Transforming the Medical Landscape, A First Look at CMS’ Interoperability and Patient Access Proposed Rule

Blog Posts - 19 February 2019


On February 11, 2018, the Centers for Medicare and Medicaid Services (CMS) released the much-anticipated Interoperability and Patient Access Proposed Rule after delays that resulted from the government shut-down. This rule clearly demonstrates that CMS remains very interested in using policy levers to increase patient access to medical information and to increase the frequency of data sharing among providers to more efficiently and effectively coordinate care. The removal of obstacles to achieving nationwide interoperability remains a prominent theme.

Below you will find a summary of the CMS proposed rule and the corresponding areas of impact to various stakeholders within the healthcare community.

Proposals that impact health plans and payers

Under the CMS proposed rule, health plans and payers will find requirements focused on promoting patient access to their medical data as well as requirements aimed at utilizing technology in the healthcare space.

  1. Initiate the sharing of information through participating in a trusted exchange network to develop a community of shared nationwide data. A trusted exchange network provides a single on-ramp to interoperability, created by a coordinating entity, for qualified health information networks and their participants.
  2. Provide health information and patient claims to patients formatted to the United States Core Data for Interoperability (USCDI) standard and transmitted using Fast Healthcare Interoperability Resources (FHIR)-based Application Programming Interface (API) technology.
  3. Allow enrollees and prospective enrollees to access their provider networks through this API technology.

Proposals that impact hospitals & healthcare providers

CMS has also proposed new requirements and model testing in an effort to incentivize the provider, health systems and hospitals to participate in interoperability activities:

  • Clinicians, hospitals, and critical access hospitals that have reported a “no” response to any of the three Promoting Interoperability attestation statements regarding information blocking will be noted in a publicly available and viewable file. Promoting Interoperability is a program requirement of Medicare dedicated to motivating clinicians, eligible hospitals, and critical access hospitals to adopt, implement, upgrade and demonstrate use of Certified Electronic Health Record Technology (CEHRT).
  • Any provider who has not included their digital contact information in the National Plan and Provider Enumeration System (NPPES) starting in the second half of 2020 will be noted in a publicly available and viewable file. The hope is that the transparency of these files for patients will motivate providers to participate in interoperability efforts.
  • To bring awareness to patient data and medical information, Medicare participating hospitals, critical access hospitals, and psychiatric hospitals, will be required to transmit a notification once a patient has been admitted, discharged, or transferred. This notification will be received by clinicians associated with the treatment of the patient.

In an effort to better coordinate care, CMS has also proposed an update that aims to improve benefit coordination for the dual eligible population by increasing the frequency by which states are required to exchange Medicare and Medicaid data. This proposed frequency has been increased from a monthly exchange to a daily exchange. State Medicaid plans will submit the required Medicare Modernization Act (MMA) file data to CMS every business day.

Providing feedback and comments to CMS proposals

As with all proposed CMS rulemaking, interested stakeholders will have an opportunity to submit public comments and feedback in response to this proposed rule and the included requests for information. Those wishing to submit comments on the Interoperability and Patient Access proposed rule or to answer specific questions from the RFI will be given a 60 day comment period following the publication of the proposed rule in the Federal Register. Comments may be submitted electronically, to www.regulations.gov, by regular mail, and by express or overnight mail.

Veradigm will be closely reviewing and providing comments on the Interoperability and Patient Access Proposed Rule to CMS. We are proud to provide initial insight into the changing medical landscape as the health community aims to move toward complete interoperability.