Difference between revisions of "ARRA"

Revision as of 17:48, 21 October 2011

The American Recovery and Reinvestment Act (ARRA) became law on February 17th, 2009 [1]. The ARRA is a $789 billion economic stimulus package, passed by the Office of the National Coordinator for Health Information Technology (ONCHIT or ONC).

Health Information Technology Economy and Clinical Health (HITECH)

The Health Information Technology Economy and Clinical Health Act (HITECH) is part of the ARRA legislation, Division A: title XIII, title XXX; Division B: title IV. HITECH encourages adoption of comprehensive electronic medical records (EMR) systems by physicians and hospitals. The act allocates $19 billion to hospitals and physicians who demonstrate meaningful use of certified electronic medical records.

The Congressional Budget Office estimates that 90 of physicians and 70 percent of hospitals will use these systems by 2020 due to this legislation. The following sections summarize the major points of HITECH.

The Health Information Technology for Economic and Clinical Health Act came in to existence as part of the American Recovery and Reinvestment Act of 2009. It imposes certain requirements on vendors of personal health records (and other related entities) in the event of certain security breaches relating to protected health information.

In February 2009, President Obama signed the Health Information Technology for Economic and Clinical Health (HITECH) Act as part of his overall economic stimulus plan. The HITECH Act continues the effort of the Health Insurance Portability and Accountability Act (HIPAA) to encourage movement to electronic patient records and to deliver stricter data protection regulations for more secure patient privacy.

Reference:

http://www.eweek.com/c/a/Health-Care-IT/How-to-Secure-Healthcare-Data-to-Meet-HITECH-Act-Compliance/

Enhanced breach notification requirements have major impact on providers, insurance companies and other EPs and their 'business associates':

Breach Notification Final Rule Update

The Interim Final Rule for Breach Notification for Unsecured Protected Health Information, issued pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, was published in the Federal Register on August 24, 2009, and became effective on September 23, 2009. During the 60-day public comment period on the Interim Final Rule, HHS received approximately 120 comments.

HHS reviewed the public comment on the interim rule and developed a final rule, which was submitted to the Office of Management and Budget (OMB) for Executive Order 12866 regulatory review on May 14, 2010. At this time, however, HHS is withdrawing the breach notification final rule from OMB review to allow for further consideration, given the Department’s experience to date in administering the regulations. This is a complex issue and the Administration is committed to ensuring that individuals’ health information is secured to the extent possible to avoid unauthorized uses and disclosures, and that individuals are appropriately notified when incidents do occur. We intend to publish a final rule in the Federal Register in the coming months.

Until such time as a new final rule is issued, the Interim Final Rule that became effective on September 23, 2009, remains in effect.

Reference: http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/finalruleupdate.html

The HIT Policy Committee

Section 3002

The HIT Standards Committee

Section 3003

Defining the certified electronic health record

A certified electronic health record system must contain medical history and problem lists, patient demographics, clinical decision support, physician order entry support, quality reporting support, and data exchange with other electronic sources. Specific criteria for "certification" are to be developed by the National Coordinator in consultation with the Director of the National Institute of Standards and Technology.

Financial Incentives

Under the economic stimulus plan, physicians and providers can qualify for $44,000 in Medicare incentives if they demonstrate "meaningful use" of an Electronic Health Record starting in 2011.

Practices with 30% or more of their patient population paying with Medicaid (20% for pediatricians) are eligible for stimulus incentive payments of up to $65,000. Practices operating in a "health provider shortage area" (HPSA) can qualify for bonus incentives. e-prescribing, Medicare's physician quality reporting initiative (PQRI) and Medicare Care Manage Performance (MCMP) can also increase your bonuses.

HITECH provides $20 Billion in potential incentives to physicians and hospitals for "meaningful users" of certified EMR systems. The elibility period runs from 2011-2016. Users (prior to 2014) may receive up to $18k for year one, $12k for year two, $8k for year three, $4k for year four, and $2k for year 5 of eligibility. Incentive is 10% higher in health professions shortage areas.

Meaningful use includes electronic prescribing, electronic information exchange, and reporting quality measures. "The eligible professional demonstates to satisfaction of the Secretary (HHS)... ...is using certified EHR technology in a meaningful manner..."

$2 Billion is available as grants and loans to support health information technology research and development of a national health IT network (sections 13301 and 3013-3015.)

Financial Penalties

In section 3006, private entities, including government contractors, are not required to implement meaningful use of certified electronic medical record. However, The National Coordinator may assess a "nominal fee" for the adoption by health care provider of a certified EMR or for provding such technology.

