Georgia HealthGeorgia Health Information

eConnectionseConnections

American Recovery and Reinvestment Act HIT Provisions

May 14 2009

Dr. Rhonda M. Medows, Commissioner

May 14, 2009

DCH MissionACCESS RESPONSIBLE HEALTHY

DCH Mission

Accessto affordable, quality health

Responsible health planning

Healthy behaviors and

quality health care in our

communities

and use of health care resources

improved health

outcomes

AgendaAgenda

• DCH Timeline & HIT Initiatives

N Additi t DCH• New Additions to DCH: – Public Health – Healthcare Facility RegulationHealthcare Facility Regulation

• Georgia Health Information Technology C tieConnections

• ARRA HITECH Opportunities• ARRA HITECH Opportunities

State preparations for Hitech:State preparations for Hitech:

Update the State Roadmap for Health IT(Re) Engage StakeholdersE t bli h St t G St tEstablish a State Governance StructurePrepare other state agencies to participate in HIEsHIEsImplement privacy strategies and reforms Determine the HIE business model Create a communications strategy Establish opportunities for Health IT training and educationand education

DCH HITT AccomplishmentsDCH HITT AccomplishmentsOctober 2006 November 2006 October 2007 November 2007

Governor Sonny CMS awarded the DCH a $3 929 855 DCH issued $853,088

Perdue issued an executive order creating the Health Information

Commissioner Medows announces HITT Advisory Board members

DCH a $3,929,855 Medicaid Transformation Grant to assist with the implementation of

in HIE grants to four organizations that will help foster the development of HIE, electronic prescribingInformation

Technology and Transparency (HITT) Advisory Board

georgiahealthinfo.gov Georgia’s transparency web site for health care consumers

First meeting of the HITT Advisory Board

electronic prescribing, and/or adoption of electronic medical records across Georgia consumers

Department of Community Health HITT Accomplishments

December 2007 January 2008 February 2008 April 2008

DCH submitted a DCH announced creation of the Georgia selectedDCH submitted a proposal to participate in the Health Information Security and P i

DCH announced creation of the Office of HITT georgiahealthinfo.gov

Request for Proposals due from prospective vendors to the DCH

Presentation of the HITT Strategic Plan to the HITT Advisory Board.

Georgia selected to participate in Phase 3 of the HISPC Consumer Education C ll b tiPrivacy

Collaborative (HISPC) with 35 other states

vendors to the DCH Georgiahealthinfo.gov Project Request for Proposals released to the public

Collaborative

DCH HITT AccomplishmentsDCH HITT AccomplishmentsMay 2008 June 2008 October 2008 December 2008 March 2009

DCH awards the Georgia was selected to Prototype of the Public launch of DCH was designated byDCH awards the

georgiahealthinfo.gov Web site contract to IBM

DCH

Georgia was selected to be a pilot site for the Medicare Demonstration Project

G i ’ EHR

Prototype of the georgiahealthinfo.gov Transparency Web site successfully launched for the Governor’s

i

Phase I of georgiahealthinfo.gov Web site December 2008

designated by Governor Sonny Perdue as the state agency to receive health information

DCH announces the Georgia Rx Exchange

Georgia’s EHR Community Partnership Convenes

review

Second year of HIE grants awarded

Phase II launch scheduled for summer of 2009

technology (HIT) grants available through the ARRA of 2009

DCH Current Initiatives

Status

HITT Advisory Council Ongoing – in Year 3 Georgia HITT Strategic Plan Georgia HITT Strategic Plan Partners: Health Industry Leaders appointed to the Council

Consumer Transparency Website Phase 2 Release in June 2009 Federal grantConsumer Transparency Website Georgiahealthinfo.gov

Phase 2 Release in June 2009. Federal grant in place. Partners: IBM, Mayo Clinic, provider groups and health plans data sourcesand health plans data sources

Community EHR Matching Grants In 3rd year Funding reduced Partners: Awarded to 3 community basedPartners: Awarded to 3 community based partnerships of health care providers

HISPC: Privacy & Security Focus: Consumer Outreach & Engagement

State awarded RTI grant for consumer outreach & education initiative.

