With participation in Stage 2 of the electronic health records program nearly dormant and many providers still having problems with Stage 1, the federal government is making big changes.

How big? Here is the opening sentence of a proposed rule issued late in the day on May 20: “This proposed rule would change the meaningful use stage timeline and the definition of certified electronic health record technology. It would also change the requirements for the reporting of clinical quality measures for 2014.”

The Centers for Medicare and Medicaid Services in December 2013 announced it would add a third year to Stage 2 in 2016 and delay the start of Stage 3 to 2017. The new proposed rule formalizes that intention, according to the agency. Providers in the proposed rule are being offered substantial new flexibility in using meaningful use criteria from 2011, 2013 and 2014 to attest for Stages 1 or 2 in 2014. In short, if a provider can’t fully implement 2014 criteria in 2014, they can attest using 2011 criteria that includes enhanced criteria under a 2013 upgrade of 2011.

The new proposed rule acknowledges that many software vendors have had difficulty making changes to their EHR products, getting the products certified and then getting customers upgraded under the timetable given in the Stage 2 final rule. “Under this proposal, valid only for the 2014 reporting year, providers would be able to use 2011 Edition CEHRT for either Stage 1 or Stage 2, would have the option to attest to the 2013 definition of meaningful use core and menu objectives, and use the 2013 definition CQMs,” according to a CMS statement.

Here is how the proposed rule interprets the above statement:

“In an effort to grant more flexibility to providers who have experienced 2014 Edition CEHRT product availability issues that impact the ability to fully implement 2014 Edition CEHRT to attest to meaningful use using 2014 Edition CEHRT, we are proposing the following changes for the Medicare and Medicaid EHR Incentive Programs for 2014 for providers that are not able to fully implement 2014 Edition CEHRT for a full EHR reporting period in 2014,” according to the rule.

“We are proposing to allow these EPs, eligible hospitals and CAHs that could not fully implement 2014 Edition CEHRT for the 2014 reporting year due to delays in 2014 Edition CEHRT availability to continue to use 2011 Edition CEHRT or a combination of 2011 Edition and 2014 Edition CEHRT for the EHR reporting periods in CY 2014 and FY 2014, respectively. These proposed alternatives are for providers that could not fully implement 2014 Edition CEHRT to meet meaningful use for the duration of an EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.

“We are proposing this change for 2014 only,” the proposed rule continues. “We will maintain the existing policy that all providers must use 2014 Edition CEHRT for the EHR reporting periods in CY 2015, FY 2015, and in subsequent years or until new certification requirements are adopted in subsequent rulemaking. We strongly recommend eligible professionals, eligible hospitals and CAHs that have not yet purchased EHR technology to obtain 2014 Edition CEHRT as these providers will still need to use 2014 Edition CEHRT for their EHR reporting period in 2015 as stated earlier.”

However, this flexibility is only for providers attesting under the Medicare incentive program. Providers seeking to qualify for Medicaid meaningful use in 2014 “must adopt, implement, or upgrade to 2014 Edition CEHRT only.”

The proposed rule, available for viewing now and being published on May 23, is here.

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