Supreme Court ACA Case: Implications Health IT - .Supreme Court’s decisions on health information

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  • TheSupremeCourtACACase:ImplicationsforHealthIT

  • ModeratorModerator

    FredHannett

    ManagingPrincipalThe Capitol AllianceTheCapitolAlliance

    ViceChair

    HIMSSPublicPolicyCommittee

  • SpeakerSpeaker

    NandanKenkeremath,JDVice PresidentVicePresidentMarwoodGroup

    Vi Ch iViceChairHIMSSLegalTaskForce

    MemberMemberHIMSSPrivacyandSecurityTaskForce

    ServedonseveralHIMSSAdHocCommittees

  • SpeakerSpeaker

    JamesB.Wieland,JD

    PrincipalOber, Kaler, Grimes & ShriverOber,Kaler,Grimes&Shriver

    MemberHIMSS L l T k FHIMSSLegalTaskForce

  • L i Obj tiLearningObjectives DefinethefourmajorissuesbeforetheSupremeCourtand

    howtheycouldbeaddressedbytheCourt

    ExplorehowtheCourtsrulingcouldinvalidateotherimportantprovisionsoftheACA,ortheentirelaw

    Discuss the short and long term implications of the Discusstheshort andlongtermimplicationsoftheSupremeCourtsdecisionsonhealthinformationtechnology

  • The Supreme Court ACA Case: Implications for Health IT

    AmericanRecoveryand

    StimulusLaw

    PatientProtectionand

    HealthcareReformLaw

    yReinvestmentActof2009

    Includes HITECH/EHR

    AffordableCareActof2010

    Supreme Court is debatingIncludesHITECH/EHRIncentiveProgram

    SupremeCourtisdebatingConstitutionalissuesregardingthislaw

    NotpartofcasebeforeSupremeCourt

  • Todays SpeakersToday sSpeakers

    NandanKenkeremath,JD

    JamesB.Wieland,JDHIMSS Legal Task ForceHIMSSLegalTaskForce

  • TheJustices'ConferenceRoom,wheretheJusticesmeetinprivatetodiscusscases.

  • Status of Case Twentysixstates,theNationalFederationofIndependent Business, and other parties haveIndependentBusiness,andotherpartieshavechallengedtheAffordableCareAct(ACA)inFederal Court on Constitutional groundsFederalCourtonConstitutionalgrounds

    TheU.S.SupremeCourtheardoralargumentsin the Affordable Care Act case on March 26intheAffordableCareActcaseonMarch2628,2012,withadecisionanticipatedbytheend of June 2012endofJune2012

  • FourMajorIssuesjfortheCourt

    Anti Injunction Act Does the Anti Injunction Act prevent a court AntiInjunctionActDoestheAntiInjunctionActpreventacourtchallengeregardingtheindividualmandateuntilapenalty/taxisactuallypaid?

    Individual MandateDoes Congress have the power under theIndividualMandate DoesCongresshavethepowerundertheConstitutiontorequiringnearlyallindividualstopurchaseminimumhealthinsurancecoverageunderthreatofpenalty?

    MedicaidExpansionIsACAsrequirementthatthestatesexpanddi id li ibili d l i i i l i f i i l fMedicaideligibilityundulycoerciveinviolationofprinciplesof

    federalismintheConstitution? Severability IfeithertheIndividualMandateortheMedicaid

    Expansions are found unconstitutional what provisions if any ofExpansionsarefoundunconstitutionalwhatprovisions,ifany,ofACAcanremainasseverable?

  • CertainArticleI,,Section8Powers

    The Congress shall have power to lay and collect taxes duties TheCongressshallhavepowertolayandcollecttaxes,duties,impostsandexcises,topaythedebtsandprovideforthecommondefenseandgeneralwelfareoftheUnitedStates;butallduties,impostsandexcisesshallbeuniformthroughouttheUnitedStatesp g

    ToregulateCommercewithforeignNations,andamongtheseveralStates,andwiththeIndianTribes

    TomakeallLawswhichshallbenecessaryandproperforcarryingi i h f i d ll h dintoExecutiontheforegoingPowers,andallotherPowersvestedbythisConstitutionintheGovernmentoftheUnitedStates,orinanyDepartmentorOfficerthereof

  • CertainStatementsofJusticeKennedy

    Duringarguments,JusticeKennedysaidthegovernmenthasa"veryheavyburdenofjustification"toshowthatCongressisallowedtochange"thel h b h d d l d hrelationshipbetweentheindividualandthegovernmentinavery

    fundamentalway

    HealsoaskedObamaadministrationlawyerifCongresscancreatei d l icommerceinordertoregulateit

    [T]hegovernmenttellsusthat[]...theinsurancemarketisunique.Andinthenextcase,itllsaythenextmarketisunique.ButIthinkitistruethatif

    i i lif f d i h i d h l hmostquestionsinlifearemattersofdegree,intheinsuranceandhealthcareworld,bothmarkets stipulatetwomarkets theyoungpersonwhoisuninsuredisuniquelyproximatelyveryclosetoaffectingtheratesof insurance and the costs of providing medical care in a way that is notofinsuranceandthecostsofprovidingmedicalcareinawaythatisnottrueinotherindustries.Thatsmyconcerninthecase.

