CMS Awards WV Medicaid $945K Federal Matching Funds for EHR Incentive Programs

iHealthBeat reports that West Virginia Medicaid along with five other states will receive federal matching funds from the Centers for Medicare and Medicaid (CMS)to help implement electronic health record (EHR) incentive programs.


West Virginia Medicaid will receive $945,000 in federal matching funds. The CMS press release indicates that West Virginia will use the funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state. The funds will be used to gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan.


The CMS press release states:

    WEST VIRGINIA TO RECEIVE FEDERAL MATCHING FUNDS FOR ELECTRONIC HEALTH RECORD INCENTIVES PROGRAM

    In another key step to further states’ role in developing a robust U.S. health information technology (HIT) infrastructure, the Centers for Medicare & Medicaid Services (CMS) announced today that West Virginia’s Medicaid program will receive federal matching funds for state planning activities necessary to implement the electronic health record (EHR) incentive program established by the American Recovery and Reinvestment Act of 2009 (Recovery Act). West Virginia will receive approximately $945,000 in federal matching funds.

    EHRs will improve the quality of health care for the citizens of West Virginia and make their care more efficient. The records make it easier for the many providers who may be treating a Medicaid patient to coordinate care. Additionally, EHRs make it easier for patients to access the information they need to make decisions about their health care.

    The Recovery Act provides a 90 percent federal match for state planning activities to administer the incentive payments to Medicaid providers, to ensure their proper payments through audits and to participate in statewide efforts to promote interoperability and meaningful use of EHR technology statewide and, eventually, across the nation.

    “We congratulate West Virginia for qualifying for these federal matching funds to assist its plan for implementing the Recovery Act’s EHR incentive program,” said Cindy Mann, director of the Center for Medicaid and State Operations at CMS. “Meaningful and interoperable use of EHRs in Medicaid will increase health care efficiency, reduce medical errors and improve quality-outcomes and patient satisfaction within and across the states.”

    West Virginia will use its federal matching funds for planning activities that include conducting a comprehensive analysis to determine the current status of HIT activities in the state. As part of that process, West Virginia will gather information on issues such as existing barriers to its use of EHRs, provider eligibility for EHR incentive payments, and the creation of a State Medicaid HIT Plan, which will define the state’s vision for its long-term HIT use.

WV HIT Funding Under HITECH: WVHIN Gets $7.8M and WV REC gets $6M

Health and Human Services Secretary Sebelius and the National Coordinator for Health Information Technology, David Blumenthal, announced the HITECH funding under the ARRA for State Health Information Exchanges (HIEs) and Regional Extension Center (RECs) across the country.

The White House Press Release provides a detailed list of HIEs and RECs receiving grants. Inormation is also available via the HHS News Release, Sebelius, Solis Announce Nearly $1 Billion Recovery Act Investments in Advancing Use of Health IT, Training Works for Health Jobs of the Future.

West Virginia will receive the following funding:

• West Virginia Department of Health and Human Resources in conjunction with the West Virginia Health Information Network HIE Award: $7,819,000

• West Virginia Health Improvement Institute, Inc. REC ward:$6,000,000

More information about the health information technology programs and awards can be found on the Office of National Coordinator HIT Website.

• State Health Information Exchange Cooperative Agreement Program

• Health Information Technology Extension Program

WV Law Blog: Welcome BR Employment Law Blog

A welcome to West Virginia's newest law blog, BR Employment Law Blog, by the Bowles Rice Employment Law Group. The blog plans to provide information useful for employers with an emphasize on news from the region of West Virginia, Kentucky, Ohio, Virginia and Maryland.

The team of employment law bloggers at Bowles Rice is lead by Beth Walker, a partner in the Charleston office who focuses her practice on labor and employment law.

Congratulations on the launch and welcome to the blogosphere!

