An already tight timeline for complying with the CMS' new interoperability regulations could put a strain on insurers as they tackle the COVID-19 outbreak.
The CMS' interoperability rule, released earlier this month, includes a host of deadlines related to data-sharing, spanning from later this year to 2022. One of the main provisions is that CMS-regulated insurers like those with Medicare Advantage and Medicaid managed care offerings will be required to get processes up and running so that beneficiaries can download claims and encounter data using third-party apps.
To do that, insurers will have to implement application programming interfaces—better known as APIs—by January 2021, just over nine months from when the final rules were released.
Before the coronavirus outbreak, that was "probably a reasonable deadline," said Ceci Connolly, president and CEO of the Alliance of Community Health Plans. But now, "we're having a hard time seeing how this massive implementation can run on a parallel track with a global pandemic."
The deadline outlined in the CMS' final rule provides some relief for insurers, as the proposed rule would have required them to begin sharing data via APIs this year. ACHP, for its part, had urged the CMS to set its compliance deadline at least a year and a half from the final rule's publication date.
Some payers, like Michigan insurer Priority Health, have voiced support for the timeline outlined in the CMS' final rule.
"While we recognize that their timelines around these initiatives are aggressive, we appreciate and agree with the agency's push for more transparency for consumers sooner, rather than later," said Marti Lolli,Priority Health's senior vice president of consumer and government markets. She said she thinks the insurer is "well-positioned" to meet the deadlines.
But January 2021 was already going to provide a difficult timeline for some insurers, and that's only compounded in the wake of COVID-19. As more U.S. patients are diagnosed with COVID-19 and the disease has mounted into a global pandemic, insurers have had their attention pulled toward addressing the outbreak, and away from other priorities—like interoperability.
The CMS is considering ways to address that burden. The CMS last weekend said it would ease reporting requirements for the 1.2 million clinicians in the Quality Payment Program and for other reporting programs in light of the COVID-19 crisis.
And a CMS official last week at a meeting of the Health Information Technology Advisory Committee said the agency was assessing other steps to take, possibly including whether to extend deadlines for implementing the interoperability rule's requirements—though it hasn't committed to doing so.
"We're in a very, very, very unique situation," Denise St. Clair, a program analyst in the CMS' health informatics office, said in response to a question over whether the CMS is considering adjusting the rule's deadlines. "We're definitely thinking through all of the real and incredibly important work that everyone needs to be focusing on right now, so that's definitely something that's under consideration."
It's unclear how adjusting those timelines would work, given that the rule—while not officially published in the Federal Register yet—has already been issued as a final version.
Typically, "changes that are made between the public inspection copy and what's posted" to the Federal Register are minimal or technical edits—not substantive changes, said Scott Weinstein, a partner at law firm McDermott Will & Emery focused on healthcare regulatory compliance. That means the CMS might need to issue a notice of enforcement discretion or conduct additional notice-and-comment rulemaking to move interoperability deadlines.
Still, the idea has earned cheers from some industry groups.
Asking payers to devote resources to compliance with these new regulations at the same time they're figuring out how to address COVID-19 is "a little unrealistic," said Joel White, executive director of the Health Innovation Alliance, a coalition of insurers, patient groups, trade organizations and technology vendors formerly known as Health IT Now.
Even if the U.S. wasn't in the midst of dealing with the pandemic, White said he would have suggested at least a 24-month implementation period for insurers to comply with the regulations.
Justine Handelman, senior vice president in the Blue Cross Blue Shield Association's office of policy and representation, in an emailed statement said the insurance federation's "number one priority is to support frontline workers and ensure Americans have access to the care they need when they need it" to address the COVID-19 outbreak.
"With this in mind, we are assessing requirements to determine priority and feasibility of implementing the rules by January 2021," Handelman said. He didn't directly comment on the possibility of the CMS adjusting its interoperability deadlines.
An ONC spokesperson said it's "premature" to discuss adjustments to the implementation timeline outlined in its information-blocking rule, a companion to the CMS' interoperability rule, since it hasn't been officially published in the Federal Register. The deadlines in the ONC's rule are a bit more malleable, as many of the deadlines are tied to six months or two years after the rule's publication, rather than specific dates.
The ONC has submitted the rule to the Office of the Federal Register for publication, the spokesperson said.
While it's important for the healthcare industry to set reasonable timelines, a public health crisis like COVID-19 also highlights need for having interoperable systems, said Dan Mendelson, founder of healthcare consultancy Avalere Health. He suggested HHS think critically about what new deadlines are realistic and stick to them, as well as providing funding to help providers "expedite" some of these interoperability changes.
"All healthcare organizations are appropriately focusing their resources right now on responding to this crisis," Mendelson said of COVID-19. But "we have to be able to follow patients around, understand where they're going and what they need" to effectively respond to the disease, he added. "Interoperability's never been more important."
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