The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) announced on July 13, 2010 the final rules to implement the electronic health record (EHR) incentive program under the Health Information Technology for Economic and Clinical Health (HITECH) Act.

Enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, the HITECH Act supports the adoption of electronic health records by providing financial incentives under Medicare and Medicaid to hospitals and eligible providers who implement and demonstrate “meaningful use” of certified technologies. The CMS regulations announced on July 13, 2010 specify the objectives that providers and hospitals must achieve in payment years 2011 and 2012 to qualify for incentive payments.
Key Provisions of the Final Rule
The CMS final meaningful use rule incorporates changes from the proposed rule that are designed to make the requirements more readily achievable while meeting the goals of the HITECH Act.
Key Provisions Include:
  • For stage 1, the proposed rule called for physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of EHRs. The final rule requires Eligible Providers (EPs) to comply with a set of 15 core objectives during the first year – or Stage 1 of adoption. Hospitals are required to comply with 14 core objectives. In addition to the core objectives, both hospitals and EPs will have to choose five of ten objectives from the menu set. The remaining five objectives will be deferred to Stage 2 of adoption. This two tiered approach ensures that the basic elements of meaningful use will be met by all EPs while at the same time allowing flexibility in other areas to reflect providers varying needs and their individual paths to full EHR adoption and use. The final rule also includes the objective of providing patient-specific educational resources for both EPs and hospitals and the objective of recording advance directives for eligible hospitals.
  • The final rule reduces the number of electronic prescriptions a EP is required to generate from 75 percent to 40 percent.
  • With respect to defining hospital-based physicians, the final rule conforms to the Continuing Extension Act of 2010. That law addressed provider concerns about hospital-based providers in ambulatory settings being unable to qualify for incentive payments by defining a hospital-based provider as performing substantially (greater than 90%) of all his/her services in an inpatient setting or emergency department only.
  • Under Medicaid, the final rule includes critical access hospitals (CAHs) in the definition of acute care hospital for the purpose of incentive program eligibility.
Timetable for Implementation
The HITECH Act states that payments for Medicare providers can begin no sooner than October 2010 for eligible hospitals and January2011 for EPS. The final rule aligns the Medicare and Medicaid program start dates. Key steps in the implementation timeline include:
  • Registration for both EPs and eligible hospitals with CMS for the EHR incentive program will begin in January 2011. Registration for both the Medicare and Medicaid incentive programs will occur at one virtual location, managed by CMS. The final rule maintains that EPs may participate in either the Medicare program or the Medicaid, but not both. Hospitals may participate in both incentive programs if they met eligibility requirements.
  • For the Medicare program, attestations may be made starting in April 2011 for both EPs and eligible hospitals.
  • Medicare incentive payments will begin in mid may 2011.
  • States will be initiating their incentive programs on a rolling basis, subject to CMS approval of the State Medicare HIT plan, which must detail how the state will implement and oversee its incentive plan.
Audacious Inquiry continues to partner with the CRISP Regional Extension Center in their effort  to fulfill their mission of assisting 1000 Maryland primary care providers successfully achieve Meaningful Use within the next two years.