred from the HIE in accordance with an authorization form signed by the patient

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participant or the patient's authorized representative.

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      (b) No authorization for release or transfer of confidential health care information from

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the HIE shall be required in the following situations:

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      (1) To a health care provider who believes, in good faith, that the information is

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necessary for diagnosis or treatment of that individual in an emergency; or

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      (2) To public health authorities in order to carry out their functions as described in this

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title and titles 21 and 23, and rules promulgated under those titles. These functions include, but

 

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are not restricted to, investigations into the causes of disease, the control of public health hazards,

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enforcement of sanitary laws, investigation of reportable diseases, certification and licensure of

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health professionals and facilities, review of health care such as that required by the federal

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government and other governmental agencies, and mandatory reporting laws set forth in Rhode

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Island general laws; and or

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      (3) To the RHIO in order for it to effectuate the operation and administrative oversight of

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the HIE. ; and

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     (4) To a health plan if the information is necessary for care management of its plan

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members, or for quality and performance measure reporting.

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      (c) The content of the authorization form for access to, or the disclosure, release or

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transfer of confidential health care information from the HIE shall be prescribed by the RHIO in

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accordance with applicable department of health regulations, but at a minimum shall contain the

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following information in a clear and conspicuous manner:

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      (1) A statement of the need for and proposed uses of that information; and

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      (2) A statement that the authorization for access to, disclosure of and/or release of

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information may be withdrawn at any future time and is subject to revocation.

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      (3) That the patient has the right not to participate in the HIE; and

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      (4) The patient's right to choose to: (i) enroll in and participate fully in the HIE; or (ii)

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designate only specific health care providers that may access the patient participant's confidential

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health care information.

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      (d) Except as specifically provided by law or this chapter, or use for clinical care, a

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patient participant's confidential health care information shall not be accessed by, given, sold,

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transferred, or in any way relayed from the HIE to any other person or entity not specified in the

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patient participant authorization form meeting the requirements of subsection (c) of this section

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without first obtaining additional authorization.

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      (e) Nothing contained in this chapter shall be construed to limit the permitted access to

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or the release, transfer, access or disclosure of confidential health care information described in

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subsection (b) of this section or under other applicable law.

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      (f) Confidential health care information received, disclosed or held by the HIE shall not

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be subject to subpoena directed to the HIE or RHIO unless the following procedures have been

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completed: (i) the person seeking the confidential health care information has already requested

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and received the confidential health care information from the health care provider that was the

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original source of the information; and (ii) a determination has been made by the superior court

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upon motion and notice to the HIE or RHIO and the parties to the litigation in which the

 

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subpoena is served that the confidential health care information sought from the HIE is not

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available from another source and is either relevant to the subject matter involved in the pending

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action or is reasonably calculated to lead to the discovery of admissible evidence in such pending

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action. Any person issuing a subpoena to the HIE or RHIO pursuant to this section shall certify

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that such measures have been completed prior to the issuance of the subpoena.

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      (g) Nothing contained herein shall interfere with or impact upon any rights or obligations

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imposed by the Workers Compensation Act as contained in title 28, chapters 29 -- 38, of the

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general laws.

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     (h) Nothing contained herein shall prohibit a health plan from becoming a data

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submitting partner. A data submitting partner is not considered a managed care entity or a

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managed care contractor and the HIE is not considered a regional or local medical information

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database pursuant to §5-37.3-4.

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     5-37.7-10. Patient's rights. -- Pursuant to this chapter, a patient participant who has his

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or her confidential health care information transferred through the HIE shall have the following

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rights:

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      (1) To obtain a copy of his or her confidential health care information from the HIE;

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      (2) To obtain a copy of the disclosure report pertaining to his or her confidential health

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care information;

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      (3) To be notified as required by chapter 49.2 of title 11, the Rhode Island identity theft

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protection act, of a breach of the security system of the HIE;

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      (4) To terminate his or her participation in the HIE in accordance with rules and

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regulations promulgated by the agency; and

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      (5) To request to amend his or her own information through the provider participant. ;

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     (6) To request their confidential health care information from the HIE be disclosed to an

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authorized representative; and

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     (7) To request their confidential health care information from the HIE be disclosed to

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health care providers who are not provider participants as defined by this chapter.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO BUSINESSES AND PROFESSIONS -- THE RHODE ISLAND HEALTH

INFORMATION EXCHANGE ACT OF 2008

***

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     This act would allow persons authorized by a patient to gain access to that patient's

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confidential health care information from the health information exchange. This act would also

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allow health plans: (1) To send information to the health information exchange; and (2) To

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receive information to which they are already legally entitled from the health information

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exchange for care coordination and management.

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     This act would take effect upon passage.

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