Medicare and Medicaid Programs; Electronic Health Record Incentive Program–Stage 2

SUMMARY: This proposed rule would specify the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it would specify payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology and other program participation requirements. This proposed rule would also revise certain Stage 1 criteria, as well as criteria that apply regardless of Stage, as finalized in the final rule titled Medicare and Medicaid Programs; Electronic Health Record Incentive Program published on July 28, 2010 in the Federal Register . The provisions included in the Medicaid section of this proposed rule (which relate to calculations of patient volume and hospital eligibility) would take effect shortly after finalization of this rule, not subject to the proposed 1 year delay for Stage 2 of meaningful use of certified EHR technology. Changes to Stage 1 of meaningful use would take effect for 2013, but most would be optional until 2014.

EFFECTIVE DATE: To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on May 7, 2012.

ADDRESSES: In commenting, please refer to file code CMS-0044-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of four ways (please choose only one of the ways listed):

1. Electronically. You may submit electronic comments on this regulation to http://www.regulations.gov. Follow the "Submit a comment" instructions.

2. By regular mail. You may mail written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-0044-P, P.O. Box 8013, Baltimore, MD 21244-8013.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By express or overnight mail. You may send written comments to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-0044-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.

4. By hand or courier. Alternatively, you may deliver (by hand or courier) your written comments ONLY to the following addresses prior to the close of the comment period:

a. For delivery in Washington, DC--Centers for Medicare & Medicaid Services, Department of Health and Human Services, Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue SW., Washington, DC 20201.

(Because access to the interior of the Hubert H. Humphrey Building is not readily available to persons without Federal government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

b. For delivery in Baltimore, MD--Centers for Medicare & Medicaid Services, Department of Health and Human Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.

If you intend to deliver your comments to the Baltimore address, call telephone number (410) 786-1066 in advance to schedule your arrival with one of our staff members.

Comments erroneously mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Elizabeth Holland, (410) 786-1309, or Robert Anthony, (410) 786-6183, EHR Incentive Program issues. Jessica Kahn, (410) 786-9361, for Medicaid Incentive Program issues. James Slade, (410) 786-1073, or Matthew Guerand, (410) 786-1450, for Medicare Advantage issues. Travis Broome, (214) 767-4450, Medicare payment adjustment issues. Douglas Brown, (410) 786-0028, or Maria Durham, (410) 786-6978, for Clinical quality measures issues. Lawrence Clark, (410) 786-5081, for Administrative appeals process issues.

SUPPLEMENTARY INFORMATION:

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.regulations.gov. Follow the search instructions on that Web site to view public comments.

Comments received timely will also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.

Acronyms

ARRA--American Recovery and Reinvestment Act of 2009

AAC--Average Allowable Cost (of certified EHR technology)

AIU--Adopt, Implement, Upgrade (certified EHR technology)

CAH--Critical Access Hospital

CAHPS--Consumer Assessment of Healthcare Providers and Systems

CCN--CMS Certification Number

CFR--Code of Federal Regulations

CHIP--Children's Health Insurance Program

CHIPRA--Children's Health Insurance Program Reauthorization Act of 2009

CMS--Centers for Medicare & Medicaid Services

CPOE--Computerized Physician Order Entry

CY--Calendar Year

EHR--Electronic Health Record

EP--Eligible Professional

EPO--Exclusive Provider Organization

FACA--Federal Advisory Committee Act

FFP--Federal Financial Participation

FFY--Federal Fiscal Year

FFS--Fee-For-Service

FQHC--Federally Qualified Health Center

FTE--Full-Time Equivalent

FY--Fiscal Year

HEDIS--Healthcare Effectiveness Data and Information Set

HHS--Department of Health and Human Services

HIE--Health Information Exchange

HIT--Health Information Technology

HITPC--Health Information Technology Policy Committee

HIPAA--Health Insurance Portability and Accountability Act of 1996

HITECH--Health Information Technology for Economic and Clinical Health Act

HMO--Health Maintenance Organization

HOS--Health Outcomes Survey

HPSA--Health Professional Shortage Area

HRSA--Health Resource and Services Administration

IAPD--Implementation Advance Planning Document

ICR--Information Collection Requirement

IHS--Indian Health Service

IPA--Independent Practice Association

IT--Information Technology

MA--Medicare Advantage

MAC--Medicare Administrative Contractor

MAO--Medicare Advantage Organization

MCO--Managed Care Organization

MITA--Medicaid Information Technology Architecture

MMIS--Medicaid Management Information Systems

MSA--Medical Savings Account

NAAC--Net Average Allowable Cost (of certified EHR technology)

NCQA--National Committee for Quality Assurance

NCVHS--National Committee on Vital and Health Statistics

NPI--National Provider Identifier

NPRM--Notice of Proposed Rulemaking

ONC--Office of the National Coordinator for Health Information Technology

PAHP--Prepaid Ambulatory Health Plan

PAPD--Planning Advance Planning Document

PFFS--Private Fee-For-Service

PHO--Physician Hospital Organization

PHS--Public Health Service

PHSA--Public Health Service Act

PIHP--Prepaid Inpatient Health Plan

POS--Place of Service

PPO--Preferred Provider Organization

PQRI--Physician Quality Reporting Initiative

PSO--Provider Sponsored Organization

RHC--Rural Health Clinic

RPPO--Regional Preferred Provider Organization

SAMHSA--Substance Abuse and Mental Health Services Administration

SMHP--State Medicaid Health Information Technology Plan

TIN--Tax Identification Number

Table of Contents

I. Executive Summary and Overview

A. Executive Summary

1. Purpose of Regulatory Action

a. Need for the Regulatory Action

b. Legal Authority for the Regulatory Action

2. Summary of Major Provisions

a. Stage 2 Meaningful Use Objectives and Measures

b. Reporting on Clinical Quality Measures (CQMs)

c. Payment Adjustments and Exceptions

d. Modifications to Medicaid EHR Incentive Program

e. Stage 2 Timeline Delay

3. Costs and Benefits

B. Overview of the HITECH Programs Created by the American Recovery and Reinvestment Act of 2009

II. Provisions of the Proposed Regulations

A. Definitions Across the Medicare FFS, Medicare Advantage, and Medicaid Programs

1. Uniform Definitions

2. Meaningful EHR User

3. Definition of Meaningful Use

a. Considerations in Defining Meaningful Use

b. Changes to Stage 1 Criteria for Meaningful Use

c. State Flexibility for Stage 2 of Meaningful Use

d. Stage 2 Criteria for Meaningful Use (Core Set and Menu Set)

--This is a summary of a Federal Register article originally published on the page number listed below--

Proposed rule.

CFR Part: "42 CFR Parts 412, 413, and 495"

RIN Number: "RIN 0938-AQ84"

Citation: "77 FR 13698"

Document Number: "CMS-0044-P"

Federal Register Page Number: "13698"

"Proposed Rules"