50 States, 50 IT Plans?

If Medicaid offices are out of sync on HITECH, 'it's going to be a mess.'

Hospitals nationwide waited months to find out the rules for meaningful use of health information technology, the standard by which they will qualify for Medicare and Medicaid bonus payments under the Health Information Technology for Economic and Clinical Health Act. But when the rules were finally released, it's quite possible only some of their questions were answered.

Much of the uncertainty is around the Medicaid half of the program.

For the most part, Medicaid meaningful use is similar to its Medicare counterpart. "Eligibility standards from state to state will not vary," notes Roderick Prior, M.D., medical director for MaineCare, that state's Medicaid program.

The federal reporting standards apply nationwide, though the final rule allows states to request approval from the Centers for Medicare and Medicaid Services to alter as many as four measures as long as they are within the parameters of the federal regulations and the capabilities of certified electronic health records.

CMS explicitly says in the final rule that it will not approve any waiver that requires additional EHR functionality. States must also demonstrate to CMS that any additional requirements do not add to the financial burden of providers.

"They're not going to be able to re-create meaningful use," says Joanne Sunquist, R.N., chief information officer at Hennepin County Medical Center in Minneapolis and a College of Healthcare Information Management Executives board member.

Edmund Billings, M.D., chief medical officer of EHR vendor Medsphere Systems in Carlsbad, Calif., says the Medicaid criteria "seem pretty solid," but each state does have some leeway, including when they pay out their incentive money. States also have discretion in terms of what they consider an "eligible provider."

States do not have to be ready for the same deadlines as Medicare, according to a CMS press officer, though they are allowed to begin their own incentive programs as early as this year.

"From what I hear, there's a huge variation across the states" in terms of readiness, Sunquist says.

This is the first time state Medicaid agencies have had to receive clinical and quality data from providers or administer incentive payments, so many are assessing their technical capabilities, according to Prior. "We've really been focusing on the question of administration," he says.

HIME formed the CHIME State CIO Network, consisting of coordinators in each state to help track developments related to in-state HITECH implementation. Sunquist, the organization's liaison for Minnesota, says the Minnesota e-Health Initiative Advisory Committee in June approved a plan, as required by CMS, largely signing off on the federal requirements. "If every state did that, I'd be happy," she says.

"I don't think the states have time to develop their own plans," Sunquist adds. "If every state goes down a separate path and with a separate timeline, it's going to be a mess."