CalHHS Data Exchange Framework Set to Boost Interoperability

The recently unveiled California Health and Human Services Agency (CalHHS) Data Exchange Framework is set to promote health data interoperability across the state, according to The National Law Review.

By January 31, 2023, hospitals, physician practices, and certain other entities must sign a data sharing agreement (DSA) governing participation in the CalHHS Data Exchange Framework. Once the Framework takes full effect on January 31, 2024, parties must exchange health data with other Framework participants. 

The Framework includes two main components: (1) a single data sharing agreement to be executed by Framework participants and (2) a standard set of policies and procedures that Framework participants will follow.

CalHHS released a final version of the DSA and an initial set of policies and procedures to govern the Framework on July 5, 2022.

Framework participants are required, when requested by another participant, to exchange “health and social services information” for certain purposes, including treatment, payment, and certain “healthcare operations.” While HIPAA permits sharing information for these purposes, the Framework makes these exchanges obligatory.

The Framework outlines that data exchange must include social determinant of health (SDOH) information, such as access to housing and food. Beginning January 31, 2026, social service organizations, such as HHS agencies and nonprofits, are expected to participate in the Framework.

The DSA references a “governance entity” with oversight of the Framework whose responsibilities include auditing compliance with the DSA. CalHHS is developing a legislative proposal for an HHS Data Exchange Board to begin surveillance of the Framework in 2023.

General acute care hospitals, physician organizations and medical groups, skilled nursing facilities, health service plans, disability insurers, Medi-Cal managed care plans, clinical laboratories, and acute psychiatric hospitals in California must execute the DSA by January 31, 2023.

However, the terms of the DSA, including its mandate to share information with other participants, will not go into effect until January 31, 2024.

Smaller providers, such as physician practices of fewer than 25 physicians and select specialty hospitals, will not be required to exchange data under the Framework until January 31, 2026.

The consequences of not executing the DSA or participating in the Framework are currently unclear. The DSA states that participants “grant to the Governance Entity the power to enforce any portion of this Agreement through measures set forth in the Policies and Procedures,” potentially including “suspension or termination of a Participant’s right to exchange” information under the DSA.

CalHHS’s outline for Framework governance suggests that future enforcement mechanisms could consist of remediation plans and civil penalties.