Health Care Reform and Health IT Stimulus: ARRA and HITECH

The American Recovery and Reinvestment Act (ARRA), signed into law on February 17, 2009 by President Obama, has many implications on health information issues and the HIM workforce.  AHIMA is actively monitoring, participating and developing resources to assist in understanding the key components of this law and the impact on the industry and practice. Information on healthcare reform will be continually evolving in the next months. Key highlights of important HIM issues include:

• Incentives for adoption of EHRs
• Health information exchange (HIE)
• New privacy regulations (Subpart D of XIII) for both HIPAA and non-HIPAA entities
• HIM workforce opportunities

This website is dedicated to providing you a central resource center on leading edge information, opportunities, and requirements that will be generated by ARRA. Remember too that weekly updates on ARRA as they happen will be posted on AHIMA’s members-only eAlert.

What’s New

Check this section frequently for new information posted on the AHIMA ARRA web page and breaking industry news.

• August 25 - ONC hosts regional extension center webcast Thursday, August 27 at 2pm ET  The Office of the National Coordinator for Health Information Technology will be hosting a Technical Assistance call/web presentation to answer questions related to the Health Information Technology Extension Program: Regional Centers Cooperative Agreement Program Funding Opportunity Announcement.  For more information go to the ONC Regional Extension Center website:  Extension Program Webcast

• August 25 - HHS Secretary Announces $25.7 Million in Grants to Expand, Improve Health Center Services   Health and Human Services Secretary Kathleen Sebelius today announced more than $25.7 million in grants to increase and improve health and support services at the nation's health centers.  See HHS Secretary Announces 25.7 Million in Grants

• August 24 - HHS Breach Notification Rules Effective September 23, 2009 Rules Released August 24  The much anticipated Interim Final Rule on Breach Notification for Unsecured Protected Health Information was published in the Monday, August 24, 2009 Federal Register (Vol. 74, No. 162, Page 42740) by the Department of Health and Human Services (HHS).  The rule becomes effective, Wednesday, September 23, 2009 and covers all HIPAA-covered entities and HIPAA-related Business Associates (BAs). 

   

  The new Breach Notification interim rule provides updated guidance specifying the technologies and methodologies that render protected health information (PHI-HIPAA definition) unusable, unreadable, or indecipherable to unauthorized individuals.  The new rule will be added as subpart D to part 164 of title 45 of the Code of Federal Regulations, and as such some of the definitions associated in part 164 will be moved accordingly. 

   

  Specifically the breach notification rule identifies what is a breach of PHI information; how an entity might investigate an incident to determine the breach, and what steps the entity must follow should it be determined that a breach has occurred.  A verified breach requires notification, as defined in the rule, of the affected individual(s) within a 60-day time period from when the breach is discovered (defined in the rule) as well as notification to HHS and potentially the media.  In providing discussion of the rule, HHS also notes and comments on situations where the federal rule may reside side-by-side with a state breach notification rule. 

   

  Since this is an interim final rule, HHS will be taking comments via its Office of Civil Rights (OCR).  Comments are in two forms:

  • Comments on the provisions of the rule are due on or before October 23, 2009, and
  • Comments on the information collection requirements associated with the rule are due on or before September 8, 2009.

   Instructions on how to comment as well as the full text of the interim rule can be found in the Federal Register of August 24 at http://edocket.access.gpo.gov/2009/pdf/E9-20169.pdf.   AHIMA has developed a number of resources to assist members with the breach notification requirements.  These resources are available below under HITECH.  

• August 24 -During a press conference last week, Dr. David Blumenthal, National Coordinator for Health Information Technology announced the availability of approximately $600M in grant funding to support creating about 70 Health Information Technology Regional Extension Centers. The purpose of the Regional Centers is to furnish assistance, defined as education, outreach, and technical assistance, to help providers in their geographic service areas select, successfully implement, and meaningfully use certified EHR technology to improve the quality and value of health care.  Regional Centers will also help providers achieve, through appropriate available infrastructures, exchange of health information in compliance with applicable statutory and regulatory requirements, and patient preferences.

   

  These grants will be awarded in three application cycles waves in fiscal 2010 beginning with the first phase preliminary applications due September 8, 2009.  To learn more about the Regional Centers and to obtain a copy of the funding opportunity, go to Health Information Technology Extension Program

   

• July 22 - A letter urging state legislators around the country to initiate HIM programs at the baccalaureate level. See NCS_workforce_education_letter

• July 13 - Through the American Recovery and Reinvestment Act (ARRA), the development of Regional Extension Centers (regional centers) offers unique opportunities for HIM professionals to be at the forefront of electronic health record (EHR) implementations. HIM professionals provide critical and essential skills as providers and entities are going through the transition to a more electronic environment to become meaningful users of EHRs. AHIMA has developed a concept paper outlining the benefits and opportunities of engaging HIM in the process and aligning them with key stakeholders to achieve meaningful use and improved use of EHRs. See The HIM Role in Assisting Regional Extension Centers July 09

