Health IT Policy Update TEFCA

It has been an active year so far in the health IT policy world. Implementation of the 21st Century Cures Act has continued at a steady clip and many policy developments have helped advance efforts to address the COVID-19 pandemic. In addition, momentum will continue with news of the Trust Exchange Framework and Common Agreement (TEFCA) going live in early 2022.

In this policy update blog, we address seven major health IT initiatives—either in the works, in waiting, or kicking off in 2022—that aim to improve the state of healthcare interoperability.

Promoting Public Health Reporting ​

Starting in 2022, The Centers for Medicare & Medicaid Services (CMS) are expanding the public health reporting requirements under the Promoting Interoperability Programs and the Merit-Based Incentive Payment System (MIPS).

Now hospitals must report on four public health measures:

  1. Syndromic surveillance
  2. Immunization registry reporting
  3. Electronic case reporting
  4. Electronic lab reporting

Eligible clinicians in MIPS must report on two public health measures:

  1. Immunization registry reporting
  2. Electronic case reporting

Eligible clinicians can also receive five bonus points if they meet one of these optional public health measures:

  1. Public health registry reporting
  2. Clinical data registry reporting
  3. Syndromic surveillance

The adoption of these changes will help increase electronic reporting to public health agencies and further cements the important role the Promoting Interoperability Programs has played in advancing public health reporting.

Trust Exchange Framework and Common Agreement (TEFCA) Set to Launch in 2022
The Trust Exchange Framework and Common Agreement (TEFCA) Is intended to establish a floor of universal interoperability across the country. In July, the Office of the National Coordinator for Health Information Technology (ONC) and The Sequoia Project, which serves as the Recognized Coordinating Entity (RCE), announced that TEFCA was moving forward and would launch in Q1 2022.

Since that announcement, ONC and the RCE have made steady progress towards that goal, releasing two key documents for public comment:

  1. The Qualified Health Information Network (QHIN) Technical Framework, which outlines functional and technical requirements for exchange
  2. A summary of the Common Agreement, which sets the terms and conditions for exchange.

As of now, progress appears on track for the Q1 launch of the full Common Agreement and QHIN Technical Framework. The implementation of TEFCA will have a significant impact on the interoperability ecosystem, accelerating the existing trends driven by national networks and pushing ubiquitous exchange beyond treatment only.

HITECH to Medicaid Enterprise System (MES) Funding Transition ​
The Medicaid Promoting Interoperability Program ended in 2021, and with it the enhanced federal matching that was part of the HITECH Act. Medicaid agencies have been actively working with CMS to transition their HITECH funding to MES funding.

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USCDI+ for Federal Agencies
ONC recently announced the USCDI+ initiative, which will support the identification and establishment of domain- or program-specific datasets for federal partners that will operate as extensions to the existing USCDI. CMS and the Centers for Disease Control and Prevention (CDC) are initial partners with respective focuses on quality measurement and public health.

Information Blocking
ONC has continued to release new educational materials about information blocking, including new FAQs. The HHS Office of the Inspector General (OIG) has yet to release a final rule that enables enforcement of information blocking for health information networks/health information exchanges and health IT developers of certified health IT to begin. HHS also has yet to release rulemaking to identify applicable disincentives for healthcare providers.

CMS Payer-to-Payer Enforcement Delay
CMS has delayed the enforcement of the payer-to-payer data exchange requirement from the Patient Access and Interoperability Final Rule until future rule making is completed. The requirement had been set to start January 1, 2022.

Upcoming Rules
In addition to these developments, we are still waiting for rules implementing the CARES Act changes to the 42 CFR Part 2 substance abuse privacy rules and the final rule implementing changes to HIPAA.

Conclusion: TEFCA and Information Blocking Make Strong Push to Set New Data-Sharing Standards

With a busy 2021 in health IT policy, we anticipate movement will continue at a rapid pace in 2022. The launch of TEFCA and the start of information blocking will have an important influence on the interoperability market, accelerating existing trends and moving us towards a state where data sharing is the default rather than the exception.

About the Author

About the Author Kory MertzAs the Senior Director of Policy at Audacious Inquiry, Kory Mertz is a subject matter expert in state and federal health IT policy, interoperability, Meaningful Use and the Quality Payment Programs.  He is experienced at interpreting federal regulation and programs, including Meaningful Use and the Quality Payment Program, and translating that knowledge into actionable steps and strategies for clients.