Federal Imperatives Impacting Administrative Simplification

There are several industry imperatives impacting administrative simplification, including:

  • HIPAA v5010: January 2012 – Deadline for health plan and provider systems. The CMS Office of E-Health Standards and Services (OESS) announced a three months extension of enforcement discretion, through June 30, 2012
  • The American Recovery and Reinvestment Act (ARRA) Health Information Technology (HITECH) Act: Through 2015 - Stakeholders will be determining how to coordinate with national and regional efforts
    • National Health Information Network (NHIN)
    • State-based decisions on the role of administrative data in HIEs and Medicaid. Over half billion dollars given to HIEs
    • Providers: “Meaningful Use” of Health Information Technology via Certified EMRs ($40 billon)
  • The Patient Protection and Affordable Care Act (ACA): Through 2017 – Stakeholders are required to meet iterative deadlines for numerous mandates. Section 1104 (Administrative Simplification) directly impacts health plans

CORE and Federal HITECH Alignment 

Through the American Recovery and Reinvestment Act (ARRA), the Centers for Medicare and Medicaid Services (CMS) is offering reimbursement incentives to physicians and hospital providers that demonstrate "meaningful use" of an electronic health record. "Meaningful use" is being defined in three stages by CMS and the Office of the National Coordinator for Health Information Technology (ONC). While administrative simplification was originally planned for inclusion in Stage 1, it has not been included in the final Stage 1 or proposed final rules for Stage 2 requirements.

Meaningful Use Stage 1:
Administrative simplification related requirements are not included in Stage 1 of meaningful use.

Meaningful Use Stage 2: 
Administrative simplification related requirements are not included in the proposed rules for Stage 2 of meaningful use. Comments were accepted on the CMS and ONC rules through May 7, 2012.

Meaningful Use Stage 3:
A date for finalizing meaningful use Stage 3 requirements has not been set.

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