II 111th CONGRESS 1st Session S. 264 IN THE SENATE OF THE UNITED STATES January 15, 2009 Ms. Stabenow introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XIX of the Social Security Act to encourage the use of certified health information technology by providers in the Medicaid program and the Children’s Health Insurance Program, and for other purposes.

1.

Short title

This Act may be cited as the E–Centives Act of 2009.

2.

Increased Matching Payments under Medicaid for Health Information Technology

Section 1903 of the Social Security Act (42 U.S.C. 1396b) is amended— (1)in subsection (a)(3)(E), by inserting (other than costs attributable to programs described in subsection (bb)) after costs incurred during such quarter; and (2)by adding at the end the following new subsections: (aa)

Enhanced Payments for Certified Health Information Technology Incentives

(1)

In general

The Secretary shall provide for payments to each State that provides incentive payments to physicians, hospitals, community health centers, rural health clinics, and community mental health centers that exhibit meaningful use of health information technology certified under this subsection, as determined by the measures for meaningful use of health information technology under paragraph (5). No payment may be made to a State for incentive payments made by a State for meaningful use of health information technology that occurs before January 1, 2010. (2)

Application

To qualify for payments under paragraph (1), a State shall submit an application in a time and manner specified by the Secretary and containing the following: (A)A description of the incentive payments. (B)A description of the method the State will use to allocate such incentive payments among physicians, hospitals, community health centers, rural health clinics, and community mental health centers, including how the State will prioritize payments to providers serving a high percentage of Medicaid, SCHIP, and uninsured patients. (C)A time line for implementing such payment incentives. (D)A plan for disseminating information to physicians, hospitals, community health centers, rural health clinics, and community mental health centers about the availability of such payment incentives. (E)An assessment of the current level of use of health information technology by physicians, hospitals, community health centers, rural health clinics, and community mental health centers in the State, using a standard assessment form developed by the Secretary. (F)Any other information required by the Secretary. (3)

Amount of payments to States

(A)

In general

Subject to subparagraph (B), the payment made to a State under this subsection for a quarter, with respect to sums expended by such State during such quarter that are attributable to providing incentive payments under paragraph (1), shall be in an amount equal to the following: (i)For any quarter in 2010, the enhanced FMAP (as defined in section 2105(b)) of such sums. (ii)For any quarter in 2011 or 2012, such sums multiplied by a percentage equal to such enhanced FMAP minus 1.5 percentage points. (iii)For any quarter in 2013 or 2014, such sums multiplied by a percentage equal to such enhanced FMAP minus 3 percentage points. (iv)For any quarter beginning after 2014, 0. (B)

Limitation

(i)

Fiscal year limitation

The total amount of payments made under this subsection shall not exceed $500,000,000 for any fiscal year. (ii)

Allocation

If the amounts otherwise payable under this subsection for a fiscal year exceed the amount specified in clause (i), the Secretary shall reduce the amounts payable under this subsection, in a manner specified by the Secretary, to comply with the limitation under such clause. (iii)

Duplicative Payments Prohibited

No payment shall be made under any other provision of this title for expenditures for which payment is made under this subsection. (C)

Manner of payment

Payment to a State under this subsection shall be made in the same manner as payments under subsection (a). (4)

Certification requirements for health information technology

(A)

In general

The Secretary, in consultation with the Office of the National Coordinator for Health Information Technology and the Certification Commission of Health Information Technology, shall determine the requirements for certification of health information technology under this subsection. (B)

Interim certification requirements

During any period in which the Secretary has not determined such certification requirements, the Secretary, for purposes of this subsection, shall use the certification requirements for health information technology established by the Certification Commission for Health Information Technology. (5)

Measures for meaningful use of health information technology

(A)

