[Med-privacy] WA State bill

[Peter Marshall]

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SENATE BILL REPORT
SB 5158

As Reported By Senate Committee On:
Health & Long-Term Care, February 10, 2005

Title: An act relating to making certain provisions in the uniform=20
health care information act consistent with the health insurance=20
portability and accountability act privacy regulation, by addressing=20
the period of validity of an authorization, accounting for disclosures,=20=

reporting of criminal activities, sharing quality improvement=20
information, and modifying provisions on payment for health care,=20
health care operations, and related definitions.

Brief Description: Modifying the uniform health care information act.

Brief History:

Committee Activity:  Health & Long-Term Care:  1/27/05, 2/10/05 [DPS].

SENATE COMMITTEE ON HEALTH & LONG-TERM CARE

Majority Report:  That Substitute Senate Bill No. 5158 be substituted=20
therefor, and the substitute bill do pass.Signed by Senators Keiser,=20
Chair; Thibaudeau, Vice Chair; Deccio, Ranking Minority Member; Benson,=20=

Brandland, Franklin, Kastama, Parlette and Poulsen.

Background: In April 2003, the Health Insurance Portability and=20
Accountability Act (HIPAA) privacy regulation established new federal=20
standards for disclosure of protected health information by hospitals=20
and other covered entities. Because both state law and HIPAA govern=20
disclosure of such information, hospitals have expressed concerns over=20=

the additional administrative burdens and the potential for the=20
application of the different laws to result in inconsistent standards=20
and lowered quality of care. There is hope that changing state law to=20
reflect the HIPAA standards can improve patient care and may ease=20
hospital administrative burdens.

  Currently, a patient may only authorize disclosure of his or her=20
information for up to 90 days. There is specific concern that this=20
small time window creates barriers to sharing information=20
electronically, particularly in community health networks. State law=20
also requires an accounting of every disclosure of information,=20
including disclosure made for health care operations and quality=20
improvement purposes. Health care facilities, particularly hospitals,=20
have commented that being required to account for disclosures that the=20=

patient already expects creates a significant administrative burden and=20=

does not assist patients. Patients are currently required to=20
specifically authorize disclosures that will be made for payment=20
purposes. Current state law does not facilitate health care providers=20
sharing quality assurance information when only one of them benefits=20
from the information shared.

Summary of Substitute Bill: The state's 90-day limit on the length of=20
validity for a health care information disclosure authorization is=20
removed. The bill brings the state law in line with the HIPAA=20
regulations by requiring that an authorization include an expiration=20
date or event that relates to the individual or to the purpose of the=20
use or disclosure. A patient's authorization to disclose health care=20
information is applicable to health care providers or health care=20
facilities. The patient may also designate a particular class of=20
persons to whom information may be disclosed instead of merely=20
designating particular individuals.

To further align state law with HIPAA, clarifying language is added to=20=

the provision that allows a health care provider or health care=20
facility to disclose information to a law enforcement official that the=20=

provider or facility in good faith believes constitutes evidence of=20
criminal conduct that occurred on the premises. The provider or=20
facility may also disclose basic identifying information for a patient=20=

brought by a public authority. Additionally, providers and facilities=20
may disclose patient information for payment purposes without receiving=20=

specific patient authorization to do so.

Required accounting for routine disclosures is changed to exempt those=20=

disclosures made for treatment, payment, and health care operations, as=20=

well as other areas where the patient would expect disclosure to be=20
made routinely. A provider or facility is allowed to disclose=20
information to another provider or facility for operational purposes,=20
if each had a relationship with the patient, the information is related=20=

to the relationship, and the disclosure is for limited purposes.

  Substitute Bill Compared to Original Bill: The substitute bill=20
clarifies that an authorization for disclosure of health care=20
information may be kept as an original or as a copy, and that=20
disclosures to immediate family is not limited to oral disclosures.
=A0=A0=A0=A0=A0=A0=A0=A0=A0

\
Testimony For: It has been exceedingly complicated for hospitals to=20
negotiate the intersection between state and federal privacy laws.=20
Bringing the state laws in line with the federal laws will alleviate=20
administrative burdens, improve the quality of care, and increase=20
patient access to care. Getting rid of the 90-day limit on=20
authorizations will be of particular help to patients whose providers=20
employ electronic medical records and similar technologies.

Testimony Against: None.

Who Testified: PRO: Taya Briley, WA State Hospital Association; Richard=20=

Meeks, University of Washington Medicine; Mary Minniti, Whatcom County=20=

Pursuing Perfection & St. Joseph's Hospital; Ellen Ruben, Harborview=20
Medical Center.=

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<=
bold><fontfamily><param>Helvetica</param><bigger><bigger><bigger><bigger><=
bigger>SENATE
BILL REPORT

SB 5158


=
</bigger></bigger></bigger></bigger></bigger></fontfamily></bold><fontfami=
ly><param>Skia</param><bigger><bigger>As
Reported By Senate Committee On:

Health & Long-Term Care, February 10, 2005


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Title:</bigger></bigger></fontfamily></bold><fontfamily><pa=
ram>Skia</param><bigger><bigger>
An act relating to making certain provisions in the uniform health
care information act consistent with the health insurance portability
and accountability act privacy regulation, by addressing the period of
validity of an authorization, accounting for disclosures, reporting of
criminal activities, sharing quality improvement information, and
modifying provisions on payment for health care, health care
operations, and related definitions.


