Washington Debrief: Meaningful Use Rulemaking at Forefront of Public Policy Activities

Sept. 28, 2015
In a meeting with high-level administration officials last Friday, CHIME emphasized that a final rule modifying parts of Stage 2 needs to be published immediately.

Federal Affairs

CHIME Meets with Top Officials on Meaningful Use

Key Takeaway: In a meeting with high-level administration officials last Friday, CHIME emphasized that a final rule modifying parts of Stage 2 needs to be published immediately in order to ensure that hospitals and other providers are best positioned to meet meaningful use in 2015.

Why It Matters: CHIME’s public policy team met with key decision-makers within the administration on meaningful use. We highlighted the impressive strides providers have made to date in meeting the program's requirements and the significant investments that have been made in critical health IT software and infrastructure. We championed the need to:

  • Continue building on these successes by making the meaningful use program more flexible 
  • Immediately release the "modifications" regulation which makes critical changes necessary to meet Stage 2
  • Hold off on finalizing the Stage 3 and version 2015 certification rules

Regarding Stage 3, we explained that a delay is necessary in order to build a framework that, among other things, promotes interoperability, better supports outcome measures, reflects participation in other programs like the Million Hearts campaign, and otherwise looks for ways to reduce regulatory burden. The goal should be to leverage technology to best help providers deliver better care.  

We continue to emphasize that several measures are outside of a provider's direct control, such as use of the patient portals. These requirements place an unfair burden on providers and put many in jeopardy of payment penalties should they not be in compliance.  CHIME stands ready to continue helping the administration identify ways to maximize the investments made to date on health IT and look for ways EHRs and other technology can be implemented in a thoughtful manner. For a legislative update, see the Congressional Affairs section below.

Leslie Kriegstein

CMS Announces New Vendor-Related Meaningful Use Hardships

Key Takeaway: Late last week, CMS announced two new scenarios that qualify providers for a meaningful use hardship exception involving their EHR products.  

Why It Matters: These changes follow almost two years of aggressive advocacy during which CHIME and others have pushed the administration to acknowledge there are situations outside the provider's control which can prevent them from meeting the meaningful use requirements despite every best effort.

CMS will allow providers to file for an exception in situations where they have changed vendors and doing so precluded successful participation in the program. Second, CMS will allow providers to file for claim hardship if the EHR product they have been using has been decertified. In both cases, providers need to file for a hardship in 2016 to avoid a 2017 financial penalty. CHIME welcomes these additional flexibilities and will continue our advocacy to account for other situations outside the provider's control including situations involving upgrades with the same vendor.

Traditionally, the hardship reporting deadline for eligible hospitals (EHs) has been April 1 and for eligible professionals June 30th. It's unclear whether the EH deadline will move to June 30th since the administration has proposed hospitals move to calendar year reporting. CHIME will update members as this information becomes available.  

ONC Invites Comments on draft 2016 Interoperability Standards Advisory

Key Takeaway: The Office of the National Coordinator for Health Information Technology (ONC) is accepting public comments on the draft 2016 Interoperability Standards Advisory (2016 Advisory).

Why It Matters: The Interoperability Standards Advisory is the model ONC uses to coordinate the identification, assessment, and determination of the “best available” interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs.

The Interoperability Standards Advisory is a non-binding, non-regulatory document meant to help facilitate discussion and debate on clinical standards currently used in healthcare and referenced in regulation. The advisory identifies specific standards and references implementation guidelines with a focus on clinical health information technology interoperability.

ONC released the 2015 Interoperability Standards Advisory last January with the Interoperability Roadmap. CHIME has been among the organizations requesting a process established prioritize standards across several important domains, as done in the Standards Advisory.

The 45-day comment period ends at 5 p.m. on Friday, Nov. 6, 2015.  Public comments will be used to update this draft in order to publish a final 2016 Advisory by the end of 2015.

Congressional Affairs

Congressional Pressure on Administration to Halt Stage 3 Rulemaking Persists

Key Takeaway: A bipartisan group of more than 100 members of the House of Representatives called on the administration to rethink the imminent release of the combined meaningful use modifications and Stage 3 rules.

Why It Matters: While the final rules are already at the Office of Management in Budget (OMB), lawmakers have ramped-up pressure on the administration after hearing from their constituencies about the need for additional flexibility in the meaningful use program, including program timing.

The letter points to the importance of accounting for forthcoming regulatory actions concerning the Merit-based Incentive Payment System (MIPS) and other needs dictated by participation in Alternative Payment Models (APM).

The bipartisan letter comes on the heels of a statement from Senator Lamar Alexander (R-TN), chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee calling on the administration to immediately release the meaningful use modifications rule and delay releasing the Stage 3 final rule until 2017. The Senate HELP Committee will hold another health IT-focused hearing on Thursday, titled, “Achieving the Promise of Health Information Technology,” which is expected to include witnesses from the Administration.

Efforts continue to increase the number of cosponsors on the bipartisan Further Flexibility in HIT Reporting and Advancing Interoperability Act (H.R. 3309) in the House, which, among other important provisions, directs HHS to press pause on the Stage 3 Final Rule until 2017. If you have not yet contacted your member of Congress to encourage their support on this important issue, please do so by adapting the form letter provided here to share your experience in the meaningful use program.

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