By Jeffrey H. Brochin, J.D.
This proposed rule is intended to improve access to, and quality of, information that Americans and their providers need in order to make informed health care decisions as envisioned in the 21st Century Cures Act.
CMS’ proposed rule contains the first phase of proposed policies centrally focused on advancing interoperability and patient access to health information using the authority available to CMS for the governance of Medicare and Medicaid, including managed care plans and the Children’s Health Insurance Program (CHIP). The agency believes that the proposed rule constitutes an important step in advancing interoperability, putting patients at the center of their health care, and ensuring that they have access to their health information (Proposed rule, 84 FR 7610, March 4, 2019).
Access to complete information. One critical issue in the U.S. health care system is that patients cannot easily access their complete health information in interoperable forms. Patients and the health care providers caring for them are often presented with an incomplete picture of their health and care, as pieces of their information are stored in various, unconnected systems and do not accompany the patient to every care setting.
CMS believes that patients should have the ability to move from health plan to health plan, provider to provider, and have both their clinical and administrative information travel with them throughout their journey. When a patient receives care from a new provider, a complete record of their health information should be readily available to that care provider, regardless of where or by whom care was previously provided. When a patient is discharged from a hospital to a post-acute care (PAC) setting there should be no question as to how, when, or where their data will be exchanged. Likewise, when an enrollee changes health plans or ages into Medicare, the enrollee should be able to have their claims history and encounter data follow so that the information is not lost.
Initiatives to improve interoperability. CMS proposed to require that information be readily accessible to patients enrolled in government-funded health care programs, as well as those enrolled in qualified health plans (QHPs) under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), through open APIs. These open APIs will allow third-party applications to connect and make information publicly available in accordance with privacy regulations. CMS also proposed requiring payers to support beneficiaries’ efforts to coordinate their own care by readily sharing information such as claims, encounter data, and clinical health information through a trusted health information exchange network.
CMS also plans to work to deter information blocking and increase the number of clinicians whose contact information is captured by a common directory. The agency proposed revising conditions of participation to require hospitals to send patient event notifications to other health care facilities in order to improve care coordination.
FederalRegisterIssuances: ProposedRules AgencyNews CHIPNews HealthInformationTechnologyNews HealthInsuranceExchangeNews ManagedCareNews MedicaidNews MedicarePartANews MedicarePartBNews ReportingTransparencyNews NewsFeed
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