CMS Proposes Rules to Improve Data Sharing Between Health Care Providers, Insurers

The Centers for Medicare & Medicaid Services (CMS) is taking further steps to cure lack of interoperability within the health care system, an issue that has long plagued the home health industry.

On Monday, CMS released proposed rules that require many providers and insurers to adopt a secure, standard format for electronic patient data by 2020. The goal of the technology is to allow information to easily move from plan to plan. The changes would also strengthen patients’ access to their health information and reduce certain burdens such as tedious data entry for providers.

Interoperability refers to the capability of computer systems or software to securely exchange and use information.


Currently, patient data often lives in silos, making it difficult for organizations such as home care and hospice providers to coordinate care.

Because different health care providers often use different communications systems, patient information is typically exchanged manually via fax, leaving room for human error during tedious and time-consuming data entry, according to a 2018 report by the National Association for Home Care & Hospice (NAHC).

The goals of CMS’s newly proposed rules are to make such issues a thing of the past, while also increasing patients’ access to their health data — two initiatives outlined last year in CMS’s MyHealthEData initiative.


“For far too long, electronic health information has been stuck in silos and inaccessible for health care consumers,” CMS Administrator Seema Verma said in a statement. “Our proposals help break down existing barriers to important data exchange needed to empower patients by giving them access to their health data. Touching all aspects of health care, from patients to providers to payers and researchers, our work leverages identified technology and standards to spark new opportunities for industry and researchers while improving health care quality for all Americans.”

Among the changes, CMS’s proposed rules would require Medicare Advantage (MA) organizations, Medicaid managed care plans, children’s health insurance program managed care entities and qualified health plan issuers in federally-facilitated exchanges to make personal health information available to patients through third-party applications and developers.

At the same time, CMS is looking to further support the electronic exchange of data for care transitions as patients move between these plan types. Specifically, CMS is proposing to make their provider networks available to enrollees and prospective enrollees through application programming interface technology.

Furthermore, CMS has proposed making the names of providers who block information or fail to update digital contact information publicly available, in addition to requiring states to exchange information on beneficiaries that are dually eligible for Medicare and Medicaid more often and requiring participating hospitals to send electronic notifications when patients are admitted, discharged or transferred.

In 2017, an Office of the National Coordinator for Health Information Technology (ONC) survey found that about 78% of home health agencies adopted electronic health record (EHR) technology. About 66% of skilled nursing facilities (SNFs) implemented EHRs. In general, integration of received information continued to lag behind for both HHAs (36%) and SNFs (18%), according to CMS.

CMS is asking providers to send them feedback on how to best promote interoperability and reduce burden when it comes to health IT, accepting comment until early April.

Read the full CMS proposal here.

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