by Margaret Young Levi and Kathie McDonald-McClure
Post-Note: On April 30, 2021, the requirements for hospitals with certain EHR capabilities to send admission, discharge and transfer notifications to other providers went into effect. See CMS webpage, “Policies and Technology for Interoperability and Burden Reduction“.
Last year, we wrote about the CMS Proposed Rule on Hospital EHR “Electronic Patient Event Notifications” in which CMS proposed new Medicare Conditions of Participation (CoPs) for hospitals that will require the hospital to send electronic event notifications to primary care or post-acute care providers identified by the patient when a patient has been admitted, discharged, or transferred (ADT Notifications). ADT Notifications are an outgrowth of the 21st Century CURES Act passed by a bi-partisan majority of Congress and signed into law on December 13, 2016 (CURES Act). The CURES Act contains aggressive goals to promote the interoperability of electronic health records and patient access to their health information.
The objective of ADT Notifications is to improve care coordination and patient outcomes. These ADT Notifications are to be integrated into either the hospital’s interoperable certified electronic health record technology (CEHRT) or other electronic administrative system such as a registration system. An ADT Notification will be required when the patient is:
- registered in the Emergency Department (ED) or as an observational stay;
- admitted to the hospital (regardless if the patient was admitted from the ED, from an observation stay, or as a direct admission from home, from their practitioner’s office, or as a transfer from some other facility);
- transferred from the ED or inpatient care; or
- discharged from the ED, observational stay or inpatient services unit.
CMS clarified that, although separate ADT Notifications will be required for an ED registration and a subsequent hospital inpatient admission, an ADT Notification would not be required for a transfer to another areas of the hospital (e.g., from ICU to a “step down” or “intermediate care” unit).
CMS is expected to publish the final rule on this topic, on May 1, 2020, with the unwieldy name of “Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-facilitated Exchanges, and Health Care Providers” [Post-Note: CMS now refers to it as the “May 2020 Interoperability and Patient Access Final Rule“]. CMS had said in March that hospitals would have six months after publication of the final rule to comply. However, on April 22, 2020, recognizing that hospitals are on the front lines of the COVID-19 public health emergency, CMS announced that it will extend the effective date of the new ADT Notifications CoP to twelve (12) months after publication of the final rule. Provided the final rule is published on May 1, 2020, this will push the effective date for the ADT Notifications CoP to May 1, 2021.
In response to comments to the proposed final rule that it could impose a burden on rural and critical access hospitals that lack the technology to accomplish ADT Notifications, CMS responded that hospitals that lack a system conformant with the ADT messaging standard (HL7 2.5.1), will not be subject to this final rule. CMS, however, suggested that one way the burden might be minimized for such hospitals is to use a Health Information Exchange (HIE). For Kentucky providers, the Kentucky Health Information Exchange (KHIE) now offers ADT Notifications and eight other event notifications for KHIE Participants, free of charge. To participate in the KHIE, visit https://khie.ky.gov to find the contact information for the Outreach Coordinator in your area or email KHIE@ky.gov.
To read the final rule, click here.