For non-users, reimbursement decreases by 1% per year from 2015-2017. If the percentage of EMR users is still >75% of eligible professionals, reimbursement decreases by 1% per year, but not may not exceed a 5% reduction.

"Significant Hardship" exception to payment adjustments may apply on a case-by-case basis, for up to 5 years, to eligible non-users "such as in the case of an eligible professional who practices in a rural area without sufficient internet access."

Privacy and Security

HITECH takes into account the Health Insurance Portability and Accountability Act (HIPAA) laws pertaining to health information standards and implementation. HITECH gives states' attorneys general the authority to prosecute HIPAA violations (section 13410). Civil and criminal penalties now apply to both Covered Entities and their business associates. Business associates of covered entities are now subject to the same HIPAA security provisions.

In the event of a security breach, all individuals with at risk unprotected health information must be notified by the Covered Entity, and Business Associates must notify their respective Covered Entities. All notifications must be made within 60 days from the first discovery of the security breach. Notification may be via certified mail, electronic mail, and/or public anouncement on the Covered Entities website and broadcast/print media.

Media notification is required if at least 500 individuals are potentially affected. In that case HHS Secretary is also notified to place a notice on the DHS website.

The American Recovery and Reinvestment Act of 2009, signed by President Obama on February 17, 2009, includes $19.2 billion in provisions for healthcare information technology (health IT). In its role as the leading authority on the appropriate implementation and use of Health IT.

Summary of HHS Recovery Operational Plan - May 2009

Background
With $167 billion dollars in American Recovery and Reinvestment Act Funding available for the Department of Health and Human Services, the ARRA legislation requires all federal agencies take responsible for managing ARRA . The Department of Health and Human Services Operational Plan for the ARRA funds was released on May 16th, prior to the 90-day deadline specified for many of its agencies.

The Operational Plan states:
• The amount of and expected availability date of health information technology funding
• The department of jurisdiction’s timeline for delivering completed projects
• Measurables for tracking success

The Recovery Plan implementation effort will be headed up by the Office of Recovery Act Coordination, headed by Deputy Assistant Secretary for Recovery Act Coordination Dennis Williams. HHS has made transparency a priority, and the office is posting updates to these efforts on www.hhs.gov/recovery . HHS was required by ARRA to submit the implementation plan within 90 days of the passage of the ARRA legislation before funding would be released.

The Office of the National Coordinator for Health IT was required to submit its Operating Plan for spending the $2B appropriated funds prior to allocating any of its funds to projects. We understand the funding description in the operational plan is consistent with the goals of the strategic plan that the Office of the National Coordinator released in June 2008 , which will be the baseline for future ONC Strategic Plans and Operational Plans.

ONC is required to update the Operational Plan on November 1st of each year between 2009-2014. Office of the National Coordinator for Health Information Technology (ONC) Operational Plan

ONC Funding
• Privacy and Security – $24.3 million
• NIST – $20 million
• Regional HIT Exchange – $300 million
• Unspecified – $1.65 billion
• Total, HIT - $2 billion

ONC Objectives
To improve the health of Americans and the performance of the nation’s health system through an unprecedented investment in health information technology (HIT) by: o Informing Health Care Professionals: Provide critical information to health care professionals to improve the quality of care delivery, reduce errors, and decrease costs. o Improving Population Health: Simplify collection, aggregation, and analysis of anonymized health information for use to improve public health and safety.

ONC Achievement Metrics
• Increase physician adoption of EHRs
• Increase the percentage of small practices with EHRs
• Percent of physician offices adopting ambulatory EHRs in the past 12 months that meet certification criteria

• Current performance measures for the Office for Civil Rights privacy measures:
  

• Percentage of privacy cases resolved per privacy case received
• Percentage of privacy complaints that require formal investigation, resolved within 365 days
• Percentage of privacy complaints that do not require formal investigation, resolved within 180 days

Centers for Medicare and Medicaid Services (CMS)
Medicare and Medicaid Health IT Adoption Incentive Payments
CMS Funding:
• Medicare Incentives – $23.1 billion (available in FY11)
• Medicaid Incentives – $21.6 billion (available in FY11)
• State Medicaid Administration – $1.05 billion
• Medicare Administrative Costs – $745.0 million
• Medicaid Administrative Costs – $300 million
• Total, Mandatory Recovery Act HIT Funds = $46.8 billion

CMS Objectives
• Promote and provide incentives for the adoption of certified electronic health records (EHRs)
• Have eligible providers (EPs) and hospitals become meaningful users of certified EHR
• Meaningful user:
o Meaningful use of EHR technology
o Information exchange
o Reporting on measure using EHR

