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.
- 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.
- 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.