• June 26 - AHIMA comments on ONC Meaningful Use Draft Definition In response to a call for comments from the Office of the National Coordinator (ONC) regarding the draft definition for meaningful use of certificated electronic health record (EHR) technology, AHIMA submitted comments last week.  In 2008, the National Priorities Partnership, convened by the National Quality Forum (NQF), released a report entitled “National Priorities and Goals” which identified a set of national priorities to help focus performance improvement efforts. Among these priorities were patient engagement, reduction of racial disparities, improved safety, increased efficiency, coordination of care, and improved population health. These priorities were used to create the framework for “meaningful use” of an EHR. AHIMA supports the approach taken by ONC to define meaningful use as measuring improvements in patient management and health. ONC was advised that the recommended timeline was very aggressive and advised they assess and determine whether the current state of EHR technology can support the measures required to meet the definition of meaningful use. See AHIMA comments on ONC Meaningful Use Draft Definition

• June 11 - AHIMA comments on ONC Regional Extension Draft Program Description  In response to a call for comments from the Office of the National Coordinator (ONC) regarding the draft description of the program for establishing regional centers to assist providers seeking to adopt and become meaningful users of health information technology, AHIMA submitted comments last week.  The concept of regional extension centers is modeled after the agricultural extension centers whereby there are centers established throughout regions within the country to assist providers with the implementation of HIT.  Levels of support are expected to range from developing and providing materials to be widely disseminated to furnishing direct, individualized, and onsite assistance. 

  AHIMA supports the development of regional extension centers, however cautioned ONC to implement the program in a thoughtful and well planned manner to avoid confusion and disruption within the healthcare industry.  See AHIMA comments on ONC Regional Extension Draft Program Description  

• May 18 – First ONC Announcement on ARRA Funding Expected ONC has indicated that information on funding for Regional Center under ARRA/HITECH will be released.  AHIMA has been working on alternatives that HIM members, associations, and educators might consider in response to such a proposal.  These will be posted on appropriate AHIMA Members-Only Communities of Practice. 

• May 15 – First meeting of the ARRA-related HIT Standards Committee to be Held.  See the ONC announcement under “Latest health IT News.”

• May 11 – First meeting of the ARRA-related HIT Policy Committee Held.  The first meeting of the HIT Policy Committee formed under ARRA was held in Washington, DC on May 11, 2009.  This was a formation meeting held under the chairmanship of Dr. David Blumenthal, ONC Coordinator.  The Committee decided to form three work groups to begin its initial work:  Meaningful Use, Certification and Adoption, and Information Exchange.  Future meetings have not yet been announced.

• May 8 – ONC announces members of the new ARRA-related HIT Committees.  In a press conference on Friday, May 8, newly appointed national coordinator for health information technology, David Blumenthal, MD, announced the members of the new formed Policy and Standards Committees for health information technology as required by ARRA/HITECH.  These members can be found at the Office of the National Coordinator for HIT (ONC), look under “Latest Health IT News.”

• April 28 -- NCVHS Holds Hearing on “Meaningful Use.”  The National Committee  on Vital and Health Statistics Executive Committee held a two-day hearing on April 28 and 29 the potential meaning  and approach to the definition of “Meaningful Use,” which will directly affect Medicare and Medicaid incentive payments coming in late 2010 (2011 Federal Fiscal Year). 

• The Agenda for that hearing can be found on the NCVHS web site.
• Sandra Fuller, AHIMA executive vice president and COO, offered comments to the executive committee on April 29. Read AHIMAs summary comments and full statement .
• “Meaningful Use” impact on HICT incentives can be found in the early discussions on Medicare and Medicaid Health Information Technology; Miscellaneous Medicare (ARRA Title IV – beginning on page 353 of ARRA).   
• A report from the NCVHS on the meeting is expected in 3 weeks.

 

• April 27 – HHS Releases Security Guidance.  HHS, as required under the privacy provisions of ARRA released guidance for HIPAA covered entities in the April 27, 2009 Federal Register (page 74FR19006).   AHIMA is in the process of responding to the questions proposed in this document and due May 21, 2009. 

• April 20 – FTC Releases Security Guidance and Breach Notification NPRM.  The Federal Trade Commission released its security guidance for non-HIPAA covered entities in the April 20, 2009 Federal Register (page 74FR1791).  AHIMA is in the process of responding to the notice of proposed rulemaking which is due June 1, 2009.

ARRA Legislation
Officially known as the American Recovery Reinvestment Act (ARRA Public Law 111-5) and Health Information Technology for Economic and Clinical Health Act (HITECH), the “Stimulus Law” was signed on February 17, 2009 by President Obama and provides $19.2 billion in spending on health IT.

AHIMA Analysis

AHIMA has completed two different perspectives for analysis of the ARRA legislation:

• AHIMA Review of ARRA  (March 2009)
• AHIMA Review of ARRA Required Reports (April 2009)
• AHIMA Analysis of ARRA Privacy (April 2009)

HITECH

Title XIII of ARRA was given a subtitle:  Health Information Technology for Economic and Clinical Health Act (HITECH).  It is this section (ARRA pages 112 – 165) that deals with many of the health information communication and technology provisions including Subpart D – Privacy (ARRA pages 144-165).

• Follow this link for Model Plan for Breach Notification
• Follow this link for Model Breach Notification Letter

• Follow this link for The Path to Security Breach Notification Regulation

• See above for AHIMA analysis on the ARRA Privacy law.
• Guidance related to Breach requirements is expected in mid-April 2009.
• Breach regulations are expected by August 2009
• HIT Committees for Policy and Security are expected to be announced by mid-May 2009.
• Funding for various implementation assistance are expected to be announced beginning in mid-May. 

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