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

Federal Information & News Dispatch, Inc.

SUMMARY: This final rule specifies 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 specifies 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 (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.

DATES: Effective dates: This final rule is effective on November 5, 2012, with the exception of the definition of "meaningful EHR user" in SEC 495.4 and the provisions in SEC 495.6(f), SEC 495.6(g), SEC 495.8, SEC 495.102(c), and part 495 subpart D, which are effective September 4, 2012.

Applicability dates: Sections 495.302, 495.304, and 495.306 are applicable beginning payment year 2013.

FOR FURTHER INFORMATION CONTACT: Elizabeth Holland, (410) 786-1309, or Robert Anthony, (410) 786-6183, EHR Incentive Program issues or Administrative appeals process issues. David Koppel, (410) 786-3255, for Medicaid Incentive Program issues. Frank Szeflinski, (303) 844-7119, for Medicare Advantage issues. Travis Broome, (214) 767-4450, Medicare payment adjustment issues. Douglas Brown, (410) 786-0028, or Maria Michaels, (410) 786-2809 for Clinical quality measures issues.

SUPPLEMENTARY INFORMATION:

Acronyms

ARRA American Recovery and Reinvestment Act of 2009

AAC Average Allowable Cost (of CEHRT)

ACO Accountable Care Organization

AIU Adopt, Implement, Upgrade (CEHRT)

CAH Critical Access Hospital

CAHPS Consumer Assessment of Healthcare Providers and Systems

CCN CMS Certification Number

CDS Clinical Decision Support

CEHRT Certified Electronic Health Record Technology

CFR Code of Federal Regulations

CHIP Children's Health Insurance Program

CHIPRA Children's Health Insurance Program Reauthorization Act of 2009CMS Centers for Medicare & Medicaid Services

CPOE Computerized Provider Order Entry

CQM Clinical Quality Measure

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

LOINC Logical Observation Identifiers and Codes System

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 CEHRT)

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

PCP Primary Care Provider

PECOS Provider Enrollment, Chain, and Ownership System

PFFS Private Fee-For-Service

PHO Physician Hospital Organization

PHR Personal Health Record

PHS Public Health Service

PHSA Public Health Service Act

PIHP Prepaid Inpatient Health Plan

POS Place of Service

PPO Preferred Provider Organization

PQRS Physician Quality Reporting System

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. Summary of 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 and Analysis of and Responses to Public Comments

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)

(1) Discussion of Whether Certain EPs, Eligible Hospitals or CAHs can meet all Stage 2 Meaningful Use Objectives Given Established Scopes of Practice

(2) EPs Practicing in Multiple Practices/Locations

(3) Discussion of the Reporting Requirements of the Measures Associated with the Stage 2 Meaningful Use Objectives

B. Reporting on Clinical Quality Measures Using Certified EHRs Technology by Eligible Professionals, Eligible Hospitals, and Critical Access Hospitals

1. Time Periods for Reporting Clinical Quality Measures

2. Certification Requirements for Clinical Quality Measures

3. Criteria for Selecting Clinical Quality Measures

4. Clinical Quality Measures for Eligible Professionals

a. Statutory and Other Considerations

b. Clinical Quality Measures for Eligible Professionals for CY 2013

c. Clinical Quality Measures for Eligible Professionals Beginning With CY 2014

5. Reporting Methods for Clinical Quality Measures for Eligible Professionals

a. Reporting Methods for Medicaid EPs

b. Reporting Methods for Medicare EPs in CY 2013

c. Reporting Methods for Medicare EPs Beginning With CY 2014

d. Group Reporting Option for Medicare and Medicaid Eligible Professionals Beginning With CY 2014

6. Clinical Quality Measures for Eligible Hospitals and Critical Access Hospitals

a. Statutory and Other Considerations

b. Clinical Quality Measures for Eligible Hospitals and CAHs for FY 2013

7. Reporting Methods for Eligible Hospitals and Critical Access Hospitals

a. Reporting Methods in FY 2013

b. Reporting Methods Beginning With FY 2014

c. Electronic Reporting of Clinical Quality Measures for Medicaid Eligible Hospitals

C. Demonstration of Meaningful Use and Other Issues

1. Demonstration of Meaningful Use

a. Common Methods of Demonstration in Medicare and Medicaid

b. Methods for Demonstration of the Stage 2 Criteria of Meaningful Use

c. Group Reporting Option of Meaningful Use Core and Menu Objectives and Associated Measures for Medicare and Medicaid EPs Beginning With CY 2014

2. Data Collection for Online Posting, Program Coordination, and Accurate Payments

3. Hospital-Based Eligible Professionals

4. Interaction With Other Programs

D. Medicare Fee-for-Service

1. General Background and Statutory Basis

2. Payment Adjustment Effective in CY 2015 and Subsequent Years for EPs Who Are Not Meaningful Users of CEHRT for an Applicable Reporting Period

a. Applicable Payment Adjustments in CY 2015 and Subsequent Calendar Years for EPs Who Are Not Meaningful Users of CEHRT

b. EHR Reporting Period for Determining Whether an EP Is Subject to the Payment Adjustment for CY 2015 and Subsequent Calendar Years

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

Final rule.

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

RIN Number: "RIN 0938-AQ84"

Citation: "77 FR 53968"

Document Number: "CMS-0044-F"

Federal Register Page Number: "53968"

"Rules and Regulations"

Copyright:	(c) 2012 Federal Information & News Dispatch, Inc.
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