Partners: 42 state collaborative

Georgia Rx Drug Exchange Planning continues as per Gov’s Executive Order. Funding in FY2010: TBD

Partners: DHR, DJJ, DOC

DCH Current Initiatives

Status

HHS (Medicare) EHR Demonstration for Primary Care Providers

Awarded to Georgia EHR Partnership CANCELLED by CMS y

y

Georgia EHR Community Partnership Collaborative created last year. Engaged in EHR adoption activities. Partners: 33 Private and Public Sector Partners: Providers, Plans, Employers, Academia, etc

EHR f M di id P id M di id EDS S b t tiEHR for Medicaid Providers: Medicaid new MMIS system includes the development of a web based EHR for use by Medicaid provider

EDS Subcontracting EMR/EHR In development Partners: EDS to announce chosen vendor

EHR/HIE requirement integrated into Medicaid, PCK and SHP health insurance plan procurement and state contracts

SHP Procurement completed required the bidders to incorporate HIT in their response as a component of their score

Medicaid CMO contact renewals include new HIT requirements Partners:Partners: SHP: Cigna & UHC Medicaid & SCHIP: CMOs

Department of Community Health: 7/1/09

Commissioner

G l C l M di id/PCK

Chief of Staff

General Counsel Medicaid/PCK

Operations State Health Plan

Finance Public Health

Information Technology Health Facility Regulationy g

Inspector General Communications

Legislative Affairs Office of Health ITLegislative Affairs Office of Health IT

Georgia Health Information Technology eConnections (HiTeC)

RX Drug Exchange

Safety Net Providers

FQHCs

State Govt Plans

Medicaid SCHIPSHP

ExchangeDCH, DHR, DJJ, DOC

FQHCsCHC

Health Depts

Public Health

Disease RegImmunizatnSurveillance

Private Providers

DoctorsHospitalDentists

Georgia Georgia Regional

Expansion

ResearchCli i l

Rural Health

Broadband

pCenter

•Clinical•HIT Effect

ConsumerOutreach

MedicareMedicaid

BroadbandTelemedici

ne

Outreach &

EducationDual

EligiblesCoordinate

ARRA HIT Provisions: HITECHARRA HIT Provisions: HITECH • DIVISION A--APPROPRIATIONS PROVISIONS

– TITLE XIII--DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES

• DIVISION B--TAX, UNEMPLOYMENT, HEALTH, STATE FISCAL RELIEF, AND OTHER PROVISIONS– TITLE IV--MEDICARE AND MEDICAID HEALTH INFORMATIONTITLE IV--MEDICARE AND MEDICAID HEALTH INFORMATION

TECHNOLOGY; MISCELLANEOUS MEDICARE PROVISIONS

• ADDITIONAL PROVISIONS:• ADDITIONAL PROVISIONS:– TITLE XXX– HEALTH INFORMATION TECHNOLOGY &

QUALITY (A) TITLE Vlll DEPTS OF LABOR HEALTH & HUMAN– TITLE Vlll—DEPTS OF LABOR, HEALTH & HUMAN SERVICES…(A)

– TITLE VI--BROADBAND TECHNOLOGY OPPORTUNITIES PROGRAM (B)

ARRA HIT PROVISIONSOPPORTUNITIESARRA HIT OPPORTUNITIES

Leadership & Regional Support • Health Information Technology Extension Program State Grants • Planning Grants to STATES

• Implementation grants to STATES • Certified EHR Technology Provider Loan Fund to• Certified EHR Technology Provider Loan Fund to

STATE Medicaid • Medicaid Provider HIT adoption Medicare • Medicare and M edicare Advantage Incentive Payments Public Health • Public Health Informatics, Immunization & Disease

RegistriesRural Health • Telemedicine and Broadband Safety Net Clinic • FQHCs HIT Systems Consumers • Consumer Advocacy and Not-For-Profit Interest Research • Regional Healthcare Information Academic ResearchResearch • Regional Healthcare Information Academic Research

Center • Health Disparities • Safety Net Clinics • Aging Services

Workforce • Education on HIT Integration • Health Informatics Programs

HIE: Interoperability • HIT Standards Development • Health Information Exchange

Privacy & Security • Security Improvements Privacy & Security y p• Privacy

ARRA HIT: State GrantsStimulus Description Federal NotesStimulus Activity

Description Federal Agency

Notes

State Grants

Planning Grants to Planning Grants to State or designated state HHS Secretary Cash or In kind MatchPlanning Grants to STATES

