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CMS Releases Proposed Updates to Medicare MIPS Promoting Interoperability Program

On May 10, 2022, the Centers for Medicare and Medicaid Services (CMS) released a notice of proposed rulemaking (NPRM) related to changes in the Medicare Program Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System. Among the proposals in this lengthy document are those related to the Promoting Interoperability Program, the successor to the Meaningful Use of Electronic Health Record (EHR) technology that was originally rooted in the 2009 HITECH Act. This program has been evolving over the years and this NPRM proposes some meaningful changes to the public health reporting component which would first be used for the calendar year 2023. 

Proposals include:

• Changes to the requirements related to Prescription Drug Monitoring Programs (PDMP) which exist now in every state, some localities, and most territories. The proposal changes the query of PDMPs from optional to required, expands the reporting to include controlled substances, and removes an exclusion based on a hospital’s inability to integrate with a state PDMP. Given the continued seriousness of addiction in the US, and advancements in the use of PDMP technology, these changes seem prudent.
• Addition of a new health information exchange (HIE) measure that would allow the use of the emerging national network based on the Trusted Exchange Framework and Common Agreement (TEFCA, see our recent comments on the Version 1 release) to fulfill this requirement fully. Use of this network would be a third HIE option. CMS is also signaling its interest in leveraging TEFCA for “payment and operations activities such as submission of clinical documentation to support claims adjudication and prior authorization processes.” It is also worth noting that CMS is requesting additional input into TEFCA in general and its potential usefulness in support of its program.
• The addition of Antimicrobial Use and Resistance (AUR) reporting through the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network (NHSN), with exclusions for hospitals that do not have any appropriate patients or care locations, and at least initially for hospitals who do not have appropriate reporting systems. This seems like a good addition given the severity of AUR in our society.
• Changes to the definition of “active engagement” between an eligible hospital and public health agencies to recognize the maturity of those relationships since the program’s start and the need to do more to move hospitals from simple registration and testing to production data submission. The changes would include for the first time the requirement that the hospital actually declare its level of engagement (by the old definition if these proposed changes are not accepted), and that it progress from one stage to another prudently. This also seems like a prudent refocus of this definition given where we are today.
• Clarity that an eligible hospital’s lack of performing required reporting to public health could be considered “information blocking” under the rule. It had never occured to me before that the information blocking rule could be used to support public health reporting. In many jurisdictions where laws or regulations require reporting the public health agency is hesitant to use a regulatory “stick” (if it even exists) for fear of alienating the provider community. Perhaps allowing the Office of the National Coordinator for Health Information Technology (ONC) to use its regulatory stick can achieve the same result with fewer public health agency “fingerprints.”
• Changes to the scoring system used for reporting to adjust for changes to the measures that are proposed. It is worth noting that the number of points associated with the required public health reporting measures would increase; the total number of points associated with HIE activities would decrease.

Comments on this NPRM are due to CMS no later than June 17, 2022. HLN contributed to comments submitted by the American Immunization Registry Association (AIRA).