ARRA HITECH Act Background

The American Recovery and Reinvestment Act (ARRA) became public law on February 17, 2009. Title XIII of ARRA was given a subtitle: Health Information Technology for Economic and Clinical Health Act (HITECH) has received $19.2 billion in funding for health IT for the distribution period of January 1, 2011 to December 30, 2013.

On June 18, 2010, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced publication of the final rule governing Electronic Health Record (EHR) incentives under the American Recovery and Reinvestment Act of 2009 (ARRA).

This rule provides the final definition of "Meaningful Use" of Electronic Health Records (EHR) systems by healthcare providers and toward an initial set of standards that must be met by certified EHR technology. This gives providers and technology vendors alike clear guidance to determining their EHR strategies.

The core and menu criteria for meaningful use that Eligible Professionals (EPs) must achieve in order to be eligible for incentive payments under the HITECH provisions of the ARRA. In the NPRM, CMS identifies three proposed stages of meaningful use criteria:

• Stage 1, focuses on the electronic capture and tracking of codified health information, use of data for care coordination purposes, and on reporting of clinical quality measures and health information to CMS. EP's must complete 15 core and 7 of 12 menu measures in order to be deemed a "meaningful" EHR user and to qualify for 2011 incentive payments.
• Stages 2 and 3, to be finalized at a later date, expand on the requirements to include disease and medication management, quality measurement and sharing of data with public health agencies.
• This set of standards that ensures accurate and secure health information exchange across different EHR systems such as:
  1. Standard formats for clinical summaries and prescriptions
  2. Standard terms to describe clinical problems, procedures, lab tests, medications and allergies
  3. Standards for the reliable and secure transportation of the above information

The standards will rely on those already established and promoted by leading standards bodies such as HL7, Integrating the Healthcare Enterprise (IHE), the National Health Information Network (NHIN) and NHIN Direct (also referred to as the "Health Internet").

What does this mean to you?
As your hospital and practice review and make technology and workflow decisions, the following are some important highlights:

• There are two CMS incentive programs – Medicare and Medicaid
• Eligible Providers (EPs) may only participate in one CMS incentive program, although EPs will have one opportunity to switch programs.
• Amount and timing of incentive payments will vary depending on when the provider elects to participate and which program they participate in (Medicare or Medicaid). The programs are structured to provide the greatest financial benefit to providers and practices participating from the beginning and for the full duration of the program.
• In general, the maximum amount of total incentive payments that an EP can receive is up to $44,000 under the Medicare program and up to $63,750 under the Medicaid program.
• To earn incentives for a given payment year, an eligible provider must demonstrate meaningful use during a designated "reporting period".
• For 2011 (the first payment year), Medicare providers need to demonstrate Meaningful Use for a minimum of 90 consecutive days. Under the proposed rule, the reporting period for the 2011 payment year could begin as early as July 2010 or as late as September 2011.
• In subsequent years, demonstration of meaningful use will be required for the full payment year.