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Brief
=
Description:</bigger></bigger></fontfamily></bold><fontfamily><param>Skia<=
/param><bigger><bigger>
Modifying the uniform health care information act.


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Brief
History:


Committee
=
Activity:</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</pa=
ram><bigger><bigger>=20
Health & Long-Term Care:  1/27/05, 2/10/05 [DPS].


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>SENATE
COMMITTEE ON HEALTH & LONG-TERM CARE


Majority
=
Report:</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</para=
m><bigger><bigger>=20
That Substitute Senate Bill No. 5158 be substituted therefor, and the
substitute bill do pass.Signed by Senators Keiser, Chair; Thibaudeau,
Vice Chair; Deccio, Ranking Minority Member; Benson, Brandland,
Franklin, Kastama, Parlette and Poulsen.


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Background:</bigger></bigger></fontfamily></bold><fontfamil=
y><param>Skia</param><bigger><bigger>
In April 2003, the Health Insurance Portability and Accountability Act
(HIPAA) privacy regulation established new federal standards for
disclosure of protected health information by hospitals and other
covered entities. Because both state law and HIPAA govern disclosure
of such information, hospitals have expressed concerns over the
additional administrative burdens and the potential for the
application of the different laws to result in inconsistent standards
and lowered quality of care. There is hope that changing state law to
reflect the HIPAA standards can improve patient care and may ease
hospital administrative burdens.=20


 Currently, a patient may only authorize disclosure of his or her
information for up to 90 days. There is specific concern that this
small time window creates barriers to sharing information
electronically, particularly in community health networks. State law
also requires an accounting of every disclosure of information,
including disclosure made for health care operations and quality
improvement purposes. Health care facilities, particularly hospitals,
have commented that being required to account for disclosures that the
patient already expects creates a significant administrative burden
and does not assist patients. Patients are currently required to
specifically authorize disclosures that will be made for payment
purposes. Current state law does not facilitate health care providers
sharing quality assurance information when only one of them benefits
from the information shared.


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Summary
of Substitute
=
Bill:</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</param>=
<bigger><bigger> The
state's 90-day limit on the length of validity for a health care
information disclosure authorization is removed. The bill brings the
state law in line with the HIPAA regulations by requiring that an
authorization include an expiration date or event that relates to the
individual or to the purpose of the use or disclosure. A patient's
authorization to disclose health care information is applicable to
health care providers or health care facilities. The patient may also
designate a particular class of persons to whom information may be
disclosed instead of merely designating particular individuals.


To further align state law with HIPAA, clarifying language is added to
the provision that allows a health care provider or health care
facility to disclose information to a law enforcement official that
the provider or facility in good faith believes constitutes evidence
of criminal conduct that occurred on the premises. The provider or
facility may also disclose basic identifying information for a patient
brought by a public authority. Additionally, providers and facilities
may disclose patient information for payment purposes without
receiving specific patient authorization to do so.=20


Required accounting for routine disclosures is changed to exempt those
disclosures made for treatment, payment, and health care operations,
as well as other areas where the patient would expect disclosure to be
made routinely. A provider or facility is allowed to disclose
information to another provider or facility for operational purposes,
if each had a relationship with the patient, the information is
related to the relationship, and the disclosure is for limited
purposes.=20



=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Substitute
Bill Compared to Original
=
Bill:</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</param>=
<bigger><bigger> The
substitute bill clarifies that an authorization for disclosure of
health care information may be kept as an original or as a copy, and
that disclosures to immediate family is not limited to oral
disclosures.

=A0=A0=A0=A0=A0=A0=A0=A0=A0


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>\</bigger></bigger></fontfamily></bold><fontfamily><param>S=
kia</param><bigger><bigger>

=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Testimony
For:
=
</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</param><bigg=
er><bigger>It
has been exceedingly complicated for hospitals to negotiate the
intersection between state and federal privacy laws. Bringing the
state laws in line with the federal laws will alleviate administrative
burdens, improve the quality of care, and increase patient access to
care. Getting rid of the 90-day limit on authorizations will be of
particular help to patients whose providers employ electronic medical
records and similar technologies.=20


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Testimony
Against:
=
</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</param><bigg=
er><bigger>None.=20


=
</bigger></bigger></fontfamily><bold><fontfamily><param>Helvetica</param><=
bigger><bigger>Who
Testified:
=
</bigger></bigger></fontfamily></bold><fontfamily><param>Skia</param><bigg=
er><bigger>PRO:
Taya Briley, WA State Hospital Association; Richard Meeks, University
of Washington Medicine; Mary Minniti, Whatcom County Pursuing
Perfection & St. Joseph's Hospital; Ellen Ruben, Harborview Medical
Center.</bigger></bigger></fontfamily>=

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