Medicare and Medicaid Promoting Interoperability Program Basics
Beginning in 2011, the Promoting Interoperability (formerly the Medicare and Medicaid EHR Incentive Programs) were developed to encourage eligible professionals (EPs) and eligible hospitals and CAHs to adopt, implement, upgrade (AIU), and demonstrate meaningful use of CEHRT.
On August 2, 2019 CMS published the Fiscal Year (FY) 2020 Medicare Hospital Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule which included program requirements for Calendar Year (CY) 2020. In this final rule, CMS continued its advancement of CEHRT utilization, focusing on burden reduction, and improving interoperability and patient access to health information.
2020 Medicare Promoting Interoperability Program Requirements
- Finalized a minimum EHR reporting period of any consecutive 90 days for new and returning participants.
- Converted the Query of PDMP measure from required to optional and eligible for five bonus points.
- Removed the Verify Opioid Treatment Agreement measure beginning in CY 2020.
- Requires all eligible hospitals and CAHs utilize 2015 Edition CEHRT.
- Requirement that EHR technology be certified to all electronic clinical quality measures (eCQMs) available to report for CY 2020 reporting period.
- Aligned the CQM submission requirements with those of the Hospital IQR program for the reporting period in CY 2021.
- Finalized an eCQM reporting period of one, self-selected quarter of discharge data for four self-selected eCQMs in the Hospital Inpatient Quality Reporting Program for CY 2020 and subsequent reporting years.
We will update this webpage with 2020 Medicaid Promoting Interoperability Program Requirements once policies have been finalized in the Medicare Physician Fee Schedule final rule that is scheduled to be released later this year. For 2019 Medicaid Promoting Interoperability Program requirements please see below:
2019 Medicaid Promoting Interoperability Program Requirements
- Beginning with the CY 2019 reporting period, all EPs, eligible hospitals and CAHs will be required to use 2015 Edition CEHRT.
- Meaningful Use Policies
- The threshold for Stage 3 Objective 6, Measure 1 (View, Download, Transmit) and Measure 2 (Secure Messaging) was set at 5 percent for the remainder of the Medicaid Promoting Interoperability Program.
- The requirement that only EPs in urgent care settings can use the Syndromic Surveillance measure to meet the Objective 8 (Public Health) was removed.
- eCQM Policies for PY 2019
- The list of available eCQMs for EPs in 2019 was aligned with the list of eCQMs available for Eligible Clinicians under MIPS in 2019. Those eCQMs can be found at https://ecqi.healthit.gov/eligible-professional-eligible-clinician-ecqms.
- In 2019, returning EPs must report on a one-year eCQM reporting period and first-time meaningful users must report on a 90-day eCQM reporting period.
- EPs are required to report on any six eCQMs related to their scope of practice.
- In addition, Medicaid EPs are required to report on at least one outcome measure. If no outcome measures are relevant, EPs must report on at least one high-priority measure. If there are no outcome or high priority measures relevant to an EP’s scope of practice, they may report on any six relevant measures.
- Program Year 2021 Policies
- In 2021 all EPs will have 90-day reporting periods for MU and eCQM to allow states to meet the statutory deadline of December 31, 2021 for all incentives to be paid.