Economic Stimulus

The American Recovery and Reinvestment Act of 2009

Please note that additional details and interpretations will be updated as they become available from Congress and the President's Administration.

Summary of Key Health Information Technology Provisions
March 6, 2009

This document is a summary of the ARRA and offered for information only. As the term “summary” implies, the following pages do not thoroughly address the depth, breadth, and complexity of the legislative language. For complete explanatory details and implications, please refer to the HIMSS Analysis of ARRA – available complimentary to HIMSS members. Further, HIMSS strongly encourages readers to consult with independent legal counsel.

On February 17, 2009, President Barack Obama signed into law the American Recovery and Reinvestment Act of 2009, H.R. 1. The Act aims to stimulate the economy through investments in infrastructure, unemployment benefits, transportation, education, and healthcare. It includes over $20 billion to aid in the development of a robust IT infrastructure for healthcare and to assist providers and other entities in adopting and using health IT. Total funding included for health IT is as follows:

• $2 billion for the Office of the National Coordinator (ONC)
• $20.819 billion in incentives through the Medicare and Medicaid reimbursement systems to assist providers in adopting EHRs
• $4.7 billion for the National Telecommunications and Information Administration’s Broadband Technology Opportunities Program
• $2.5 billion for the U.S. Department of Agriculture’s Distance Learning, Telemedicine, and Broadband Program
• $1.5 billion for construction, renovation, and equipment for health centers through the Health Resources and Services Administration
• $1.1 billion for comparative effectiveness research within the Agency for Healthcare Research and Quality (AHRQ), National Institutes of Health (NIH), and the Department of Health and Human Services (HHS).
• $85 million for health IT, including telehealth services, within the Indian Health Service
• $500 million for the Social Security Administration
• $50 million for information technology within the Veterans Benefits Administration

A breakdown of health IT provisions included under specific health IT sections of the legislation are as follows:

2. Funding and Incentives:

b. Loans to Providers: The National Coordinator may award competitive grants to eligible entities (State or Indian Tribe) for the establishment of programs for loans to healthcare providers. An eligible entity shall establish a certified EHR technology Loan Fund, and comply with other requirements contained in this section. A grant to an eligible entity this section shall be deposited in the Loan Fund established by the eligible entity. Each eligible entity must provide a strategic plan that identifies the intended uses of amounts available to the Loan Fund of such entity.

Loans under this section may be used by a healthcare provider to carryout such activities as 1) facilitate the purchase of certified EHR technology; 2) Enhance the utilization of certified EHR technology; 3) Train personnel in the use of such technology; or, 4) Improve the secure electronic exchange of health information.

The National Coordinator may not make a grant under this section to an eligible entity unless the entity agrees to make available non-Federal contributions (through donations of pubic or private entities or directly) in cash to the costs of carrying out the activities for which the grant is awarded in an amount equal to not less that $1 for each $5 of Federal funds provided under the grant.

The Secretary may not make an award under this section prior to January 1, 2010.

c. Incentives through Medicare for the Meaningful Use of Certified EHR Technology: Establishment of incentive payments through Medicare for the meaningful use of certified EHR technology by “eligible professionals and hospitals”. The CBO estimates the total cost of Medicare and Medicaid incentives for eligible professionals and hospitals that demonstrate a meaningful use of certified EHR technology to be $20.819. $20.819 is derived from the sum of the total costs of the incentives in fiscal year 2009 – fiscal year 2015 ($36.368 billion) and the total savings that are achieved in fiscal year 2016 – fiscal year 2019 through the incentives ($15.549 billion).

Incentive payments to eligible professionals:
An eligible professional (physician) will receive incentive payments as specified in the legislation, for the first five years (2011 –2015), for demonstrating a meaningful use of EHR technology and demonstrated performance during the reporting period for each payment year. If an eligible professional does not demonstrate meaningful use by 2015, his/her reimbursement payments under Medicare will begin to be reduced. No incentive payment will be made after 2016.

A meaningful user is an eligible professional (physician) that:

1) Demonstrates to the satisfaction of the Secretary that during such period the professional is using certified EHR technology in a meaningful manner, which shall include the use of electronic prescribing as determined to be appropriate by the Secretary;

The American Recovery and Reinvestment Act of 2009 Page 3 of 10 HIMSS Summary of Key Health Information Technology Provisions 3/6/09 ©2009 Healthcare Information and Management Systems Society (HIMSS).

2) Demonstrates to the satisfaction of the Secretary that during such period such 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 as promoting care coordination; and 3) Submits information for such period, in a form and manner specified by the Secretary, on such clinical quality measures and such other measures as selected by the Secretary.

Certified EHR technology means an EHR that is certified to meeting standards pursuant to this Act. To be qualified as a certified EHR technology, the certified technology must include patient demographic and clinical health information, such as medical history and problem lists, and has the capacity to provide clinical decision support to support physician order entry, to capture and query information relevant to healthcare quality, and to exchange electronic health information with, and integrate such information from other sources.