Planning Grants to State or designated state entity for planning activities, including: • Identify state and local resources • Enhance participation in secure nationwide HIE • Assisting patients in utilizing HI E

HHS Secretary –ONC

Cash or In-kind Match required beginning FFY 2011

g p gImplementation grants to STATES

Implementation Grants to perform following activities: • Complementing other federal grants & programs • Providing technical assistance for exchange

Effective strategies for the underserved

HHS Secretary – ONC

Cash or In-kind Match required beginning FFY 2011

• Effective strategies for the underserved• Encourage clinicians use of extension centers • Support public health use of EHR • Promote use of EHR for quality improvement

thru quality metric reportingthru quality metric reporting

State Grant: Certified EHR Technology Loan F d F P id

Competitive grants to states to establish Loan Fund to distribute funds to providers for adoption of EHR

HHS Secretary – ONC

$1 state to $5 feds Matching funds required; 4% admin may be drawn f f d d ti b k tFund For Providers from fund dating back to establishment of fund

ARRA HIT: Medicaid & Medicare Stimulus Description Federal Notes Activity

pAgency

Medicaid Medicaid Provider HIT

Up to 100% reimbursement of Medicaid providers for:

HHS Secretary-Medicaid

Reimbursement not to exceed an amount

adoption • purchase • installation • upgrade • operation

determined through a study of aggregate data on average costs of system & discharge services as it relates to p

• training • maintenance

Not to exceed a total amount to be determined by the Secretary.

hospital reimbursement

y y Medicaid Admin: 90% reimbursement to State for

administration of HIT adoption program HHS Secretary Medicaid

Available thru 2016

Medicare Medicare and Enhanced reimbursement of claims for qualified HHS Secretary- Limits placed on total amount Medicare Advantage Incentive Payments

Medicare providers who use EHR in meaningful ways thru a single consolidated payment or installments as determined by the Secretary beginning in 2011. (Providers can not receive d li ti t f M di id)

Medicare providers can receive between 2011 and 2014.

duplicative payments from Medicaid)

ARRA HIT: Research & Workforce Stimulus Activity

Description FederalAgency

Notes

Research Academic Research Establishment of Regional Health Care NIST in consultation AppropriationAcademic Research Establishment of Regional Health Care

Information Enterprise Integration Research Center by an academic institution and/or consortium

NIST in consultation with National Science Foundation (NSF)

Appropriation Not specified

Health Disparities Assessment of Impact of HIT on Communities with Health Disparities and recommendations to increase

HHS – ONC Appropriation Not specifiedHealth Disparities and recommendations to increase

adoption among such communities Not specified

Safety Net Clinics Contract with entity to study efficient reimbursement incentives for improving health care quality in FQHCs, Rural Health Clinics, and Free Clinics.

HHS Secretary Appropriation Not specified

FQHCs, Rural Health Clinics, and Free Clinics. Aging Services Contract with entity to study use of aging services

technology HHS Secretary Appropriation

Not specified Workforce Education Grants to educational institutions to integrate HIT into HHS 50% match requiredEducation Grants to educational institutions to integrate HIT into

clinical education HHS 50% match required

Assistance to educational institutions to expand medical/health informatics programs

HHS Secretary in collaboration with NSF

Appropriation Not specified

NSF

ARRA HIT: Public Health & S f t N tSafety Nets

Stimulus A i i

Description Federal A

Notes Activity Agency

Public Health Public Health Informatics

Vaccine and Disease Registries etcHHS- ONC $2 Billion

Vaccine and Disease Registries, etcRural Health Telemedicine and Broadband

Grants and loans for broadband infrastructure development in rural

Secretary of Agriculture -

$2.5 Billion and Broadband infrastructure development in rural

areas Agriculture -Rural Utilities Service

Safety Net yClinic FQHCs Grants Acquisition of HIT systems,

construction and renovation HHS - HRSA $1.5 Billion

ARRA HIT: Interoperability & PrivacyPrivacy

Stimulus Activity Description Federal Agency Notes HIE: Interoperability HIT Standards Advancement of health Dept. of Commerce ï $20 MillionDevelopment care information integration

standards and conformance

National Institute of Standards and Technology (NIST)

