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CMS, ONC Release Proposed Rules on Interoperability

The Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) released proposed rules intended to increase interoperability and improve patients’ access to their health information, while reducing regulatory burden on hospitals.

The proposed rules support CMS’ MyHealthEData initiative and implement provisions of the 21st Century Cures Act.

CMS Proposal

The proposed rule on interoperability and patient access aims to increase patient access to health data, promote interoperability across providers and payers, and improve care coordination. Specifically, the rule would:

  • revise the Medicare hospital conditions of participation (CoPs) to require hospitals to send electronic notifications to other providers and facilities when a patient is admitted, discharged, or transferred;
  • update the frequency with which states must exchange certain data on beneficiaries dually eligible for Medicare and Medicaid to improve benefit coordination for this population; and
  • make public a list of hospitals and other providers engaging in “information blocking,” or practices that create excessive barriers to increasing interoperability.

The proposed rule also would require Medicare Advantage plans, state Medicaid fee-for-service and managed care plans, qualified health plans sold on Affordable Care Act exchanges, and certain other payers to increase access to health information by:

  • developing application programming interfaces (APIs) to make patient claims and other health information available through third-party applications and developers;
  • making provider networks available to enrollees and prospective enrollees through API technology;
  • enabling care coordination through trusted exchange networks;
  • ensuring patients maintain access to their health information even as they move between plan types; and
  • increasing access to health information networks to participate in nationwide exchange of data.

The proposal also includes two requests for feedback on how to improve patient identification and safety to encourage better care coordination across health care settings. The request also seeks ways to promote adoption of interoperable health IT systems across health care settings, including long-term and post-acute care, behavioral health, and settings serving dual-eligible individuals.

CMS also seeks input on promoting interoperability as part of innovative payment and service delivery models developed and tested through the Center for Medicare and Medicaid Innovation.

ONC Proposal

Meanwhile, the ONC proposed rule would implement parts of the 21st Century Cures Act related to advancing interoperability; supporting the access, exchange, and use of electronic health information; and addressing information blocking.

The proposed rule emphasizes the importance of patient access to electronic health information with a provision requiring that patients can electronically access such information at no cost.

The proposed rule creates a new certification criterion and other new standards for APIs. It also defines exceptions to the information blocking provisions of the 21st Century Cures Act.

ONC acknowledges the burden hospitals face when switching electronic health record systems and proposes to require that technology developers create ways to export electronic health information to more easily facilitate these transitions.

Both proposed rules were released on the websites of their respective agencies. Comments are due 60 days after they are posted to the Federal Register.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Rachel Schwartz is a former policy associate at America's Essential Hospitals.

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