State Legislatures and Health Information Technology

HIMSSChapter Advocacy Liaison Roundtable Training

June 10, 2008

Kory Mertz, Research AnalystNational Conference of State Legislatures

About NCSL

• Bipartisan organization made up of all the state and territorial legislatures.

• The problem solvers for state legislatures. • Our mission is:

– To improve the quality and effectiveness of state legislatures

– To promote policy innovation and communication among state legislatures

– To ensure state legislatures a strong, cohesive voice in the federal system

NCSL’s Health IT Activities• Project HITCh

– Public-Private partnership with NCSL Foundation (AARP, BCBSA, EDS, ESRI, HIMSS, Johnson and Johnson, MAXIMUS and Quest Diagnostics)

– Goal: To increase legislators’ knowledge and leadership in health IT.

• Activities– State Alliance for e-Health subcontract– Technical assistance to states– Educational sessions for legislators– Legislative tracking– Platform for states in national activities– Special projects: i.e., State-Level Health Information

Exchange Project

HITCh and HIMSS

• HIMSS is a founding member of HITCh

• HITCh at HIMSS Annual Conference–HITCh session–HITCh legislators

States and Health IT• States view health IT as a vital tool to

increase quality and decrease costs

• States are actively working to address barriers to health IT adoption and are using various policy levers to promote its adoption and use– Targeted financing initiatives– Updating privacy laws to facilitate HIE– Leveraging state purchasing power – Promoting the use of standards-based health

IT systems– Mandates and incentives

State Legislation

• Over 300 hundred health IT bills have been introduced in 2007 and 2008

• 93 bills have passed in 42 states and the District of Columbia

• Searchable database of state health IT bills is available at http://www.ncsl.org/programs/health/forum/Hitch/HIT_database.cfm

Health IT Financing

• States view health IT spending as a necessary investment in quality and efficiency.– States do not want to replace funds from

private sector or other sources. – States are targeting funding toward groups

that otherwise could not adopt health IT, such as community health centers, small practices and rural providers.

– Public health is an additional area that requires state funding (disease surveillance, collection and analysis of population health data).

What are States Financing?

• Start-up Funding– Study commissions, state health information exchanges,

infrastructure, health IT in state facilities or in facilities with underserved populations, for example.

• Operational Funding (largest share of spending)– health IT in health insurance programs (Medicaid, state

employee health) or contracted services, public health activities (bio-surveillance, registries), operating entities that set state health IT policy, for example.

• Support for Private-sector Investments – Grants, revolving loan funds, tax incentives, financial

incentives in contracts with providers, for example.

Level of Funding Unclear

• Beyond HIE and EMR/EHR, little state consensus on what counts as health IT. States disagree on inclusion or exclusion of telemedicine, bio-surveillance and MMIS.

• Hard to count dollars because a significant portion of funds are inside budgets for program operations.

• What is the level of private spending on health IT in the state?

State Needs

• Legislators want to learn about the return on investment for the state financially and in terms of improved health outcomes.

• States see a role for themselves in allocating the costs of new systems across interested groups.

• How to achieve sustainability? How soon?

How States are Funding Health IT

• Study commissions – Laws authorizing commissions often supply funding

• Establish a fund for health IT development– Missouri SB 577 (2007) “There is hereby created

in the state treasury the "Health Care Technology Fund" which shall consist of all gifts, donations, transfers, and moneys appropriated by the general assembly, and bequests to the fund.”

• Authorize an entity to collect or receive funds– Vermont HB 229 (2007) “VITL … may accept any

and all donations, gifts, and grants of money, equipment, supplies, materials, and services from the federal or any local government, or any agency thereof, and from any person, firm, or corporation...”

How States are Funding Health IT

• Appropriations• Grants: States target groups otherwise not able to afford

health IT such as community health centers, small practices and rural providers.– Minnesota HB 1078 (2007) gives preference to projects

benefiting providers located in rural and underserved areas which have an unmet need for the development and funding of electronic health records. Grant funds awarded on a three-to-one match basis with maximum grant of $900,000.

• Tax incentives– Wisconsin SB 40 (2007) creates a tax credit for providers

who purchase electronic medical records. Providers can claim up to 50% of the cost of the system with a maximum of $10 million a year.

