Hi I'm Kaitlin Ryan from Cognizant.
Welcome to our healthcare interoperability Ask the Expert video series.
Today, we'll be answering a few foundational questions about the ONC and CMS interoperability
rules.
The first question is for Gary Meyer, our lead interoperability consultant.
Gary, what is the probability compliance deadline?
In March, 2020, CMS and ONC announced their interoperability and patient their interoperability
ad patient access final rules.
Of greatest interest to payers, was the dates for three specific things.
The patient access API.
The provider directory API and payer to payer data exchange.
The two API's were given a deadline of January 1 2021.
Where payer to payer data exchange was given a deadline next year, on January, 1 2022.
Later, in response to the pressures that COVID-19 put on the US healthcare system, CMS announced
a sort of a delay.
It's important to understand, with nuance what they did.
While the government could have delayed the deadline they didn't.
That's not quite what they did.
Instead, they are applying policy of enforcement discretion.
For the first deadline.
That is for the patient access API to the provider directory.
The applicable date for these API milestones remains at January 1 2021, the deferred enforcement
date is six months later, on July.
Now, depending upon unique business factors, many clients are pressing into the January
1 deadline, while others by targeting July 1st.
It's a key topic for the interoperability leadership team to discuss with the legal
team, and others in the organization, in light the contracts for the effective lines of business.
In summary, the regulatory dates for the patient access API, and provider directory API, are
1/1/21 with deferred enforcement date of 7/1/21.
The date for payer to payer data exchange is 1/1/22.
Thanks, Gary.
Jay Sultan, our VP of healthcare strategy will be answering our next question.
Jay, what are the penalties for non-compliance?
The rule itself doesn't specify penalties.
Now there is a penalty specified in the law, the 21st Century Cures Act called information
blocking.
Its a million dollar fine every time the organization, doesn't provide the data the way they're supposed
to have.
And that million dollar fine happens basically every time the user is trying to click to
get the data off the application.
Now, we're unclear whether that can apply to health plans we're clear, it can apply
to hospitals EMRs HIEs.
The language in the rules ambiguous about health plans, but we warn health plans they
want to be prepared that rule might get applied and make sure that you're not having any problems.
So, if that's not the penalty what is?
Well it's all the regular things CMS does to enforce, it’s barring people from doing
Medicare Advantage enrollments.
It's decertifying managed Medicaid plans.
It's penalties on things like HCCs and HEDIS and stars and that kind of thing.
So we CMS has said they're going to be very aggressive in enforcing this rule, and we
encourage plans to be careful.
We also tell you we expect to see more guidance about this come out between now and the end
of the year.
Thanks, Jay.
And Thank you for joining us.
Visit cognizant.com to learn more about our interoperability solutions and look for additional
Ask the Expert videos coming soon.