y the Certification Commission for Health Information Technology (CCHIT®) and is a pre-market CCHIT Certified® 2011 Ambulatory EHR additionally certified for Child Health EHR technology. Aprima 2011 also achieved a usability score of 5 out of 5. The Aprima 2011 product’s CCHIT certification is pre-market, pending live use of the application in two practices for 45 days.

Aprima 2011 also preliminarily meets 24 of 24 requirements for Eligible Providers published by the U.S. Department of Health and Human Services (HHS) in the Interim Final Rule. Inspection information is available at http://www.cchit.org/products/ifrstage1/arraeligibleprovider/2123. For the purpose of qualifying products for ARRA incentives, CCHIT anticipates, but has not yet received, accreditation by HHS.

“It is no longer a promise, it is a fact,” said Neil Simon, Aprima Medical Software’s Chief Operating Officer. “We told our customers and prospects that we would deliver a CCHIT Certified 2011 Ambulatory EHR product and we have delivered on that promise. Promise made, promise kept!

In recognition of the broad need for EHRs in the pediatric and family care practice segments of the market, the company submitted Aprima 2011 for the additional certification by CCHIT for Child Health EHR technology.

“While our clients represent more than 40 specialties nationwide, the pediatric and family care practices tend to be smaller and have historically felt priced out of the EHR market,” stated Michael Nissenbaum, Aprima Medical Software’s President and CEO. “We made the additional modifications for these providers, thus earning the Certification Commission’s additionally certified for Child Health EHR technology label. Our customers have embraced our template-free, content-rich application, and now influential bodies like the Regional Extension Centers (RECs) can look to Aprima 2011 as the electronic health record solution of choice that is certified to address the needs of their communities from infant to aged.”

“The next step for Aprima 2011 development is to complete work on additional features and functions beyond the Meaningful Use requirements,” explained Simon. “These enhancements will enable Aprima 2011 to leapfrog the market.” Aprima will demonstrate these features, along with all the Meaningful Use functionality, at its 2010 Aprima National User Conference in Dallas, August 6 – 8.

“These certifications are the continuation of our commitment to our clientele to consistently meet all national standards,” said Nissenbaum. “We have met all available years of the Certification Commission’s certifying criteria (2006, 2007, 2008, and now 2011). Our prospects and clients can be assured that this will continue in the future.”

The CCHIT Certified® 2011 certification program, opening on April 7, 2010, is one of two distinct, but complementary, programs of certification offered by CCHIT, the second is the Preliminary ARRA IFR Stage 1. Health IT companies may be certified in one or both programs.

In the CCHIT Certified 2011 program, products are rigorously inspected against integrated EHR functionality, interoperability, and security criteria independently developed by the Commission’s broadly representative, expert work groups, using the Commission’s published testing methods. This program is intended to serve health care providers looking for maximal assurance that a product will meet their complex needs.

The Preliminary ARRA IFR Stage 1 program tests complete EHRs or EHR modules against criteria and standards published by the US Department of Health and Human Services (HHS) in the Interim Final Rule (IFR) on “Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology” on January 13, 2010, and effective on February 12, 2010.

This program, based on the federal standards for certified EHR technology to support the Stage 1 incentives under the American Recovery and Reinvestment Act of 2009 (ARRA), is designed to demonstrate that a vendor’s product is extremely well prepared to be certified once the Office of the National Coordinator (ONC) accredited testing and certification becomes available. When that occurs, CCHIT will replace the Preliminary ARRA program with a final, ONC-accredited ARRA certification program. Aprima 2011 will apply for that certification once the accredited certifying organization’s procedures are in place. CCHIT does not offer a guarantee that it will be accredited.

All testing for Preliminary ARRA IFR Stage 1 or final ARRA Stage 1 is conducted separately from the CCHIT Certified testing.

The heat on the Obama Administration and Congressional leadership over the cost of health care reform is not expected to ease anytime soon, with the release last week of additional information from the Congressional Budget Office on the Patient Protection and Affordable Care Act. The updated analysis shows the cost of the new law could easily exceed $1 trillion because of possible discretionary spending of at least $115 billion over the 2010-2019 period.

