Washington Debrief: Industry Hopes Substantial MU Changes for Stage 3 Proposed Rules

Jan. 12, 2015
Stage 3 proposed rules are currently under review at the Office of Management and Budget (OMB) – the last stop before being released for public comment. A description accompanying the rules suggest that Centers for Medicare and Medicaid Services (CMS) may revise the 2015 reporting period, change program timelines and propose a new single definition for Meaningful Use.
Top News
Industry Hopeful for Substantive MU Changes with Stage 3 Proposed Rules
Key Takeaway:  Stage 3 proposed rules are currently under review at the Office of Management and Budget (OMB) – the last stop before being released for public comment.  A description accompanying the rules suggest that Centers for Medicare and Medicaid Services (CMS) may revise the 2015 reporting period, change program timelines and propose a new single definition for Meaningful Use.
Why it Matters:  The Stage 3 Notice for Proposd Rulemaking (NPRM) process is the most likely vehicle CMS and Office of the National Coordinator for Health IT (ONC) could use to make changes that CHIME and other stakeholders have been advocating.  This is the best chance to make substantive changes to meaningful use and revive an ailing program.
Industry observers were propelled into activity during the first week of 2015, as federal officials indicated that rules for Stage 3 Meaningful Use were one step from being unveiled.  The Office of Management and Budget began reviewing both the CMS and ONC rules proposing the contours of Stage 3 and a new Edition of Certified EHR Technology (CEHRT).  According to notes accompanying the rules, CMS is proposing Stage 3 criteria that will focus “on advanced use of EHR technology to promote improved outcomes for patients.” The notes go on, stating “Stage 3 will also propose changes to the reporting period, timelines, and structure of the program, including providing a single definition of meaningful use.  These changes will provide a flexible, yet, clearer framework to ensure future sustainability of the EHR program and reduce confusion stemming from multiple stage requirements.”
Industry observers were quick to note that these changes could be the very things that CHIME and other stakeholders have been advocating for nearly a year.  Specifically, CHIME will be looking for the following changes:
A shortened, 90-day EHR reporting period in 2015;
90-day EHR reporting period options for any provider in their first year of a new Stage;
An extension to Stage lengths, so providers may have three years at each Stage;
Changes to the “all-or-nothing” construct for providers who miss a limited number of objectives – especially now that MU has entered its penalty phase; and
A policy pathway that lessens the compliance burden for providers post-Stage 3.
The proposed rules are not expected until early to mid-February.
Legislation & Politics
Senators Request GAO Review of Federal HIE Grants
Key Takeaway: Three members of the Senate Health, Education, Labor and Pensions (HELP) and authors of the “Reboot” report requested the Government Accountability Office (GAO) review the use of the nearly $600 million in federal grants dedicated to the establishment health information exchanges (HIEs) nationwide.
What It Matters: In the latest example of Congressional interest in the health IT space, Senators Lamar Alexander (R-TN), Richard Burr (R-NC), and Mike Enzi (R-WY) requested a review of what resulted from ONC’s $564 million grant program to help states build the health information exchanges. With the perceived lack nationwide interoperability, the Senators are questioning the value of the government’s robust financial investment.
HIEs have been instructed to develop their own solvency models now that federal funds have been exhausted, these three Senators, including Senator Alexander, the new Chairman of the powerful HELP Committee, are requesting the GAO examine the ONC grants intended establish health information exchanges that in many cases have failed. The GAO review is now underway.
Administration
CMS Extends ICD-10 End-to-End Testing Opportunity for Providers
Key Takeaway:  CMS officials extended their call for volunteer providers to perform end-to-end testing for ICD-10.  Providers now have until January 21 to register for testing to be done in late April.
Why it Matters:  The additional time should encourage more providers to test their systems’ readiness for ICD-10, which will be enforced October 1, 2015.  
According to CMS officials, the goal of end-to-end testing is to demonstrate that providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems; to help CMS test its software changes and to ensure that accurate remittance advices are produced.  To volunteer as a testing submitter:
Volunteer forms are available on your MAC website.
Completed volunteer forms are due January 21.
CMS will review applications and select the group of testing submitters.
By February 13, the MACs and CEDI will notify the volunteers selected to test and provide them with the information needed for the testing.
The April session is the second of three planned testing periods. Results from the first round of end-to-end testing are expected by the end of February.

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