On September 4, 2012, CMS published a final rule specifying the “Stage 2” meaningful use criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid EHR incentive payments. By way of background, under Stage 1 (which began in 2011), “meaningful use” consists of transferring data to EHRs and being able to share information such as electronic copies and visit summaries for patients (note that certain Stage 1 criteria are modified under the Stage 2 final rule). Stage 2 meaningful use criteria, which are the focus of this final rule, seek to increase the exchange of clinically relevant information between providers and promote patients’ secure online access to their health information. With regard to timing, the final rule provides that any provider who first attested to Stage 1 criteria in 2011 will have until 2014 to attest to Stage 2 criteria (instead of 2013 as provided under the Stage 1 final rule). The final rule also specifies Medicare payment adjustments that will apply beginning in 2015 for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology and other program participation requirements according to the applicable schedule. CMS adopted certain hardship exceptions to the payment adjustments related to: availability of internet access or barriers to obtaining information technology infrastructure; newly practicing EPs who would not otherwise be able to avoid payment adjustments; unforeseen circumstances such as natural disasters; and certain scope of practice issues, such as lack of face-to-face or telemedicine interaction with patients or lack of control over the availability of Certified EHR Technology at their practice location, to recognize certain barriers concentrated among specialties such as anesthesiology, radiology, and pathology. Looking ahead to Stage 3, under which “meaningful use” will include demonstrating improvement in quality of health care, CMS states in the preamble to the rule that it intends to finalize Stage 3 criteria through rulemaking in 2014, with Stage 3 starting in 2016.

Also on September 4, HHS published a final certification criteria rule establishing the technical capabilities and related standards and implementation specifications that Certified EHR Technology will need to include, at a minimum, to support the achievement of “meaningful use” by EPs, eligible hospitals, and CAHs under the Medicare and Medicaid EHR incentive programs beginning with the 2014 EHR reporting periods. The final rule also makes changes to the permanent certification program for health information technology, including changing the program’s name to the ONC HIT Certification Program. The rule is effective October 4, 2012.