IHA Daily Briefing: Feb. 11

CMS, ONC Propose EHI Interoperability and Use Changes
Legislation Focuses on 96-Hour Rule
Register for IHA's April HCPro Medicare Boot Camp
Briefly Noted

CMS, ONC Propose EHI Interoperability and Use Changes
Today, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator (ONC) issued proposed rules supporting seamless and secure access, exchange and use of electronic health information (EHI). These rules are said to increase choice and competition while fostering innovation that promotes patient access to and control over their health information.

In the CMS rule, it proposes requirements that Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Qualified Health Plans in the Federally-facilitated Exchanges must provide enrollees with immediate electronic access to medical claims and other health information electronically by 2020.

In addition, the CMS rule also proposes to publicly report providers or hospitals that participate in “information blocking,” practices that unreasonably limit the availability, disclosure, and use of electronic health information and undermine efforts to improve interoperability. Making this information publicly available may incentivize providers and clinicians to refrain from such practices.

The ONC proposed rule would require patients to have electronic access to their EHI at no cost.

CMS and the ONC are also requesting feedback on how to improve patient identification and safety to encourage better coordination of care across different healthcare settings while advancing interoperability. Specifically, CMS is looking for comments that  can promote wide adoption of interoperable health IT systems for use across healthcare settings such as long-term and post-acute care, behavioral health, and settings serving individuals who are dually eligible for Medicare and Medicaid and/or receiving home and community-based services. CMS is also looking for comments on pricing information that could be included as part of an EHI and would help the public see the prices they are paying for their healthcare.

More details on the specific proposals can be found in a CMS fact sheet and ONC fact sheet. Comments on both proposed rules will be due no later than 60 days after publication in the Federal Register.


Legislation Focuses on 96-Hour Rule
IHA-supported legislation, introduced last week by Reps. Adrian Smith (R-NE) and Terri Sewell (D-AL), would remove the physician certification requirement of the 96-Hour Rule for critical access hospitals (CAHs).

Under the 96-Hour Rule, CAHs must satisfy a condition of payment for the Medicare program that requires physicians to certify a patient is reasonably expected to be transferred or discharged within 96 hours of being admitted. According to a recent report issued by the American Hospital Association (AHA), “This additional step and limitation is detrimental to CAHs, and may force them to eliminate ‘96-hour-plus’ services, ultimately affecting access to appropriate care for Medicare beneficiaries in these facilities.”

The Critical Access Hospital Relief Act (H.R. 1041) would eliminate the physician certification requirement; however it would maintain as a condition of participation the requirement CAHs have an annual average length of stay of 96 hours or less.

In recent years, the Centers for Medicare & Medicaid Services has directed auditors to make the physician-certification requirement a “low priority for medical record reviews.”

While CAHs appreciate this regulatory effort to reduce the burden of the 96-Hour Rule, IHA urges Congress to make the statutory changes necessary to eliminate the requirement.


Register for IHA's April HCPro Medicare Boot Camp
Stay up-to-date on the latest Medicare requirements for patient status and the role of the utilization review (UR) committee by attending IHA's HCPro Medicare Boot Camp®—Utilization Review Version on April 24-25.

Held at IHA's Springfield office, this intensive two-day program will teach participants how to:

  • Manage patient status;
  • Obtain correct Medicare reimbursement; and
  • Maintain regulatory compliance.

Expert presenter Kimberly A. H. Baker, JD, CPC, will share her insight from over 25 years of healthcare experience in Medicare coverage, payment, and coding regulations and requirements. She is currently HCPro's director of Medicare and compliance.

This course offers valuable knowledge for staff from multiple departments, including:

  • UR coordinators, managers, directors, committee members and physician advisors;
  • Case managers, care coordinators and nurse managers;
  • Compliance officers, auditors and staff;
  • Revenue cycle staff; and
  • Chief nursing officers.

Space is limited—don't wait to reserve your spot. A registration discount is offered for two or more attendees from the same organization. Register today.


Briefly Noted
The Centers for Medicare & Medicaid Services (CMS) has published an informational bulletin on the 2019 Federal Poverty Level Standards.