CMS Delivery Schedule
• 2009 Milestones:
o Coordinate with ONC to develop policies such as the definition of meaningful use
o Develop proposed rules to allow public input to the incentive program policies
o Plan system and other requirements needed to support the incentives program
o Plan national outreach program
•2010 Milestones:
o Conduct outreach to eligible professionals and providers and to State Medicaid Agencies
o Develop systems to support the payment of incentives
o Develop final rules to establish policies needed to pay incentives
o Develop systems to monitor and evaluate incentive payments
• No Sooner than October 2010:
o Start to pay hospital incentives for Medicare and monitor payments
• No sooner than January 2011
o Start to pay eligible professionals for Medicare and monitor payments
o Begin and monitor Medicaid incentive payments to eligible professionals and hospitals
•2011 – 2016:
o Continue paying hospital incentives for Medicare and monitor payments
o Continue paying eligible professionals incentives for Medicare and monitor payments
•2011 – 2021:
o Continue paying Medicaid incentives to eligible professionals and hospitals and monitor payments
•2015 and thereafter:
o Initiate payment reduction to Medicare hospitals and eligible professionals that fail to adopt EHR
CMS Achievement Metrics
• Initial outcome measure will be developed by December 1, 2009
• The measures below will be reported quarterly on www.recovery.gov
o Meaningful use of certified EHRs by Eligible Professionals (Medicare) - # of EPs qualifying as meaningful users under the Medicare incentives program
o Meaningful use of certified EHRs by Eligible Professionals (Medicaid) - # of EPs qualifying as meaningful users under the Medicaid incentives program
o Meaningful use of certified EHRs by hospitals (Medicare) - # of hospitals qualifying as meaningful users under the Medicare incentives program
o Meaningful use of certified EHRs by hospitals (Medicaid) - # of hospitals qualifying as meaningful users under the Medicaid incentives program

Health Resources and Services Administration (HRSA)
Community Health Centers Construction, Renovation, Equipment, and Health IT
Types of Available Grant Money:
• Capital Improvement Grants- $850 million (for use on capital improvements, including EHR adoption) * WILL BE SPENT IN FY09
• Health Information Technology Systems/Networks Grants- $125 million *WILL BE SPENT IN FY09
• Facility Investment Grants- $512.5 million * WILL BE SPENT IN FY10
• TOTAL: $1.5 billion

HRSA Objectives:
• preserve and create jobs
• promote economic recovery
• all capital funding opportunities will support health center efforts to modernize facilities and systems, and in turn improve access to quality, comprehensive, culturally competent and affordable primary and preventive health care for medically underserved populations.

HRSA Delivery Schedule:
• Capital Improvement Program Awards
o Guidance Released: May 1, 2009
o Application Phase: May 1 – June 2, 2009
o Award Date: July 1, 2009
o Project Period: July 1, 2009 – June 30, 2011
o First Quarterly Report: October 1, 2009
• HIT Systems/Networks Awards:
o Guidance Released: FY 2009
o Application Phase: FY 2009
o Review Phase: FY 2009
o Award Date: FY 2009
o Project Period: FY 2009 – FY 2010
o First Quarterly Report: October 1, 2009
• Facility Investment Awards
o Guidance Released: FY 2009
o Application Phase: FY 2009
o Review Phase: FY 2010
o Award Date: FY 2010
o Project Period: FY 2010 – FY 2011
o First Quarterly Report: January 1, 2010

HRSA Achievement Metrics
HRSA will issue Quarterly reports on www.recovery.gov indicating the number of community health centers that have either adopted a certified Electronic Health Record, or have upgraded/expanded a current certified Electronic Health Record

Indian Health Service (IHS) Implementation Plan for Health IT Adoption
IHS Funding:
•Certified Electronic Health Record Adoption
o $61.7 million (34.8 in FY09 and 26.9 in FY10)
􀂃CPOE
􀂃Clinical Decision Support
􀂃Quality Reporting
􀂃Health Information Exchange
􀂃Certification
􀂃Deployment
•Personal Health Record Adoption
o$2.5 million ($1.7 million in FY09 and $0.8 million in FY10)
•Telehealth and Network Infrastructure
o$16.7 million ($12.7 million in FY09 and $4.0 million in FY10)
•Administration Costs- $4.1 million

IHS Objectives:
• Deploy enhanced electronic health information technology to expand services, improve patient care quality, decrease service disparities, and expand access by Indians to out‐of‐network services and reimbursements.
• Modernize and enhance network hardware and software capacity so that all Indian health care sites enhance the delivery of care and benefit from new health care information tools and security