Lorman Medical Records Law Seminar: March 18, 2010

On March 18, 2010 I will be speaking on Medical Records Law at a seminar in Charleston, West Virginia. The seminar is sponsored by Lorman Educational Services. Joining me for the day long seminar will be three very knowledgeable health care colleagues:

• Michael T. Harmon, MPA, CIPP/G, Compliance Specialist for the West Virginia Mutual Insurance Company, a Medical Professional Liability Insurance Company
• Sallie H. Milam, J.D., CIPP/G, Executive Director of the West Virginia Health Information Network and Chief Privacy Officer for the West Virginia State Government
• James W. Thomas, Esq., Manager of the Charleston, West Virginia Business Law Department of Jackson Kelly PLLC whose practice focuses primarily upon health care matters of a business, regulatory and operational nature
  

Additional information about the seminar and how to register can be found at Lorman Educational Services. Following is the full seminar agenda:

8:30 am – 9:00 am			Registration
9:00 am – 9:15 am			Overview
9:15 am – 10:30 am			HIPAA Compliance: Reality and Perspective
			— Michael T. Harmon, MPA, CIPP/G
			Overview Enforcement Complaints Case Examples Summary of HITECH Changes
10:30 am – 10:45 am			Break
10:45 am – 12:00 pm			HITECH Financial Incentives for Implementation of HIT
			— James W. Thomas, Esq.
			Qualifying an Electronic Health Record System Available Financial Incentives
12:00 pm – 1:00 pm			Lunch (On Your Own)
1:00 pm – 2:00 pm			Health Information Exchange in West Virginia: Impact on Patient Records
			— Sallie H. Milam, J.D., CIPP/G
2:00 pm – 2:15 pm			Break
2:15 pm – 3:30 pm			Consumer Driven Health Care: HITECH, Health 2.0, Social Media and Personal Health Records
			— Robert L. Coffield, Esq.
			HITECH Breach Notification Requirements Impact of Health 2.0 and Social Media Technology on the Future of Health Care Development and Adoption of Personal Health Records Discuss the Legal Implications of Emerging Technology
3:30 pm – 4:30 pm			Panel Discussion
			— Robert L. Coffield, Esq., Michael T. Harmon, MPA, CIPP/G, Sallie H. Milam, J.D., CIPP/G and James W. Thomas, Esq.

West Virginia State Bar and Office of Disciplinary Counsel News

The West Virginia State Bar announced today that the Office of Disciplinary Counsel has a new website. Also, the West Virginia State Bar has redesigned its website design..

The new Office of Disciplinary Counsel website contains information about the disciplinary complaint process the function of the Lawyer Disciplinary Board, the Rules of professional Conduct and the disciplinary complaint process. The website also has links to all Legal Ethics Opinions issued by the Lawyer Disciplinary Board and recent disciplinary decisions issued by the Supreme Court of Appeals of West Virginia.

Also, the West Virginia State Bar announces that the West Virginia Supreme Court of Appeal has entered order with a proposed amendment to Rule 8, Rules for Admission Pro Hac Vice. The proposed amendment increases the fee pad to the West Virginia State Bar for each individual applicant for pro hac vice admission from $250 to $350. Public comment on the proposed rule is being received through January 25, 2010.
A copy of the proposed order:

Request for Comments on Proposed Amendment to Rule 8.0 Admission pro hac vice, of the West Virginia Rules of Admission to the Practice of Law

UPDATE (3/16/10):

The West Virginia State Bar's Unlawful Practice of Law Committee released Advisory Opinion 10-001, relating to questions from attorneys regarding its interpretation of Rule 8 of the West Virginia Rules of Admission to the Practice of Law, relating to admissions pro hac vice.

Advisory Opinion 10-001 addresses the following issues:

1. Whether the requirement in Rule 8 of of admission pro hac vice extends to matters in which no action, suit or proceeding is pending;

2. To what extent is the responsible local attorney required to participate in proceedings involving the attorney admitted pro hac vice;

3. Whether presiding judicial officers can "excuse" local counsel form participation or "waive" the requirement of participating; and

4. What limitations exist for attorneys seeking to be admitted pro hac vice, particularly their ability to be admitted on a frequent basis, or in multiple or consolidated actions.

Thanks Esse Diem: The Best Blogs You're Not Reading Yet

A quick thanks to Elizabeth Damewood-Gaucher author of the Esse Diem Blog for including the Health Care Law Blog on her short list of The Best Blogs You're Not Reading Yet.

I would agree with her list and glad that am a regular reader of 4 out of the 5. All produce great content and cover distinct niche areas. For example, the Rainmaking Blog focuses on the business of law and tells you where to wear you nametag. Lee Kraus' Learning and Technology is the place I first learn about new technology tools that I can use - he is always thinking on the edge of the practical use of technology. Professional Studio 365 focuses on bridging the gap between college and the workforce for those just starting their career. I don't follow the Bad Leader Blog, but what a great name. You've got to love the lead in line, "what we can learn from bad leaders . . ."

"Thanks You" Elizabeth for including us on your list.

