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ONC, CMS Issue Final Interoperability and Information Blocking Rules

March 13, 2020

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Gayle Lee, Director, Physician Payment & Quality

The Department of Health and Human Services’ (HHS’) Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) issued final rules on March 9 implementing provisions required by the 21st Century Cures Act (P.L 114-255). The regulations on interoperability and information blocking and the technology certification program make revisions to the proposed rule based on comments submitted by stakeholders, including the AAMC.

Among other items, the ONC final rule establishes regulations to prevent “information blocking” practices by health care providers, developers of certified health IT, health information exchanges, and health information networks. It also identifies reasonable and necessary activities that do not constitute information blocking. It updates 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. It also makes EHI available through application programming interfaces (APIs). In addition, it implements a requirement that electronic health records (EHRs) have the capability to export a patient’s EHI upon request. 

The CMS final rule requires 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, the CMS amends its conditions of participation (COPs) to require hospitals, including psychiatric and critical access hospitals, to send electronic  notifications of a patient’s admission, discharge, and/or transfer to another health care facility or to another community provider or practitioner. The COP notification requirement will become effective six months after the publication of the final rule.

ONC and CMS also issued accompanying fact sheets for both the ONC final rule and the CMS final rule.

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