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GOP Senators Press CMS on Stage 2 Hardship Exemptions

March 7, 2014
by Gabriel Perna
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Six Republican Senators sent a letter to Marilyn Tavenner, R.N., chief administrator for the Centers for Medicare & Medicaid Services (CMS), asking for details on the agency's plans on how they will grant healthcare providers exemptions for Stage 2 of the new electronic health records (EHR) meaningful use program.

The letter is in response to the comments from Tavenner, R.N., chief administrator for the Centers for Medicare & Medicaid Services (CMS), at HIMSS14, on the timing of Stage 2 of meaningful use. At HIMSS, Tavenner said that there would be no added flexibility for upcoming deadlines, as requested by the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) and a number of other stakeholder groups. She did say the agency would work with organizations to grant hardship exemptions.

Senators Lamar Alexander (R-Tenn.), John Thune (R-S.D.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.) and Pat Roberts (R-Kan.), were  all part of a larger group that has expressed concern before, to Health and Human Services Secretary Kathleen Sebelius, requesting added time for Stage 2 attestation. They did not get that.

“Despite the overwhelming outpouring of concern about the Stage 2 regulations, you announced in a speech last week that the timing of Stage 2 will not change.  Instead, you said that hardship exceptions will be available.  We were disappointed to hear this announcement, even more so because of the lack of clarity about how the exceptions will be administered," the Senators wrote to Tavenner.

The Senators note that on the CMS website there are no explicit details on the plan for exemptions and says hardship exceptions are available only in certain narrow circumstances. "How will these categories be expanded?  Will the applications be due April 1?  What documentation or standard of proof must be met to obtain an exception?  What is the timing for review, and will there be an appeals process?” the Senators asked in the letter.

The letter is below:

Dear Administrator Tavenner:

We are writing to seek more information about how the Centers for Medicare and Medicaid Services (CMS) intends to give hardship exceptions to providers across the country struggling to meet the burdens of new electronic health records regulations.  We are disappointed by your announcement last week that CMS will not give the extra time providers need to properly upgrade their systems.  CMS seems to view hardship exceptions as a solution, yet so far has offered no details about how the exemptions will be granted or how the exemptions will address widespread concerns about timing.

The electronic health records (EHR) meaningful use program was enacted in 2009 as part of the American Recovery and Reinvestment Act (aka the “stimulus”).  As with most programs in the stimulus, the funds for EHRs were rushed out with little foresight or long-term planning.  Stage 1 of the program was designed to increase adoption of EHRs, without any thought as to whether those systems would meet the future goals of the program that depend on interoperability.

Stage 2 regulations of the electronic health records meaningful use program impose new requirements on providers, and due to the lack of foresight in the initial Stage 1 planning, many providers are finding their old technology needs substantial, costly, and time-consuming upgrades.  If providers are unable to meet their new requirements in 2014, they will have to pay steep penalties.  These penalties are unfair to providers who are making good faith efforts to upgrade their electronic health record systems, but do not have enough time or the financial resources to accomplish this upgrade in the timeframe CMS allowed.

On September 24, 2013, we wrote to Secretary Sebelius asking the administration to give additional time to providers to meet these new Stage 2 requirements.  Since sending that letter, we have collectively heard from countless constituents and other providers that the current timetable for the electronic health records program is an unsustainable burden on their practices.  Last week, close to 50 provider groups representing nearly every hospital, doctor, and vendor organization in America warned CMS that the program is at risk of failure due to the many providers and vendors who may be unable to upgrade their systems in time.

Despite the overwhelming outpouring of concern about the Stage 2 regulations, you announced in a speech last week that the timing of Stage 2 will not change.  Instead, you said that hardship exceptions will be available.  We were disappointed to hear this announcement, even more so because of the lack of clarity about how the exceptions will be administered.

Thus, we are writing to ask that you immediately clarify how the hardship exceptions will be granted.  The CMS website currently says hardship exceptions are available only in certain narrow circumstances—such as a lack of broadband internet or an unforeseen natural disaster.  How will these categories be expanded?  Will the applications be due April 1?  What documentation or standard of proof must be met to obtain an exception?  What is the timing for review, and will there be an appeals process?

Given the importance of this issue to hundreds of thousands of providers participating in the electronic health records program, we urge CMS to respond to our request for clarification as soon as possible.

Read the source article at help.senate.gov

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