On September 4, 2014, the Department of Health and Human Services (“HHS”) published a final rule modifying the Medicare and Medicaid Electronic Health Record (“EHR”) Meaningful Use Incentive Program. The modification brings welcome change, allowing increased flexibility while also assuaging several provider concerns.

The new rule, effective October 1, 2014, comes in response to numerous public comments lamenting the inability of providers to meet the 2014 meaningful use objectives—an inability that brought with it financial penalties. As part of the new rule, HHS made four distinct changes to the EHR Incentive Program:

1. Altered the meaningful use stage timeline and definition of certified electronic health record technology (“CEHRT”). The new rule implements a one-year extension of Stage 2 for providers that first joined the Program in 2011 or 2012. The timeline to begin Stage 3 has thus been postponed until 2017. In keeping with this timeline shift, HHS also formally modified the CEHRT definition to reflect this date change, thus postponing until 2015 the required start date for exclusive use of 2014 Edition CEHRT.

2. Set the requirements for reporting on meaningful use objectives and measures, as well as the reporting requirements for clinical quality measure (“CQM”) submission. Participants can now use 2011 Edition CEHRT—or a combination of 2011 and 2014 Edition CEHRT—to demonstrate satisfaction of the meaningful use objectives for the 2014 reporting period. Thus, participants are no longer limited to 2014 Edition CEHRT. The method of CQM submission now depends on which edition of CEHRT a participant uses to record, calculate, and report its CQMs for the 2014 reporting period.

Practically speaking, perhaps the most meaningful effect of this change is that program participants will not be held responsible for their inability to implement 2014 CEHRT due to vendor and developer delays or other delays in the certification of EHR technology.

3. Adopted alternative Incentive Program measures for eligible hospitals and critical access hospitals (“CAHs”) to report satisfaction of Stage 2 meaningful use measures. Stage 2 objectives require eligible hospitals and CAHs to provide electronic lab results to ambulatory providers for more than 20% of the lab orders received. Now, when determining whether participants have met this 20% threshold, the new rule allows eligible hospitals and CAHs to include in the denominator all lab orders received, rather than only those received electronically.

Stage 2 objectives also require eligible hospitals and CAHs to allow patients to view online, download, and transmit information about hospital admission. The new rule clarifies that satisfaction of this CQM is based upon the number of unique patients discharged from a hospital’s inpatient or emergency department during the EHR reporting period.

The new rule also formally adopts a “case threshold exemption.” Eligible hospitals and CAHs with 5 or fewer discharges during the 90-day reporting period (or 20 or fewer discharges during the full year reporting period) would thus be exempt from certain CQM reporting measures. The new rule also finalizes a number of technical corrections to CQM electronic specifications.

4. Updated the Data Element Catalog (“DEC”) and the Quality Reporting Document Architecture (“QRDA”) Category Standards. The DEC requires EHR technology to be able to electronically record all of the data that would be necessary to report on 2014 CQM. HHS updated the DEC—now DEC Version 1.1—to be able to capture those necessary data points. Similarly, HHS updated the QRDA to capture certain data, such as National Provider Identification Numbers, that are necessary for CMS to properly process electronic reporting file submissions.

For additional information, the HHS Press Release is also available here.