Revenue sources

• States are looking at various means to fund health IT.

• Medicaid and federal transfers dominate, but the state share is large.

• States are looking at creating dedicate funding sources but few have so far. They view health IT as a way to create net savings.

• Revenue sources in play but not generally adopted: dues, bonds, insurer assessment, user fees.

Updating Privacy Laws to Allow for HIE

• States are taking varying approaches to this– Minnesota: Allow for record locator service and provider

representation of consent. Require audit trail and provides for penalties (HB 1078, 2007)

– Nevada: Exempts covered entities from state rules if they meet the standards of HIPPA for the electronic exchange of individually identifiable health information (SB 536, 2007)

• A number of states have bills before the legislatures on privacy and HIE this year (RI, NH, LA, NM, WI)

• California expands data breach notification to include health information and expands its health data laws to PHR vendors (AB 1298, 2007)

Leveraging State Purchasing

• Medicaid– 37 states have e-health activities in Medicaid*– According to HHS OIG 9 states currently have

primarily claims based EHRs and 27 states are working on EHR initiatives

– Targeted reimbursement

• State Employee Health Plans– Minnesota plan requires e-prescribing in 2011 – CalPERS initiative with CalRHIO– 8 states have PHRs*

*Source: Commonwealth Fund & NGA eHealth Survey, conducted by HMA, 2007

Promoting the Use of Standards-based Health IT Systems

• Virginia state agencies are required to purchase health IT systems that adhere to interoperability standards. In addition, the state requires that any health IT systems purchased by agencies grantees also meet these standards.

• Minnesota requires EHRs meet interoperability standards

Mandates and Incentives

• A number of states are looking at this.– Minnesota’s 2015 EHR and 2011 e-prescribing

capability mandated for all providers are the only ones enacted so far

– Other states have looked at mandates • Licensure requirements for providers and facilities

• Incentives

State Alliance for e-Health• Comprised of state legislators, governors, attorneys

general, insurance commissioners and a public health official

• Charge:– Identify, assess and, through consensus solutions, map

ways to resolve state health IT issues that affect multiple states and pose challenges to interoperable electronic health information exchange

– Provide a forum in which states may collaborate so as to increase the efficiency and effectiveness of the health IT initiatives that they develop

• Run by the National Governors Associations through a contract with the Office of the National Coordinator for Health Information Technology (ONC)

• NCSL, along with NAAG, works closely with NGA – Legislative tracking– Education and outreach

The State Alliance’s Membership

Voting Membership• Governor Phil Bredesen, TN, Co-Chair• Governor Jim Douglas, VT, Co-Chair• Assemblyman Herb Conaway, NJ• Senator Richard Moore, MA• Representative Gayle Harrell, FL• Representative Ken Svedjan, ND• Attorney General Steve Carter, IN• Commissioner Jane Cline, WV• Former Governor Jim Geringer, WY• Attorney General Hardy Myers, OR• Commissioner Sandy Praeger, KS• Executive Director David Sundwall, UT & ASTHO• Former Governor Tom Vilsack, IA (new 2008)• Former Governor Jeanne Shaheen, NH (2007)

Advisory MembershipBrian DeVore, Intel

Stephen Palmer, TX

Joy Pritts, Georgetown University

Marshall Ruffin, Accenture

Wayne Sensor, Alegent Health

Reed Tuckson, UnitedHealth Group

Other State Activities

• HISPC– To identify, propose solutions, and develop

implementation plans for identified variations in organization-level business policies and state laws that affect health information exchange. http://privacysecurity.rti.org/

• State-Level Health Information Exchange–Targeting organized state-level HIE

efforts http://www.staterhio.org/

State Leaders

• Minnesota– 2015 EHR and 2011 E-prescribing mandate– Implementation plan

• Arizona– Medicaid

• New Hampshire– E-prescribing

• New York– HEAL Grants– Accreditation study

So What Does it all Mean?

• State leadership is vital• Public/private initiatives• Have a plan

Thank You

Contact Information Kory MertzPhone: (202) 624-3580Email: kory.mertz@ncsl.orgNational Conference of State Legislatures

NCSL health IT websitehttp://www.ncsl.org/programs/health/forum/hitch/