Here's What You Need to Know About the New ONC & CMS Final Rules

A quick glance at the most important updates

Here’s what you need to know about the new final rules from the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) that address several provisions of the 21st Century Cures Act.

The ONC Rule:

• Intends to support the seamless and secure access, exchange, and use of electronic health information (EHI). It focuses on standardized application programming interfaces (APIs), implementing the information-blocking provisions of the Cures Act. It also includes several changes to the current 2015 Certification standards, such as the requirement for EHRs to use the U.S. Core Data for Interoperability (USCDI).

• Prohibits “information blocking” by payers and health systems, because this practice restricts access to health care information and slows down interoperability. As a result, payers and health systems must then provide data through an API to give patients access to their own data. The rule also identifies activities that don’t constitute information blocking.

• Establishes secure API requirements to support patients’ access to and control of their own electronic health information.

• Requires that EHRs provide the clinical data necessary to promote new business models of care.

The CMS Rule:

• Requires health plans in Medicare Advantage, Medicaid, and HIP to share their claims data electronically with patients.

• Creates a “Condition of Participation” for all Medicare and Medicaid participating hospitals, which mandates that they send electronic notifications to another health care facility or community provider/practitioner when a patient is admitted, discharged, or transferred.

• Requires states to submit enrollee data daily (starting on April 1, 2022) for beneficiaries enrolled in Medicare and Medicaid.

For guidance on what these rules mean for you and your practice, visit this webpage from ONC or this webpage from CMS.