WVHCA Report: $1.1B Cost Saving from Adoption of HIT

iHealthBeat reports on the release of a new report prepared by CCRC Actuaries for the West Virginia Health Care Authority.

The full report is available via the West Virginians for Affordable Health Care website and is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

According to the articles, the report indicates that the adoption of health information technology (HIT) and implementation of centralized medical care through medical home concepts could save West Virginia's health care system more than $1.1B in 2014. The estimates in the report used insurance claims data from more that 800,000 West Virginia residents, including data from Medicaid and Mountain State Blue Cross Blue Shield.

More details in the AP article by Tom Breen from the Charleston Gazette and Washington Post, Report: Health strategy could save W.Va. $1B.

The Washington Post article indicates:

. . . In the case of electronic prescriptions, the report estimates an overall savings of $164 million in 2014, including nearly $51 million in savings to private insurers and $42 million in savings to policyholders. . .

. . . The report estimates that a statewide rollout of medical homes would cost about $45 million up front and incur ongoing costs of about $368 million . . .

. . . Estimates suggest that about nine in 10 health care offices still keep everything in paper. As the new report says, up front costs for physicians run from $25,000 to $45,000 and have annual costs thereafter of between $2,000 and $9,000, steep amounts for small practices . . .

UPDATE: Thanks to a reader comment - you can now read the full report. The report is titled, Health Care Financing in the State of West Virginia: An analysis and Projection of the Current System and Potential Transformations, August 2009.

Following is the Executive Summary of the report which contains some very interesting statistics on the state of health care in West Virginia.


Executive Summary

• A cohort model was developed to simulate health care eligibility, utilization and insurance availability of the projected 1,828,538 West Virginians in 2009.
• The model utilizes 8,640 cohorts to represent current insured status, health care utilization, age, gender, and household income.
• The projected average age in 2009 is 40.2 years.
  
• West Virginia is projected to have a population of 1,806,545 in 2019 and the average age is projected to increase to 42.2 years.
• The number of commercially insureds is 757,884 in 2009.
• The number of non-Medicare PEIA insureds is 175,324 in 2009.
• The number of non-dual eligible Medicaid insureds is 321,113 in 2009.
• The number of dual eligible Medicaid/Medicare insureds is 57,118 in 2009.
• The number of Medicare eligible PEIA insureds is 37,784 in 2009.
• The number of other Medicare insureds is 168,571 in 2009.
• The number of West Virginia CHIP insureds is 24,480 in 2009.
• The number of uninsured West Virginians is 286,264 in 2009.
• Health care costs can be defined as charges or as allowed charges. In terms of allowed charges, projected West Virginia expenditures total $13.1 billion in 2009.
• Allowed charges are projected to grow to $24.4 billion in 2019.
• In 2009, the uninsured population is projected to incur $3.2 billion in allowed charges, resulting in bad debt and charity care of almost $900 million.
• Initiative I, Adult Medicaid Expansion, is projected to cost the State of West Virginia $56.8 million and the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $611.5 million. Low income residents see the majority of the savings, spending $591.5 million less on health care.
• Initiative II, Adult Medicaid Expansion Combined with an Insurance Mandate for Employers and Individuals, is projected to cost the State of West Virginia $56.8 million in higher Medicaid expenditures and $1,004.3 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $2,176.0 million. Low income residents see the majority of the savings, spending $2,212.8 million less on health care.
• Initiative III, Adult Medicaid Expansion combined with an Insurance Mandate for Individuals, is projected to cost the State of West Virginia $56.8 million, $983.4 million in insurance premium subsidy. The initiative will cost the Federal Government $162.0 million in 2014, while overall health care expenditures will decrease $1,634.7 million. Low income residents see the majority of the savings, spending $1,656.2 million less on health care.
• Initiative IV, Medical Home, is projected to save the State of West Virginia $57.3 million in claim expenditures and the Federal Government $199.3 million in 2014, and overall health care expenditures will decrease $642.6 million. Low income residents and insurance companies see the majority of the savings, spending $170.6 million and $173.2 million less on health care, respectively. This initiative requires $45 million of initial costs and a total of $368.2 million of ongoing physician reimbursement per year.
• Initiative V, e-Prescribing, is projected to save the State of West Virginia $16.0 million in claim expenditures and the Federal Government $53.8 million in 2014, and overall health care expenditures will decrease $164.0 million. Low income residents and insurance companies see the majority of the savings, spending $41.9 million and $45.6 million less on health care, respectively. The cost of implementing e-prescribing has not been projected.
• Initiative VI, Electronic Medical Records, is projected to save the State of West Virginia $28.3 million and the Federal Government $98.5 million in 2014, and overall health care expenditures will decrease $317.6 million. Low income residents and insurance companies see the majority of the savings, spending $84.3 million and $85.6 million less on health care, respectively. This initiative requires around $25,000 to $45,000 of initial costs and an annual cost of $3,000 to $9,000 per provider. However, these cost estimates appear to be declining over time.
  

