On Monday, January 4, HIMSS submitted comments to the Centers for Medicare & Medicaid Services (CMS) on the Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients’ Electronic Access to Health Information Proposed Regulation.
HIMSS articulated support for the work completed thus far across the Department of Health and Human Services (HHS) to provide patients with more access to and control over their data. HIMSS also endorsed the emphasis in the Proposed Regulation to achieve appropriate and necessary access to complete health records for patients, providers, and payers, while at the same time, reducing burden across the healthcare ecosystem.
The HIMSS Comment Letter discussed how patients should be at the center of their own care, and the thrust in this regulation, as well as in the CMS Interoperability and Patient Access Final Regulation, affirms that goal. By placing patients at the center of their own care, the Proposed Regulation leads to greater patient empowerment and improved outcomes.
In addition, HIMSS communicated how changes to the prior authorization process included in this proposal also help improve the patient experience and access to care. Emphasis in the HIMSS Comment Letter was placed on the importance of the clinical relevance of this prior authorization-related information throughout the sharing and exchange between patients, providers, as well as payers and CMS should prioritize how this information benefits patients.
Moreover, HIMSS offered the following thoughts and recommendations.
As CMS continues to advance patient-directed decision making and formal shared decision making as a broader construct across all its programs, the agency should work to create more resources for patients on the benefits of and positive outcomes that result from an individual’s greater control of their health information.
The requirements and implementation timelines in the Proposed Regulation, combined with the requirements in ONC’s 21st Century Cures Act Final Regulation, the CMS Interoperability and Patient Access Final Regulation, and the 2015 Edition Cures Update, is stretching the health information and technology development, deployment, and training resources of all healthcare stakeholders.
CMS should create a compendium tool to help payers navigate what is required and the required implementation dates as they currently exist in this Proposed Regulation as well as the CMS Interoperability and Patient Access Final Regulation. The Regulation proposes the adoption of certain IGs needed to support the API policies included. HIMSS asked for clarity on whether this proposal is putting forth updated IGs for the current versions of the three standards identified, or if CMS is allowing for later versions of these standards to be accompanied by their own IGs.
CMS also included several Requests for Information (RFIs) and HIMSS incorporated some thoughts on the RFIs and offered to provide more extensive follow-up with CMS on these topics at a future date.
Overall, HIMSS supported the steps included in the Proposed Regulation to achieve appropriate and necessary access to complete health records for patients, providers, and payers, while reducing burden across the healthcare ecosystem.
The HIMSS policy team works closely with the U.S. Congress, federal decision makers, state legislatures and governments, and other organizations to recommend policy, and legislative and regulatory solutions to improve health through information and technology.