Health Information Technology in ARRA: What Legislators Need to Know

1. Health Information Technology in ARRA: What Legislators Need to Know Senator Richard Moore Massachusetts July 22,2009

2. What’s in the Law? • ARRA was enacted in February 2009 as an economic recovery package. • A key element is $49 billion investment in HIT. • HIT investments have goal of reducing costs and improving quality by increasing efficiency. • ARRA is designed to expedite HIT adoption through financial incentives.

3. ARRA Provisions Important to States • Medicaid Incentive Payments to Providers • Medicare Incentive Payments to Providers • Grants to States to Promote IT • Competitive Grants to States and Indian Tribes for Electronic Health Record Adoption Loan Programs

4. Medicare Incentives • Medicare incentives will be implemented by federal government • Targeted at health care providers who achieve “meaningful use” of technology. • Medicare law says “meaningful use” includes use of certified technology, information exchange, and ability to report using electronic medical records.

5. What is Meaningful Use? • Medicare statute says: • Use of certified electronic health record technology • Information exchange • Ability to report using electronic health records.

6. More on Federal Approach • Among items federal workgroup suggests as meaningful use of HIT: • Access to comprehensive patient data • Exchange meaningful clinical information among health care team. • Report to patient registries for quality improvement • Provide patients and families with knowledge to make decisions. • Ensure privacy and security protections

7. Grant Programs • Competitive grants will be available to states or state-designated entities. • Grants for planning, grants for implementation, and grants to develop adoption loan programs. • Funds will be disbursed under leadership of Office of National Coordinator. Rules and regulations are under development.

8. Medicaid Financial Incentives • Medicaid incentives are state option. • Medicaid incentives targeted to providers treating significant numbers of Medicaid patients. • Medicaid agencies can develop a definition of meaningful use that is different from federal definition. • Medicaid makes financing available for purchase and implementation in addition to use.

9. Medicaid Financial Incentives: Significant Money • Medicaid financial incentives will begin in 2011. • Eligible professionals can receive up to $21,250 to cover the cost of purchasing or upgrading certified technology. • Providers can get an additional $8500 annually for five years as long ass they continue to demonstrate meaningful use. • Total: $63,750 per provider, a larger figure than the Medicare incentives.

10. What can states do to get ready?

11. Set up an Infrastructure • Establish a Health Information Exchange infrastructure • Develop a plan for statewide exchange of information to support improved health outcomes • Sort out responsible entity or entities. • Get lots of consumer and stakeholder input.

12. Set up an Infrastructure • State Examples • Maryland set up a single health information exchange for the state . As of October 2014, payors may not reimburse providers who do not have an electronic health records that exchanges data over the exchange. • Michigan set up an entity to operate exchanges in each of nine medical trading areas.

13. Ensure Privacy of Information • ARRA expanded privacy laws to cover e-health entities such as health information exchanges • ARRA added a breach notification requirement. • ARRA provides state attorneys general with power to enforce federal privacy laws • State can build on this federal floor.

14. Ensure Privacy of Information • State Opportunities • Examine the impact of the new privacy landscape. • CA passed law in 2009 requiring study and policy recommendations aimed at expanding hit while safeguarding privacy. • Educate patients and providers. • WA created a website to educate patients about the value of exchanging health data. • Update laws to facilitate exchange. • Several states have created new sections of privacy law to enable electronic data exchange while maintaining privacy.

15. Get Ready to Receive ARRA funds • Identify point of leadership • Health agency, CIO, or Governor's Office among those identified. • Consider need for matching funds in future. • Set up state oversight strategies. • To get federal admin money for Medicaid incentives, states must demonstrate adequate oversight and tracking of meaningful use. • Define meaningful use. • Providers and vendors may need lead time.