The number of states now challenging the new law in court stands at 20, and the states have been joined in the suit by the National Federation of Independent Business. Also last week, the Milliman Medical Index for 2010 was released, and it contains more worrisome news — health care costs continue to rise at an unsustainable rate. The report found that costs increased $1,303 for the typical family of four in the past year and now stand at $18,074.

Federal

As the comment period ended with respect to medical loss ratio (MLR) regulations, a flurry of letters were sent last week to both the National Association of Insurance Commissioners and the U.S. Department of Health and Human Services. Several insurers and several employer groups have written with comments and concerns, including the American Benefits Council, the National Coalition on Benefits and the National Retail Federation. In all cases, the comments point out that it's important to assure that positive, quality-oriented elements of health care, such as health information technology, disease management and wellness programs, fraud and abuse regimens, all should count as quality measures when calculating a company's MLR. The National Retail Federation in particular noted the need for a national MLR for large employer business.

In the never-ending roll-out of proposed health care reform regulations, the Administration last week published yet another set of Interim Final Regulations. This set deals with coverage for dependent children up to age 26 pursuant to the requirement that insurers and group plans allow kids to stay on their parents' policies or coverage until age 26.  Comments are due by August 11, but the rule is effective July 12, 2010. Many insurers have already announced that they will implement this provision early (e.g., May 31 for Aetna) to cover graduating college students who may have otherwise faced the summer without insurance. Whether self-funded employers follow suit is not as clear. Also, with the temporary fix of Medicare physician reimbursement rates set to run out the end of May, the House is expected to take up a more lasting fix sometime this week. If the House proceeds as expected it will attempt to install a five-year suspension of any physician rate cuts. Aetna supports the change, as it will give this market predictability.

States

COLORADO: The General Assembly recently adjourned a 2010 session that was focused heavily on health care issues. Outgoing Governor Bill Ritter succeeded in his goal of leaving a health care reform legacy with the passage of unisex rating in the individual market, a plain language requirement for insurance forms and contracts, an all-payer database and the creation of a task force to develop standard coding and edits for claims. Although the oral chemotherapy mandate passed, the industry was successful in helping to defeat a bill that would have prohibited carriers from setting rates for non-covered services and one making the wrongful denial of a claim an unfair claim practice.

DELAWARE: Debate resumed last week on a bill that would prohibit health insurers from denying coverage for medically necessary procedures and tests. The bill was voted out of committee with the understanding that significant changes are needed before a full vote occurs. The Department of Insurance presented testimony applauding the intent of the sponsor but reserving full support, indicating there is benefit in allowing preauthorization to limit unnecessary medical testing. Additionally the Comptroller General provided testimony on the potential cost impact to the state health benefits plan.  An actual dollar figure has not yet been quantified.The legislature will be in recess for the next two weeks, returning June 1.

FLORIDA: The legislature adjourned for 2010 with no significant health care bills passing. The only exception was in the area of Medicaid, legislation regarding provider-sponsored networks was passed. Legislation that was defeated includes mandates for coverage of Down's Syndrome and other developmental disabilities, and problematic pharmacy legislation.

GEORGIA: The legislature adjourned for 2010 after a number of negative health care bills were defeated, including a proposed tax on health plans and restrictions on rental networks. Among the legislation that did pass was, most significantly, a bill that would

apply state prompt-pay laws to self-funded plans. The bill also contains an extension of time for payment of paper claims and a compliance threshold of 95 percent before any fines are imposed. Several interested parties are working with the Governor's office to encourage a veto of the bill, but this is unlikely.

