[Federal Register Volume 76, Number 16 (Tuesday, January 25, 2011)]
[Pages 4350-4351]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-1447]



Health Information Technology Extension Program

ACTION: Public Notice.


SUMMARY: This notice announces changes to the Health Information 
Technology Extension Program, which assists providers seeking to adopt 
and become meaningful users of health information technology, as 
authorized under section 3012(c) of the Public Health Service Act, as 
added by the American Recovery and Reinvestment Act of 2009 (Pub. L. 
111-5) (ARRA).

FOR FURTHER INFORMATION CONTACT: The Office of the National Coordinator 
for Health Information Technology, 200 Independence Ave, SW., Suite 
729D, Washington, DC 20201, Phone 202-690-7151, E-mail: 
[email protected].


I. Background

    On February 17, 2009, the President signed the American Recovery 
and Reinvestment Act of 2009 (ARRA). Title XIII of Division A and Title 
IV of Division B of ARRA, together cited as the Health Information 
Technology for Economic and Clinical Health Act (HITECH Act), include 
provisions to promote meaningful use of health information technology 
to improve the quality and value of American health care. The HITECH 
Act also established the Office of the National Coordinator for Health 
Information Technology (ONC) within the U.S. Department of Health and 
Human Services (HHS) as the principal Federal entity responsible for 
coordinating the effort to implement a nationwide health information 
technology (health IT) infrastructure that allows for the use and 
exchange of electronic health information in electronic format.
    Subtitles A and B of Title IV in Division B of ARRA authorize 
incentive payments for eligible Medicare and Medicaid providers' 
adoption and meaningful use of certified electronic health record (EHR) 
technology. In 2015, Medicare eligible providers are expected to have 
adopted and be actively utilizing certified EHR technology in 
compliance with the ``meaningful use'' definition or they will be 
subject to payment adjustments under Medicare (per sections 4101(b) and 
4102(b) of ARRA). The detailed criteria to qualify for meaningful use 
incentive payments were established by the Secretary of HHS (hereafter 
referred to as the Secretary) through the formal notice-and-comment 
rulemaking process. For access to the most current publicly available 
information about meaningful use, please visit the Meaningful Use 
section of the ONC programmatic Web site (http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__meaningful_use_announcement/2996) and http://www.cms.gov/EHRIncentivePrograms/.
    Providers seeking to meaningfully use certified EHR technology face 
a variety of challenging tasks. Those tasks include assessing needs, 
selecting and negotiating with a system vendor or reseller, 
implementing project management, and instituting workflow changes to 
improve clinical performance and ultimately, outcomes. Past experience 
has shown that robust local technical assistance can result in 
effective implementation of EHRs and quality improvement throughout a 
defined geographic area.
    Section 3012 of the Public Health Service Act (PHSA), as added by 
ARRA (see Appendix A), authorized the establishment of the Health 
Information Technology Extension Program (Extension Program). By 
statute, the Extension Program is to include a national Health 
Information Technology

[[Page 4351]]

