On Friday, August 29 the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released a final rule modifying the Medicare and Medicaid Electronic Health Record Incentive program for 2014, and making other changes to the program. The new rule, which is scheduled for publication in the Federal Register September 4 and will be effective as of October 1, is available here. CMS's press release on the rule is here. CMS has also published a quick guide to the rule.

The new rule provides flexibility for the 2014 reporting period for providers who have been unable to implement 2014 Edition certified EHR technology due to delays in the availability of EHR technology certified to the 2014 standards. It also finalizes the extension of Stage 2 of the incentive program through 2016 for certain providers, and announces the Stage 3 timeline, which will begin in 2017 for providers who first became meaningful EHR users in 2011 or 2012.

Flexibility of Implementation of 2014 Edition Certified EHR Technology

In September, 2012 the Department of Health and Human Services issued a final rule adopting EHR certification criteria for 2014. At the same time, CMS issued a final rule specifying Stage 2 criteria that eligible providers must meet to qualify for meaningful use payments. In the new rule, CMS acknowledges that some EHR vendors had insufficient time to make the changes necessary to conform to the 2014 EHR certification criteria, and that this resulted in delays in certification and in implementation by providers. In particular, CMS received feedback that the amount of time available after the publication of the Stage 2 final rule was too short for many EHR vendors to make the coding changes required for 2014 edition certification, and due to a backlog, many EHR products were certified later than anticipated. CMS states that the modification in the new rule is intended to provide:

relief to those providers . . . where their vendors did not have 2014 CEHRT ready, and therefore would be unable to meet meaningful use for an EHR reporting period in 2014. These providers would otherwise not be participating in the program which would weaken the overall momentum and diminish essential program goals.

CMS says that the modification provides flexibility that will allow more providers to participate and meet important meaningful use objectives like drug interaction and drug allergy checks, providing clinical summaries to patients, electronic prescribing, reporting on key public health data and reporting on quality measures.

The flexibility applies only to 2014 reporting periods. For Stage 1, the rule now allows providers who could not fully implement 2014 Edition certified EHR technology due to delays in availability, and who use only 2011 Edition certified EHR technology, to satisfy the 2013 Stage 1 criteria. If a provider uses a combination of 2011 and 2014 Edition technology , it may choose to satisfy the 2013 or 2014 Stage 1 criteria.

A provider scheduled to begin Stage 2 in 2014 that is unable to fully implement all the functions of 2014 Edition certified EHR technology required for the Stage 2 has the same options, with the additional alternative of implementing the Stage 2 criteria if it uses 2014 Edition technology, or a mix of 2011 and 2014 Edition technology.

All eligible providers are required to use the 2014 Edition certified EHR technology in 2015. CMS's press release contains a chart summarizing the options.

A provider that takes advantage of this flexibility will be required to attest that it is unable to fully implement 2014 Edition certified EHR technology for an EHR reporting period in 2014 due to delays in 2014 Edition certified EHR technology availability.

Extension of Stage 2 and Stage 3

CMS has extended Stage 2 of the EHR Incentive Program for one year, through 2016, for those providers that first became meaningful users in 2011 or 2012. Stage 3 will also now begin in 2017 for those providers. The goals for these extensions are to focus efforts on the enhanced patient engagement, interoperability, and health information exchange requirements of Stage 2, and to allow CMS to analyze data from Stage 2 to inform development of the criteria for Stage 3. However, CMS is maintaining the existing timeline for providers that first became meaningful users in 2013 or subsequent reporting periods, until or unless different requirements are adopted by rulemaking. CMS's press release contains an updated meaningful use timeline, which indicates the stage that a provider must meet depending on its initial year of participation in the EHR Incentive Program.

Hooper, Lundy & Bookman assists clients with a range of information technology and reimbursement matters, including technology licensing and meaningful use incentive payments.

For more information, please contact: In San Francisco, Paul Smith, Steve Phillips or Katrina Pagonis; in Los Angeles, Hope Levy-Biehl or Amy Joseph; and in Washington, D.C., Bob Roth.

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