INDIANA: After a financial review of the Patient Protection and Affordable Care Act's impact on the Indiana Medicaid program and the state budget, Milliman reported its findings last week to the State Budget Committee. Milliman placed the total fiscal impact to the budget during the next 10 years at an estimated $3.6 billion. The predominant driver is expected to be enrollment expansions, which are estimated to increase from 1 million in 2010 to 1.55 million under PPACA. Other cost drivers include the impact of a reduced FMAP on Medicaid eligibles, pharmacy rebate loss, administrative expenditures (personnel and data systems), and increases to the Indiana Medicaid fee schedule from 60-65 percent of Medicare today to 80 percent of Medicare, to assure access to care. It was stressed that the final actual cost will be largely dependent on how many residents enroll in health care programs while eligible for Medicaid.

IOWA: Insurance Commissioner Susan Voss held a meeting with insurance industry representatives on May 7 to discuss the implementation of a health care cost bill. Specifically,certain provisions require the Iowa Insurance Division to 1) hold a public hearing regarding any proposed rate increases that exceed national health care spending by at least 15 percent; and 2) convene a work group to consider ways to reduce the cost of health care and health insurance premiums. Commissioner Voss noted that the requirement for a hearing applies only to rates filed for approval – the individual market in Iowa. Also, there will be only one hearing per carrier even when the carrier makes filings for several products. Hearings are intended to collect comments from consumers; carriers are not expected to address comments or make a presentation.  Commissioner Voss announced that the work group on reducing costs will not be convened until at least July 1, 2010.  The Commissioner is requesting input from health insurance industry representatives and consumer groups on costs.

MASSACHUSETTS: Small businesses are opposing a proposal they say would shift more health insurance costs onto them for the treatment of developmentally disabled children. The proposal would require insurance companies to absorb the cost of copayments and deductibles for physical and speech therapy and other services provided through a state-run, early intervention program for children up to 3 years old. Until now, the state has funded co-pays and deductibles for the program, but it now faces a $10 million shortfall. Businesses leaders say this would add about $4 million in costs onto smaller companies. The Retailers Association of Massachusetts and 11 other business and insurance groups sent a letter last week to Senate Ways and Means Chairman Steven Panagiotakos urging him to kill the proposal. Panagiotakos said his committee has not decided whether to include the measure in the proposed state budget but that it has the support of many of his colleagues. Currently, families with developmentally disabled children are charged a fee, based on their income, to participate in the program. The Patrick administration has said those fees could go up by as much as 600 percent. Advocacy groups developed a plan, approved by the House last month, that would cut the program’s shortfall nearly in half. It would raise fees more modestly but would also require insurers to pick up the $4 million in co-pays and deductibles currently covered by the state.

MISSOURI: An autism mandate bill was passed by the legislature just prior to the conclusion of the current session last week. It is now on its way to the desk of Governor Jay Nixon, who has spoken publicly in support of the measure. Effective with all policies renewed or delivered on or after January 1, 2011, coverage of autism disorder treatment would be mandated for children through age 18 and capped at $40,000 annually; coverage may exceed that amount with approval of the health plan. The coverage limit would be raised every three years per the consumer pricing index. Small employers can ask for a waiver if their costs exceed 2.5 percent of total claims in a year.

NEW JERSEY: Governor Chris Christie is establishing an executive work group to oversee implementation of federal health care reform. The full membership has yet to be announced, but it is expected to include key leadership from the Banking & Insurance Department, Health & Senior Services, and Human Services. In other business, the June 30 budget deadline and the state’s nearly $11 billion deficit have set the stage for an ideological showdown. Despite the governor’s outright defiance in refusing to signany legislation that increases taxes, Senate and Assembly leadership have introduced legislation to temporarily raise the income tax on residents earning more than $1 million. The revenue generated from this proposed tax would be used to restore cuts made to the senior pharmaceutical assistance program and property tax rebates.

Legislative action was taken on a bill designed to lighten the impact of an employer tax for the state’s unemployment fund. A significant deficit in the fund triggered a $1 billion employer tax to replenish the fund, which currently equates to an approximate tax of $400 per employee.  In response to advocacy from the business community, the legislature is attempting to do a phased-in reduction of the tax to $300 million this year.