Final Rules for Stage 2 EHR Incentive Programs Released

First, the Centers for Medicare & Medicaid Services (CMS) released the long-awaited final rule to govern Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. The rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to participate in the EHR Incentive Programs.

  • Click here for the full text of CMS’s final rule.
  • Click here to see the fact sheet on CMS’s final rule.

Second,  the Office of the National Coordinator for Health Information Technology (ONC) also announced a related final rule, which specifies the technical capabilities and related standards and implementation specifications that Certified EHR Technology will need to include to support the achievement of meaningful use by EPs, eligible hospitals, and CAHs under the EHR Incentive Programs.

  • Click here for the full text of the ONC rule.
  • Click here  to read a fact sheet on ONC’s standards and certification criteria final rule.

Stay tuned.  We will be posting more about these final rules in the days to come.

CMS Releases Proposed Rule for Stage 2 Meaningful Use of Electronic Health Records

On Thursday, February 23, 2012, the Centers for Medicare and Medicaid Services (CMS), pursuant to the Health Information Technology for Economic and Clinical Health (HITECH) Act, released a 455-page Proposed Rule specifying the Stage 2 criteria that eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid incentives related to electronic health records (EHRs).  The Proposed Rule also proposes to modify certain Stage 1 criteria, as well as criteria that apply regardless of Stage, as previously published in the Final Rule on July 28, 2010 in the Federal Register.  The proposed provisions related to Medicaid (calculations of patient volume and hospital eligibility) would take effect shortly after the finalization of the Proposed Rule and would not be subject to the proposed one-year delay for Stage 2 meaningful use of a certified EHR.  The Proposed Rule states that the changes to Stage 1 would take effect for 2013, but that most changes would be optional until 2014.  Last but not least, the Proposed Rule addresses the Medicare payment adjustments that will take place for EPs, eligible hospitals and CAHs who fail to demonstrate a meaningful use of certified EHRs by 2015 and proposed exceptions to such adjustments.

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Early Meaningful Users Promised Stage 2 Extension

On November 30, 2011, U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius issued a press release announcing proposed steps to encourage physicians and hospitals to adopt electronic health records (EHRs) this year and receive incentive payments made available under the Health Information Technology for Economic and Clinical Health (HITECH) Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA). 

Under the HITECH Act, physicians and hospitals have the opportunity to earn financial incentives from Medicare and Medicaid if they demonstrate the adoption and meaningful use of certified EHRs in a series of three stages. Under the current rules, physicians and hospitals that adopt EHRs in 2011 and attest to meeting Stage 1 meaningful use standards by February 28, 2012 must meet Stage 2 standards in 2013. If they wait until 2012 to attest to Stage 1, providers could delay Stage 2 compliance until 2014. To encourage more providers to adopt EHRs in 2011, instead of waiting until 2012, HHS proposes to allow providers who qualify for Stage 1 meaningful use in 2011 an extension until 2014 to meet Stage 2 standards. HHS clarified that providers first attesting to meaningful use in 2011 qualify for both 2011 and 2012 incentive payments.

These proposed steps are consistent with June 2011 recommendations from the Health IT Policy Committee (HITPC).  As we reported this summer, HITPC advocated that providers who begin to attest to meaningful use in 2011 be provided an extra year “to phase in the stage 2 expectations (i.e., Stage 2 for those who attest in 2011 would begin in 2014).”  HHS listened!

HHS intends to publish this extension in the Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM) in February 2012.

At the same time, HHS also released new data from the Centers for Disease Control and Prevention (CDC) showing increased adoption of EHRs by physicians.  The CDC report documented that physicians’ adoption of health information technology (IT) doubled in two years, and 52% of physicians intend to apply for meaningful use incentives, up from 41% in 2010.  Click here to access additional information about achieving meaningful use, including the CDC report.

Health IT Policy Committee Recommends Delay for Stage 2 Meaningful Use

UPDATE: On July 6, 2011, Farzad Mostashari, M.D., ONC Chief, backed the ONC Policy Committee’s recommendation to delay implementing Stage 2 meaningful use criteria.


On June 16, 2011, Paul Tang, M.D. , as Vice Chair of the Health IT Policy Committee for the  Office of National Coordinator (ONC), wrote a letter to Farzad Mostashari, M.D., the ONC National Coordinator, requesting a delay in implementing Stage 2 of the meaningful use criteria that eligible healthcare providers must meet in order to obtain the monetary incentives for adoption of electronic health records (EHRs).  The monetary incentives were established pursuant to the Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH Act), which was part of the American Recovery and Reinvestment Act of 2009 (ARRA).  Dr. Tang states in the letter:

The HITPC has heard from both the vendor community and the provider community that the current schedule for compliance with stage 2 meaningful use objectives in 2013 poses a nearly insurmountable timing challenge for those who attest to meaningful use in 2011. With the anticipated release of the final rule for stage 2 in June, 2012, it would require EHR vendors to design, develop, and release new functionality, and for eligible hospitals to upgrade, implement and begin using the new functionality by the beginning of the reporting year in October of 2012. After careful consideration of the trade-offs between the urgency with which new functionality is needed and the ability to safely deliver and to effectively use the new functionality, the HITPC recommends that—only for those who begin to attest to MU in 2011—an extra year be provided to phase in the stage 2 expectations (ie., Stage 2 for those who attest in 2011 would begin in 2014).

The Committee asserts that the delay would only affect providers who implement Stage 1 in 2011.  This assumes that providers who wait until 2012 to implement Stage 1 would not have been ready to implement Stage 2 until 2014 anyway.  The letter also sets forth the proposals for stengthening Stage 1 criteria in Stage 2.  The Committee voted 12 to 5 in favor of the recommendations in the letter.  To read the entire 14-page letter, click here.

CMS Posts Helpful EHR Incentive Program Registration Guides

CMS has posted very helpful Electronic Health Record (EHR) Registration User Guides, one for Eligible Hospitals and one for Eligible Professionals. The Guides provide an excellent overview of the path to receiving EHR Incentives available under the Health Information Technology for Economic and Clinical Health (HITECH) Act.  As I pointed out in my previous post, CMS is encouraging Eligible Hospitals and Eligible Professionals to go ahead and register in advance of making an attestation to meaningful use of a certified EHR.  CMS has set up the system so that registrants do not have to fear that registration alone could somehow subject them to penalties later for failing to follow through with implementing and making an meaningful use of an EHR.  This is evident by reviewing the way in which the registration system is broken down into four parts or “tabs”: Registration, Attestation,  Status and Account Management.
Registration Tab. Here is where hospitals and physicians (as well as other practitioners eligible for incentives under State Medicaid programs) can register for the EHR Incentive Program.  Registrants also will access this Tab to take one of the following actions: Continue an Incomplete Registration, Modify an Existing Registration, Resubmit a registration that was previously deemed ineligible, Reactivate a Registration, Switch Incentive Programs (Medicare/Medicaid), Switch Medicaid State, and Cancel Participation in the EHR Incentive Program.
Attestation Tab.  Under this Tab is where registrants can submit their Attestation of meaningful use when ready.  This Tab also provides options and instructions for Registrants wanting to: Continue an Incomplete Attestation, Modify an Existing Attestation, or Discontinue an Attestation.
Status Tab.  Here, registrants can view the status of Registration, Attestation and their EHR Incentive Payment.
Account Management Tab.  Here, registrants can Update Account Information, Request Access to Organizations, or Remove Access to Organizations.
The Hospital Guide can be accessed here and the Eligible Professional Guide can be accessed here.