What Do the New Interoperability Rule and Information Blocking Rule Mean?

On Monday, March 9, the Office of the National Coordinator for Health Information Technology (ONC) of the Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released two new rules. The announcement includes a new interoperability rule as well as an information blocking rule. So, what do these new rules mean, and how will they impact healthcare data?

New Rules Proposed Last Year

The rules, originally proposed over a year ago, apply to any hospital, physician, or health plan that receives reimbursements from Medicare or Medicaid. In this past year, stakeholders were allowed to make comments. The onus for these rules was to transform patient access to their medical records, which should accelerate the movement toward value-based care.

New Interoperability Rule Defines Big Changes

The new rule will require payers and hospitals to make significant changes. The Interoperability and Patient Access final rule requires Medicaid, Children’s Health Insurance Program (CHIP), Medicare Advantage (M.A.) plans, and other qualified health plans offer access to enrollee data immediate access by January 2021. 

The effort behind this accessibility is to boost the digital transformation of healthcare data sharing. 

Key Requirements and Timelines

The new rule lays out these requirements and deadlines:

Patient access

The majority of healthcare parties, including CMS-regulated payers, Medicaid fee for service programs, Medicaid managed care plans, CHIP fee for service plans, and CHIP managed care entities must implement a secure, standards-based (HL7 FHIR Release 4.0.1) API to enable patients easy access to claims and encounter information. This includes costs and is to be accessible via a third-party app. Implementation must occur by January 1, 2021.

Provider directory

CMS-regulated payers will need to publish provider directory information by January 1, 2021, for public consumption.

Admission, discharge, and transfer event notifications

All hospitals will now be required to provide electronic notifications of a patient’s admission, discharge, or transfer. The policy is effective six months after the CMS rule publication.

Payer to payer data exchange

Payers will need to exchange patient clinical data, specifically the U.S. Core Data for Interoperability, at a patient’s request. Payers will have to establish a process for this data sharing by January 1, 2022. The result of this new rule should make it less cumbersome for patients to provide past information to a new payer. 

Public reporting and information blocking

In late 2020, CMS will begin to publicly report clinicians and hospitals that are engaging in information blocking based on how they have implemented Promoting Interoperability Program requirements. 

Digital contact information

CMS will also begin in late 2020 the process of publicly publishing providers that do not list or update their digital contact information in the National Plan and Provider Enumeration System. Providers will need to include secure digital endpoints, such as direct address or FHIR API endpoint. This push comes from the perspective of facilitating better care coordination. 

How Can Your Organization Plan to Meet the New Rule Obligations?

At the heart of these rules is the need to develop secure and seamless data sharing. Data sharing has been an obstacle in healthcare for many years, but there’s no doubt that healthcare data is one of your most valuable assets. However, it’s not just yours to access and store. Data has to be accessible to other parties, including patients, providers, and payers, to achieve true interoperability.

While you may already have a framework in place, there will much work to do and a quickly approaching timeline. Critical to your success will be developing a secure API, delivering a patient-facing app, and transferring data to other stakeholders. 

As a leader in healthcare data management, we have extensive experience in interoperability, accessibility, and portability. Explore our custom data solutions and data sharing services to see how we can help.