WVHIN Releases RFP for West Virginia Health Information Exchange

Today the West Virginia Health Information Network released a Request for Proposal (RFP) for a statewide Health Information Exchange. More information, including the deadlines, bidder worksheets and a full copy of the RFP are available on the WVHIN website.

Following are sections from the RFP that provide a general overview of the proposed West Virginia Health Information Exchange and a general scope of the RFP:

The West Virginia Health Information Network (WVHIN) is soliciting proposals to provide a statewide Health Information Exchange (HIE) infrastructure platform for physicians, hospitals, other health care organizations, and consumers. The purpose of this Request for Proposal (RFP) is to obtain vendor services and expertise in support of the WVHIN. Details on the scope of work, requirements and deliverables are contained in this RFP. WVHIN reserves the right to use the results of this RFP to obtain services for additional and related work should the need arise throughout the course of this project . . .

. . . According to the eHealth Initiative’s Sixth Annual Survey of Health Information Exchange 2009, there are almost 200 self‐reported HIE initiatives across the country with a substantially increased number of organizations that reported being operational. The impetus for HIEs has increased as a result of the passage of the American Recovery and Reinvestment Act (ARRA) of 2009 and specifically key provisions from the Health Information Technology for Economic and Clinical Health (HITECH) Act. These provisions called for the Office of the National Coordinator (ONC) to create a program to engage in collaborative agreements with states or “qualified” state‐designated non‐profit, multistakeholder partnerships to “conduct activities to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards.” . . .

. . . There are 1.8 million people in the very rural state of West Virginia with a high level of elderly and low‐income people in many of the rural areas. With a geographically dispersed population, access to and coordination of care is a critical issue. To serve this rural population, there is a relatively high number of hospitals with less than 100 beds and a high level of clinics serving the underserved making access and care coordination both difficult and essential. Based on the population profile and the number of small providers, a strong case was made for the need for a statewide HIE, which will help providers overcome communication and geographic barriers to access and coordination of care.

The WVHIN was established in July 2006 by the West Virginia Legislature at the request of the Governor. The WVHIN is a sub‐agency under the West Virginia Health Care Authority. The intent of the legislation was for the WVHIN “to promote the design, implementation, operation and maintenance of a fully interoperable statewide network to facilitate public and private use of health care information in the state”. With this authority, the WVHIN established a multi‐stakeholder board and has been working with stakeholders to develop and implement a state‐level HIE. . .

. . . With this mandate, the WVHIN established a vision to enable “high quality, patient centered care facilitated by health information technology”. The WVHIN mission is as follows: “The West Virginia Health Information Network provides the health care community a trusted, integrated and seamless electronic structure enabling medical data exchange necessary for high quality, patient‐centered care.” Guiding principles have been established around collaboration, facilitation of patient‐centric care, enabled participation by all providers, quality improvement, patient participation, privacy and security, and sustainability.

The WVHIN, along with health systems, physicians, other providers, payers, and consumers, has a unique opportunity to establish a state‐level HIE infrastructure that helps communities and regions share data across organizations. The WVHIN is well positioned to provide a cost‐effective HIE infrastructure that benefits from economies of scale while enabling communities to develop their own unique solutions. As a convener and collaborator, the WVHIN will build bridges between health care stakeholders to launch and fund HIEs. It will help communities address complex issues such as setting standards for interoperable data exchange, addressing liability, setting policies for privacy and security, and exchanging data across state lines. It will collaborate with other health information technology (HIT) and HIE initiatives such as the Regional Extension Center (REC) to be initiated, public health, Medicaid, and others, to leverage collective resources. WVHIN activities are being pursued within the parameters of the West Virginia Statewide Health Information Technology Strategic Plan. WVHIN is one of several participating entities that jointly developed the strategic plan.

