CMS Issues Final Rule to Advance Interoperability

WASHINGTON, D.C. (April 28, 2020)—On March 9, 2020, both the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued for display on the ONC website final rules that advance the goals of interoperability of electronic health care records (EHR). On April 22, 2020 these rules went on display at the federal register (FR) and will be published in the FR on May 1, 2020.

The National Association for Home Care & Hospice (NAHC) addressed the Final Rule in an April 24 article: “Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-facilitated Exchanges, and Health Care Providers”; also referred to as the “Interoperability and Patient Access” final rule.

CMS modified implementation dates for several of the provisions of the final rule to provide flexibility related to the COVID-19 public health emergency (PHE).

The rule requires new policies for CMS regulated payers, specifically, Medicare Advantage organizations, Medicaid Fee- for-Services (FFS), Medicaid managed care, Children Health Insurance Program (CHIP) FFS programs, CHIP managed care entities, and Qualified Health Plans (QHP) on the Federally-facilitated Exchanges(FFE), with some exceptions for the QHPs.

Beginning Jan. 1, 2021, the stated payers will be required to implement and maintain a secure, standards-based application programming interface(API) that allows patients to easily access their claims and encounter information, and except for QHP on FFEs, be required to make provider directory information publicly available via a standards-based API. In response to the PHE, CMS is exercising its enforcement discretion to extend these requirements by six months or until July 1, 2020.

Beginning on Jan. 1, 2022, payers will be required to exchange certain patient clinical data at the patient’s request, allowing the patient to take their information with them as they move from payer to payer over time to help create a cumulative health record with their current payer. Starting on April 1, 2022, State Medicaid offices will be required to exchange certain enrollee data for individuals dually eligible for Medicare and Medicaid to CMS on a daily basis to ensure beneficiaries are getting access to appropriate services and that these services are billed appropriately the first time.

In late 2020, CMS will publicly report eligible clinicians, hospitals and critical access hospitals (CAHs) that may be information blocking based on how they attested to certain Promoting Interoperability Program requirements. Also in late 2020, CMS will begin publicly reporting in those providers who do not list or update their digital contact information in the National Plan and Provider Enumeration System (NPPES). This includes providing digital contact information such as secure digital endpoints.

CMS is modifying the Conditions of Participation (CoPs) to require hospitals, including psychiatric hospitals and CAHs to send electronic patient event notifications of a patient’s admission, discharge, and/or transfer to another healthcare facility or to another community provider or practitioner. This policy will be applicable 12 months after publication of this rule in the federal register.

None of the provisions in the final rule would require home health or hospice agencies to adopt an EHR, even those post-acute care providers that hospitals are required to send patient event notifications.

“this … standard takes into account the fact that some recipients may not be able to receive patient event notifications, or may not be able to receive notifications in a manner consistent with a hospital system’s capabilities, and the fact that hospitals and CAHs may not be able to identify provider recipients for some patients. We expect that surveyors will evaluate whether a hospital is making a reasonable effort to send patient event notifications while working within the constraints of its existing technology infrastructure,” the rule reads.