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  • Washington Highlights

    ONC and CMS Issue Rules on Interoperability and Information Blocking

    Gayle Lee, Director, Physician Payment & Quality

    The Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare and Medicaid Services (CMS) Feb. 11 proposed rules implementing provisions in the 21st Century Cures Act (P.L. 114-255) regarding interoperability, information blocking, and the certification program.

    The ONC rule would update the 2015 Edition certification criteria for health information systems to ensure that health information technology (HIT) systems send and receive electronic health information (EHI) in a structured format and make EHI available through application programming interfaces (APIs). In addition, HIT developers must assure HHS that they will not take any action that constitutes information blocking of EHI and violations will be subject to enforcement.

    The CMS rule proposes to require Medicare Advantage organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee For Service programs and managed care plans, CHIP managed care entities, and Qualified Health Plan issuers of the federal exchanges to implement API standards to make patient claims and other health information available to patients through third-party applications. In addition, these plans would be required in 2020 to support electronic exchange of data for transitions of care (e.g., diagnoses, procedures, tests, providers seen) as patients move between these plan types.

    To prevent clinicians, hospitals, and critical access hospitals (CAHs) from information blocking, CMS proposes to make publicly available a list of clinicians and hospitals who submit a "no" response to any of the three attestation statements regarding the prevention of information blocking in the Promoting Interoperability Programs. In addition, CMS would amend its conditions of participation to require Medicare participating acute-care hospitals, long-term care hospitals, inpatient rehabilitation facilities, psychiatric hospitals, children’s hospitals, cancer hospitals, and CAHs to send electronic notifications to receiving providers when an inpatient is admitted, discharged, or transferred.

    CMS also announced two requests for information soliciting feedback on interoperability and HIT adoption in post-acute care and behavioral health care settings, and the role of matching in interoperability and improved patient care.

    ONC and CMS have both released fact sheets of their proposed rules.

    The AAMC plans to submit comments on both rules, which are due in early April.