Health Information Support regional or sub- HHS – Office of $300 MillionExchange

pp gnational efforts toward HIE National Coordinator

(ONC)

$

Privacy & Security Security To improve HIT security HHS - Public Health $50 MillionSecurity To improve HIT security

HIPAA update & monitoring Breach reporting

HHS Public Health and Social Services Emergency Fund

$50 Million

Privacy Develop and maintain an multi-faceted national

HHS Office for Civil Rights

Appropriation Not specifiedmulti-faceted national

education initiative to enhance public transparency regarding uses of protected health

Rights Not specified

uses of protected health information (PHI)

ARRA Funding to Incent Provider Adoption of EHRAdoption of EHR

ARRA Medicare Incentives Medicaid Incentives Agency Distributor of

CMS CMS and State

Funds Use of Funds Incentive thru carriers Incentives thru States Fund Recipients • Acute Care Hospitals

• Physicians • Acute Care Hospitals • Children’s Hospitals

• Dentists • Physicians, • Dentists, • Nurse Practitioners (Midwives),• FQHC

Must meet a threshold percentage (30%) of Medicaid patients

Incentive Payments

For meaningful use of certified EHRs 2011 through 2015

• Incentives can be used for initial EHR purchase

2011 through 2015• Can be made for 5 years only

and payments to be made no later then 2021

Maximum $45 K $65 KMaximum Payment

$45 K $65 K

ARRA: HIT Provider LoansARRA: HIT Provider LoansEHR Technology Loan funding can be utilized for the following

activities:1. HIT Architecture that will support the nationwide electronic

exchange2. Integration of HIT into training of health professionals and

others in the health care industryothers in the health care industry3. Training and dissemination of information on best practices to

integrate HIT into a provider’s delivery of care. 4. Regional and sub regional efforts towards health information g g

exchange5. Infrastructure and tools to promote telemedicine and 6. Promotion of the interoperability of clinical data repositories or

registriesregistries7. Implementation of e-prescribing or electronic health records

systems that will lead to HIE among several healthcare entities8. Expansion of current HIEs to include additional healthcare

entities or enhanced capabilities, including the ability for quality reporting of clinical data

9. Implementation of Personal Health Records by providers who have EHRs

ARRA: “Meaningful User” (Title IV Division B)ARRA: Meaningful User (Title IV, Division B)

• A meaningful user is an eligible professionalA meaningful user is an eligible professional (physician) that: – Demonstrates the use of certified EHR technology in

a meaningful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary;by the Secretary;

– Demonstrates that certified EHR technology is connected in a manner that provides, in accordance with law and standards applicable to the exchange of information, for the electronic exchange of health information to improve the quality of health care, such p q y ,as promoting care coordination;

– Submits information on clinical quality measures

ARRA: “Qualified EHR” (Title XIII Division A)ARRA: Qualified EHR (Title XIII, Division A)

• EHR must include the following:EHR must include the following:– Patient demographic and clinical health

information such as medical history andinformation, such as medical history and problem lists,

– Capacity to provide clinical decision supportCapacity to provide clinical decision supportto support physician order entry

– Ability to capture and query information y p q yrelevant to health care quality

– Ability to exchange electronic health y ginformation with, and integrate such information from other sources

Federal HIT Initiatives (www.healthit.hhs.gov)

• Goal 1: Patient-Focused Health Care. Enable the transformation to higher quality, more cost-efficient, patient-focused health care through electronic health information access and use by care providers, and by patients and their designees.

