Health Policy Check Up News

ONC and CMS Introduce Proposed Rules on Target Data Blocking

Both the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) have introduced proposed rules on Target Data Blocking, which, if properly tailored and modified, have the potential to substantially impact Accountable Care Organizations (ACOs), Independent Physician Associations (IPAs), Clinically Integrated Networks (CINs) and other value-based care organizations (VBCOs) by greatly expanding data transparency as between payers, including Medicare Advantage Organizations (MAOs), and VBCOs.

The CMS proposed rule on target data blocking is designed to transition the industry towards interoperability, and further builds upon CMS’ goals, deriving from the 21st Century Cures Act and Executive Order 13813, to improve access to, and the quality of, information that Americans need to make informed health care decisions, including data about health care prices and outcomes, while minimizing reporting burdens on affected plans, health care providers, or payers.

According to the ONC, their proposed rule on target data blocking would implement certain provisions of the 21st Century Cures Act, including more fully and completely describing the conditions and maintenance of certification requirements for health information technology (health IT) developers under the ONC Health IT Certification Program (Program), the voluntary certification of health IT for use by pediatric health care providers, and by insulating certain reasonable and necessary IT activities that do not constitute information blocking. The implementation of these provisions would advance interoperability and support the access, exchange, and use of electronic health information. The proposed rule would also modify the 2015 Edition health IT certification criteria and Program in additional ways to advance interoperability, enhance health IT certification, and reduce burden and costs.

Why You Should Participate:

For VBCOs, expansion and clarification of the 21st Century Cures Act prohibition on “information blocking” presents a rare opportunity to create a more level playing field as between VBCOs and payers by forcing the enhancement of payer data transparency, which is critical for VBCOs to gather and/or review the data and methodologies held/employed by payers to calculate patient risk scores and to confirm the accuracy of payer-calculated accrued shared savings (or shared risk). Additionally, VBCOs, being in the unique position of having comprehensive in-house data analytics departments and proprietary healthcare data analytics methodologies or software, must be certain that the new Health IT requirements imposed by the proposed rulemakings are both clear and reasonably implementable from both a cost and technological standpoint.

Submitting targeted, concise comments to CMS and ONC expressing questions and concerns relevant to the above issues is one means of ensuring your company’s continued success in the fast-changing value-based care landscape. Indeed, even if the agencies disagree with a proposed suggestions for improving the rules, in so doing, they will have to provide reasons therefor, thereby providing you with invaluable advanced guidance for full compliance with the rules prior to their implementation.

There are multiple ways to can respond to the ONC’s “21st Century Cures Act: Interoperability, Information Blocking and the ONC Health IT Certification Program” and/or CMS’ “Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Interoperability and Patient Access for Medicare Advantage Organization and Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans in the Federally-facilitated Exchanges and Health Care Providers” proposed rules. Contact Frier Levitt Government Affairs to have your voice heard.