Chapter 067
2016 -- S 2898
Enacted 06/13/2016

A N   A C T
RELATING TO BUSINESSES AND PROFESSIONS -- THE RHODE ISLAND HEALTH INFORMATION EXCHANGE ACT OF 2008

Introduced By: Senator Joshua Miller
Date Introduced: April 07, 2016

It is enacted by the General Assembly as follows:
     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
Chapter 5-37.7 entitled "Rhode Island Health Information Exchange Act of 2008" are hereby
amended to read as follows:
     5-37.7-3. Definitions. -- As used in this chapter:
      (a) "Agency" means the Rhode Island department of health.
      (b) "Authorized representative" means:
      (1) A person empowered by the patient participant to assert or to waive the
confidentiality, or to disclose or authorize the disclosure of confidential information, as
established by this chapter. That person is not, except by explicit authorization, empowered to
waive confidentiality or to disclose or consent to the disclosure of confidential information; or
      (2) A person appointed by the patient participant to make health care decisions on his or
her behalf through a valid durable power of attorney for health care as set forth in Rhode Island
general laws § 23-4.10-2; or
      (3) A guardian or conservator, with authority to make health care decisions, if the patient
participant is decisionally impaired; or
      (4) Another legally appropriate medical decision maker temporarily if the patient
participant is decisionally impaired and no health care agent, guardian or conservator is available;
or
      (5) If the patient participant is deceased, his or her personal representative or, in the
absence of that representative, his or her heirs-at-law; or
      (6) A parent with the authority to make health care decisions for the parent's child; or
     (7) A person authorized by the patient participant or their authorized representative to
access their confidential health care information from the HIE, including family members or other
proxies as designated by the patient, to assist patient participant with the coordination of their
care.
      (c) "Authorization form" means the form described in § 5-37.7-7 of this chapter and by
which a patient participant provides authorization for the RHIO to allow access to, review of,
and/or disclosure of the patient participant's confidential health care information by electronic,
written, or other means.
      (d) "Business associate" means a business associate as defined by HIPAA.
      (e) "Confidential health care information" means all information relating to a patient
participant's health care history, diagnosis, condition, treatment, or evaluation.
      (f) "Coordination of care" means the process of coordinating, planning, monitoring,
and/or sharing information relating to, and assessing a care plan for, treatment of a patient.
      (g) "Data-submitting partner" means an individual, organization, or entity that has
entered into a business associate agreement with the RHIO and submits patient participants'
confidential health care information through the HIE.
      (h) "Department of health" means the Rhode Island department of health.
      (i) "Disclosure report" means a report generated by the HIE relating to the record of
access to, review of, and/or disclosure of a patient's confidential health care information received,
accessed, or held by the HIE.
      (j) "Electronic mobilization" means the capability to move clinical information
electronically between disparate health care information systems while maintaining the accuracy
of the information being exchanged.
      (k) "Emergency" means the sudden onset of a medical, mental or substance abuse, or
other condition manifesting itself by acute symptoms of severity (e.g. severe pain) where the
absence of medical attention could reasonably be expected, by a prudent lay person, to result in
placing the patient's health in serious jeopardy, serious impairment to bodily or mental functions,
or serious dysfunction of any bodily organ or part.
      (l) "Health care provider" means any person or entity licensed by this state to provide or
lawfully providing health care services, including, but not limited to, a physician, hospital,
intermediate care facility or other health care facility, dentist, nurse, optometrist, podiatrist,
physical therapist, psychiatric social worker, pharmacist or psychologist, and any officer,
employee, or agent of that provider acting in the course and scope of his or her employment or
agency related to or supportive of health care services.
      (m) "Health care services" means acts of diagnosis, treatment, medical evaluation,
referral or counseling or any other acts that may be permissible under the health care licensing
statutes of this state.
      (n) "Health Information Exchange" or "HIE" means the technical system operated, or to
be operated, by the RHIO under state authority allowing for the statewide electronic mobilization
of confidential health care information, pursuant to this chapter.
     (o) "Health plan" means an individual plan or a group plan that provides, or pays the cost
of, health care services for patient participants.
      (o)(p) "HIE Advisory Commission" means the advisory body established by the
department of health in order to provide community input and policy recommendations regarding
the use of the confidential health care information of the HIE.
      (p)(q) "HIPAA" means the hHealth iInsurance pPortability and aAccountability aAct of
1996, as amended.
      (q)(r) "Participant" means a patient participant, a patient participant's authorized
representative, a provider participant, a data submitting partner, the regional health information
organization, and the department of health, that has agreed to authorize, submit, access, and/or
disclose confidential health care information via the HIE in accordance with this chapter.
      (r)(s) "Participation" means a patient participant's authorization, submission, access,
and/or disclosure of confidential health care information via the HIE in accordance with this
chapter.
      (s)(t) "Patient participant" means a person who receives health care services from a
provider participant and has agreed to participate in the HIE through the mechanisms established
in this chapter.
      (t)(u) "Provider participant" means a pharmacy, laboratory, or health care provider, or
health plan who is providing health care services to or pays for the cost of health care services for
a patient participant and/or is submitting or accessing health care information through the HIE
and has executed an electronic and/or written agreement regarding disclosure, access, receipt,
retention, or release of confidential health care information to the HIE;
      (u)(v) "Regional health information organization" or "RHIO" means the organization
designated as the RHIO by the state to provide administrative and operational support to the HIE.
     5-37.7-4. Participation in the health information exchange. -- (a) There shall be
established a statewide HIE under state authority to allow for the electronic mobilization of
confidential health care information in Rhode Island. Confidential health care information may
only be accessed, released, or transferred from the HIE in accordance with this chapter.
      (b) The state of Rhode Island has an interest in encouraging participation in the HIE by
all interested parties, including, but not limited to, health care providers, patients, health plans,
entities submitting information to the HIE, entities obtaining information from the HIE, and the
