December 17, 2020
Maverick's Update
Only What Matters on Health Information Policy
Why does it seem like just when things should be winding down for the holidays, things are ramping up instead? Maverick Health Policy is all too aware of looming deadlines for comments on federal rules and the must-read end-of-year spending bill /economic stimulus package. After a year like 2020, it seems like Congress should also create a new federal holiday called “Relax Renew Refresh” -- that lasts, say, the entire month of January. The only relaxing we know about is the relaxed requirements of the new HIPAA Privacy Rule.
This week’s health information news:
Starting in 2021, the CMS Interoperability and Patient Access rule will give individuals the right to download their own health information that is currently kept by their health plan onto an app of their choice, and the HHS Office of Civil Rights just proposed changes to the HIPAA Privacy Rule to make sure there are less barriers to getting health information where it needs to go. The new rule streamlines timeframes, fees, and identity verification associated with accessing information -- and makes it much easier for providers to share information on a patient’s behalf without having to worry about privacy concerns.
To get expensive medical services and prescription medications paid for, physicians and patients must sometimes get permission from health plans -- a process known as prior authorization. It is an important check and balance to ensure care is both necessary and is part of the benefit package that was purchased, but it is one of the biggest pain points of our health care system -- leading to unnecessary delays in care and physician burnout. A new CMS rule, effective in 2023, would streamline that process so prior authorization is automatic and fast -- but it applies only to some health plans (Medicaid, CHIP and individual exchange plans).
Except for limited items like home pregnancy tests, getting a diagnostic test used to mean going to a hospital or doctor’s office. The booming at-home lab testing market is changing all of that very quickly -- leading us to wonder how, exactly, the test result is going to be included in an individual’s medical record or, when necessary, reported to public health authorities.
One Thoughtful Paragraph
Connecting the dots between the many federal regulations that are governing health care operations is going to be an interesting challenge for hospital and health plan compliance officers, but also for all the technology companies that are trying to help. We have already mentioned (above) the HIPAA Privacy Rule changes, the interoperability rule and new prior authorization rule. There is also the 21st Century Cures Act Information Blocking and Health IT Certification rule, the ever-evolving scope of telehealth regulatory waivers and oversight, the updates to the Stark Physician Self-Referral law, and the three new safe harbors in the Anti-Kickback statute to protect certain payments among individuals and entities in a value-based arrangement. We are also anticipating that the price transparency rules -- for both hospitals and plans -- will have a major impact on health data exchange. And there are many others to consider -- like the new voluntary direct contract model -- that encourages the use of modern tools to deliver value-based care to improve the health of Medicare beneficiaries. With a new administration poised to issue all manner of pandemic-related rules that will ramp up lab test and vaccination tracking and reporting, and the anticipated data exchange and care coordination challenges that come with these necessary mandates, 2021 promises to be another breathless scenario for the health care industry.