IHS Delivery Schedule:
• Certified EHR-Comprehensive Health Information
o Contract Supplements-April-June 2009
o New Awards- October-December 2010
o Work Milestones
􀂃Acquire Practice Management Solution
􀂃EHR Web Interface (2011)
oDelivery- July-September 2011

•Certified EHR-CPOE
oContract Supplements-April-June 2009
oNew Awards- October-December 2010
oWork Milestones
􀂃 Pharmacy Drug File Enhancement
􀂃 Consolidated Mail Outpatient Pharmacy
o Delivery- January-March 2011

• Certified EHR- Clinical Decision Support
o Contract Supplements-April-June 2009
o New Awards-None
o Work Milestones
􀂃 Care Management Functionality (June 2010)
􀂃 ER Dashboard Application (March 2010)
o Delivery- September 2010

• Certified EHR- Quality and Performance Reporting
oContract Supplements-April-June 2009
oNew Awards-None
o Work Milestones
􀂃Add 2 performance measures to Clinical Reporting System’s Select Measures Report
oDelivery- July 2010

•Certified EHR- Health Information Exchange
oContract Supplements (April-June 2009)
oNew Awards (October 2010)
oWork Milestones
􀂃Deploy Master Patient Index (January-March 2010)
􀂃Complete NHIN Connection (March 2010)
oDelivery- September 2010

•Certified EHR- Certification
oContract Supplements-April-June 2009
oNew Awards (October 2010)
oWork Milestones
􀂃Complete DHR Inpatient Certification
oDelivery-(July 2010)

•Certified EHR- Deployment
oContract Supplements-April-June 2009
oNew Awards: None
oWork Milestones
􀂃Implement use of 80 RPMS in Alaskan Villages (July 2011)
oDelivery- September 2011

•Personal Health Record Adoption
oContract Supplements-April-June 2009
oNew Awards: (October 2010)
oWork Milestones
􀂃Complete Requirements for Initial PHR (December 2010)
oDelivery- (April-June 2010)

•Telehealth and Network Infrastructure
oContract Supplements-April-June 2009
oNew Awards: (July-September 2009)
oDelivery- (April-June 2010)
•Progress reports will be posted Quarterly on www.Recovery.gov

HHS, AHRQ, and NIH Comparative Effectiveness Research
Comparative Effectiveness Research Types of Funding Available
• HHS Discretionary Funding- $400 million
• AHRQ- $300 million
• NIH- $400 million

Comparative Effectiveness Research Objectives
• Comparative effectiveness research is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions.
• The purpose of this research is to inform patients, providers, and decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances.
• Research will include medications, procedures, medical and assistive devices and technologies, behavioral change strategies, and delivery system interventions. Comparative Effectiveness Research Delivery Schedule
• HHS will release delivery schedule before June 30, 2009

Comparative Effectiveness Research Achievement Metrics
• The Comparative Effectiveness Research Council will meet 14 times in FY09 and 6 times in FY10 to direct the research effort.
HHS Information Technology Security
HHS IT Security Types of Funding
• HHS Information Technology Security-$50 million ($31.9 million in FY09, $18.1 million in FY10)

HHS IT Security Objectives
•provide the ability to rapidly determine the enterprise security risk posture of operational IT systems and computer networks throughout HHS by funding the following areas: oSecurity Incident Response & Coordination
oOPDIV Security Engineering and Technical Staff Support
oEnterprise-wide Security Situational Awareness
oEndpoint (Desktop Computer) Protection, Internet Content Web Security Filtering, and Data Loss Prevention
oEnhanced OPDIV Security Architecture, Engineering and Implementation

HHS IT Security Achievement Metrics
•Percentage of HHS laptops and desktops secured with encryption
•Percentage of HHS enterprise network infrastructure monitored by the CSIRC with automated intrusion detection systems
•Percentage of HHS IT systems protected with advanced Internet content filtering and anti-malware solutions
•Percentage of HHS critical IT systems audit logs reviewed by CSIRC and OPDIV

References
1. Economic Stimulus for the Healthcare IT Industry
http://www.himss.org/EconomicStimulus/
2. Summary of HHS Recovery Operational Plan - May 2009
http://www.himss.org/content/output/9C4893475B064F1694FFF962B909E32B.pdf

Submitted by Supachai Parchariyanon

References

1. "Public Law 111-5 [2] (retrieved 2/28/2010)
2. "Title IV-Health Information for Economic and Clinical Health Act" [3] (retrieved 2/28/2010)
3. Full text of ARRA [4]