A 1930 Medical Record

I was recently in my hometown of New Martinsville visiting my dad, a retired family physician. When I arrived he had waiting for me a copy of one of my grandfather's medical records from the 1930s. My grandfather, Dr. Albert Coffield, practiced rural medicine in Wetzel County, West Virginia from 1911 until his death in 1936.

My dad told me the following story about the medical record.

My dad was a doctor who practiced out of his house on Coffield Ridge in Wetzel County. After my dad died in 1936 our mother sold the household furnishing and his office equipment. I was 12 years old when he died and my older brother was a first year student at West Virginia University. Since my mother wasn't employed she decided to move us to Morgantown where the University was so that my older brother could continue his college education. As a way to continue the family income she rented rooms to college students - many who came to the University from Wetzel County.

Included in the sale of the household and office furnishing was a wooden credenza with metal alphabetized slides. Behind some of the slides were some old medical records that were left in the credenza.

Thirty years later a lady who was a patient of mine brought the wooden credenza to me and told me that she had bought the credenza at the auction of my family's household items in 1936. She told me that she thought I would appreciate having it.

Here are photos of the medical record of a patient from 1934. The medical record format is simple yet complete. It contains all the important demographic and clinical information - including the patient statement, habits, family history, past history, physician examination and diagnosis. On the back is additional space for notes and a drawing of the internal organs that I suspect was meant to be used with the patient for education and instruction. It even has a built in billing record section that even the change:healthcare crowd would love.

What can these photos tell us about the current health care reform debate. Compare these photos of a medical record from 1934 to those that cost .73 cents today. Could today's physician and his or her patient get "meaningful use" out of this record?

A close up of the billing section for the change:healthcare gang.

West Virginia H1N1 (Swine) Flu Resource Center

The West Virginia Department of Health and Human Resources (DHHR) unveiled a website for sharing information and updates specific to West Virginia about the H1N1 Flu also known as Swine Flu. The website has information for prevention, schools, businesses, parents and providers.

The new West Virginia H1N1 (Swine) Flu Resource Center can be found at www.wvflu.org. The website also has includes a link to the federal Flu.Gov website with national information.

Please spread the word about the new website (but don't spread the flu).

Create WV Conference 2009: A personal invitation to attend . . .

Over the last few years I have been involved in Create West Virginia, an organization affiliated with Vision Shared whose mission to create and stimulate new economy growth and empower West Virginians to grow creative communities in West Virginia. Communities centered on innovation, technology, entrepreneurship, education, quality of life and arts/culture.

Each year Create WV holds an annual conference. The first annual conference was held in 2007 and attracted approximately 250 attendees. Last year’s event held at Snowshoe Resort and attracted 395 attendees. This year’s Create West Virginia 2009 Conference is set for October 18-20 in Huntington, WV at the Big Sandy Arena.

I want to personally invite you to attend the Create West Virginia Conference 2009. Check out the keynote speakers and sessions.

A special attraction this year will be a live Mountain Stage performance on Sunday evening at the Keith Albee Theater featuring West Virginia native, Kathy Mattea, and The Songcatchers, The Ahs, Shannon Whitworth and Or, The Whale.

Click here for more information about the conference including how to register.

Feel free to forward a link of this invitation to others who you think might be interested in attending the conference.

Viral Health Effort Via Twitter: Fit West Virginia (#FitWV)

Dawn Miller of the Charleston Gazette highlights the ongoing Fit West Virginia (#FitWV) effort ongoing via Twitter in her op-ed piece, West Virginians try to tip scales on obesity.

The idea was born back on West Virginia Day as a result of Jason Keeling asking his blog readers to discuss solutions to West Virginia's problems in a post, West Virginia: Using Social Media for the Mountain State's Betterment. In response, Skip Lineberg of Maple Creative responded with his post, A Fitter West Virginia.

As a result of that "healthy idea seed" being planted a core group of West Virginia tweeters have been regularly posting on Twitter using the hashtag #FitWV. The effort has created a viral movement of West Virginians supporting other West Virginians in making health choices, exercising regularly, etc. Hopefully, this positive discussion is bringing about positive change and support to those participating.

As the country discussed health care reform efforts like #FitWV should be made a part of the equation. As Jordan Shlain, MD says in his recent op-ed over at The Health Care Blog:

. . . Nowhere in this debate is the patient, the consumer, and the citizen: the American! We lack accountability, responsibility and civic sensibility. It is Joe Diabetic that snacks on ice cream, misses appointments and doesn't take his insulin that increases the cost of health care. This diabetic will be admitted to your local ER with diabetic ketoacidosis and have many subsequent hospital admissions at our (read: your) expense, not his. This is a fundamental collective action problem.