In general

For purposes of this subsection, the Secretary shall publish standard measures of meaningful use of health information technology to be used by providers to demonstrate meaningful use of certified health information technology. Such measures may include— (i)self-certification of operational use of such technology; (ii)the submission of (or ability to submit), in a form and manner specified by the Secretary, such information on clinical measures and data (that do not include individually identifiable health information) from such technology as indicates a meaningful utilization of such technology; and (iii)such other means as the Secretary may specify. (B)

Alternative measures

The Secretary may establish and apply different measures based on the stage of implementation or adoption of the certified health information technology involved. (bb)

Payments for electronic information and eligibility systems and patient registries

(1)

In general

In addition to the payments provided under subsection (a), the Secretary shall provide for payments to each State that establishes a program to— (A)design, develop, install, maintain, and operate— (i)electronic information and eligibility systems; and (ii)patient registries for the purpose of disease screening; (B)coordinate benefits and services under this title and under title XVIII for individuals under the State plan who are full-benefit dual eligible individuals. (C)train providers in the use of such systems and registries. (2)

Application

To qualify for payments under paragraph (1), a State shall submit an application in such time and manner as required by the Secretary and containing such information as the Secretary specifies and include, at a minimum, a description of the electronic information and eligibility systems and patient registries covered by the program described in paragraph (1). (3)

Amount of payments to States

(A)

In general

The payments made a State under this subsection shall be an amount equal to— (i)90 percent of so much of the sums expended by such State during any quarter commencing on or after January 1, 2010, as are attributable to— (I)the design, development, or installation of electronic information and eligibility systems and patient registries under paragraph (1); and (II)training staff employed by providers on the use of such system or registry during the three-year period beginning on the date such system or registry is installed; and (ii)75 percent of so much of the sums expended by such State during any quarter commencing on or after January 1, 2010, as are attributable to— (I)the maintenance of such systems and registries; and (II)training for staff employed by providers on the use of a system or registry that occurs after the last day of the end of the period described in clause (i)(II). (B)

Manner of payment

Payment to a State under this subsection shall be made in the same manner as payments under subsection (a). (4)

Electronic information and eligibility system defined

For purposes of this subsection, the term electronic information and eligibility system means a system for determining eligibility and exchanging information that meets such requirements as the Secretary shall specify. Such requirements for a system shall include a requirement that the system— (A)be interconnected and interoperable with other electronic systems and registries, including— (i)systems administered by the Centers for Disease Control for disease reporting purposes; (ii)systems that exist for the purpose of determining eligibility for the Medicare program under title XVIII; and (iii)systems that exist for the purpose of determining eligibility for the Temporary Assistance for Needy Families program under title IV, free and reduced price lunches under the Richard B. Russell National School Lunch Act (42 U.S.C. 1751 et seq.), or other federally funded programs targeted to low-income populations; and (B)can be used to automatically send, receive, and integrate data (including laboratory results and medical histories) from systems and registries administered by other providers or organizations or through a health information exchange. .

3.

Medicaid transformation payments report

(a)

In general

Not later than June 30, 2009, the Secretary of Health and Human Services shall submit to Congress a report on Medicaid transformation payments under section 1903(z) of the Social Security Act (42 U.S.C. 1396b(z)). (b)

Contents

The report under subsection (a) shall include— (1)a description— (A)of the financial costs and benefits of the Medicaid transformation payments; (B)of the entities to which such costs and benefits accrue; and (C)of any reduction in duplicative or unnecessary care resulting from methods adopted by States and funded by such payments; and (2)an analysis of the information contained in the reports submitted to the Secretary by States under section 1903(z)(3)(C) of the Social Security Act during the two-year period ending on December 31, 2008, including— (A)the impact of the methods funded by the payments on— (i)health care quality and safety; and (ii)the privacy and security of identifiable health information; (B)the effect of such methods on furthering interconnectedness between— (i)providers and State Medicaid programs; and (ii)State Medicaid programs and other programs for low-income populations administered by State and Federal entities; (C)the extent to which such methods reduce the administrative burden on such programs; and (D)the contribution of the payments to the goals of public health and public health reporting.