On August 29, 2014, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) issued a final rule modifying the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. While CMS is responsible for managing the EHR incentive programs and meaningful use, ONC is responsible for creating and maintaining an EHR certification program. The final rule includes the following significant changes: (1) the issuance of various options providers may use to meet the 2014 reporting requirements; (2) extension of the deadline for implementation of Stage 3 for certain providers; and (3) modification of the reporting requirements for Clinical Quality Measures (CQMs) to reflect a provider’s choice of certified electronic health record technology (CEHRT).

2014 Reporting Options:

Due to product availability delays, CMS and ONC recognized that many providers may have difficulty fully implementing the 2014 Edition CEHRT to meet meaningful use. As a result, CMS and ONC developed the following three options providers can utilize for their 2014 meaningful use attestations:

Option 1: Utilize 2011 Edition CEHRT. Eligible professional (“EPs”), eligible hospitals (“EHs”) and critical access hospitals (“CAHs”) may use the 2011 Edition CEHRT for the 2014 EHR reporting period and must meet the meaningful use objectives and measures for Stage 1 that were applicable during the 2013 payment year, regardless of the provider’s current stage of meaningful use.

Option 2: Utilize a Combination of 2011 and 2014 Edition CEHRT. The second option for EPs, EHs, and CAHs who were impacted by the delays is to utilize a combination of 2011 Edition CEHRT and 2014 Edition CEHRT for their 2014 reporting period. These providers may choose to meet (a) the 2013 Stage 1 objectives and measures; (b) 2014 Stage 1 objectives and measures, or (c) for those providers scheduled to begin Stage 2 in 2014, the Stage 2 objectives and associated measures.

Option 3: Utilize 2014 Edition CEHRT for 2014 Stage 1 Objectives and Measures Instead of Stage 2 Objectives and Measures. For some EPs, EHs, and CAHs, the 2014 Edition CEHRT availability delays resulted in the inability to fully implement all the necessary Stage 2 objectives and measures for the 2014 reporting period. Consequently, CMS and ONC are permitting providers scheduled to begin Stage 2 for the 2014 EHR reporting period to attest to the Stage 1 objectives and measures.

Under all three options, the EP, EH or CAH utilizing the alternative reporting measures for 2014 must attest that it was “not able to fully implement” 2014 Edition CEHRT due to “delays in 2014 Edition CEHRT availability.” CMS and ONC did not intend for the alternative reporting options to be broadly utilized by providers. Therefore, the final rule provides guidance on the terms “not able to fully implement” and “delays in 2014 Edition CEHRT availability,” which limit who can attest to meeting these requirement.

The final rule lists the following examples of situations that would not be permissible reasons to “not be able to fully implement” 2014 Edition CEHRT and, therefore, would not be grounds to use the optional reporting requirements: (a) failure to implement due to financial issues, such as the costs of implementing, upgrading, installing, or testing; (b) experiencing personnel problems, such as staff changes and turnover; and (c) inaction or delay by the provider, including waiting too long to engage a vendor or the provider’s inability or refusal to purchase requisite software updates. Regarding “delays in 2014 Edition CEHRT availability, CMS and ONC clarified that this term refers specifically to one or more delays related to the development, certification, testing and release of an EHR product by the EHR vendor or developer, not from merely whether the software is certified and then installed or not.

The above-mentioned attestation options are not available to providers who have fully implemented 2014 Edition CEHRT.

Stage 3 Implementation Extension:

Another significant change in the final rule was the finalization of the proposed delay in the deadline for implementation of Stage 3 meaningful use requirements for those providers who became meaningful users of EHR in 2011 or 2012. Originally set for January 1, 2016, the Stage 3 deadline has not been delayed until January 1, 2017. The delay is intended to provide CMS and ONC with the opportunity to focus on successful implementation of the Stage 2 requirements. The Stage 3 objectives and measures, as well as reporting criteria, will be defined in future rulemaking.

CQM Submissions for 2014:

In light of the 2014 reporting changes, CMS and ONC also adjusted the CQM submission requirements. For providers who choose to attest to the 2013 Stage 1 objectives and measures, they must also report the CQMs that were applicable for 2013. Similarly, those providers choosing to attest to the 2014 Stage 1 or Stage 2 objectives and measures must also report the 2014 CQMs in the manner required for 2014.

The reporting options set forth in the final rule only apply to the 2014 reporting period. No changes have been made to reporting requirements for 2015. Providers must use 2014 Edition CEHRT for the 2015 reporting period and for subsequent years.