  • SeverabilityOptions

    The Court could just strike the IndividualTheCourtcouldjuststriketheIndividualMandate

    TheObamaadministrationarguesthatonlyfprovisionsforpreexistingconditionsand

    guaranteedissuerequirementsshouldbeinvalidated if the individual mandate is struckinvalidatediftheindividualmandateisstruck

    TheCourtcouldfindadditionalrelatedprovisionstostrike

    TheCourtcouldstrikeallofACA

  • ACAOverview HealthInformationT h lTechnology

    ACAsThreeHealthITThemes: EnhanceQualityReportingandMeasurement

    ExpandandEnhanceQualityReporting ImproveQualityofCare EncourageQualityCarethroughReimbursement

    EstablishUniformOperatingRulesandStandards HealthITWorkforceInitiatives

    Many of the ACA Health IT provisions reflect the increasing adoption by the federalManyoftheACAHealthITprovisionsreflecttheincreasingadoptionbythefederalgovernmentofHealthITenabledperformancemeasurementsforhealthcarepurchasingandotherinnovativeprograms.ThisadoptionwillcontinueregardlessofthefateoftheACAintheSupremeCourt.

    FundingmaybetheissueforcertainoftheACAprovisions,dependingontheSupremeCourtsdecision.

  • Quality ReportingDataQuality:Thelegislationincludesprovisionsregarding quality reporting by healthcare

    QualityReporting

    regardingqualityreportingbyhealthcareproviders.HealthITisakeytoolamongtheseprovisionstoefficientlyimprovetheaccuracyp y p yandexpandthescopeandtypeofdatacollected

    h bl h f l Section2717: Directstheestablishmentofqualityreportingrequirementsforgrouporindividualhealthinsuranceissuersofferinginsurance

  • Quality ReportingQualityReporting

    Section30043005:Requireslongtermcarehospitals,inpatientrehabilitationhospitals,hospiceprograms and cancer hospitals to submit data onprogramsandcancerhospitalstosubmitdataonqualitymeasurestotheSecretary

  • QualityReporting Section3013: Directstheestablishmentofnewqualitymeasureswherenoqualitymeasuresexistandtoimprove update and expand existing qualityimprove,update,andexpandexistingqualitymeasures.Thelawdefinesaqualitymeasureasastandardformeasuringtheimprovementofpopulationg p p phealthorofhealthplans,serviceproviders,andothercliniciansinthedeliveryofhealthcareservices.Thelaw requires grants to be awarded to entities for thelawrequiresgrantstobeawardedtoentitiesforthepurposeofdevelopingqualitymeasuresthatallowfortheassessmentof,amongothers,meaningfuluseofhealthIT,healthdisparities,andequityofhealthservices.

  • Quality Reporting

    Section4302:Requiresfederallyconductedorsupportedh l h ll d

    QualityReporting

    healthcareprogramsorsurveystocollectandreportdemographicdata,includingethnicity,sex,primarylanguage,anddisabilitystatus,aswellasdataatthesmallestgeographiclevelpossible,suchasstateorlocal,etc.RequiresHHS,withtheOfficeoftheNationalCoordinator(ONC),todevelopnationalstandardsfordatacollection,andinteroperabilityandsecurityfordatamanagementsystems.

  • QualityReporting Section6301: CallsupontheOfficeofCommunicationandKnowledgeTransfertodisseminate findings of government sponsoreddisseminatefindingsofgovernmentsponsoredresearchtogroupssuchas,amongothers,vendorsofhealthITfocusedonclinicaldecisionsupport.TheOffice must assist users of health IT so that theOfficemustassistusersofhealthITsothattheresearchisincorporatedintoclinicalpracticesinatimelyandefficientmanner

    Section10332: RequiresclaimsdataforitemsandservicesunderMedicarepartsA,B,andDtobe

    d il bl f f l i fmadeavailableforperformanceevaluationsofprovidersandsuppliersofhealthcareservices

  • QualityReporting Section10333: Establishesgrantstosupportthedevelopmentofcommunitybasedcollaborativecarenetworks Grants can be used for among manynetworks.Grantscanbeusedfor,amongmanythings,telehealthservices

    Section 10109: Directs the Secretary to seek input Section10109: DirectstheSecretarytoseekinputonavarietyoftopicsfromsuchorganizationsastheNationalCommitteeonVitalandHealthStatistics(NCVHS),theHealthInformationTechnologyPolicyCommittee,andtheHealthInformationTechnologyStandards Committee and standard settingStandardsCommittee,andstandardsettingorganizationsandstakeholdersasdeterminedappropriate

  • QualityReporting

    Section 10305: requires the public reporting of

    Q y p g

    Section10305: requiresthepublicreportingofperformanceinformation,whichmustbealignedwiththeexpansion,interoperabilityefforts,andstandardsettingofhealthIT

  • NewProgramsPrograms:Thelegislationestablishesahostofnewprograms to foster quality healthcare Health IT is a

    g

    programstofosterqualityhealthcare.HealthITisakeyfactorinmanyofthesenewprograms

    Section 1322: Creates the Consumer Operated andSection1322: CreatestheConsumerOperatedandOrientedPlan(COOP)programtoestablishnonprofithealthinsurancecompanies.OrganizationsintheCOOPprogram may enter into collective purchasing agreementsprogrammayenterintocollectivepurchasingagreementsforitemsandservicessuchashealthIT

  • NewPrograms

    Section1323: Requirestheestablishmentofi i d ff d bl i h l h

    g

    competitiveandaffordablecommunityhealthinsuranceoptionsofferedthroughtheExchanges.The non profit entities that will provide theThenonprofitentitiesthatwillprovidethecommunityoptionshall,amongotherthings,includeproceduresfortheuseoftechnologysothatrealp gytimedatacanbeusedtoinvestigateindicationsoffraudandabuse

  • New Progra

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