The final rule outlining Stage 1 was published in the Federal Register in July 2010 and became effective September 26, 2010. The final rule can be found here. Meaningful Use Stage 1 laid out ground rules for electronic health information use. All participating providers are required to comply with the 15 core requirements, and choose an additional five of the 10 menu requirements. The National Learning Consortium (NLC) created a checklist to help make the requirements clear, which can be accessed here. 17
Topics:
Health Information Technology
Medicaid/CHIP Data Requirements
Medicare Data Requirements
Medical Records Collection, Retention, and Access
Privacy and Confidentiality
HITECH/ARRA
The Health Information Technology for Economic and Clinical health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA)
The American Recovery and Reinvestment Act of 2009 (ARRA)1 directed the adoption and meaningful use of health information technology (HIT) as a national policy priority. Within ARRA, the Health Information Technology for Economic and Clinical Health (HITECH) Act established a legal framework for advancing HIT adoption and use.2 It also amended the Social Security Act to create financial incentives in the Medicare and Medicaid programs to encourage qualifying health care professionals and hospitals to become meaningful users of certified electronic health record (EHR) technology (CEHRT).3 Our complete summaries of the Social Security Act incorporate these amendments and can be found for Medicare here4 and for Medicaid here.5 You can also read an analysis of the major health provisions contained in ARRA here6 and view a side-by-side comparison of these provisions here.7
The HITECH Act authorizes the payment of financial incentives to eligible health care professionals who participate in Medicare and Medicaid and who are meaningful users of certified EHR technology.8 While Medicare incentives are limited to reimbursements for providers who can demonstrate meaningful use, Medicaid incentive payments are available to cover costs incurred by qualified providers and hospitals related to “adopting, implementing, or upgrading” (AIU) certified EHRs,9 in addition to bonus payments (for up to five years) for providers who “demonstrate meaningful use of certified EHR technology.”10 CMS decided to implement the meaningful use program in three stages: Stage 1 meaningful use criteria primarily address the capture of health information;11 Stage 2 meaningful use criteria are intended to expand upon the initial criteria to include more robust requirements for health information exchange;12 and Stage 3 meaningful use criteria, to be proposed by the end of 2013, would make the measure of meaningful use more robust by adding criteria that focus on quality, safety and efficiency improvements, decision support for national high priority conditions, patient access to self-management tools, and access to comprehensive patient data and improving population health.13
The Government Accountability Office (GAO) estimates that up to $30 billion in EHR incentive payments are available under program, covering all three stages from 2011 through 2019.14 CMS reports that as of July 2012, more than $6 billion in Medicare and Medicaid incentive payments have been made to 132,511 physicians and hospitals that demonstrated meaningful use of EHRs in Stage 1 of the program.15
A more comprehensive overview of the HITECH Act is located here.16 The following pages contain detailed information about each stage of the program:
Meaningful Use Stage 1
Meaningful Use Stage 2
On August 23, 2012, the Centers for Medicare and Medicaid Services (CMS) published a final rule on the Stage 2 Meaningful Use criteria that eligible professionals (EPs), eligible hospitals and critical access hospitals (CAHs) must meet to qualify as meaningful users of electronic health records (EHRs) and receive incentive payments under the Medicare and Medicaid programs. This final rule builds upon the Stage 2 proposed rule, released on March 7, 2012. Participating providers must begin following Stage 2 requirements two years after the implementation of Stage 1 to receive payments.
Stage 2 requirements build on those outlined in Stage 1, further advancing the use of electronic health records and electronic prescriptions. CMS released a Stage 2 tip sheet (can be accessed here) comparing Stages 1 and 2. In 2017, requirements for "Modified Stage 2" were released, expanding on the requirements from 2012.18
Meaningful Use Stage 3
On November 14, 2016, CMS released their final rule describing Stage 3 of Meaningful use (found here). This Stage focuses on further expanding the functionality and of EHRs, specifically the interoperability of EHRs between different practices. This stage was officially established in 2017, and providers were required to comply with this stage by 2018. 19
Footnotes
- 1. The American Recovery and Reinvestment Act (ARRA), P.L. 111-5, 123 Stat. 115 (2009).
- 2. Public Health Service Act § 3000 et seq. [42 U.S.C. § 201 et seq.] (as added by ARRA § 13101). The term “HITECH Act” refers collectively to ARRA’s Title XIII (“Health Information Technology”) of Division A and Title IV (“Medicare and Medicaid Health Information Technology; Miscellaneous Medicare Provisions”) of Division B.
- 3. Social Security Act § 1903 (a)(3)(F) [42 U.S.C. § 1396b et seq.] (as added by ARRA § 4201(a)(1)).
- 4. http://www.healthinfolaw.org/federal-law/medicare-title-xviii-social-security-act.
- 5. http://www.healthinfolaw.org/federal-law/medicaid-title-xix-social-security-act.
- 6. http://sphhs.gwu.edu/departments/healthpolicy/CHPR/downloads/Legal_Barriers_Stimulus_Cover_Memo_021809.pdf.
- 7. http://sphhs.gwu.edu/departments/healthpolicy/CHPR/downloads/Economic-Stimulus-side-by-side-chart-021809.pdf.
- 8. Social Security Act § 1848(o)(1)(A)(i) [42 U.S.C. §1395w-4 et seq.] (as added by ARRA § 4101(a)) (Medicare incentive program); Social Security Act § 1903 (a)(3)(F) [42 U.S.C. § 1396b et seq.] (as added by ARRA § 4201(a)(1)) (Medicaid incentive program).
- 9. Social Security Act § 1903(t)(6)(C)(i)(I) [42 U.S.C §1396b et seq.] (as added by ARRA §4201(a)(2)).
- 10. Social Security Act § 1903(t)(6)(C)(i)(II) [42 U.S.C §1396b et seq.] (as added by ARRA §4201(a)(2)).
- 11. 75 Fed. Reg. 44314, 44566 (to be codified at 42 C.F.R § 495.6).
- 12. 75 Fed. Reg. 44314, 44321-22.
- 13. 75 Fed. Reg. 44314, 44322.
- 14. United States Government Accountability Office, Report to Congressional Committees, “Electronic Health Records: First Year of CMS’s Incentive Programs Shows Opportunities to Improve Processes to Verify Providers Met Requirements.” GAO-12-481. Available at: http://www.gao.gov/assets/600/590538.pdf
- 15. Centers for Medicare and Medicaid Services, “Monthly EHR Medicare and Medicaid Incentive Report,” July 2012, Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/July2012_MonthlyReports.pdf
- 16. http://www.healthreformgps.org/resources/health-information-technology-adoption-incentives/.
- 17.
- 18. Centers for Medicare and Medicaid Services. "2017 Modified Stage 2 Program Requirements for Eligible Hospitals, CAHs, and Dual Eligible Hospitals Atteesting to CMS." Available at: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage2Modified_RequireEH.html
- 19. Centers for Medicare and Medicaid Services. "Stage 3 Program Requirements" Available here: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage3_RequieEH.html
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