Our town square is so big that we can get away with malfeasance to our village (and our country) with no shame. Yet, the forces of economics do not defy gravity and the cost of health care is now affecting all of us. Those of us that are untethered from the reality of cost are driving our health care 'car' into the ground. . .

If you use Twitter -- please join the effort.

Dawn Miller also provides a link to some great new information from the Centers for Disease Control. The CDC released last month "Recommended Community Strategies and Measurements to Prevent Obesity in the United States."

Ms. Miller writes:

The CDC did all the research and evaluation work, so individual communities don't have to. They assembled a group of people with experience in urban planning, nutrition, physical activity, obesity prevention and local government. The group reviewed a couple years' worth of research, evaluated various tactics and settled on 24 recommendations. For each one, the CDC summarizes the evidence behind it and suggests ways to measure progress. Communities should:

1. Make healthier food and drinks available in public places. Schools are key, but think also of after-school programs, child care centers, parks, playgrounds, swimming pools, city and county buildings, prisons and juvenile detention centers.

2. Make healthier food more affordable in those public venues. Lower prices, provide discount coupons or offer vouchers for healthy choices.

3. Improve the availability of full-service grocery stores in underserved areas. One study of 10,000 people showed that black residents in neighborhoods with at least one supermarket were more likely to consume the recommended amount of fruits and vegetables than those in neighborhoods without supermarkets. Residents consumed 32 percent more fruits and vegetables for each additional supermarket in their census tract.

More supermarkets also raised real estate values, economic activity and employment and lowered food prices.

4. Provide incentives to food retailers -- supermarkets, convenience stores, corner stores, street vendors -- to locate in underserved areas or to offer healthier food and drinks. Incentives can be tax benefits and discounts, loans, loan guarantees, start-up grants, investment grants for improved refrigeration, supportive zoning and technical assistance.

5. Make it easier to buy foods from farms.

6. Provide incentives for the production, distribution and procurement of foods from local farms.

Did you know that the United States does not produce enough fruits, vegetables and whole grains for every American to eat the recommended amount of these foods? Dispersing agricultural production throughout the country would increase the amount of available produce, improve economic development and contribute to environmental sustainability.

7. Restrict availability of less healthy foods and drinks in public places.

8. Offer smaller portion options in public places.

9. Limit advertisements of less healthy foods and drinks.

10. Discourage people from drinking sugar-sweetened beverages.

11. Support breastfeeding, which appears to provide some protection from obesity later in life.

12. Require physical education in schools.

13. Increase the amount of physical activity in school PE programs. Modify games so that more students are moving at all times, or switch to activities in which all students stay active. Improving phys ed improves aerobic fitness among students.

14. Increase opportunities for extracurricular physical activity.

15. Reduce screen time in public settings. TV and computer time displaces physical activity, lowers metabolism, increases snacking and exposes children to marketing of fattening foods.

16. Improve access to outdoor recreational facilities, such as parks, green spaces, outdoor sports fields, walking and biking trails, public pools and community playgrounds. Access also depends on how close such places are to homes and schools, cost and hours of operation.

17. Support bicycling. Create bike lanes, shared-use paths and routes on existing and new roads. Provide bike racks near commercial areas. Improving bicycling infrastructure can increase how often people bike for utilitarian purposes, such as going to work and school or running errands.

18. Support walking. Build sidewalks, footpaths, walking trails and pedestrian crossings. Improve street lighting, make crossings safer, use traffic calming approaches. Walking is a regular activity of moderate intensity that a large number of people can do.

19. Locate schools within easy walking distance of residential areas.

20. Improve access to public transportation to increase biking and walking to and from transit points.

21. Zone for mixed-use development, including residential, commercial, institutional and other uses. This cuts the distance between home and shopping, for example, and encourages people to make more trips by foot or bike.

22. Enhance personal safety in areas where people are or could be physically active.

23. Enhance traffic safety in areas where people are or could be physically active.

24. Participate in community coalitions or partnerships.

WV Medicaid Redesign Program: New Report Examines The Mountain Health Choices Program

A new report prepared by West Virginia University researchers examines the the Mountain Health Choices Program, one of the two redesigned West Virginia Medicaid plans to target improving the long-term health of West Virginia Medicaid beneficiaries through engaging beneficiaries to become more involved in their health care.

