Updated Meaningful Use Rules Released

After months of waiting, CMS and ONC finally issued final rules (with comment) pertaining to Stage 3 Meaningful Use, 2015-2018 EHR Incentive Program and 2015 edition of CEHRT certification.  CMS announced that the rules, numbering 750+ pages, are designed to “simplify requirements and add new flexibilities for providers to make electronic health information available when and where it matters most.”  CMS’ announcement also signaled more rules to come, CMS has opened a 60-day comment period for additional feedback about the EHR Incentive Programs and in particular the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), “which established the Merit-based Incentive Payment System and consolidates certain aspects of a number of quality measurement and federal incentive programs into one more efficient framework.” Expected release for MACRA is spring 2016.

Highlights of the final rule include:

  • 2015 reporting for EPs and EHs is any continuous 90 day period within CY 2015 by Feb. 29. 2016, which may be extended to March if providers need additional time.
  • 2016 & 2017 new Medicare and Medicaid providers (and 2018 Medicaid providers) may report on any 90 days.
  • Most changes in the rule will not be required until 2018 (but providers who are ready may transition to the next phase in 2017).
  • 2015-2017 EPs will report on 10 objectives, EHs on 9 objectives, including one public health reporting objective.
  • Modified patient action measures in Stage 2 objectives.
  • 90 day reporting period for any provider moving to Stage 3 in 2017.
  • Finalization of the use of application program interfaces (APIs) which allow the use of new programs/functions that will help patients have access to their healthcare records, including on mobile devices.
  • Focus on interoperability in Stage 3 rules.

The final rules will be officially published in the Federal Register on October 16, 2015.

For more information regarding the EHR Incentive Program and these new rules please contact Elana Zana.

Meaningful Use Attestation in 2014 – Picture Update

CMS and the Office of the National Coordinator (ONC) recently announced modifications to the meaningful use attestation requirements for 2014. Following significant lobbying from EHR vendors, eligible professionals (EPs), and hospitals, CMS issued a brief reprieve to meeting Stage 2 meaningful use in 2014 – for some lucky participants. Recognizing that EPs and hospitals may still be using 2011 certified EHR technology (CEHRT) or a mixture of 2011 and 2014 CEHRT, CMS created a chart of decision points meant to enable flexibility for EPs and hospitals alike. These options also accommodate EPs and hospitals that have upgraded to the 2014 CEHRT but are still unable to meet the Stage 2 requirements within the mandatory timetables.

However, this flexibility comes with a caveat: EPs and hospitals must explain that their failure to meet Stage 2 in 2014 as scheduled is because they could not “fully implement 2014 Edition CEHRT for the EHR reporting period in 2014 due to delays in 2014 Edition CEHRT availability.” So who is allowed to claim this exception? Though CMS does not provide an exhaustive list of examples, its published comments in the final rule provide some insights and helpful explanations.

Below are maps of decision points and examples of acceptable and unacceptable justifications for not meeting an EP’s scheduled meaningful use stage in 2014, whether it be the 2014 Stage 1 or Stage 2 objectives and measures. Any EPs or hospitals that attest for a different stage than what they were scheduled for must be prepared to defend this decision in an audit, understanding that each case will be evaluated individually; this defense should therefore be very well documented.

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Michelle Holmes, consultant with ECG Management Consultants co-authored this post.