American Recovery and Reinvestment Act ARRA

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American Recovery and Reinvestment Act (ARRA)

• The Power of New HIPAA Legislation

Robert H. Roswell, M.D.
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Health Information Technology

• 17.2 B for Medicare and Medicaid incentives for
  physician and hospital adoption of electronic
  health records (EHRs)
• 2B for grants from the Secretary of HHS and the
  Office of the National Coordinator for Health
  Information Technology (ONCHIT)

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Meaningful use of certified EHR technology

• Using a certified EHR technology including the
  use of electronic prescribing
• Connected in a manner that provides for
  electronic exchange of health information
• Submits information on clinical quality measures

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Incentive payments for eligible professionals

• 2011 18,000
• 2012 12,000
• 2013 8,000
• 2014 4,000
• 2015 2,000
• Total 44,000
• (plus an additional 4,400 if in a designated
  health professional shortage area)
• Penalties begin in 2015 if EHR has not been
  adopted

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Medicaid Incentives

• Up to 21,250 for adoption of certified EHR
  technology
• Up to 8,500 a year for 5 years for operation and
  maintenance
• Total funding cap of 63,750 per eligible
  physician (Medicaid patients comprise 30 of
  practice 20 for pediatricians)

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Oklahoma CMS Electronic Health Record Pilot

• Primary care physicians in small group practices
  (fewer than 20 physicians) who see 50 or more FFS
  Medicare patients/
• 2010 5,000
• 2011 8,000
• 2012 15,000
• 2013 15,000
• 2014 15,000
• Total 58,000

This pilot program was canceled by CMS on 4-8-09
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Incentive payments for eligible hospitals

• Base amount (2M) plus a a discharge-related
  payment up to 11M
• Year 1 100
• Year 2 75
• Year 3 50
• Year 4 25
• Beginning in 2011

Penalties begin in 2015 for hospitals not
adopting EMRs.
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Meaningful Use Certified

• New HIT Standards Committee must define initial
  certification criteria by December 31st, 2009
• Certification Commission for Health Information
  Technology (CCHIT)

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Additional Interest Items

• Health care Information Enterprise Integration
  Research Centers
• interfaces including VR
• Interoperability software
• Dependability
• Quality and productivity impact
• Reduction of medical errors
• Health information enterprise management
• Competitive merit-reviewed grant program
  administered by NIST

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Additional Interest Items

• Infrastructure and tools for the promotion of
  telemedicine
• Promotion of interoperability of clinical data
  repositories or registries
• Grant funding from the Secretary of HHS (ONCHIT)

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Demonstration Program to Integrate Information
Technology Into Clinical Education

• School of Medicine, Dentistry, Nursing, Pharmacy,
  or Allied Health
• HHS grants funds up to 50 of total cost can not
  be used to purchase hardware, software, or
  services

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Information Technology Professionals in Health
care

• Medical health Informatics education programs for
  health care and IT students
• Developing and revising curricula in medical
  health informatics and related disciplines
• Equipment and student recruitment
• Priority given existing programs and those
  designed to be completed in less than six months

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New HIPAA Requirements

• ARRA broadens privacy and security requirements
  established under the Health Insurance
  Portability and Accountability Act of 1996

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New HIPAA Requirements

• Business associates (including vendors and health
  information exchanges) are now directly subject
  to HIPAA requirements. BA contracts should be
  revised to reflect this change.

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New HIPAA Requirements

• Mandatory notification of patients in the event
  of a PHI security breach. Patients must be
  notified within 60 days, and both media and HHS
  must be notified if more than 500 patients are
  involved in the breach.

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New HIPAA Requirements

• Individual patient right to restrict disclosure
  of PHI when paid for in full by the individual.

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New HIPAA Requirements

• Only Minimum necessary patient data may be
  shared among healthcare organizations to support
  medical care. HHS will define minimum
  necessary.

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New HIPAA Requirements

• HHS required to provide enhanced education on
  health information privacy through regional
  offices and nationally.

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New HIPAA Requirements

• With certain exceptions, the sale of PHI is
  prohibited by health plans or providers.

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New HIPAA Requirements

• Patient right to request electronic health
  information in electronic format and direct such
  information to a designated party.

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New HIPAA Requirements

• Restriction on use of PHI for marketing purposes
  unless covered by plan.

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New HIPAA Requirements

• More conspicuous notice of patient's right to opt
  out of receiving charitable solicitations.

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New HIPAA Requirements

• States authorized to file HIPAA lawsuits.
• Penalties increased
• Patients may now receive a portion of civil
  penalties
• HHS required to conduct HIPAA audits

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Questions or Comments?