BREAKING NEWS: Obama Signs MU Hardship Exemption Law

Written By: Dr. Jay Henry

If our members meet meaningful use for 2015 they need to attest.   If they did not meet MU for 2015 they can claim a hardship exemption before March 15, 2016 to avoid penalties in 2017.   The exemption will be approved based on the fact that CMS released the final rule so late in the year.

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On December 28, 2015, President Obama signed into law the Patient Access and Medicare Protection Act. The law states that the Center for Medicare & Medicaid Services (CMS) will approve hardship exception applications submitted by eligible professionals, hospitals, and critical access hospitals that did not meet Meaningful Use (MU) in 2015. Previously, hardship exceptions were individually reviewed and granted only if CMS determined that a provider demonstrated circumstances that posed a significant barrier to achieving MU. This year, submission of a timely hardship exemption application guarantees that the provider will avoid the 2017 penalty for not meeting MU in 2015. The bill was introduced by Senator Rob Portman (R-Ohio), and included legislative language based on the Meaningful Use Hardship Relief Act, sponsored by Rep. Tom Price, M.D. (R-Ga.), giving CMS the authority to grant hardship exceptions to affected providers for 2015

CMS did not publish the final rule for the 2015-2017 EHR Incentive Program until October 6, 2015. As a result of the delay, fewer than 90 days, which are required for a 2015 reporting period, remained in the calendar year. “The recent modifications rule for Stage 2 of the Meaningful Use program for electronic health records failed to offer physicians and hospitals enough time to actually comply with the new requirements,” said Price in a statement. “This much-needed relief will make the hardship application process much easier for doctors to avoid penalties stemming from the administration’s mistake, and thereby provide more time to care for patients.”

Section 4 of the bill states that eligible professionals must submit a hardship exception application no later than March 15, 2016 and eligible hospitals and critical access hospitals must submit an application before April 1, 2016. Application forms are not available at this time, but Quality Insights will notify providers when CMS posts information on its website.

Please Note:

Providers that meet MU in 2015 must submit an attestation to be eligible for an EHR incentive. The hardship exception is only for providers that were unable to meet MU in 2015.

The reporting period for all providers in 2016 is the full calendar year, except new providers entering the EHR program for the first time who will have a 90-day reporting period. Therefore, it is important to make sure all of the functionalities required for the entire reporting period are available beginning January 1 to meet MU in 2016.

Prior Authorization Standards Bill Passes Ohio Senate

By: Executive Director Keith Kerns, Esq.

Ohio’s healthcare providers and patients scored a victory in the Ohio General Assembly this week before the state legislature broke for its holiday break.  Senate Bill 129, a measure supported by the Ohio Optometric Association, Ohio State Medical Association and other provider groups, passed the Ohio Senate by unanimous vote.  If adopted the bill will establish common standards for health care prior authorization requests, including the establishment of time-frames in which third party payers must respond to requests.

Specifically, SB 129 would:

  • Require insurers to accept electronic submissions of prior authorization requests,
  • Require insurers to respond to prior authorization requests within 5 days and within one day for requests of an urgent nature,
  • Create a streamlined appeal process when a prior authorization request is denied.   The appeals process would first allow the provider to appeal to the individual who made the initial determination and then appeal to a panel that includes a clinical peer.  Finally, the provider may seek an external review if necessary.  The bill also creates expedited time frames which must be followed in the appeals process,
  • Require insurers to provide advance notice of any changes to the prior authorization process including providing detailed instructions should new information be required, and
  • Create a process to handle prior authorizations of new medical procedures and for medications for chronic conditions.

SB 129 was introduced by Sen. Randy Gardner (R-Bowling Green) in March.  The OOA testified in support of the bill last month before the Ohio Senate Insurance Committee.  The bill will now move to the House for consideration.  To learn more about OOA legislative priorities, please visit: OOA Advocacy Page