Journal of AHIMA - November/December 2011

Regulation Watch

REGULATION

PRIVACY AND SECURITY

Breach notification, noncovered entities Breach notification covered entities HIPAA privacy modifications Accounting of disclosure

EHR INCENTIVE PROGRAM

Certification program, temporary Certification program, permanent EHR Standards, certification criteria Meaningful use, stage 1

Meaningful Use, stage 2

PUBLICATION DATE

August 2009

July 2010

May 2011

June 2010

January 2011

July 2010

N/A

Accounting of Disclosures

OCR chose to manage the modifications to the HIPAA accounting of disclosure provisions in a separate rule. In May 2010 OCR published a request for information on accounting of disclosures. A silence of a year ensued, and then in May 2011 OCR published a proposed rule.

OCR proposed a new “access report” that it expected would be easier for covered entities to maintain and more likely to provide individuals with the information they want. The report would not distinguish between use and disclosure; instead it would identify anyone inside or outside the facility who accessed an individual’s information.

The report would be restricted to protected health information contained within the individual’s designated record set and existing in electronic format.

The access report received mixed reviews. While many industry groups in principle supported the spirit of the report, some also judged it too burdensome, and others felt it required considerable refinement.

Again, OCR can proceed to an interim final rule that would take effect but be subject to modification, or it could issue a final rule. Presumably it will consider revisions to the proposed access report in light of the many comments it received.

Meaningful Use

Much of the meaningful use regulations appeared in a rush last summer: final rules on stage 1 of the program, EHR standards and certification criteria, and a certification program.

Rulemaking on the certification program is complete, with the

STATUS

Final rule Interim final rule Proposed rule Proposed rule

NEXT UP

N/A
Final rule
Interim final or final rule
Interim final or final rule
Final rule
Final rule
Final rule
Final rule
Under discussion
Sunsets with effective date of
permanent program
Scheduled to begin January 1, 2012

permanent program scheduled to be January 1, 2012.

By far the most widely awaited rule this fall is a proposed rule on stage 2 of the incentive program. The policy advisory committee to the Office of the National Coordinator released a glimpse of its work in January 2011, and that preview and the committee’s subsequent discussions have set the industry’s expectations of what may be coming.

It is expected that all objectives in stage 1 will become mandatory under stage 2, and a limited number of new objectives will be added. Many of the measures in the committee’s early draft increased, but not all.

The stage 2 start date is a closely watched item. By the time the committee submitted its final recommendations, it seemed likely that stage 2 would be delayed in some manner. There was prevailing concern that vendor and providers would not have time to implement the final requirements before the reporting period began in 2013.

Another item on the watch list is the quality measures to be reported under stage 2. The committee did not offer a preview of its recommendations, but it is expected that the number and the scope will increase.

Once the requirements become final, revised standards and certification criteria must be published.

The Centers for Medicare and Medicaid Services has indicated it will release a proposed rule by end of the year, with a final rule targeted for summer 2012. ¢