HHS/ONC Finalizes Rules to Promote Interoperability/ Patient Access

March 12, 2020
Policy Snapshot

On March 9, the Department of Health and Human Services (HHS) finalized two rules that will give patients safer, more secure access to their health data. The two rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS), implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act and support the MyHealthEData initiative. These final rules require both public and private entities to share health information between patients and other parties, while keeping that information private and secure.

The ONC Final Rule:

  • Identifies and finalizes the reasonable and necessary activities that do not constitute information blocking while establishing new rules to prevent these practices by health care providers, developers of certified health IT, health information exchanges, and health information networks
  • Updates certification requirements for health IT developers and establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security
  • Requires electronic health records to provide the clinical data necessary, including core data classes and elements to promote new business models of care
  • Establishes secure, standards-based Application Programming Interface (API) requirements to support a patient’s access and control of their electronic health information

The CMS Interoperability and Patient Access final rule requires health plans in Medicare Advantage, Medicaid, CHIP, and through the federal exchanges to share claims data electronically with patients. Beginning January 1, 2021, Medicare Advantage, Medicaid, CHIP, and—for plan years beginning on or after January 1, 2021—plans on the federal exchanges will be required to share claims and other health information with patients in a safe, secure, understandable, user-friendly electronic format through the Patient Access API.

The CMS final rule also establishes a new Condition of Participation for all Medicare and Medicaid participating hospitals, requiring them to send electronic notifications to another health care facility or community provider or practitioner when a patient is admitted, discharged, or transferred. Additionally, CMS is requiring states to send enrollee data daily beginning April 1, 2022, for beneficiaries enrolled in both Medicare and Medicaid, improving the coordination of care for this population.

For more information:

See the full text of this excerpted CMS Press Release (issued March 9).