CMS Delays Interoperability Final Rule Roll Out Due to COVID-19

Because hospitals, health systems, and providers are on the frontlines of treating and covering patients with COVID-19, the Centers for Medicare and Medicaid Services (CMS) decided to extend the implementation timeline of the recent Interoperability and Patient Access final rule.

The current coronavirus public health emergency has undoubtedly shaken the healthcare industry. Many are putting unprecedented time and resources into combatting the disease, so complying with a new rule may be low on many priority lists.

“[These] actions follow the extensive steps CMS has taken to ease the burden on the healthcare industry as it fights COVID-19,” reported Seema Verma, CMS administrator in her statement.

The original rule was released on March 9, 2020. It intended to provide patients with greater access to their health information and better coordinate their own healthcare as a part of the MyHealthEData initiative. Payers originally had until January 2, 2021 to implement these policies outlined in the final rule. But the extension gives them until July 1, 2021 to comply.

“The Interoperability and Patient Access final rule delivers on the Administration’s promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it,” the extension announcement said.

There are two main policies in the final ruling payers must work to implement: the Patient Access API and the Provider Directory API.

The Patient Access API will give patients access to all of the information related to their medical visit including clinical data and costs while the Provider Directory API gives patients information on providers in order to make informed decisions for their care.

Both policies aim to empower patients with information and coordinate their own care. Having access to their own health information will make coordination across providers and health systems easier by eliminating interoperability challenges. And having access to verified provider information allows patients to critically think about who they want to administer their care.

“Now more than ever, patients need secure access to their healthcare data,” Verma continued.

All CMS-regulated health plans including Medicare Advantage, Medicaid, the Children’s Health Insurance Program, and Qualified Health Plans on federally-facilitated exchanges must comply with the new rule. So members in each of these plans will have access to their health information in a way they never did before.

But implementing these APIs requires a robust infrastructure to manage these databases. Above all, patient’s private health information must be protected, meaning security protocols must be strict and up to date with federal standards. At the same time, information should be easily transferable to patients ensuring a quick and user-friendly experience.

Balancing ease of use with security and privacy is a challenge in it of itself. But payers are being asked to manage this in the midst of also managing a public health emergency.

CMS has outlined an implementation plan for payers to ease payer burden and promote a smoother rollout. This guidance will allow payers to comply with the policies without needing to recreate the wheel. While it is not required that plans follow these guidelines, they were intended to make implementation easier. Payers can then focus on coverage, treatment, and provider support for the coronavirus instead of building and implementing a compliance strategy for the new rule.

The implementation guidance ensures support for patient privacy and security, highlighting key aspects of the rule including claims and encounter data, clinical data, plan coverage and formularies, and provider directory.

Having the support for implementation will empower payers as they roll out these new rules while also ensuring they have the time an ability to focus on their COVID-19 strategy.