CMS takes hands off approach to HIE, MU in new Medicaid managed care rule

The new final Medicaid and CHIP managed care rule does not change Meaningful Use, data exchange and health IT requirements, despite commenters' requests to do so.

The rule, released April 25, and slated to be published in the Federal Register May 6, modernizes how Medicaid managed care plans operate.  However, the Centers for Medicare & Medicaid Services did not use the rule as an opportunity to advance or encourage interoperability or certified electronic health record technology, as it has in other rules, such as payment regulations.

For instance, while CMS encourages states, managed care organizations and others to use health information exchange (HIE) and certified EHR technology, it reiterates that it does not have the statutory authority to broaden the HITECH Act to include additional incentives for provider types, nor does it have the statutory authority to modify the EHR incentive programs. CMS also says in the rule that states have the flexibility to require managed care plan participation in delivery system reform or performance improvement, such as provider health information exchange projects, but that it would not be a requirement for state Medicaid managed care contracts.

"We do not believe it is appropriate for us to require or mandate this option, as states may have various options or paths to increase EHR and HIE adoption outside of their managed care contracts," the agency says.

In addition, CMS does not offer additional incentives for providers not currently in the Meaningful Use program. Instead, it says that states that desire to create an initiative of reform for providers currently not in the program can do so so long as it does not result in a new regulatory framework. If a state does so, CMS says the state "would benefit" to take the Office of the National Coordinator for Health IT's certification criteria for data exchange into account to support EHR systems consistent for providers who are part of Meaningful Use.

It also notes that HIE and data exchange are "important tools" and says it will continue to convene stakeholders, partner with others and release guidance regarding HIE and other topics.

To learn more:
- read the rule (.pdf)