HIMSS Responds to the CMS Interoperability and Patient Access Proposed Rule

On June 3, HIMSS submitted its public comment letter to the Centers for Medicare & Medicaid Services (CMS) Proposed Rule on 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. HIMSS utilized its membership’s expertise to offer feedback on potential ways to improve access to, and the quality of, information that Americans need to make better-informed healthcare decisions, including data about health care prices and outcomes, while minimizing reporting burdens on affected plans, health care providers, or payers.

HIMSS supports CMS’s focus in this rule on interoperability and patient access to data through enhanced use of technology such as application programming interfaces (APIs) and agrees with the CMS goals and general approach to advance interoperability and patient access. In the letter, HIMSS offers its backing of the CMS proposal to require Medicare Advantage (MA) organizations, state Medicaid and Children's Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plans (QHPs) on the federally-facilitated exchanges (FFEs), to use open APIs. Making patient information more readily available will enable patients to better understand their healthcare cost, and offer provider organizations and researchers the opportunity to deliver very real value in efforts to foster better outcomes for patients and decrease unnecessary cost expenditures across our healthcare system.

HIMSS is supportive of the intent behind the proposal to revise the Conditions of Participation for Medicare and Medicaid participating hospitals to include a requirement for sending electronic notifications upon a patient's admission, discharge, and/or transfer (ADT) to another healthcare facility or provider. However with this increased data sharing (including ADT feeds) is a critical component of healthcare transformational efforts, HIMSS does not want CMS to use Conditions of Participation requirements as a vehicle to facilitate this exchange, and instead HIMSS ask CMS to utilize the Promoting Interoperability Program (PIP) for this purpose.

While HIMSS agrees with the proposal that requires CMS programmatic payers to participate in trust exchange networks to improve interoperability, HIMSS is concerned about the timeline for implementation of this proposed requirement. HIMSS recommends that CMS should not require the use of trust exchange networks for private payers until the structure and requirements around the TEFCA are more clearly defined and enacted.

Any healthcare practice that unreasonably limits the availability, disclosure, and use of electronic health information undermines efforts to improve interoperability. For this reason, HIMSS offers its support of the proposal to make publicly available the names of those organizations or providers that submit a “no” response to any of the three attestation statements regarding the prevention of information blocking in PIP, as this transparency should help contribute to greater information sharing.

View the full letter

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