Today's Charleston Gazette reports on the release and outcome of the report. The Gazette describes the program as follows:

"The program created a two-tier system in which people who agreed to sign pledges committing them to certain behaviors like visiting the doctor more frequently were enrolled in an enhanced plan with more perks than traditional Medicaid offered. Those who didn't sign the agreements are enrolled in a basic plan, with fewer benefits than traditional Medicaid."

The report, Mountain Health Choices Beneficiary Report - A Report to the West Virginia Burea for Medical Services was released this week at the West Virginia Health Improvement Institute meeting. The report was prepared by the Bureau of Business and Economic Research.

West Virginia Health Care Authority Revises Fee Schedule for Certificate of Need Program

On July 15, 2009, the West Virginia Health Care Authority filed with the West Virginia Secretary of State proposed amendments to the its procedural rule regarding the schedule of fees for the filing of certificate of need applications and exemption requests under the West Virginia Certificate of Need Program.

The amendment revises the fee schedule pursuant to Senate Bill 321 passed during the 2009 Legislative Session. The amendment required the fee schedule contain a maximum amount or cap for certificate of need application fees.

The proposed rule, Fee Schedule for Certificate of Need Matters, CSR 65-10 (redline version showing amendments) has been filed with the West Virginia Secretary of State. Written comments to the proposed rule may be submitted to the Authority before August 14, 2009 at 5:00 p.m.

WV Northern District Court: Attorney Filing Manual

Brian Peterson highlights a great resource for lawyers who regularly practice in the United States District Court for the Northern District Court of West Virginia.

The Attorney Filing Manual is a 20 page manual that provides guidance to lawyers on how to e-file certain types of documents wth the Court. The manual explains when documents should be filed electronically and the exceptions to the mandatory electronic filing requirements. The manual contains specifics on the filing of all types of pleadings and provides sample certificate of services format for electronic filing.

The manual also discussed the use of "hyperlinks" in documents and allows electronically filed documents to contain hyperlinks to other portions of the document or to internet sites that contain source documkents for citations. However, the manual states that hyperlinks do not replace standard citations format and "neither the hyperlink, or any site to which it refers, shall be considered part of the record."

Proposed Certificate of Need Rule: Hospital Ambulatory Health Care Facility

On June 8, 2009, the West Virginia Health Care Authority filed a proposed legislative rule with the Secretary of State and Legislative Rule-Making Review Committee titled Hospital Ambulatory Health Care Facilities. CSR 65-27. The official notice can be found in the June 12, 2009 issue of the West Virginia Register.

The proposed rule impacts the procedure used by West Virginia hospitals to obtain approval prior to developing an ambulatory health care facility. The proposed legislative rule establishes the circumstances and procedures by which a certificate of need may not be required for the construction, development, acquisition or other establishment by a hospital of an ambulatory health care facility. The proposed rule sets out exemption criteria and the exemption procedure.

The Authority established a comment period for interested parties to submit comments concerning the  proposed rule. Written comments must be submitted to the Authority before July 8, 2009 at 5:00 p.m.

West Virginia Lawyer Disciplinary Board Issues Legal Ethics Opinion on Metadata

On June 10, 2009, the West Virginia Lawyer Disciplinary Board issued Legal Ethics Opinion 2009-01 (What is Metadata and Why Should Lawyers Be Cautious?) to raise awareness among lawyers to be cautious when dealing with metadata. The opinion describes "metadata" as the data behind the data - including the location where the document is created, opened or saved, author's identity, number of revisions, comments and redlining.

The opinion concludes that lawyers have a duty on both ends. The lawyer sending electronic information has the burden of understanding what information may be contained in the electronic document and take reasonable steps to protect metadata in transmitted documents. Likewise, the receiving lawyer has the duty and burden when receiving inadvertently provided metadata to consult with the sender and abide by the senders instructions before reviewing such metadata.

The opinion also points out that different rules on removing metadata apply in the context of responding to discovery responses and subpoenas. In this case the electronic documents may be tangible evidence and the rules of professional conduct may prohibit the removal of metadata, subject to an assertion that the metadata is privileged.

More thoughts on the metadata opinion by Brian Peterson at West Virginia Legal Weblog.

