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CCH® BENEFITS — 07/21/10

Electronic Health Records: Final Rules Issued On Meaningful Use, IT Certification

from Spencer’s Benefits Reports: On July 14, the Department of Health and Human Services (HHS) announced two companion final rules dealing with electronic health records (EHR) and related technology requirements of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

Regulations issued by the Centers for Medicare and Medicaid Services (CMS) define the minimum requirements and specified objectives that providers must meet through their use of certified EHR technology in order to qualify for incentive payments. The other rule, issued by the Office of the National Coordinator for Health Information Technology (ONC), identifies the standards and criteria and the technical capabilities required for the certification of EHR technology, so that eligible professionals and hospitals may be assured that the systems they adopt are capable of performing the required functions. Both rules are scheduled to be published in the July 28 Federal Register.

With “meaningful use” definitions in place, EHR system vendors can ensure that their systems deliver the required capabilities, and providers can be assured that the system they acquire will support achievement of “meaningful use” objectives. In addition, a concentrated five-year national initiative to adopt and use electronic records in health care can begin, HHS asserted.

HHS may spend as much as $27 billion in incentive payments to medical providers over ten years. Eligible medical professionals may receive as much as $44,000 under Medicare and $63,750 under Medicaid, and hospitals may receive millions of dollars for implementation and meaningful use of certified EHRs under both Medicare and Medicaid.

The CMS rule also finalizes a proposed rule that was issued on Jan, 13, 2010. The final rule includes modifications addressing stakeholder concerns while retaining the intent and structure of the incentive programs. In particular, while the proposed rule called on eligible professionals to meet 25 requirements (23 for hospitals) in their use of EHRs, the final rule divides the requirements into a “core” group of requirements that must be met, plus an additional “menu” of procedures from which providers may choose. This “two-track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing flexibility in other areas to reflect providers’ needs and their individual path to full EHR use.

“CMS received more than 2,000 comments on the proposed rule,” said Marilyn Tavenner, principal deputy administrator of the CMS. “Many comments were from those who will be most immediately affected by EHR technology—health care providers and patients. We carefully considered every comment and the final meaningful use rules incorporate changes that are designed to make the requirements achievable while meeting the goals of the HITECH Act.”

Meaningful Use Incentives

Requirements for meaningful use incentive payments will be implemented over a multi-year period, phasing in additional requirements that will improve performance on information technology (IT) and quality objectives over time. The final CMS rule specifies initial criteria that eligible professionals (EPs) and eligible hospitals must meet. The rule also includes the formula for the calculation of the incentive payment amounts; a schedule for payment adjustments under Medicare for covered professional services and inpatient hospital services provided by EPs and eligible hospitals that fail to demonstrate meaningful use of certified EHR technology by 2015; and other program participation requirements.

Key changes in the final CMS rule include the following:

• Greater flexibility for eligible professionals and hospitals to meet and report certain objectives for demonstrating meaningful use. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers may choose any five to defer in 2011-2012.
• Objectives for providing condition-specific patient education resources for both eligible professionals and eligible hospitals and of recording advance directives for eligible hospitals, according to recommendations from the Health Information Technology Policy Committee.
• A definition of a hospital-based eligible professional as one who performs substantially all of his or her services in an inpatient hospital setting or emergency room only, according to the Continuing Extension Act of 2010.

CMS’ and ONC’s final rules complement two other recently issued HHS rules. On June 24, ONC published a final rule establishing a temporary certification program for health information technology. On July 8, the Office for Civil Rights announced a proposed rule that would strengthen and expand privacy, security, and enforcement protections under the Health Insurance Portability and Accountability Act of 1996.

As part of this process, HHS is establishing a nationwide network of Regional Extension Centers to assist providers in adopting and using in a meaningful way certified EHR technology.

A CMS/ONC fact sheet on both rules is available at http://www.cms.gov/EHRIncentivePrograms/. Technical fact sheets on CMS’s final rule are available at http://www.cms.gov/EHRIncentivePrograms/. A technical fact sheet on ONC’s standards and certification criteria final rule is available at http://healthit.hhs.gov/standardsandcertification.

For more information on this and related topics, consult the CCH Pension Plan Guide, CCH Employee Benefits Management, and Spencer's Benefits Reports.

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