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Meaningful Use Update: Flexible Options for CY 2018

on Thursday, 7 September 2017 in Health Law Alert: Erin E. Busch, Editor

On August 2, 2017, in the 2018 Medicare Hospital Inpatient Prospective Payment System and Long Term Acute Care Hospital Prospective Payment System Final Rule (the “Final Rule”), the Centers for Medicare and Medicaid Services (“CMS”) released changes to the Medicare and Medicaid Electronic Health Record Incentive Program (“Meaningful Use”).  The rules affect Meaningful Use requirements for calendar year (“CY”) 2018 reporting periods – and include a revised reporting period, certified electronic health record technology (“CEHRT”) requirements, and an exception for de-certified software.  Highlights of the revised rules include the following:

90-Day Reporting Period.  For CY 2018, CMS finalized a change in the EHR reporting period from a full calendar year to a 90-day reporting period for new and returning participants in the Medicare and Medicaid Meaningful Use programs.  This means eligible professionals, eligible hospitals, and critical access hospitals must use a minimum of any 90-day continuous period from January 1, 2018 through December 31, 2018.  The goal is to allow participants additional time to test and implement 2015 Edition CEHRT, including application programming interface (“API”) functionality required for Stage 3.  CMS declined to implement a permanent 90-day reporting period for future years. 

CY 2018 Certification Requirements.  In 2015, CMS finalized rules about which edition of CEHRT participants must use to demonstrate Meaningful Use.  The rules stated that in 2018 all participants will be required to use 2015 Edition CEHRT.  However, Stage 3 requires many new functionalities; and providers across the country expressed concerns about patient safety, staff training, and workflow concerns if required to move to Stage 3 by CY 2018.  In addition, many organizations have experienced significant vendor delays and short timelines to revise internal practices to implement Stage 3 requirements.  In the Final Rule, CMS provides for a flexible approach in 2018.  Participants may attest to either Modified Stage 2 or Stage 3 as follows:

  • Modified Stage 2 (using 2014 Edition CEHRT, 2015 Edition CEHRT, or a combination of 2014 and 2015 Edition CEHRT).
  • Stage 3 (using 2015 Edition CEHRT or a combination of 2014 and 2015 Edition CEHRT).

The CEHRT edition (or combination) used to attest must support the objectives and measures to which the participant plans to attest (either Modified Stage 2 or Stage 3). 

Exception for De-Certified Software.  As mandated by the 21st Century Cures Act, CMS also finalized an exception to the Medicare payment adjustment for participants who are unable to meet Meaningful Use requirements due to their CEHRT being de-certified by the Office of National Coordinator of Health IT Certification Program.  This new exception will help ease the financial losses for those participants who intended to meet Meaningful Use requirements and adopted and implemented CEHRT – only to have the software de-certified outside of their control.  CMS plans to develop an application process for participants to demonstrate that they qualify for this exception.

Overall, the Final Rule provides greater flexibility and additional time to allow providers to transition to Stage 3.  Organizations should be familiar with the CY 2018 requirements and continue to devote resources to upgrading and implementing new technology, training staff, and revising workflow processes.

Michael W. Chase


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