CMS issues final rule to provide patients with access to health data

Agency codifies MyHealthEData initiative and makes changes to Promoting Interoperability Programs, formerly known as Meaningful Use.

The Centers for Medicare and Medicaid Services on Thursday finalized a rule designed to put patients in control of their own health data and to overhaul the Meaningful Use program.

In March, CMS announced at the HIMSS18 conference the launch of the MyHealthEData initiative—led by the White House Office of American Innovation—to ensure patients have access to their full healthcare records and can decide how their data is used.

Thursday’s release of the final FY 2019 Inpatient Prospective Payment System and the Long-Term Care Hospital Prospective Payment System rule codifies MyHealthEData and makes changes to the Medicare and Medicaid Promoting Interoperability Programs (formerly known as Meaningful Use) by placing an emphasis on measures that require the exchange of health information between providers and patients.

“The policies released today begin implementing core pieces of the White House-led MyHealthEData initiative through several steps to strengthen interoperability,” said CMS in Thursday’s announcement. “In the IPPS/LTCH PPS final rule, CMS overhauls the Medicare and Medicaid Promoting Interoperability Programs…to make the program more flexible and less burdensome; emphasize measures that require the exchange of health information between providers and patients; and incentivize providers to make it easier for patients to obtain their medical records electronically.”

Also See: Fed initiative to put patients in control of their health data

In an effort to ensure that data follows the patient and is in a usable and secure electronic format, the CMS rule finalized the requirement for providers to use 2015 Edition Certified EHR Technology (CEHRT) beginning in 2019. The updated 2015 Edition CEHRT includes technical requirements focused on interoperability and the ability of patients and their care teams to share healthcare data more effectively through application programming interfaces.

“The final rule reiterates the requirement for providers to use the 2015 Edition of certified electronic health record technology in 2019 as part of demonstrating meaningful use to qualify for incentive payments and avoid reductions to Medicare payments,” the CMS rule states.

“This updated technology includes the use of application programming interfaces (APIs), which have the potential to improve the flow of information between providers and patients,” the agency added. “APIs can enable patients to collect their health information from multiple providers and incorporate it into a single portal, application, program or other software. This will support a patient’s ability to share their information with another member of their care team or with a new doctor, which can reduce duplication and encourage continuity of care.”

Among other key provisions, the rule finalizes an EHR reporting period of a minimum of any continuous 90-day period in each of calendar years 2019 and 2020 for new and returning participants attesting to CMS or their state Medicaid agency. In addition, for the Medicare Promoting Interoperability Program, the final rule includes a new performance-based scoring methodology consisting of a smaller set of objectives that will “provide a more flexible, less burdensome structure allowing eligible hospitals and critical access hospitals to place their focus back on patients,” according to CMS.

For eligible hospitals and CAHs that report electronic clinical quality measures (eCQMs), the reporting period for the Medicare and Medicaid Promoting Interoperability Programs has been finalized as one, self‑selected calendar quarter of CY 2019 data, reporting on at least four self-selected eCQMs from a set of 16.

“In this rule, CMS finalizes the submission period for the Medicare Promoting Interoperability Program as the two months following the close of the Calendar Year 2019, ending February 29, 2020,” states the agency. “In addition, beginning with the reporting period in 2020, we will remove eight of the 16 eCQMs, consistent with CMS’ commitment to producing a smaller set of more meaningful measures that are also in alignment with the Hospital Inpatient Quality Reporting (IQR) Program.”

The final rule also includes two new electronic prescribing measures related to e-prescribing of opioids.

The Query of PDMP measure will be optional in CY 2019 and will be required beginning in CY 2020,” according to CMS. “This will allow additional time to develop, test and refine certification criteria and standards and workflows, while taking an aggressive stance to combat the opioid epidemic. The Verify Opioid Treatment Agreement will be optional for both CYs 2019 and 2020. We believe that extending the optional reporting status will allow healthcare providers additional time to research and implement methods for verifying the existence of an opioid treatment agreement, expansion of the use of such agreements in practice, and development of system changes and clinical workflows.”

A fact sheet on the FY 2019 IPPS/LTCH PPS final rule is available here.

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