Public Policy Update for March

Congressional Affairs

Congress Votes on Healthcare Reform

Nothing finalized as I put this update together but Health Reform is expected to pass with 216 or 217 votes.

On Thursday afternoon, the reconciliation bill, HR 4872, was released by the House of Representatives. Because Congressional leaders promised 72 hours for review, a vote on the final package—that includes the Senate-passed bill, HR 3590, the Patient Protection and Affordable Care Act— was now scheduled for Sunday afternoon, March 21. The House needs 216 votes for passage. If approved by the House, the package would be considered in the Senate as early as next week, under a process that would require 51 votes for passage rather than the 60-vote threshold to break a filibuster. The reconciliation bill was released after the Congressional Budget Office released its preliminary analysis of the legislation, which puts a $940 billion price tag on the bill over 10 years, with a $138 billion deficit reduction over the same time period.

Groups both pro- and con- have been campaigning hard in Washington, DC this week. President Obama has been meeting one on one with undecided Democrats to urge them to vote yes. Several hundred Tea Party activists protested healthcare reform efforts outside Democratic Congressional offices on Tuesday. And more than 200 advocacy and healthcare organizations placed ads in Capitol Hill newspapers on Wednesday calling for lawmakers to pass the bill. The Washington Post has a graphic showing which way Members of Congress are leaning, and which Members are still undecided.

Governors are frustrated that they have not been able to contribute more to the healthcare reform process. “Polls have shown consistently that the American people are not happy with process,” said Governor Jim Douglas (R) of Vermont. “They want Republicans and Democrats to work together. There’s a clear difference between the level of cooperation in Congress and [among the] nation’s governors, who work with each other and steal good ideas and implement them, who have to balance budgets and get the job done in time.”

Clarification of Eligible Providers in a Hospital Setting Closer to Final Passage
HR 4213, the Tax Extenders Act, amends ARRA to exclude “outpatient” from the definition of hospital based eligible professionals and insert “emergency room setting.” This legislation removes the exclusion of hospital based outpatient physicians from receiving incentive payments. After passage in the Senate last week by a vote of 62-36, House and Senate leaders will work to iron out the differences between the Senate version and similar legislation that passed the House in late 2009.

The EHR language reads:
SEC. 219. EHR CLARIFICATION.

(a) QUALIFICATION FOR CLINIC-BASED PHYSICIANS.—

(1) MEDICARE.—Section 1848(o)(1)(C)(ii) of the
Social Security Act (42 U.S.C. 1395w–4(o)(1)(C)(ii)) is amended by striking ‘‘setting (whether inpatient or outpatient)’’ and inserting ‘‘inpatient or emergency room setting’’.

(2) MEDICAID.—Section 1903(t)(3)(D) of the Social Security Act (42 U.S.C. 1396b(t)(3)(D)) is amended by striking ‘‘setting (whether inpatient or outpatient)’’ and inserting ‘‘inpatient or emergency room setting’’.

(b) EFFECTIVE DATE.—The amendments made by subsection (a) shall be effective as if included in the enactment of the HITECH Act (included in the American Recovery and Reinvestment Act of 2009 (Public Law 111–5)).

(c) IMPLEMENTATION.—Notwithstanding any other provision of law, the Secretary may implement the amendments made by this section by program instruction or otherwise.

Public Policy Events:

National Health IT Week 2010 will take place June 14-18, 2010.

The Government Health IT Conference, “Innovation 2010, On the Threshold of Meaningful Use,” is scheduled for June 15-16, 2010, in Washington DC. Registration is now open. The deadline for Calls for Proposals is March 22, 2010.

The HIMSS 9th Annual Policy Summit will be held June 16-17, 2010, in Washington, DC. Registration is now open.
HHS Releases Additional HIE Funds to States
This week, HHS Secretary Kathleen Sebelius and National Coordinator for Health IT Dr. David Blumenthal announced that an additional $162 million in ARRA funds would be awarded to 16 states to assist them in facilitating “non-proprietary health information exchange that adheres to national standards.” Said Dr. Blumenthal, “Health information exchange will enable eligible healthcare providers to be deemed meaningful users of health IT and receive incentive payments under the Medicare and Medicaid electronic health record (EHR) incentive program.” According to HHS, every state and eligible territory has now been awarded funds under this program.

