CMS, ONC Release Proposed Rule for Stage 3 Meaningful Use

The proposed rule for stage 3 of the “meaningful use” EHR Incentive Program contains eight objectives focused on advanced use of electronic health records (EHRs), federal health IT officials announced last week. Additionally, the requirements for the 2015 Edition Health IT Certification Criteria were announced.

According to the proposal, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) would require eligible professionals to comply with meaningful use requirements by 2018, regardless of their prior participation in the program. The new rule also maintains current payment adjustments and hardship exemptions.

In the rule’s announcement, CMS and ONC said they predict that it would cost eligible professionals $54,000 to purchase and implement a certified EHR and $10,000 annually for ongoing maintenance, according to estimates by the Congressional Budget Office.

The measures that might prove most challenging to providers and HIM departments remain the patient engagement requirements. Under stage 2 of the program, providers had to prove that 5 percent of their patients viewed, downloaded, or transmitted their records. The proposal says providers can use a third-party application programming interface (API) to gather this data

Stage 3 bumps that requirement up to 25 percent of patients. Stage 3 also raises the stakes on the rate of secure messaging from 5 percent in stage 2 to 25 percent in stage 3.

Another measure requires eligible professionals to implement clinical decision support systems for “interventions related to four or more CQMs at a relevant point in patient care for the entire EHR reporting period.

“Absent four clinical quality measures (CQMs) related to an EP, eligible hospital, or CAH’s scope of practice or patient population, the clinical decision support interventions must be related to high-priority health conditions,” the rule states.

What’s more, CMS said it is considering additional changes to meaningful use beginning in 2015 through separate rulemaking. CMS is considering proposals to:

  • Realign hospital EHR reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs.
  • Modify other aspects of the program to match long-term goals, reduce complexity, and lessen providers’ reporting burdens.
  • Shorten the EHR reporting period in 2015 to 90 days to accommodate these changes.


Click here to read the full proposed rule. Comments will be accepted until May 29.

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