New Information From CMS and ONC

[Thomas, Cheyenne A.--IRM (Silva)]

Hi All,

A number of items were released the day before Christmas from CMS and ONC. 

• The first is information on how to register and an announcement that registration will be open on 01/03/10.  However, they have not highlighted a couple of items that is important to know.  First, accordingly to a recent FAQ, once you make an election on this registration site, it may not be changed.  Here is the text:

Hospitals that are eligible for EHR incentive payments under both Medicare and Medicaid should select "Both Medicare and Medicaid" during the registration process, even if they plan to apply only for a Medicaid EHR incentive payment by adopting, implementing, or upgrading certified EHR technology. Dually-eligible hospitals can then attest through CMS for their Medicare EHR incentive payment at a later date, if they so desire. It is important for a dually-eligible hospital to select "Both Medicare and Medicaid" from the start of registration in order to maintain this option. Hospitals that register only for the Medicaid program (or only the Medicare program) will not be able to manually change their registration (i.e., change to "Both Medicare and Medicaid" or from one program to the other) after a payment is initiated and this may cause significant delays in receiving a Medicare EHR incentive payment.

According to a recent announcement from the AHA, there may be some issues with registering as "Both Medicaid and Medicare" for states that have not yet enacted their incentive plan.  I have pasted the text from AHA below.  Because of this, I think we should advise our facilities to postpone registration until this is cleared up.  The only deadline for registration is that it must be done prior to attestation so we have some time and I think prudence is the better approach here.

AHA Text:
What CMS did not announce, is that there are still some bugs in its system for hospital registration. I am still waiting on clarification from them about current status, and it may be fixed by January 3, but as of last week, a hospital in a state WITHOUT a live Medicaid registration site would NOT be able to register for either “Medicaid only” or for “both Medicare and Medicaid.” They will only be allowed to register as “Medicare only.” This is unfortunate because CMS will not allow hospitals to change their registration status (e.g. from Medicare to Medicaid or to both) later in the year through an automated process. It will require a manual process through CMS. I am working with CMS to get the best possible guidance for hospitals about when and how to register and will share it in early January.

• The second is a fact sheet for each objective.  I am in the process of download and reviewing these currently but here is the link to get to them:

http://www.cms.gov/EHRIncentivePrograms/Downloads/Hosp_CAH_MU-TOC.pdf

• The third is an update from ONC regarding the requirement to have technology available for all objectives even those that are deferred.  Here is what we received from AHA.  I am looking into this as well and will ask Chantal at ONC to keep me posted as well.

ONC has attempted to address our concerns on the issue of certification for 19 versus 24 objectives through a revision of FAQ-17 and the addition of FAQ-21. The full text of both FAQs is below. Although we will need some time to fully digest and analyze the implications of the FAQs, the bottom line is that they will require hospitals to “possess” certified EHRs to support all 24 objectives of meaningful use, and “demonstrate” meaningful use of 19 objectives. The guidance defines “possession” to be either physically having the technology or having a contract that provides “a legally enforceable right… to access and use” the technology at your discretion (and possibly in the future). The extent to which you implement the technology will not affect your “possession” of it. ONC assumes that in their vendor contracts, hospitals will be able to make payment contingent on actual use so that they may “possess” functionality that they do not plan to implement immediately. FAQ-21 is dedicated to explaining this concept and providing examples. The FAQs are posted at: http://healthit.hhs.gov/portal/server.pt/community/onc_regulations_faqs/3163.

That is it for now.  Still reviewing.  As usual, they posted during a holiday so that it will take people a while to sort it out.  By the way, CMS has completely restructured its EHR website so there may be some other hidden info that I have not found yet. 

Thanks,
Cheyenne Thomas
INHS/IRM
Manager, Regional Accounts
509-232-8180
thom...@inhs.org

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