The Centers for Medicare & Medicaid Services (CMS) has published a sweeping final rule with comment period that specifies the requirements that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and Medicaid electronic health record (EHR) incentive payments and avoid downward payment adjustments under the Medicare EHR Incentive Program. Notably, the rule establishes the requirements for Stage 3 of the program as optional in 2017 and required for all participants beginning in 2018.

The rule also, among other things, changes the Medicare and Medicaid EHR Incentive Programs reporting period in 2015 to a 90-day period aligned with the calendar year, and removes reporting requirements related to measures that CMS contends have become redundant, duplicative, or topped out. The final rule also continues to encourage the electronic submission of clinical quality measure data, establishes requirements to transition the program to a single stage, and aligns reporting for providers in the Medicare and Medicaid EHR Incentive Programs. CMS expects cost savings for hospitals and providers that have additional time to meet the requirements of the program under the final rule, which was published October 16, 2015. CMS also reminds EPs and eligible hospitals that they may be exempt from payment adjustments if they can show that demonstrating meaningful use of Certified EHR Technology (CEHRT) would result in a significant hardship. For instance, CMS notes that providers switching EHR vendors or who have other technology difficulties – even for reasons “related to the timing of the publication of the final rule” – may be eligible for a hardship exception. Hardship applications are considered on a case-by-case basis.

In light of enactment of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which will sunset the current meaningful use payment adjustment for EPs at the end of CY 2018 and establish a Merit-Based Incentive Payment System (MIPS) incorporating meaningful use, CMS is soliciting comments on policies to support the transition to MIPS. Such comments are due December 15, 2015. The MACRA MIPS provisions will be subject to additional rulemaking.

In a related development, the HHS Office of the National Coordinator for Health Information Technology (ONC) published a rule on October 16, 2016 that finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria) and a new 2015 Edition Base EHR definition. The certification criteria establish the capabilities and specify the related standards and implementation specifications that CEHRT need to include, at a minimum, to support the achievement of meaningful use by EPs, eligible hospitals, and CAHs under the Medicare and Medicaid EHR Incentive Programs. The Base EHR definition for 2015 has been revised, to, among other things, include care plan data and new patient data (e.g., Unique Device Identifiers).