Texas Legislative Update Presentation to the Texas State Health Information Management Spring Conference Nora Belcher, Executive Director Texas e-Health Alliance April 25, 2014

This presentation will: – – Assess the state of Texas in terms of implementation of the HITECH Act, – – Discuss how legislation and public policy involving HIT have evolved, and – – and provide an overview of HIT trends and an assessment of the future of HIT in Texas. Slide 2 Overview

© Ingenix, Inc. 3 Internet Revolution: Value to Users Internet use exploded once content became accessible and useful. Computer developed - IBM ARPANET Mosaic Web Browser Today, health care information technology (HIT) is at the “1997” of the Internet age Prodigy WWW HTML TCP/IP Standard Source: U.S. Census Bureau, Population Division, Education & Social Stratification Branch, “Reported Internet Usage for Households, by Selected Householder Characteristics,:2007” % U.S. Households Using the Internet at Home HIT Today First e- mail sent

Texas Status Pre-HITECH – – Privacy protections in Chapter 181 Health and Safety Code in 2001 – – Texas Health Services Authority created in 2007 – – Most statutes and processes geared toward paper/fax HITECH passage in 2009 included 3 key components: – – EHR Adoption Incentives and Penalties – – HIE Planning and Implementation – – Strengthening HIPAA to Protect Patient Privacy HITECH

HITECH in Texas State Level Implementation – – HHSC administered EHR Incentive Program and local HIE grant program (over $ 1 billion) – – THSA implementing white space strategy and state- level shared services – – Local HIEs completed planning and moving into implementation Federal Implementation – – HIPAA final rules implementing HITECH final in January 2013 – – FDA guidance on mobile medical devices – – ONC working through the stages of meaningful use

Texas Legislature Before 2005 – 0 health IT bills filed 2005 – 1 health IT bill filed 2007 – 6 health IT bills filed 2009 – 30 health IT bills filed health IT bills filed – Electronic prescribing – Privacy – Telehealth/remote monitoring 2013 – 1 health IT specific bill filed Page 6

Texas Legislature Before 2005 – 0 health IT bills filed 2005 – 1 health IT bill filed 2007 – 6 health IT bills filed 2009 – 30 health IT bills filed health IT bills filed – Electronic prescribing – Privacy – Telehealth/remote monitoring 2013 – 1 health IT specific bill filed Page 7

2013 Texas Legislature SB 1367 (Duncan/Smithee)- winds down the risk pool at TDI, and provides THSA with $5 million dollars in bridge funding. SB 1643 (Williams/Alvarado)- includes the changes needed to allow HIEs to access the prescription drug monitoring program at DPS. Page 8

2013 Texas Legislature Medicaid – SB 7 (Nelson/Raymond)- Medicaid delivery and quality reforms, including managed care expansion for long term care – SB 8 (Nelson/Kolkhorst)- Medicaid fraud and abuse program changes HB 300 Technical Corrections – SB 1609 (Schwertner/Kolkhorst)- training clarifications – SB 1610 (Schwertner/Kolkhorst)- breach notification clarifications Page 9

2013 Texas Legislature Providers – SB 166 (Deuell/Larson)- allows providers to read and store mag stripe data from driver's license – SB 406 (Nelson/Kolkhorst)- allows for limited but extended prescriptive authority for ANPS under physician delegation – SB 945 (Nelson/S. Davis)- mandates that hospital employees involved in direct patient care wear photo IDs Page 10

2013 Texas Legislature Department of Insurance – SB 644 (Huffman/Zerwas)- creates a standardized prior authorization form for prescription drug benefits – SB 1216 (Eltife/S. Davis)- creates a standardized prior authorization form for medical care and health care services Cancer Prevention and Research Institute of Texas (CPRIT) – SB 149 (Nelson/Keffer)- CPRIT reforms Page 11

2013 Texas Legislature Department of Information Resources – HB 2738 (Elkins/Ellis)- DIR to study state agency technology efficiency – SB 1102 (Van de Putte/Larson)- Creates a new position at DIR for a cybersecurity director Tax Policy – HB 800 (Murphy/Deuell)- research and development tax credit – HB 1133 (Otto/Estes)- sales tax exemption for telecom manufacturing Page 12

Topics for 2015 Interoperability and use of standards in state agency IT systems HHS System Sunset review Access to public health registries for HIEs Provider/HIE “safe harbors” Remote monitoring Consumer telemedicine Page 13

Conclusion Texas was well positioned for success with the passage of HITECH. The legislature and the related state agencies have been identifying- and making- needed changes to foster the adoption of HIT. Progress is being made in EHR adoption at the physician and hospital level; work remains to be done in long term care and mental health. Significant barriers still exist to EHR and HIE adoption, which will need to be overcome for HIT to be successful. Policymakers are concerned about privacy and security, costs, quality, and the rate and volume of changes that providers have to react to. Policymakers in the future will be responding to growing concerns about patient access to their records and consumer engagement.

Page 15 “Patient Engagement is the blockbuster drug of the 21 st Century” - Leonard Kish, August 28, 2012

Nora Belcher Texas e-Health Alliance 512/ © 2013 HIMSS