Progress Made on Stimulus Package Provisions, Funding

The federal government continues to move ahead with implementing various provisions of the American Recovery and Reinvestment Act of 2009. This update summarizes certain significant developments throughout June and July.

Health IT Policy and Standards

On July 13, CMS released the much-anticipated “meaningful use” final rule on the Medicare and Medicaid electronic health record incentive program, and the Office of the National Coordinator for Health IT released the final rule on standards for certified EHR technology.

Final rule modifications were based on over 2,000 comments received by CMS.  Key changes in the meaningful use final rule include:

  • Greater flexibility in meeting and reporting certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012; 
  • An objective of providing condition-specific patient education resources for both physicians and hospitals and recording advance directives for eligible hospitals;
  • Defining a hospital-based provider as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only (conforms to the Continuing Extension Act of 2010); and
  • Including critical access hospitals within the definition of acute care hospital for the purpose of incentive program eligibility under Medicaid.

Additional information is also available in an article posting to the New England Journal of Medicine‘s Health Care Reform Center.

The Health IT Policy Committee’s Privacy and Security Tiger Team convened several times in July. The July 6 meeting focused on health information exchange framing and basic models. The July 9 meeting addressed the notice of proposed rulemaking implementing changes to the HIPAA rules included in HITECH.  The topic of the July 13 meeting was data collection, use and disclosure limits.

The 15-member Privacy and Security Tiger Team was established in June by ONC and includes members from the Health IT Policy and Standards committees and the National Committee on Vital and Health Statistics.

On June 30, the Health IT Standards Committee met to discuss a range of NHIN Direct issues, including:

  • Specifications;
  • Standards and interoperability framework; and
  • Concept of operations.

In addition, the Clinical Operations work group presented information on electronic document standards for encounter summaries.

Sam Karp, California HealthCare Foundation vice president of programs, is the co-chair of the Clinical Operations work group. CHCF publishes California Healthline.

On June 29, the Privacy and Security Tiger Team held a hearing to discuss technologies that enable consumers to choose whether to share their information in a health information exchange. The hearing included technology users’ testimonies, developer demonstrations and an expert panel.

On June 25, the Health IT Policy Committee approved recommendations from the Privacy and Security Tiger Team. Recommendations included the establishment of health data exchange credentials and personal health information policies. 

EHR Certification

ONC has started accepting applications from organizations seeking to be named as testing and certification bodies for EHR systems. Under ARRA, health care providers who demonstrate “meaningful use” of certified EHR systems will qualify for federal incentive payments.

The final rule on temporary testing and certification program can be found in the June 24 edition of the Federal Register. ONC has posted a range of materials about temporary certification on its website.

Medicare and Medicaid EHR Incentive Programs

An amendment related to the Medicaid EHR Incentive program has been included in the American Jobs and Closing Tax Loopholes Act of 2010 (HR 4213), which recently passed the House. The provision simplifies Medicaid incentives to eligible professionals (EPs). Currently, EPs may receive up to 85% of net average allowable costs of certified EHRs (to a maximum of $63,750). The payment, however, must be reduced by amounts received from other sources. The amendment ensures that payments are reduced only when an EP receives private support. The bill has not yet passed the Senate.

Meanwhile, CMS launched a website dedicated to the Medicaid and Medicare EHR Incentive Program. The website provides up-to-date information, such as eligibility, certification and criteria for achieving meaningful use. The website will also track upcoming EHR training and events.

Regional Extension Centers

On July 7, 2010, ONC released $14 million to fund additional Health IT Regional Extension Centers in Orange County, Calif., New Hampshire and select counties in Florida. Full applications are due on Aug. 6.

Under the REC Cooperative Agreement program, RECs are required to submit monthly reports to ONC during their two-year project periods. Data include:

  • The number of REC-registered providers;
  • The number of providers who have purchased and are using a certified EHR; and
  • The number of health care providers who meet EHR meaningful use criteria.

On June 30, HHS published a summary of the data elements for which it seeks public comment.

Broadband

On July 3, the Obama administration announced $795 million in grants and loans for 66 new broadband projects. The projects were selected by the departments of Commerce and Agriculture, and will mainly deal with building out broadband infrastructure and providing the technology to public computing centers. Recipients provided $200 million in matching grants.

On June 7, USDA released “Connecting Rural America,” a report describing projects funded by round one of the Broadband Initiatives Program. As part of the program, USDA’s Rural Utilities Service awarded $1.068 billion of ARRA funding to 68 recipients.

Comparative Effectiveness Research

Agencies and offices within HHS have made available a number of opportunities to further research and activities on Comparative Effectiveness Research (CER).  The opportunities include the following:

  • Agency for Health Research and Quality: A June 23 competitive task order to evaluate ARRA grantee projects to accelerate dissemination of CER findings. Contractors will provide grantees with continuous feedback, assess individual project success, and develop and implement a strategy to generate and share actionable information related to CER findings;
  • The Office of the Assistant Secretary for Planning and Evaluation: A Request for Task Order Proposal to current contractors to identify optimal care delivery components that best support the use of evidence-based practices for schizophrenic patients enrolled in Medicaid; and
  • CDC: A contract to support monitoring and evaluation of the ARRA-funded Communities Putting Prevention to Work initiative. Activities will include quantitative and qualitative evaluation methods. Case studies will be conducted to determine successful and unsuccessful initiatives and factors that determine differential outcomes.

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