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How LHDs Can Benefit from the Stimulus Package

The information below is designed to help LHDs understand some of the health information technology (HIT) provisions in the American Recovery and Reinvestment Act (ARRA) including how they may be able to take advantage of new initiatives.  These provisions within ARRA are collectively known as the Health Information Technology for Economic and Clinical Health (HITECH) Act.  The national landscape for HIT is changing rapidly as a result of ARRA and, where possible, links have been provided so that visitors to the page can find the latest information.
State Health Information Exchange (HIE) Grants
The Office of the National Coordinator for Health Information Technology (ONC), an office within the Department of Health and Human Services, has awarded grants to states or state-designated entities to support the development of mechanisms for information sharing within an emerging nationwide system of networks ($564 million). ARRA includes as one of the purposes of state grants “supporting public health agencies’ authorized use of and access to electronic health information.” States or state-designated entities are required to consult with public health agencies in carrying out funded activities.

Recommendation to LHDs:  Identify who in your state is developing the HIE and ensure that they are taking into account your specific local needs.

More information: ONC’s page on the state HIE grants
HIT Regional Extension Centers
The ONC has also announced the availability of grants for HIT Regional Extension Center Grants ($598 million).  There will be approximately 70 extension centers and one national Health Information Technology Research Center (HITRC).  The regional centers will offer technical assistance, guidance, and information on best practices to support and accelerate healthcare providers’ efforts to become meaningful users of EHRs. The HITRC will gather relevant information on effective practices from a wide variety of sources across the country, help the regional centers collaborate with one another and with relevant stakeholders to identify, and share best practices in EHR adoption.

Recommendation to LHDs: Take advantage of services offered by the extension centers once they become available, particularly if you are considering applying to receive Medicaid bonus payments (see below).

More information: ONC’s page on HIT regional extension centers
Meaningful Use
Throughout much of the HITECH Act references are made to “meaningful use” and “meaningful users.”  This set of criteria will be used to determine who is eligible to receive Medicare and Medicaid incentive payments (see below).  The Stage 1 criteria for meaningful use have been finalized and include a list of 15 mandatory “core” objectives, along with 10 optional “menu” objectives. Providers must choose five of the menu objectives, including at least one of the three public health objectives: capability to submit immunization information, capability to submit electronic lab results, and capability to submit syndromic surveillance data.

Recommendation to LHDs: Familiarize yourself with the meaningful use grid. Consider how your LHD will position itself to electronically send and receive public health information.

More information: Summary of the final meaningful use rule (July 2010)
NACCHO''s comments to CMS on the proposed meaningful use rule (March 2010)
CMS Final Rule Meaningful Use Stage 1 Objectives and Measures
Final Rule Meaningful Use Standards Quick List
Incentive Payments for Medicare and Medicaid Providers
There is over $20 billion allocated in ARRA for the Centers for Medicare and Medicaid Services (CMS) to provide incentives and support for the adoption of certified EHRs. ARRA authorizes bonus payments for eligible professionals and hospitals participating in Medicare or Medicaid if they become meaningful users of certified EHRs (see above).  For the Medicaid payments, professionals not based in hospitals are eligible if they have at least 30 percent of their patient volume attributable to Medicaid patients.  For pediatricians not based in hospitals that figure is 20 percent. According to the final rule on meaningful use, this proportion can be applied across a clinic or other group setting.

These bonus payments will help lessen the financial burden for many healthcare providers to adopt this HIT. Medicare incentive payments begin in 2011, and from 2015 onwards ARRA mandates penalties under Medicare for eligible providers and hospitals that fail to demonstrate meaningful use of EHRs.  Medicaid bonus payments will also begin in 2011 and continue through to 2021 (though as there are five years of payments, providers must begin receiving theirs by 2016).

Recommendation to LHDs: Many LHDs provide clinical services and receive reimbursement from Medicaid, and this may be an opportunity to cost-effectively implement an EHR in your department.  NACCHO can work with LHDs to help them get started on planning and implementing an EHR.

More information: CMS’s page on Medicare and Medicaid bonus payments
NACCHO’s Activities
NACCHO has a number of recently completed, current, and planned activities that will help ensure that LHDs are best able to take advantage of the HIT provisions in ARRA:

  • Developing a map of state HIE and regional extension center grant recipients so that LHDs can identify potential partners in their area.  You can view and contribute to the map here.
  • Conducted an informatics needs assessment of LHDs to identify what would be the most effective way of increasing the use of public health informatics at a local level.  More information and findings can be found here.
  • Representing the views of LHDs when meeting with officials at ONC and other federal agencies, including ensuring that LHDs are eligible for funding opportunities under ARRA.
  • Providing comment on the definition of meaningful use. NACCHO's comments on Stage 1 can be found here.
  • Collecting examples of LHDs that have successfully implemented EHRs and HIEs.
  • Identify and disseminate resources that LHDs can use when planning and implementing EHRs or HIEs.