Health, Children's Health Insurance Program

Rule R382-2

Electronic Personal Medical Records for the Children's Health Insurance Program

Notice of Proposed Rule

(New Rule)

DAR File No.: 36429
Filed: 07/02/2012 12:44:52 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 46, 2012 General Session, requires the Department to implement by rule a program to enroll individuals who receive services under the Children's Health Insurance Program (CHIP) in the Clinical Health Information Exchange (cHIE). The bill also requires the Department to notify these individuals of their right to opt out of cHIE. This rule describes the process the Department will use to enroll individuals in cHIE.

Summary of the rule or change:

The rule states that the Department will provide notice to all individuals who receive CHIP services before they enroll in cHIE. The rule also specifies when cHIE enrollment will occur and describes how cHIE will address cases for when an individual already declares his status with cHIE before enrolling in CHIP.

State statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

The Department estimates about $20,000 in one-time costs for programming changes to existing systems and for mailing notification letters to all current CHIP clients. Costs are covered by a federal grant and by a reduction in the Department's payments to the Utah Health Information Network (UHIN) for cHIE.

local governments:

There is no impact to local governments because they do not fund or provide CHIP services to CHIP clients.

small businesses:

The Department does not anticipate any costs or savings because this rule does not impose new requirements or administrative expenses on small businesses.

persons other than small businesses, businesses, or local governmental entities:

The Department does not anticipate any costs or savings because this rule does not impose new requirements or administrative expenses on CHIP providers. There are also no administrative costs to CHIP clients who choose to submit a form if they opt out of cHIE.

Compliance costs for affected persons:

The Department does not anticipate any costs to a single CHIP provider or to a single UHIN insurer because this rule does not impose new requirements or administrative expenses on these persons or entities. There are also no administrative costs to a single CHIP client who chooses to submit a form through a provider if the client opts out of cHIE.

Comments by the department head on the fiscal impact the rule may have on businesses:

H.B. 46, 2012 General Session, requires the Department to implement by rule a program to enroll individuals who receive services under the Children's Health Insurance Program (CHIP) and the Medicaid Program in the Clinical Health Information Exchange (cHIE). This should have a positive fiscal impact on providers serving these persons by making treatment records available.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Children's Health Insurance Program
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

08/14/2012

This rule may become effective on:

09/01/2012

Authorized by:

David Patton, Executive Director

R382. Health, Health Care Financing, Coverage and Reimbursement Policy.

R382-2. Electronic Personal Medical Records for the Children's Health Insurance Program.

R382-2-1. Introduction and Authority.

This rule is promulgated under authority granted in Section 26-40-103, as last amended by Laws of Utah 2012, Chapters 28 and 369.

 

R382-2-2. Purpose.

This rule establishes requirements for enrolling Children's Health Insurance Program (CHIP) beneficiaries in the electronic exchange of clinical health information unless the beneficiary or the beneficiary's parent or legal guardian opts the beneficiary out.

 

R382-2-3. Definitions.

These definitions apply to Rule R382-2:

(1) "Technical Specifications" means the technical specifications document published by the Utah Health Information Network (UHIN) that describes the variables and formats of the data to be submitted as well as submission directions and guidelines.

(2) "Program Website" means the Department of Health, Department of Workforce Services, Division of Medicaid and Health Financing, and the CHIP websites.

 

R382-2-4. Enrollment Notification.

(1) Prior to the enrollment process in the Clinical Health Information Exchange (cHIE), the Department will provide Notice of Intent to enroll CHIP beneficiaries in cHIE and the right of beneficiaries to opt out.

(2) The Department will provide additional education regarding the beneficiary's right to opt out on the program websites.

 

R382-2-5. Enrollment Process.

(1) The Department will provide cHIE an enrollment file of all CHIP beneficiaries.

(2) The enrollment file will contain the succeeding month's CHIP enrollment.

(3) cHIE will enroll CHIP beneficiaries on the first day of the succeeding month.

(4) Submission procedures and guidelines, including required data elements, will be described in detail in the technical specifications published by UHIN and will be included in the Department's Operating Agreement with cHIE.

(5) The Department will use a secure format to transfer any enrollment files to cHIE.

 

R382-2-6. Exemptions.

(1) An individual's previous consent status in cHIE will be honored by cHIE and will not be overridden by the CHIP enrollment file.

 

KEY: CHIP, cHIE

Date of Enactment or Last Substantive Amendment: 2012

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-40-103