CMS and the Office of the National Coordinator for Health IT released the final rules for Stage 3 of the meaningful use program, modifications for 2015 through 2017 and the 2015 Edition Health IT Certification Criteria, Health Data Management reports.

Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified electronic health records can qualify for Medicaid and Medicare incentive payments. (Goedert, Health Data Management, 10/6).

The proposals for the meaningful use modifications for 2015 through 2017 and Stage 3 were combined into a single final rule, which was published on the Federal Register (Jayanthi, Becker's Health IT & CIO Review, 10/7).

Overall, Patrick Conway, CMO and deputy administrator for innovation and quality at CMS, said the rule "eliminated unnecessary requirements, simplified and increased flexibility for those that remain, and focused on interoperability, information exchange and patient engagement" (Murphy, EHR Intelligence, 10/6).

Program Modifications for 2015 Through 2017

Under the meaningful use modifications for 2015 through 2017:

• Eligible professionals will have just 10 reporting objectives, down from 18 in the previous two stages; and
• Eligible hospitals will have just nine reporting objectives, down from 20.

The rule also includes a more flexible reporting period. For example, the rule:

• Shortens Medicare and Medicaid meaningful use attestation for eligible professionals and hospitals to a 90-day period in 2015, as well as for new participants in 2016 and 2017; and
• Moves the reporting period for participants to the calendar year instead of the fiscal year (Health Data Management, 10/6).

Stage 3 Details

Under the final rule, Stage 3 will:

• Be optional in 2017, and providers who elect to begin Stage 3 that year will be able to attest for a 90-day reporting period;
• Be mandatory in 2018 (McCann, Healthcare IT News, 10/6); and
• Have eight reporting objections for eligible professionals and hospitals, more than 60% of which require interoperability, compared with 33% under Stage 2 (CMS fact sheet, 10/6).

Comment Period

CMS also announced a 60-day public comment period for the final rule to "gather additional feedback about the EHR incentive programs going forward" (Conn, Modern Healthcare, 10/6).

In particular, the agency is seeking comments as it prepares to fold the program in 2019 into the Merit-Based Incentive Payment System called for under the law passed earlier this year that replaced the Medicare's sustainable growth rate. CMS expects to release proposed rules for MIPS by mid-2016 (Health Data Management, 10/6).

CMS CMO Patrick Conway said that the additional comment period will allow the agency "to get to a similar place" as it would have if it had delayed the rule (Modern Healthcare, 10/6). Conway added that the deadline for reporting in 2015 could be extended, and that providers can apply for hardship exemptions if needed (Durben Hirsch, FierceEMR, 10/6).

2015 Edition Health IT Certification Criteria Final Rule

Meanwhile, ONC released the 2015 Edition Health IT Certification Criteria final rule (EHR Intelligence, 10/6).

According to HHS, the rule aims to bolster interoperability, as well as transparency and competition in the health IT market (HHS release, 10/6).

Among other things, the final rule requires:

• Application programming interfaces to support electronic data exchange;
• Certified health IT to include capabilities to record and export clinical quality measure data; and
• Demographic criteria to include smoking status, sexual orientation and gender identity.

However, it does not include privacy and security capabilities and certification criteria (Becker's Health IT & CIO Review, 10/7).

According to Modern Healthcare, the regulations also aim to prevent providers and vendors from actively blocking information exchange (Modern Healthcare, 10/6).

Further, the rule aims to allow 2015 certified EHR technology to exist outside of the meaningful use program, which aligns with ONC's goal to make the certification program "more open and accessible to other types of health IT beyond EHR technology and for health IT that supports care and practice settings beyond those included in the EHR Incentive Programs" (Becker's Health IT & CIO Review, 10/7).

In a statement, National Coordinator for Health Karen DeSalvo said, "This rule is a key step forward in our work with the private sector to realize the shared goal of making actionable electronic health information available when and where it matters most to transform care and improve health for the individual, community and larger population" (HHS release, 10/6).

Reaction

In a release, the College of Healthcare Information Management Executives applauded CMS for finalizing the meaningful use program modification rule, as well as allowing another comment period for the Stage 3 provisions.

CHIME noted that the "rule grants flexibility for providers who are doing their best to not only meet the intent of the federal program, but also ensure the adoption of health information technology that improves patient care." However, the group urged CMS to implement an automatic hardship exemption for those who are unable to meet the 90-day reporting period (CHIME release, 10/6).

The Healthcare Information and Management Systems Society in a statement said it appreciated CMS' and ONC's efforts "to simplify and provide flexibility for meeting the meaningful use program requirements." Specifically, HIMSS said it supports:

• The 90-day reporting period for 2015; and
• The emphasis on 2018 as the first year that providers will be required to comply with Stage 3 (HIMSS release, 10/6).

Meanwhile, Sen. Lamar Alexander (R-Tenn.), who had urged HHS to delay issuing the final rule for Stage 3, criticized the agency for "rushing" to publish it. In a statement, he said, "Instead of taking the time to get the Stage 3 rule right, they've rushed ahead," noting that Stage 2 compliance is still low (Alexander release, 10/6).

The American Hospital Association in a statement said while it was pleased with the 90-day reporting period, the release of the Stage 3 rule was "deeply disappointing" and "too much too soon." AHA added, "Despite the urging of hospitals, physicians and Congress, the Stage 3 final rule includes many new and more challenging requirements" (Modern Healthcare, 10/6).

Steven Stack, president of the American Medical Association, in a statement also raised concerns about Stage 3, noting that it 3 still "requires significant changes to ensure successful participation, and improve the usability and interoperability of EHR systems."

However, Stack said the group supported CMS' decision to allow providers who are unable to attest this year to apply for hardship exemptions (AMA release, 10/6).