The effective use of electronic health records and health information exchange in Medicaid and the Children’s Health Insurance Program can help the state improve care and gain efficiencies. A number of health information technology projects originated in state or federal legislation in 2009.
In 2009, the Texas Legislature passed House Bill 1218, which requires the Health and Human Services Commission to develop a health information exchange system for Medicaid and CHIP. The Electronic Health Information Exchange System Advisory Committee was created to help HHSC develop and implement this exchange.
This committee was replaced in July 2016 with the e-Health Advisory Committee, established to advise HHSC executive commissioner and HHS agencies on strategic planning, policy, rules and services related to the use of health information technology, health information exchange systems, telemedicine, and telehealth services.
Note: As established in federal rule, 2016 was the last year for an eligible professional or hospital to start participation in the program. Therefore, HHSC can no longer accept new participants into the program.
State Medicaid programs established Electronic Health Record Incentive Programs to provide incentive payments to health-care professionals and hospitals that meet specific eligibility requirements when they adopt, implement and meaningfully use certified electronic health record technology (CEHRT).
To be eligible for the Medicaid EHR Incentive Program, health-care professionals and hospitals must meet federally-defined eligibility requirements and meet minimum Medicaid patient volume thresholds.
Eligible professionals and hospitals also must meet meaningful use criteria. Since the program’s inception in 2011, federal meaningful use requirements have evolved over three stages. At a minimum, a meaningful user of CEHRT must:
- Demonstrate use of CEHRT for electronic capture of clinical data.
- Demonstrate connectivity to other providers and allow for provider-patient exchange of health information to improve access to the full view of a patient’s health history.
- Use CEHRT to submit, in a form and manner specified by the Secretary of HHS, information on clinical quality measures and other measures.
- Use CEHRT to actively engage with a public health agency to submit electronic public health data, as applicable.
The Electronic Health Record Incentive Program final rule was released on July 28, 2010. It outlined what participating providers needed to do to qualify for the Medicaid EHR incentive payments. In subsequent rule-making from 2012 through 2017, the federal Centers for Medicare & Medicaid Services (CMS) modified program requirements, with a focus on using CEHRT to improve care coordination and clinical outcomes.
Prescribers can request Medicaid medication history through their e-prescribing tool, as long as the prescriber has client consent and the client allows Medicaid to share their history. Providers also can transmit electronic prescriptions to pharmacies capable of receiving electronic prescriptions. E-prescribing not only replaces paper prescriptions with electronic prescriptions, but also includes the electronic exchange of prescription, drug formulary, client benefit, and patient information among prescribers, pharmacies, and payers.
The American Recovery and Reinvestment Act of 2009 allows for the payment of federal incentives to Medicaid and Medicare providers for the adoption and meaningful use of electronic health record (EHR) technology. The use of e-prescribing is included as meaningful use criteria. Therefore, providers that are eligible to receive the incentives must utilize e-prescribing capabilities within a certified EHR. Under federal law, providers that adopt EHR technology can apply for incentive payments beginning in federal fiscal years 2011 through 2016.