HHS Releases Final Interoperability Rules
March 2020 ~
CMS and the Department of Health & Human Services (HHS)’ Office of the National Coordinator for Health Information Technology (ONC) have released two interoperability rules. The new rules aim to make it easier for patients to access and share their information and aim to end information blocking by requiring public and private entities to securely share health information with patients and penalize those who fail to do so.
According to the HHS press release, the two rules implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act (Cures Act) and support the President’s MyHealthEData initiative. As stated in the release, the final rules deliver on the Administration’s promise to put patients at the center of their care by promoting patient access and the use of their personal health information and spurring the use of and development of new smartphone applications.
Cures Act Final Rule
The ONC’s Cures Act Final Rule identifies and finalizes the reasonable and necessary activities that do not constitute information blocking (outlining eight exceptions) while establishing new rules to prevent “information blocking” practices (e.g., anti-competitive behaviors) by healthcare providers, developers of certified health IT, health information exchanges, and health information networks as required by the Cures Act.
The rule calls on the healthcare industry to adopt standardized application programming interfaces (APIs), which will help allow individuals to securely and easily access structured electronic health information using smartphone applications. The ONC rule updates certification requirements for health IT developers and establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security including (with limitations) screenshots and video, which are critical forms of visual communication for such issues.
The ONC final rule also includes a provision requiring that patients can electronically access all of their electronic health information (EHI), structured and/or unstructured, at no cost. Under the rule, electronic health records are required to provide the clinical data necessary, including core data classes and elements, to promote new business models of care. This rule advances common data through the U.S. Core Data for Interoperability (USCDI). The USCDI is a standardized set of health data classes and data elements that are essential for nationwide, interoperable health information exchange. The USCDI includes “clinical notes,” allergies, and medications among other important clinical data, to help improve the flow of electronic health information and ensure that the information can be effectively understood when it is received. It also includes essential demographic data to support patient matching across care settings.
CMS Interoperability and Patient Access Final Rule
Building on the foundation established by ONC’s final rule, the CMS Interoperability and Patient Access Final Rule (CMS-9115-F) requires health plans in Medicare Advantage, Medicaid, CHIP, and through the federal Exchanges to share claims data electronically with patients. The final rule sets in place new policies that give patients access to their health information and moves the healthcare system toward greater interoperability. These new policies include:
- Patient Access API (applicable January 1, 2021)
- Provider Directory API (applicable January 1, 2021)
- Payer-to-Payer Data Exchange (applicable January 1, 2022)
- Improving the Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges (applicable April 1, 2022)
- Public Reporting and Information Blocking (applicable late 2020)
- Digital Contact Information (applicable late 2020)
- Admission, Discharge, and Transfer Event Notifications (applicable fall 2020)
Beginning January 1, 2021, Medicare Advantage, Medicaid, CHIP, and, for plan years beginning on or after January 1, 2021, plans on the federal Exchanges will be required to share claims and other health information with patients in a safe, secure, understandable, user-friendly electronic format through the Patient Access API.
The Patient Access API will allow patients to access their data through any third-party application they choose to connect to the API and could also be used to integrate a health plan’s information to a patient’s electronic health record (EHR). By requiring their relevant health information including their claims to be shared with them, patients can take this information with them as they move from plan to plan, and provider to provider throughout the healthcare system.
To further advance the mission of fostering innovation, the CMS final rule establishes a new Condition of Participation (CoP) for all Medicare and Medicaid participating hospitals, requiring them to send electronic notifications to another healthcare facility or community provider or practitioner when a patient is admitted, discharged, or transferred. These notifications can facilitate better care coordination and improve patient outcomes by allowing a receiving provider, facility, or practitioner to reach out to the patient and deliver appropriate and timely follow-up care.
Additionally, CMS is requiring states to send enrollee data daily, beginning April 1, 2022, for beneficiaries enrolled in both Medicare and Medicaid, improving the coordination of care for this population. This ensures beneficiaries are getting access to appropriate services and that these services are billed appropriately the first time, eliminating waste and burden.
For more information, see the ONC Final Rule, the CMS Final Rule Fact Sheet, CMS Final Rule, and the ONC Final Rule.
Source(s): U.S. Department of Health & Human Services; Modern Healthcare; Fierce Healthcare; HIPAA Journal; Health Leaders Media; HealthcareDIVE; HIT Consultant;