RHIO. The Rhode Island department of health is also considered a participant for public health
purposes.
      (c) Patients and health care providers shall have the choice to participate in the HIE, as
defined by regulations in accordance with § 5-37.7-3,; provided, however, that provider
participants must continue to maintain their own medical record meeting the documentation and
other standards imposed by otherwise applicable law.
      (d) Participation in the HIE shall have no impact on the content of, or use or disclosure
of, confidential health care information of patient participants that is held in locations other than
the HIE. Nothing in this chapter shall be construed to limit, change, or otherwise affect entities'
rights to exchange confidential health care information in accordance with other applicable laws.
      (e) The state of Rhode Island hereby imposes on the HIE and the RHIO as a matter of
state law, the obligation to maintain, and abide by the terms of, HIPAA complaint business
associate agreements, including, without limitation, the obligations to use appropriate safeguards
to prevent use or disclosure of confidential health care information in accordance with HIPAA
and this chapter,; not to use or disclose confidential health care information other than as
permitted by HIPAA and this chapter,; or to make any amendment to a confidential health care
record that a provider participant so directs; and to respond to a request by a patient participant to
make an amendment to the patient participant's confidential health care record.
     5-37.7-7. Disclosure. -- (a) (1) Except as provided in subsection (b) of this section, a
patient participant's confidential health care information may only be accessed, released, or
transferred from the HIE in accordance with an authorization form signed by the patient
participant or the patient's authorized representative.
      (b) No authorization for release or transfer of confidential health care information from
the HIE shall be required in the following situations:
      (1) To a health care provider who believes, in good faith, that the information is
necessary for diagnosis or treatment of that individual in an emergency; or
      (2) To public health authorities in order to carry out their functions as described in this
title and titles 21 and 23, and rules promulgated under those titles. These functions include, but
are not restricted to, investigations into the causes of disease, the control of public health hazards,
enforcement of sanitary laws, investigation of reportable diseases, certification and licensure of
health professionals and facilities, review of health care such as that required by the federal
government and other governmental agencies, and mandatory reporting laws set forth in Rhode
Island general laws; and or
      (3) To the RHIO in order for it to effectuate the operation and administrative oversight of
the HIE. ; and
     (4) To a health plan, if the information is necessary for care management of its plan
members, or for quality and performance measure reporting.
      (c) The content of the authorization form for access to, or the disclosure, release, or
transfer of confidential health care information from the HIE, shall be prescribed by the RHIO in
accordance with applicable department of health regulations, but, at a minimum, shall contain the
following information in a clear and conspicuous manner:
      (1) A statement of the need for and proposed uses of that information; and
      (2) A statement that the authorization for access to, disclosure of, and/or release of
information may be withdrawn at any future time and is subject to revocation.;
      (3) That the patient has the right not to participate in the HIE; and
      (4) The patient's right to choose to: (i) eEnroll in and participate fully in the HIE; or (ii)
dDesignate only specific health care providers that may access the patient participant's
confidential health care information.
      (d) Except as specifically provided by law or this chapter, or use for clinical care, a
patient participant's confidential health care information shall not be accessed by, given, sold,
transferred, or in any way relayed from the HIE to any other person or entity not specified in the
patient participant authorization form meeting the requirements of subsection (c) of this section
without first obtaining additional authorization.
      (e) Nothing contained in this chapter shall be construed to limit the permitted access to,
or the release, transfer, access or disclosure of, confidential health care information described in
subsection (b) of this section or under other applicable law.
      (f) Confidential health care information received, disclosed, or held by the HIE shall not
be subject to subpoena directed to the HIE or RHIO unless the following procedures have been
completed: (i) tThe person seeking the confidential health care information has already requested
and received the confidential health care information from the health care provider that was the
original source of the information; and (ii) aA determination has been made by the superior court,
upon motion and notice to the HIE or RHIO and the parties to the litigation in which the
subpoena is served, that the confidential health care information sought from the HIE is not
available from another source and is either relevant to the subject matter involved in the pending
action or is reasonably calculated to lead to the discovery of admissible evidence in such pending
action. Any person issuing a subpoena to the HIE or RHIO pursuant to this section shall certify
that such measures have been completed prior to the issuance of the subpoena.
      (g) Nothing contained herein shall interfere with, or impact upon, any rights or
obligations imposed by the Workers Compensation Act as contained in title 28, chapters 29 --
38, of the general laws. Chapters 29-38 of title 28.
     (h) Nothing contained herein shall prohibit a health plan from becoming a data-
submitting partner. A data-submitting partner is not considered a managed care entity or a
managed care contractor and the HIE is not considered a regional or local medical information
database pursuant to §5-37.3-4.
     5-37.7-10. Patient's rights. -- Pursuant to this chapter, a patient participant who has his
or her confidential health care information transferred through the HIE shall have the following
rights:
      (1) To obtain a copy of his or her confidential health care information from the HIE;
      (2) To obtain a copy of the disclosure report pertaining to his or her confidential health
care information;
      (3) To be notified as required by chapter 49.2 of title 11, the Rhode Island identity theft
protection act, of a breach of the security system of the HIE;
      (4) To terminate his or her participation in the HIE in accordance with rules and
regulations promulgated by the agency; and
      (5) To request to amend his or her own information through the provider participant. ;
     (6) To request their confidential health care information from the HIE be disclosed to an
authorized representative; and
     (7) To request their confidential health care information from the HIE be disclosed to
health care providers who are not provider participants as defined by this chapter.
     SECTION 2. This act shall take effect upon passage.
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LC005180
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