• Goal 2: Population Health. Enable the appropriate, authorized, and timely access and use of electronic health information to benefit public health, biomedical research, quality o at o to be e t pub c ea t , b o ed ca esea c , qua tyimprovement, and emergency preparedness

• Four recurring themes1 I t bilit1. Interoperability 2. Adoption 3 Privacy and Security3. Privacy and Security 4. Collaborative Governance

Federal Agencies with HIT Initiatives 1. AHRQ (Agency for Healthcare Research and Quality) 2. ASPE (Assistant Secretary for Planning and Evaluation) 3 ASPR (A i t t S t f P d d3. ASPR (Assistant Secretary for Preparedness and

Response) 4. CDC (Center for Disease Control and Prevention) 5. CMS (Centers for Medicare & Medicaid Services) Federal6. FDA (Food and Drug Administration) 7. HRSA (Health Resources and Services Administration) 8. IHS (Indian Health Service)

Federal Health IT I iti ti9. NIH (National Institutes of Health)

10. NIST (National Institute of Standards and Technology) 11. ONC (Office of the National Coordinator for Health

Information Technology)

Initiativesgy)

12. HHS/OS (Department of Health and Human Services, Office of the Secretary)

13. SAMHSA (Substance Abuse and Mental Health Services Administration) http://healthit.hhs.gov Administration)

14. DoD (Department of Defense) 15. SSA (Social Security Administration) 16. VA (Department of Veterans Affairs) 17. FCC (Federal Communications Commission)

Children’s Health Insurance Program Reauthorization Action ofProgram Reauthorization Action of

2009 (CHIPRA)• HHS will provide $20 million annually for a p y

demonstration project during FY 09 to FY 13. Grants for up to 10 states and child health providers to promote the use of health information technology for:gy

• Experiment with and evaluation of new measures of quality

• Promote the use of health information technology in care• Promote the use of health information technology in care delivery for children

• Evaluate provider based models which improve the d li f hild ’ h lth i i l didelivery of children’s health care services including chronic conditions

• Demonstrate the impact of the model electronic health precord format for children

• Demonstration grants can be multistate projects.

DCH ARRA Website ARRA Stimulus Funding

On Friday, February 13, 2009, the House of Representatives and Senate approved the conference report for the American Recovery and Reinvestment Act of 2009 (ARRA 2009). ARRA 2009 was signed by President Barack Obama on Tuesday 2009 was signed by President Barack Obama on Tuesday, February 17, 2009. This Web site, www.dch.georgia.gov/stimulus, will be the vehicle that the Georgia Department of Community Health utilizes to keep Georgians informed about Stimulus funds as it relates to this Department.

For More Information - Call (404) 651-9928 or Email dchstimulus@dch.ga.gov

For More Information: Recovery Funding - Orange represents counties that received ARRA monies. Click map for more

details or download the following: IDS Grant Funding (pdf) or DSH ARRA Funds by

County.

Quick Links

• ARRA Information FMAP Weekly Summary -

5/1/ 2009

For More Information:

Call (404) 651-9928 or

Email: dchstimulus@dch ga gov• Presentation on

ARRA - 5/11/2009

• ARRA General FAQs - revised

Email: dchstimulus@dch.ga.gov

Website: www.dch.georgia.gov/stimuluswww.dch.georgia.gov/stimulus

4/2/2009 • Click here to

view the Final Legislation

• Additional Resources

Federal AgenciesFederal Agencies

HIT Initiatives

Federal Agencies HIT InitiativesAge nc y P ro gram sIN TE R O P ER A B ILIT Y AHRQ (Age nc y for Hea lthc are Res ea rc h an d Q ua lity)

H ea lth IT P o rtfo lio - G oals 1 a nd 2 U .S . H e a lth In fo rm a tio n Kn o w le d g eb a se - G o a ls 1 a n d 2

S G

C D C (C en te r for D ise ase C on tro l an d Preve ntion )

B io Se n se - G o a l 2 E PI-X - G oa l 2 N atio n a l H e a lth ca re Sa fe ty N e tw o rk - G o a l 2 P ub li c H e a lth In fo rm a tio n N e tw o rk - G o a l 2 P ub li c H e a lth P re p a red n e ss S yste m s - G oa l 2 IC D -1 0 - G o a l 1

CM S (Cen te rs fo r M e dica re & M ed ic aid Se rvices )

IC D 1 0 G o a l 1 M e d ica id Info rm a tion T e ch no lo g y Arch ite cture - G oa ls 1 a n d 2 M e d ica id Tra n sfo rm a tio n G ra n ts - G o a ls 1 an d 2 B en e fic ia ry In form a tio n S erv ice s - G o a l 1

