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What You Need to Know About the CMS Interoperability & Patient Access Rules

The CMS Interoperability and Patient Access final ruling sets standards for interoperability and greater transparency between hospitals and other care providers. While this rule is intended to provide patients with access to quality information, it can also provide benefits for care teams. Here’s what you need to know about the rules.

Section X Provisions

The Section X provisions update the existing Conditions of Participation to require hospitals (even psychiatric and critical access hospitals) to send notifications to certain healthcare providers when a patient is admitted, discharged, or transferred. As for which healthcare providers need to be notified, there are two specific requirements:

  • Primary care providers: Defined as the patient’s established primary care practitioner, practice group, and other practitioners or practice groups identified by the patient as the entity primarily responsible for their care
  • Post-acute care providers: Defined as any post-acute care service provider/agency or other outpatient service provider(s) responsible for the patient’s follow-up or ancillary care with whom the patient has an established care relationship prior to admission or to whom the patient is being transferred or referred

Event Notification Requirements

The rule includes a broad requirement for sending notifications rather than specifying methods or data elements for sending information. While this provides flexibility, it can also muddle the prospect of deciding how to meet the requirements. Here are basic standards to keep in mind:

  • Content of event notifications: Notifications, at a minimum, must include the patient’s name, the treating provider’s name, and the sending organization’s name. Institutions may include more information.
  • Regulations of event notifications: For an action to serve as the basis for a measure under the Promoting Interoperability Program, the action must require the use of certified health IT.
  • Use of intermediaries: An intermediary—such as a health information exchange or third-party aggregator of ADT data—may be used to facilitate exchange of information.

To learn more about the CMS interoperability and Patient Access final ruling—including the changes to the Conditions of Participation—read this whitepaper.

Amanda Weller
Content Marketing Manager