HIT Policy Committee Meets
The HIT Policy Committee met on Wednesday, March 17. The agenda included updates from the Workgroups and discussion with the HIT Standards Committee on continued efforts to synchronize policy and standards harmonization efforts. Of particular note was an update on the progress made by the Strategic Plan Workgroup on the Health IT Strategic Framework, which is on track to be delivered to ONC by Spring 2010 for publication in October 2010. In addition, the Certification/Adoption Workgroup provided a summary of their February 25 hearing on patient safety. The Workgroup is working through a series of recommendations for the HIT Policy Committee that will include an emphasis on patient engagement in identifying errors; provider training on reporting patient safety issues; the development of a national health IT reporting system to capture incidents and potential hazards with health IT, to include specific recommendations on certification criteria and software requirements for Stage 2 of meaningful use; and the creation of a toolkit for best safety practices. Audio of the meeting is available on the ONC website.

FCC Releases National Broadband Plan
The Federal Communications Commission has released the National Broadband Plan to ensure every American has “access to broadband capability.” On the Healthcare chapter, the Plan’s Executive Summary notes that “Broadband can help improve the quality and lower the cost of health care through health IT and improved data capture and use, which will enable clearer understanding of the most effective treatments and processes. To achieve these objectives, the plan has recommendations that will: help ensure health care providers have access to affordable broadband by transforming the FCC’s Rural Health Care Program; create incentives for adoption by expanding reimbursement for e-care; remove barriers to e-care by modernizing regulations like device approval, credentialing, privileging and licensing; and drive innovative applications and advanced analytics by ensuring patients have control over their health data and ensuring interoperability of data.”


ONC Launches NHIN Direct
The NHIN Direct project was recently launched by the Office of the National Coordinator for Health IT as the result of a recommendation made by the NHIN Workgroup of the HIT Policy Committee, to enable a secure health information exchange at a more local and less complex level than the Nationwide Health Information Network. “NHIN Direct is the set of standards, policies and services that enable simple, secure transport of health information between authorized care providers. NHIN Direct enables standards-based health information exchange in support of core Stage 1 Meaningful Use measures.” For example, NHIN Direct can be used by a primary care provider to send a referral or care summary to a local specialist. As part of the project, Arien Malec, Coordinator for the NHIN Direct project, is running an NHIN Direct blog and discussion board to engage stakeholders. For more information, please see NHIN Direct FAQ.

Upcoming Federal Events:

The HIT Standards Committee’s Vocabulary Task Force is holding a public meeting on March 23, 2010 in Washington, DC. The subject will be vocabulary subsets and value sets, particularly in the public sector.

The HIT Standards Committee is scheduled to meet on March 24, 2010, from 9:00 am – 3:00 pm.

On March 25, 2010 from 4:00 – 5:00 pm EDT, ONC and NIST will present an informational webinar on the recently released Certification Programs for HIT NPRM. The public comment period ends April 9 on the temporary certification program and May 10 on the permanent certification program.

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State Government Affairs

NCSL Tracks State HIT Legislation
The National Conference of State Legislatures has released the March issue of its Project HITCh newsletter (Health Information Technology Champions). In addition to stories about Federal Certification Processes and Grants, the newsletter notes that several states are considering “legislation to establish state coordinators for HIT, responding to the requirements in the HITECH Act. Some examples include Connecticut (HB 5354), Mississippi (HB 941), Pennsylvania (SB 8), and Wisconsin (HB 779). Some states are also creating their own funding initiatives. In Maine, the legislature is considering SB 675, which would create a $10 million bond issue to purchase software and equipment for providers in the state so they could utilize HIE. New Jersey is considering AB 1986, which would establish the Electronic Health Information Technology Fund, or e-HIT fund. The fund would provide revenue to carry out the state’s HIT plan by levying a 0.199% tax on all health insurance claims in the state.”