CMS Promoting Interoperability in 2021: All good things must come to an end?

Noam H. Arzt, Ph.D.We have spent years involved with the management of the Center for Medicare and Medicaid Services (CMS) Electronic Health Records (EHR) Incentive Programs which were created by the HITECH Act (2009). These programs were recently renamed Promoting Interoperability (PI) programs. In a nutshell, these programs were tied to the Medicare and Medicaid insurance programs and provided financial incentives over a number of years to ambulatory providers and hospitals to adopt and use EHRs. Vendors submitted their technology products for testing and certification that they performed specific functions and could exchange data using specified message formats.

Adoption was indeed fairly wide-spread; whether the use of EHRs improved the health and quality of care of patients at a reasonable cost is a matter still being debated. As of October 2018 more than $13 billion in incentive funds had been paid to over 460,000 eligible professional and over 13,000 hospitals in the Medicaid incentive program alone. Nearly $25 billion had been paid to over 1 million eligible professionals and more than 15,000 hospitals under the Medicare program.

For public health, these programs have had a significant positive impact on health care providers' reporting of immunizations, electronic laboratory results, syndromic surveillance indicators, cancer incidents, hospital-acquired infections, and other information, especially where reporting is not mandatory in the jurisdiction.

But the provisions of the HITECH Act are due to expire on September 30, 2021 (see CMS timeline). These are the programs affected:

Promoting Interoperability: Medicaid -This program will in fact end on September 30, 2021. For the last several years, the reporting period has been any continuous 90 day period within a calendar year, though CMS is allowing the 2021 reporting period to extend to December 31, 2021. No payments will be made to any provider after 2021.

Promoting Interoperability: Medicare -While the incentive program will also end on September 30, 2021 and any outstanding incentive payments will stop, we believe the downward payment adjustment (i.e., penalty) for non-participation or non-attestation will stay in place.

The impact on the healthcare community will be significant, and there are still many unanswered questions for the provider community or for public health agencies. While 2021 may seem like it's far off, here are some issues to consider as we get into 2020:

• As Promoting Interoperability requirements fall away, especially for Medicaid-only program participants, jurisdictions may see a drop in public health reporting, especially where reporting is not mandatory.
• Jurisdictions need to be prepared to modify any public websites, educational materials, or other communications related to the Medicaid Promoting Interoperability Program in their states as the program comes to an end. Remember, attestation by eligible providers and hospitals will continue into 2022 so jurisdictions need to be prepared to continue to support any documentation requirements.
• Jurisdictions may want to consider mandatory public health reporting requirements where they might not currently exist. This may require not only strong agency and broader community support and potentially significant lead time to garner legislative support and action.
• The HITECH Act also supported Medicaid 90/10 matching funds for State HIE activities through FY2021, provided through the Implementation Advanced Planning Document (IAPD) process . The availability of this funding will end on September 30, 2021. Jurisdictions must be cognizant of funding request schedules and by when funding must be completed or encumbered..
• Hospitals that have been eligible for both the Medicare and Medicaid PI programs have typically attested to the Medicare program. Starting in 2019 they meet the requirements of the Medicaid PI program as well. Ostensibly, a hospital that was only Medicaid eligible and not Medicare eligible will simply stop participating after 2021.
• Professionals who may have been eligible for both programs were advised by CMS to choose the Medicaid Promoting Interoperability Program since participation is only allowed in one program. As the Medicaid Promoting Interoperability Program is phased out, jurisdictions should be prepared for eligible providers to migrate to the Medicare Promoting Interoperability Program. While the impact on public health reporting should be transparent and seamless, there may be administrative questions as these providers may need to re-register with CMS.

There is a nice article about the sun setting of CMS funding and ongoing Medicaid programs available to public health agencies in the December 2019 edition of the AIRA Snapshots Newsletter.

Thanks to Steve Eichner of the Texas Department of State Health Services for a careful review of this material.