On May 20, 2014, the Centers for Medicare & Medicaid Services ("CMS") and the Office of the National Coordinator for Health Information Technology ("ONC") announced a proposed rule that grants certain health care providers additional time to upgrade electronic health record systems to meet meaningful use requirements under the Medicare and Medicaid electronic health record ("EHR") Incentive Programs.

Background

The American Recovery and Reinvestment Act of 2009 amended the Social Security Act to authorize incentive payments to be made to eligible professionals ("EPs"),  eligible hospitals, critical access hospitals ("CAHs") and Medicare Advantage organizations to encourage the adoption and meaningful use of certified electronic health record technology("CEHRT").

CMS and ONC adopted a final rule on September 4, 2012 that established the timeline for stages of meaningful use through 2021. After its adoption, numerous EHR vendors informed CMS and ONC that the timeframe to make the required coding changes to implement the 2014 Edition CEHRT was too short.  As a result, the 2014 Edition CEHRT has not been timely available to providers, which has made it difficult for providers to effectively implement the 2014 CEHRT and demonstrate meaningful use in 2014.

The Proposed Rule

The Proposed Rule allows EPs, eligible hospitals and CAHs that were unable to fully implement 2014 Edition CEHRT for the 2014 reporting year to continue to use 2011 Edition CEHRT or a combination of the 2011 Edition and 2014 Edition CEHRT for the 2014 reporting periods. The Proposed Rule also allows additional time to use 2014 Stage 1 objectives and measures for providers already using 2014 Edition CEHRT. The changes only apply to 2014. Meaningful use timelines established for 2015 and subsequent years are unchanged by this Proposed Rule.

Use of 2011 Edition CEHRT only

EPs, eligible hospitals and CAHs that will only use 2011 Edition CEHRT for the 2014 reporting period must meet the meaningful use objectives and measures for Stage 1 that were applicable for the 2013 payment year, regardless of their current stage of meaningful use (i.e., Stage 1 or 2). Providers who use only 2011 Edition CEHRT must attest that they are unable to fully implement 2014 Edition CEHRT due to availability delays.

Use of a combination of 2011 and 2014 Edition CEHRT

EPs, eligible hospitals and CAHs that will use a combination of 2011 Edition CEHRT and 2014 Edition CEHRT for the 2014 reporting year may choose to meet the following meaningful use objectives and measures:

  • If the provider was scheduled to demonstrate Stage 1 meaningful use in 2014, the provider would be able to attest to 2013 Stage 1 objectives and measures or 2014 Stage 1 objectives and measures.
  • If the provider was scheduled to demonstrate Stage 2 meaningful use in 2014, the provider would be able to attest to 2013 Stage 1 objectives and measures, 2014 Stage 1 objectives and measures, or 2014 Stage 2 objectives and measures.

Providers who use a combination of the 2011 and 2014 Edition CEHRT must attest that they are unable to fully implement 2014 Edition CEHRT due to availability delays.

Use of 2014 Edition CEHRT

EPs, eligible hospitals and CAHs that are scheduled to demonstrate Stage 2 meaningful use in 2014 can meet either 2014 Stage 1 objectives and measures or 2014 Stage 2 objectives and measuresusing 2014 Edition CEHRT. EPs, eligible hospitals and CAHs that are scheduled to demonstrate Stage 1 in 2014 must meet 2014 Stage 1 objectives and measures.

Providers using 2014 Edition CEHRT who were scheduled to demonstrate Stage 2 measures and objectives who choose to meet Stage 1 objectives and measures must attest that they are unable to fully implement 2014 Edition CEHRT due to availability delays.

The Proposed Rule would also make the following changes:

  • Extends Stage 2 of meaningful use through 2016 and allows Stage 3 of meaningful use to begin on January 1, 2017 for EPs, and October 1, 2016 for eligible hospitals and CAHs that first became meaningful users in 2011 or 2012 .

  • Implements changes for reporting on clinical quality measures in 2014.

  • Revises dates within the definition of CEHRT to support the additional time to upgrade electronic health record systems for 2014.

Public comment on the Proposed Rule began on May 23, 2014 and will continue for a period of 60 days. Comments must be received by 5:00 P.M. on July 21, 2014.