Research Center (HITRC), and grant funding toward the creation and 
operation of Regional Extension Centers (Regional Centers).
    The purpose of the Regional Centers is to furnish assistance 
(defined as education, outreach, and technical assistance) to help 
providers in their geographic service areas select, successfully 
implement, and meaningfully use certified EHR technology to improve the 
quality and value of health care. Regional Centers will also help 
providers achieve, through appropriate available infrastructures, 
exchange of health information in compliance with applicable statutory 
and regulatory requirements, and patient preferences. In doing this 
work, Regional Centers will also seek to ensure consistency with any 
applicable State HIE plan(s) that are developed under the cooperative 
agreements issued by ONC pursuant to section 3013 of the PHSA.
    Pursuant to requirements of section 3012(c)(5) of the PHSA, 
Regional Centers must give priority to providers that are primary-care 
providers (physicians and/or other health care professionals with 
prescriptive privileges, such as physician assistants and nurse 
practitioners) in any of the following settings:
     Individual and small group practices (ten or fewer 
professionals with prescriptive privileges) primarily focused on 
primary care;
     Public and Critical Access Hospitals;
     Community Health Centers and Rural Health Clinics; and
     Other settings that predominantly serve uninsured, 
underinsured, and medically underserved populations.
    A practice otherwise meeting the definition of individual or small-
group physician practice, above, may participate in shared-services 
and/or group purchasing agreements, and/or reciprocal agreements for 
patient coverage, with other physician practices without affecting its 
status as individual or small-group practice for purposes of the 
Regional Centers.
    In any given Regional Center's service area, some priority primary-
care providers (as described above) may have already acquired and/or 
implemented EHR technology. Such providers remain priority providers, 
though the technical assistance required is anticipated to be focused 
on movement from having an EHR to achieving all aspects of meaningful 
use of EHR technology, including but not necessarily limited to 
electronic exchange of health information and reporting of quality 
measures using the EHR.
    The ultimate measure of a Regional Center's effectiveness will be 
whether it has assisted providers in becoming meaningful users of 
certified EHR technology.
    Cooperative agreement awards were made pursuant to an open 
competition to establish 62 Regional Centers. The awards were made on a 
rolling basis. The first set of 32 Regional Center awards was made in 
February 2010, the second set of 28 awards was made in April 2010, and 
the final 2 awards were made in September 2010.
    While section 3012(c)(5) of the PHSA generally limited Federal 
funding for Regional Centers to 50% of their capital and annual 
operating and maintenance funds, it included a provision allowing for 
different cost sharing in instances in which the prescribed cost 
sharing ceiling would ``render this cost-sharing requirement 
detrimental to the program.'' The Secretary made this finding, and, as 
a result, the original cooperative agreement award was comprised of a 
four-year project period, consisting of two two-year budget periods. 
The first budget period (years 1 and 2) had a 90/10 cost share 
requirement and the second budget period (years 3 and 4) had a 10/90 
cost share requirement. For the first budget period the grantee was 
responsible for contributing 1 dollar for every 9 Federal dollars. For 
the second budget period, the grantee was responsible for contributing 
9 dollars for every 1 dollar of Federal funds.

II. Description of Changes

    In overseeing the ongoing Extension Program, the Secretary found 
that the established cost sharing requirements (90/10 in years one and 
two, and 10/90 in years three and four) are continuing to ``render 
[the] cost-sharing requirement detrimental to the program'' due to 
national economic conditions To alleviate these concerns, the Secretary 
will be seeking bi-lateral modifications to the grants to alter the 
initial timeline and cost-sharing requirements in the Regional Center 
grants. Through these modifications, the timeline would be lengthened 
in the first budget period from two years to four years, and the cost-
sharing requirement would reflect a 90/10 Federal/grantee cost share 
for all four years. Modifications will be effectuated through the 
execution of revised Notice of Grant Awards (NGA).
    If modified, the cost share requirements for the cooperative 
agreement will be as follows:

                                                  Federal     Recipient
                                                 amount of    amount of
                     Year                          costs        costs
                                                 (percent)    (percent)
1.............................................           90           10
2.............................................           90           10
3.............................................           90           10
4.............................................           90           10

    It is expected that the Regional Centers will generate resources to 
support cost sharing in ways that demonstrate hospital, provider, and 
community commitment to the project and its goals of supporting 
adoption and meaningful use of health IT. Such sources of funding to 
support the project's cost share obligation under the cooperative 
agreement could include per-provider participation fees. This statement 
does not preclude recipients using other legal sources of cost sharing 
contributions as governed by 45 CFR part 74. All of the funds for 
cooperative agreement should be spent during the base award's budget 
period (Years 1, 2, 3, and 4), including the cost sharing requirement 
described above.
    Fees and other funds generated by the project are considered 
program income under 45 CFR Part 74. Program income generated by the 
recipient must be retained by the recipient and first used to finance 
the non-Federal share of the project. To support sustainability, ONC 
places no limits on the accrual of program income. After the Federal 
cost sharing requirement is met, program income generated using Federal 
funds, including fees for services, must be added to funds committed to 
the project by the Federal government and used to further eligible 
project or program objectives.
    As stated in the original Funding Opportunity Announcement (FOA), a 
positive biennial evaluation will be required for grantees to continue 
work in years 3 and 4 of the grant; this requirement is unchanged by 
the December 2010 waiver. The anticipated bi-lateral modifications to 
the original grants will include achievement of a positive biennial 
evaluation as a term and condition of the grant. The previously 
approved goals, objectives, activities and timelines of the Regional 
Center program remain unchanged.

David Blumenthal,
National Coordinator for Health Information Technology.
[FR Doc. 2011-1447 Filed 1-24-11; 8:45 am]