The West Virginia Lawyer Disciplinary Board also issued Legal Ethics Opinion 2009-02 (Wholly-Owned Subsidiary Law Firms) on June 10, 2009. This opinion looks at the question of whether one law firm can organize a wholly-owned subsidiary law firm. The Board concluded that law firms are allowed to form wholly-owned subsidiary entities but cautioned that law firms should keep these entities transparent and fully disclose to the public and clients the relationship among the seperate entities.

were passed by the Lawyer Disciplinary Board at its June 5, 2009 meeting and entered on June 10, 2009. Click here 2009-01 and 2009-02 for the full Opinions.

Modern Day Hatfield-McCoy: Google Health and Microsoft HealthVault

The Hatfields and McCoys, a metaphor for a modern day high-tech industry rivalry centered on personal health records (PHRs) involving Google Health, Microsoft HealthVault and other PHR vendors. An image that a West Virginia health care lawyer can really appreciate.

Thanks to a tweet by @2healthguru for pointing out the CNET article, Microsoft, Google in healthy competition. The article provides a good overview of the developing PHR movement and some insight into the future. However, I'm a bit concerned by the accuracy of the article when I see two of the individuals mentioned in the article (Matthew Holt and Dave deBronkart) tweeting (here and here) that they weren't really interviewed for the article.

Later this week I will be in D.C.along with others testifying at the Hearing on Personal Health Records before the National Committee on Vital and Health Statistics (NCVHS), Subcommittee on Privacy, Confidentiality and Security . The Subcommittee is looking at the future of the PHR marketplace and consumer-facing health information technology.

The story of the Hatfield-McCoy feud is woven into the fabric of southern West Virginia lore along the Tug River and well known by all West Virginians. Above is a photo of the West Virginia Hatfield clan around 1897, led by Devil Anse Hatfield, second from the left. For more history and photos check out the West Virginia Division of Culture and History.

Note: If you are into off-road vehicle trails, come visit West Virginia and check out the modern day version -- the Hatfield-McCoy Trails.

Charleston FestivALL 2009: A City Becomes A Work Of Art

The preliminary lineup of events for Charleston FestivALL 2009 was announced today. Ten days of music, art, theater, entertainment, creativity and fun bring the city of Charleston alive from June 19 - 27, 2009. Where the city become a work of art!

As many of my friends, colleagues and regular readers know I love the Charleston FestivALL (my past posts) and am already excited about this years expanded ten day event. The event highlights why I love West Virginia and its creative powers and people. To experience a visual understanding of this feeling check out FestivALL from 2006-2009 through the eye of Rick Lee.

The image above will be a part of the official FestivALL 2009 poster. This year's poster, conceived and designed by Alex Morgado, is a symbol of the FestivALL idea. Local artists have contributed designs for letters. At the opening ceremonies, each letter will be taken to a different part of the city where it will be displayed during the ten days of FestivALL. At the end, they will be gathered and displayed together.

Check out the schedule of events (and pre-festival events) by FestivALL Executive Director, Larry Groce. Also, the lineup was announced in today's Charleston Gazette. Last year there were 83 different events featuring 169 performances, exhibitions and presentations by 378 companies, troupes and individual artists.

UPDATE (5/12/2009): FestivALL has launched its new web site which includes a full 2009 schedule. The web site has a cool and creative roll over of the artwork, "A City Becomes A Work Of Art." Check it out.

WV Senator Rockefeller: The Health Information Technology Public Utility Act of 2009

Yesterday West Virginia Senator Jay Rockefeller introduced "The Health Information Technology Public Utility Act of 2009"(Senate Bill 890) to facilitate the nationwide adoption of electronic health records (EHRs) though an "open source" public utility model.

A copy of Senate Bill 890 is available on Thomas (GPO PDF version).  According to the press release the Act would:

• Create a new federal Public Utility Board within the Office of the National Coordinator for Health IT to direct and oversee formation of this HIT Public Utility Model, its implementation, and its ongoing operation.
• Implement and administer a new 21st Century Health IT Grant program for safety-net providers to cover the full cost of open source software implementation and maintenance for up to five years, with the possibility of renewal for up to five years if required benchmarks are met.
• Facilitate ongoing communication with open source user groups to incorporate improvements and innovations from them into the core programs.
• Ensure interoperability between these programs, including as innovations are incorporated, and develop mechanisms to integrate open source software with Medicaid and CHIP billing.
• Create a child-specific Electronic Health Record (EHR) to be used in Medicaid, CHIP, and other federal children’s health programs.
• Develop and integrate quality and performance measurement into open source software modules.