Bill would set health record rules and require urgent care at emergency centers

Covered organizations would follow rules for keeping and sharing electronic health information. The rules cover state and local agencies, medical facilities, high-level providers, insurers, pharmacy benefit managers, and other listed organizations, subject to exceptions. High-level providers with solo or group practices that served fewer than 500 patients last year and reasonably expect to serve fewer than 500 this year would be exempt from the general rules, but must provide records electronically when a patient asks. The Department would grant a waiver to a high-level provider if it finds the provider lacks needed infrastructure and getting it is not reasonably practical. The rules could not require use of a health information exchange or let an organization meet the rules by using a fee-charging service in the stated circumstances.

Emergency care centers would provide urgent care and report information for public comparisons. Independent centers for emergency medical care would provide urgent care and report information about their services and patient outcomes. The Department would make information available to consumers and post comparisons online. Centers would provide urgent care during operating hours, with an exception for centers already licensed when the act was enacted. They could not charge more for urgent care than urgent care centers customarily charge. The five-mile licensing limit would not block licenses for centers already operating when the act was enacted or for projects that met the stated steps by January 1, 2025. Value-based Medicaid payments would depend on federal authorization and available money. The Department would seek needed federal approval only to the extent money is available. Most provisions about emergency care centers would take effect January 1, 2026, if approved; preliminary work could begin upon approval.

Medicaid providers would keep claim records, and the Department could review claims and deny or recover payments. These requirements apply to providers of services under Medicaid. The Department could deny or recover payment if required documents do not verify a claim. For reviews of services that may exceed a recipient's needs, be unnecessary, or conflict with professional standards or Medicaid rules, the Department would notify the provider and request documents. After review, it could deny or recover payment, require prior approval, or take another authorized action; in most cases the provider would have an opportunity for a hearing. If the provider does not submit requested documents on time, the Department may act without that hearing opportunity. The claim record and review provisions would take effect October 1, 2026, for their main purposes, if approved; preparatory work could begin upon approval.

Patient-facing health care providers could not be bound by noncompetition agreements, and patients could request electronic records without a fee. The noncompetition rule covers patient-facing providers of health care. The record rule applies to electronic records requested by a patient for the patient or a covered entity. The noncompetition rule covers providers whose main duties involve clinical care and who are not employed or contracted mainly for administrative work. The free record rule applies when a patient requests electronic records for the patient or a covered entity. A custodian would have seven business days to send the records to the patient or covered entity.