CMS and ONC Propose New Rules for Interoperability

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CMS and ONC Propose New Rules for Interoperability

Rules for Interoperability and Patient Access to Electronic Health Information

The U.S. Department of Health and Human Services (HHS) recently proposed new rules to support seamless and secure access, exchange, and use of electronic health information (EHI). The rules were issued by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The intention of the rules is to increase choice and competition, which will be realized by:

  • Improving secure patient access to their health information
  • Giving patients more control over their health information
  • Requiring that patient access to the EHI be free to patients

ONC’s Proposed Rule

Electronic Health Information and Patient Access

ONC’s rule promotes secure and (more) immediate access to health information. This applies to both patients and their providers. The rule calls for the adoption of standardized application programming interfaces (APIs). APIs will enable patients to access their data using their smartphones and other mobile devices.

Additionally, the rule implements the information blocking provisions outlined in the 21st Century Cures Act. This will support access and exchange of electronic health information . The rule included seven proposed exceptions to the definition of information blocking, as well.

ONC also proposes patients be able to access their EHI at no cost. This would help patients see the prices they are paying for their healthcare.

Finally, ONC’s proposed rule would modify the 2015 Edition health IT certification criteria and program to advance interoperability, enhance health IT certification, and reduce burden and costs.

CMS’s Proposed Rule

CMS’ proposed changes to the healthcare delivery system support the MyHealthEData initiative. The goal of the changes is to increase the flow of health information, reduce burden on patients and providers, and foster innovation. In 2018, CMS finalized regulations that use potential payment reductions for hospitals and clinicians to encourage providers to improve patient access to their electronic health information. CMS is now proposing requirements that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges provide patients with immediate electronic access to medical claims and other EHI by 2020.

CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care as patients move between these plan types. By ensuring patients have easy access to their information, and that information follows them on their healthcare journey, redundant procedures and testing will be eliminated. Thus, clinicians will have the time to focus on improving care coordination and, ultimately, health outcomes.

CMS Administrator Seema Verma said, “By requiring health insurers to share their information in an accessible format by 2020, 125 million patients will have access to their health claims information electronically. This unprecedented step toward a healthcare future where patients are able to obtain and share their health data, securely and privately, with just a few clicks, is just the beginning of a digital data revolution that truly empowers American patients.”

Combined, these proposed rules address technical and industry factors that create barriers to interoperability and limit a patient’s ability to access their health information. Aligning these requirements for payers, health care providers, and health IT developers will help drive an interoperable health IT infrastructure across systems. This ensures providers and patients have access to health data when and where it is needed.

Additional Resources:

Fact sheet on the CMS proposed rule (CMS-9115-P)

Fact sheets on the ONC proposed rule

To read all 724 pages of the HHS’s new rules


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Do the MACRA – Changes are coming sooner than you think


To end the year on a high note, Centers for Medicare & Medicaid Services (CMS) released the Final Rule on October 14, 2016, for the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA). The changes provide the most complex and significant change to reimbursement in over 20 years. But how soon will these changes affect you?


Probably sooner than you think. The timeline is aggressive and performance measures will go into effect this year. It is already important to be tracking services and patient information in an easily reportable format. As healthcare providers, you will still be expected to provide the best care to your patients and you will be rewarded for doing so. You have choices, but ultimately the changes can help increase your payout and ability to provide care for patients, if you know the intricacies of the plan.


Education will be key for your team, so make sure your leaders (especially your C-suite) understand how the changes will affect your health center. Optimize what knowledge you have from Meaningful Use to help estimate your Merit-Based Incentive Payment System (MIPS) score.


One of the easiest ways to get ready for the upcoming changes is to make sure your EHR partner is up to the task. Your EHR should be certified and capable of adapting to payment changes quickly and efficiently. An effective EHR must be able to provide important reports easily. You should also expect more service from your vendor to help explain changes and decide the best path for your clinic, community health center or local health department. A true EHR partner will provide dedicated billing experts to guide you through the new details in the Final Rule. Your billing team is sure to have questions, as with any major change to reimbursements, and they should know where to go to get help.


Don’t lose out on reimbursements with an old system or a system that expects you to figure out complicated government changes by yourself.


For more details on billing to Medicaid and Medicare, visit the CMS website.


For more information about the new payment models, check out the new Quality Payment Program Website.

Core Quality Measures Collaborative Released Seven sets of Clinical Quality Measures

Seven new core quality measure sets to be used as a basis for quality-based payments. This was recently announced by America’s Health Insurance Plans (AHIP) and its member plans’ Chief Medical Officers, leaders from Centers for Medicare & Medicaid Services (CMS) and the National Quality Forum (NQF), as well as national physician organizations, employers, consumers, and patient groups. For Public Health Departments, Federally Qualified Health Centers, and Community Health Centers, this should help reduce the complexities of meaningful use compliance.
According to a CMS press release, the Collaborative’s goal is to establish broadly agreed upon core measure sets that could be harmonized across both commercial and government payers. They also believe this will help accelerate the shift to value-based payment. The new sets will make the measures meaningful to patients, consumers, and physicians, simplifying measure selection, while reducing collection burdens and administration costs.
“In the U.S. Health care system, where we are moving to measure and pay for quality, patients and care providers deserve a uniform approach to measure quality,” said CMS Acting Administrator Andy Slavitt. “This agreement today will reduce unnecessary burden for physicians and accelerate the country’s movement to better quality.”
The seven measure sets include:
ACO and PCMH / Primary Care Measures
Cardiovascular Measures
Gastroenterology Measures
HIV / Hep C Core Measures
Medical Oncology Measures
OB/GYN Measures
Orthopedic Measures


These are just the first seven sets published. CMS and the Collaborative will continue to monitor progress, invite broader participation, and add additional measures and measure sets.