A closer look at emergency rules for Oklahoma’s health information exchange (Capitol Update)

It appears that, with the passage of emergency rules by the Oklahoma Health Care Authority (OHCA) board on July 17, the battle over the health information exchange (HIE) in Oklahoma is, at least temporarily, on pause. Those wanting a more expansive opportunity to opt out of the exchange appear to have won the day. 

As part of the original legislation transferring management of Oklahoma’s Medicaid program from the OHCA to private insurance companies, all health care providers were required to subscribe and connect to the HIE. Subsequently the legislature passed Senate Bill 1369 requiring all health care providers “as defined by the rules promulgated by the OHCA board” to utilize the HIE.

SB 1369 also authorized the OHCA board to promulgate rules allowing exemptions from the requirement based on “financial hardship, size, or technological capability of a health care provider or such other bases as may be provided by rules promulgated by the Board.” On March 22, 2023, OHCA passed permanent rules taking an inclusive approach, broadly defining health care provider, and narrowly limiting exemptions.

However, last session the legislature neither approved nor disapproved the rules, leaving the decision to the governor. He disapproved the rules, likely to the surprise of OHCA. 

Supporters of an inclusive HIE felt that a centralized record of patient health-related information where various health care providers caring for the same patient could quickly and conveniently access the information would provide better-informed treatment. But since passage of the HIE legislation, there has been conflict over whether belonging to the HIE should be mandatory and how broad the exemptions should be. 

Most of the conflict seemed to center around the cost to health care providers and privacy concerns for patients, especially for mental health and substance-use-disorder patients. 

The new emergency rules continue to define health care providers broadly, pretty much including everyone who provides health care services. “Health care provider” includes, but is not limited to, facilities such as ambulatory surgery centers, clinics, home care agencies, hospices, hospitals, intermediate care facilities, laboratories, long-term care agencies, medical centers, mental health and substance-use-disorder treatment centers, nursing homes, Program of All-Inclusive Care for the Elderly (PACE) centers, pharmacies, physicians’ offices, psychiatric hospitals, public health clinics, and rehabilitation centers.

However, having required all providers to utilize the HIE, the emergency rules also allow all providers, upon application, to obtain an exemption. The emergency rules provide that any health care provider as defined in the rules may register an exemption from utilizing the HIE by registering an exemption with the Office of the State Coordinator for HIE. All providers that register an exemption shall be granted such exemption and shall not be subject to pay subscription fees and/or connection fees. The exemption will automatically renew annually unless the provider withdraws their exemption and elects to participate. 

The emergency rules will go into effect upon approval by the governor, who one could safely assume, was consulted ahead of time and which will be coming soon.


Steve Lewis served as Speaker of the Oklahoma House of Representatives from 1989-1990. He currently practices law in Tulsa and represents clients at the Capitol.

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