H R S A (He alth Res ou rc es a ndH ea lth IT E le ctro n ic H e a lth R e co rd a n d Inn o va tio n s G ra n ts - G o a l 1 T e le h ea lth G ra nts - G o a l 1 H R S A (He alth Res ou rc es a nd

Se rvic es A dm inis tration ) R eg io n a l G e ne tic a n d N e w b o rn Sc re e n in g Se rv ic e C ol lab o ra tives -G o a l 1 C on n e ctio n s Projec t - G o a l 2

O NC (O ffi f th N ti l

P la nn in g fo r AH IC 2 .0 - G o a ls 1 an d 2 C ertifica tio n C o mm iss ion fo r H ea lth ca re I nfo rm atio n T ec hn o lo g y - G o a ls 1 a n d 2O NC (O ffic e of th e Nation al

Coo rd ina to r for H ealth Inform ation Te chn olog y)

1 a n d 2 F e d era l In terd e p a rtm e n tal H ea lth IT C o lla b ora tive - G o a ls 1 a n d 2 F e d era l H e a lth Arch itec tu re - G o a ls 1 a nd 2 H ea lth ca re In fo rm atio n T ech n o lo g y Sta n da rd s Pa n e l - G o a ls 1 a nd 2 N atio n w id e H e a lth Info rm a tio n N e tw o rk - G oa ls 1 a nd 2 U se C a se D e ve lo p m e nt - G o als 1 a n d 2

FCC (Fe dera l Co m m un ic ation s Com m is sion ) R ura l H e a lth C a re P i lot P ro g ra m - G o a ls 1 an d 2

Federal Agencies HIT InitiativesFederal Agency ProgramsFederal Agency ProgramsADOPTION AHRQ (Agency for Healthcare Research and Quality) Health IT Portfolio - Goals 1 and 2

CDC (C t f Di Bi S G l 2CDC (Center for Disease Control and Prevention)

BioSense - Goal 2 Public Health Information Network - Goal 2 EHR Adoption Demonstration - Goal 1 E-Prescribing Efforts - Goal 1 ICD 10 Goal 1 and 2

CMS (Centers for Medicare & Medicaid Services)

ICD-10 - Goal 1 and 2Medicaid Information Technology Architecture - Goals 1 and 2 Medicaid Transformation Grants - Goal 1 Beneficiary Information Services - Goal 1 yReimbursement for Telehealth - Goal 1

HRSA (Health Resources and Services Administration)

Rural Hospital Flexibility Grant Program - Goal 1 Health IT Electronic Health Record and Innovations Grants - Goal 1

ONC (Office of the National Coordinator for Health Information Technology)

Certification Commission for Healthcare Information Technology - Goal 1 Secure Messaging Pilot - Goal 1 Standardized Measures for Adoption of EHRs - Information Technology) Goal 1 Use Case Development - Goals 1 and 2

Federal Agencies HIT InitiativesgAgency Programs P i & S it Privacy & Security

AHRQ (Agency for Healthcare Research and Quality)

Health IT Portfolio - Goal 1 and 2 Quality) CMS (Centers for Medicare & Medicaid Services) HIPAA Security Rule - Goal 1 and 2

Anti-fraud Activities - Goal 1

ONC (Office of the National Coordinator for Health

CCHIT - Goal 1 Health Information Security and Privacy Collaborative (HISPC) - Goal 1 and 2 Health IT Standards Panel (HITSP) - Goal 1 and 2Information Technology) Health IT Standards Panel (HITSP) - Goal 1 and 2 Nationwide Health Information Network (NHIN) - Goal 1 and 2 State Alliance for e-Health - Goal 1 and 2

Federal Agencies HIT Programs

Federal Agency Programsg y gCollaborative Governance

A ti f d A ti iti G l 1Anti-fraud Activities - Goal 1 CCHIT - Goal 1 Health Information Security and Privacy Collaborative (HISPC) Goals 1 and 2ONC (Office of the National

Coordinator for Health Information Technology)

Collaborative (HISPC) - Goals 1 and 2 Health IT Standards Panel (HITSP) - Goals 1 and 2 Nationwide Health Information NetworkNationwide Health Information Network (NHIN) - Goals 1 and 2 State Alliance for e-Health - Goals 1 and 22

Parking LotParking Lot

END•END