Official website of the State of California
Official website of the State of California
CMS rules and other federal requirements were considered when drafting the DxF Policies and Procedures. In addition, the Department of Health Care Access and Information (HCAI) continues to monitor new and developing federal requirements for impact on the DxF.
Both Health and Safety Code section 130290 and the DxF Data Elements to Be Exchanged Policy and Procedure, which can be found on the Policies and Procedures section of the DxF website, require that health plans provide Access to or Exchange of claims, encounter, and clinical information that parallels the data required of plans by the CMS Interoperability and Patient Access Rule. Likewise, DxF requires that health care providers provide Access to or Exchange of the same data (that is, electronic health information (EHI)) that is required by the Federal Information Blocking Regulations, which is in turn already more than that required by the CMS Interoperability and Prior Authorization Final Rule.
However, both the CMS Interoperability and Patient Access Rule and the CMS Interoperability and Prior Authorization Final Rule focus on Fast Healthcare Interoperability Resources (FHIR) as the required transport, whereas the DxF Technical Requirements for
Exchange Policy and Procedure requires that all Participants support the same Integrating the Healthcare Enterprise (IHE) profiles found in eHealth Exchange, Carequality, and Trusted Exchange Framework and Common Agreement’s Qualified Health Information Network Technical Framework that are likely already available to many health systems. FHIR is optional, but encouraged, in the Technical Requirements for Exchange Policy and Procedure
A Participant is not permitted to Access Health and Social Services Information (HSSI) for the purpose of selling the information it Accesses or Exchanges, whether the Participant uses its own technology, a Qualified Health Information Organization (QHIO), an Intermediary that has signed the DxF Data Sharing Agreement (DSA) but is not a QHIO, or an Intermediary that has not signed the DxF DSA:
Unless otherwise permitted by Applicable Law or a legally valid agreement, Participants shall not access Health and Social Services Information through the DSA in order to sell such information. (DxF Permitted, Required, and Prohibited Purposes P&P, Section II.3
Further, while a Participant may De-Identify and Use HSSI received from another Participant, they may not sell de-identified HSSI when it includes information received from another Participant.
Participant may de-identify and use Health and Social Services Information received from another Participant under the DSA and Use or Disclose such De-Identified Health and Social Services Information so long as permitted by Applicable Law and consistent with this section. […] Participants may not sell de-identified Health and Social Services Information when that de-identified Health and Social Services Information includes information received from another Participant. (DxF Privacy Standards and Security Safeguards P&P, Section III.1.a.ii)
Non-Intermediary Participants are not permitted to charge fees for the Exchange of Health and Social Services Information (HSSI) for a Required Purpose under the DxF Data Sharing Agreement (DSA). This is true whether they use their own technology, a Qualified Health Information Organization (QHIO), an Intermediary that has signed the DxF DSA but is not a QHIO, or an Intermediary that has not signed the DxF DSA.
A Participant shall not charge fees to any other Participant for any Exchange of Health and Social Services Information under the Data Exchange Framework for a Required Purpose. (DxF Fees P&P, Section II.1.a.)
All Participants have a duty to respond to requests for HSSI and must fulfill that duty by providing the information in accordance with Applicable Law OR other appropriate response.
All Participants shall respond to requests for Health and Social Services Information made by other Participants and shall share Health and Social Services Information when required under the Permitted, Required, and Prohibited Purposes Policy and Procedure. A Participant shall fulfill its duty to respond by either providing the requested Health and Social Services Information it Maintains in accordance with the Data Sharing Agreement (the “DSA”) and Applicable Law; or… providing an appropriate error message or null response as specified by the technical standard in use and in accordance with the Technical Requirements for Exchange Policy and Procedure. (DxF Requirement to Exchange Health and Social Services Information P&P, Section III.1.a)
Non-Intermediary Participants that use an Intermediary that is not a QHIO to meet DxF requirements must ensure that the Intermediary provides services in such a way as to allow the non-Intermediary Participant to comply with the DxF DSA and its Policies and Procedures, regardless of whether the Intermediary is a DxF Participant or not. This includes obtaining reasonable assurances that the Intermediary meets the non-Intermediary Participant’s duty to respond and does not charge fees to other Participants other than their own contracted client for the Exchange of their HSSI for Required Purpose.
If a Participant elects not to execute an agreement with a Qualified HIO and instead elects to use its own technology or to execute an agreement with another entity that provides data exchange, the Participant must comply with or obtain reasonable assurances that the other entity enables the Participant to comply with, the minimum requirements for data exchange set forth in the Policies and Procedures or Specifications. (DxF DSA, Section 7(a).)
Non-Intermediary Participants that choose to execute a contract with an Intermediary to help them meet DxF requirements, however, may be charged fees by that Intermediary, in accordance with the DxF Fees P&P:
A Participant shall not charge fees to any other Participant for any Exchange of Health and Social Services Information under the Data Exchange Framework for a Required Purpose. However, a Participant that is an Intermediary may charge fees to another Participant if the Participant that is an Intermediary has executed a contract with the other Participant to provide services. For contracts to provide services to assist another Participant in meeting its obligations under the Data Sharing Agreement, the fees shall be consistent with Applicable Law, including but not limited to the Fees Exception in the Federal Information Blocking Regulations. (DxF Fees P&P, Section II.1.a.)
The Data Exchange Framework (DxF) Data Sharing Agreement (DSA) and its Policies and Procedures (P&Ps) require that Hospitals and Emergency Departments, and optionally Skilled Nursing Facilities, that are signatories to the DxF DSA send Notification of Admissions and Discharges to any authorized organization that is a signatory to the DxF DSA as requested via a Roster of Individuals. A Participant may choose to use a QHIO to send Notification of Admissions and Discharges, and the QHIO Program requires that QHIOs share Rosters of Individuals with the other QHIOs to help facilitate Notification of Admissions and Discharges.
The DxF DSA and its P&Ps do not prohibit a QHIO from including the names of Individuals requested by non-signatories on their Rosters for Notification of Admissions and Discharges, so long as it complies with Applicable Law.
The DxF DSA and its P&Ps do not prohibit QHIOs from sharing Notifications of Admissions and Discharges for Individuals requested by non-signatories, so long as the Disclosure complies with Applicable Law and relevant agreements. The DxF DSA and its P&Ps likewise do not require that a signatory to the DxF DSA send Notifications of Admissions and Discharges to non-Participants, whether or not the notifications are facilitated by a QHIO.
The DxF Data Sharing Agreement (DSA) and its Policies and Procedures govern and require the Exchange of Health and Social Services Information under the DxF only among signatories to the DxF DSA. The DxF does not prohibit Exchange among nonsignatories or between signatories and non-signatories, whether or not the Exchange is facilitated by a QHIO. QHIOs and other Intermediaries assisting Participants to meet their DxF requirements should review their Business Associate Agreements (BAAs) and other agreements with their customers, as well as Applicable Law, in determining what Exchange they can facilitate among signatories and non-signatories to the DxF DSA.
The DxF does not prohibit a QHIO who receives an Admission or Discharge Event or Notification of an Admission or Discharge from a DxF signatory from sharing any notification of the Event with a non-signatory, so long as the Exchange is permitted by Applicable Law and relevant BAAs or other agreements the QHIO has with its customers.