Summer 2009
HIM and the American Recovery and Reinvestment Act
On February 17, President Obama signed into law the American Recovery and Reinvestment Act (ARRA). ARRA provides approximately $59 billion to the Department of Health and Human Services (HHS) for healthcare research and direct patient care, to improve health information technology (HIT) and infrastructure, and to provide education and training for the current and future work force. Of that $59 billion, $19 billion is allocated for Medicare and Medicaid HIT physician incentives, $2 billion to the Office of the National Coordinator for Health Information Technology, $14 billion for health and life science research and infrastructure, $10.4 billion to the National Institutes of Health (NIH) for scientific challenges and new research activity, $1.5 billion to Community Health Centers, $1 billion for preventive and wellness implementation and research, more than $1.1 billion to NIH to conduct comparative effectiveness research, and $100 million for HIT security and accountability.
Figure 1. ARRA allocations for healthcare in billions of dollars.
ARRA directly impacts the field of HIM in three ways:
- Grant funding in the areas of HIT adoption and implementation; health information exchange (HIE) at state and federal levels through broadband expansion and interoperability; patient safety and quality of care
- HIPAA amendments on privacy and security
- Funding for work force education and training
ARRA formally establishes the Office of the National Coordinator for Health Information Technology (ONCHIT) within HHS and creates the HIT Policy and Standards Committees. The HIT Policy and Standards Committees will be assigned the responsibility of creating policy and making funding recommendations for the following:
- Data collection on quality measures and public reporting information
- Data for bio-surveillance and public health
- Recommendations on technology to enhance medical research and public safety
- Use of electronic health records
- Telemedicine
- Reduce medical errors
- Continuity of care (medical homes)
- Healthcare needs of diverse and underserved populations
- Privacy and security of patient records
HIM, HIT Research
Research funding for HIE and HIT adoption is primarily divided into infrastructure, implementation, and quality improvement/patient safety. Approximately $14 billion has been allocated to support health and life science research including $600 million to the National Institute of Standards and Technology for scientific and technical research and to test HIT security and interoperability standards; $650 million for community-based prevention and wellness strategies (including HIT adoption) for chronic diseases and $300 million for immunizations; and finally, $1 billion for ARRA Challenge grants. The Secretary of HHS is required to invest a minimum of $300 million to support regional and state HIE. A total of $1.1 billion has been allocated for comparative effectiveness research—$300 million to the Agency for Healthcare Research Quality (AHRQ) to carry out research, $400 million to NIH to support research, and $400 million to the Secretary of HHS for development and dissemination.
HIPAA
ARRA expands current Health Information Portability and Accountability Act (HIPAA) patient health information privacy and security protections. Under ARRA, specific attention is given to patient health information that is electronically exchanged. ARRA explicitly focuses on: protecting the electronic exchange of patient information within the context of HIPAA rules directly related to business associate agreements and other non-HIPAA covered entities; direct patient payment for healthcare services; increasing monetary penalties for HIPAA violations; defining what constitutes a breach; disclosure of information upon request; and sales and marketing of protected health information.
Work Force Education and Training
ARRA stimulus dollars will be distributed as part of the Workforce Investment Act. The Department of Labor’s Employment and Training Administration was allocated approximately $3.95 billion under ARRA. Money is available to state and local governments, as well as non-profit organizations. In terms of available funds for higher education and re-training the current work force, $500 million is designated for adult employment and training programs with priority given to those who receive public assistance and other low-income individuals. Roughly $1.25 billion is designated for employment and training programs for dislocated workers, and $750 million for competitive grants for worker training and placement in high-growth and emerging industry sectors. The Secretary of Labor is required to prioritize the remaining $250 million for programs that train and place workers in healthcare.
Visit the following AHIMA links for more information on ARRA:
AHIMA General Analysis
AHIMA Analysis of Required Reports
AHIMA Analysis of Privacy Revisions
AHIMA’s ARRA Resource Page
Journal of AHIMA