Legislation Expands Scope of EHR Meaningful Use Eligibility

As President Obama signed new legislation expanding EHR meaningful use incentive eligibility to outpatient-based hospital physicians, Congress recently introduced a new bill that extends eligibility to additional hospitals.

The need for additional clarifying legislation may speak to the lack of understanding on the part of Congress as to the implications of their initial language in ARRA, says Margret Amatayakul, MBA, RHIA, CHPS, CPHIT, CPEHR, CPHIE, FHIMSS, president of Margret\A Consulting, LLC, in Schaumburg, IL.

Obama signed The Continuing Extension Act of 2010 (HR 4851) into law April 15. The Act changes the definition of "hospital-based physician" as it was original stated in the 2009 American Recovery and Reinvestment Act's HITECH legislation.

Amatayakul supports the broader definition. "This will open the door to many more providers who do need to be incentivized [to adopt EHRs]."

The Continuing Extension Act changes the word "outpatient" in the description of a hospital-based setting "whether inpatient or outpatient" to read "inpatient or emergency room setting." The change is in effect as if it was included in the original HITECH Act.

This was a necessary change, Amatayakul says. "It became obvious that [ARRA] was not going to cover providers that had to buy their own system, but did much of their work in hospital. For example, 90% of nephrologists work in dialysis center in a hospital, but many use their own system to document."

However, the new language explicitly stating the ineligibility of emergency room physicians may leave some wondering about their blatant exclusion from incentives. "[Physicians] contracted to work in the ED may have their own system and use it in the hospital," says Amatayakul, who believes it will be interesting to see what comes out in terms of public comment on this aspect of the act.

Bringing behavioral, mental health on-board

Meanwhile, Representatives Patrick Kennedy (D-RI) and Tim Murphy (R-PA) introduced the HITECH Extension for Behavioral Health Services Act of 2010 (HR 5025) to the House April 14. This proposed legislation would further expand meaningful use incentive eligibility to behavioral and mental healthcare providers.

The bill proposes the following change:

Public Health Service Act (42 U.S.C. 300jj[3]) is amended [to include] `behavioral and mental health professionals (as defined in section 331(a)(3)(E)(i)), a substance abuse professional, a psychiatric hospital (as defined in section 1861(f) of the SSA (42 U.S.C. 1395x(f))), a behavioral and mental health clinic, a substance abuse treatment facility'.

The new legislation would make inpatient psychiatric hospitals, as well as clinical social workers and clinical psychologist providing qualified psychologist services eligible for Medicare meaningful use incentives. It also makes public psychiatric hospitals, as well as private psychiatric hospitals and mental health and substance abuse treatment facilities with at least 10% of their patient volume being individuals receiving Medicaid assistance eligible for the Medicaid incentives.