Officials at the U.S. Department of Health and Human Services (HHS) today started a new war on patients’ health record access nightmare with 251 pages of draft regulations.
Teams at two HHS units — the Centers for Medicare and Medicaid Services (CMS) and the HHS Office of the Secretary — are trying to push the health plans under HHS jurisdiction to make their computers work together better, and to shame providers that keep patient records locked up in an effort to hold on to patients.
If successful, the proposed regulations could help patients get their health records more easily, and reduce the need for patients with serious health problems to haul piles of paper records to every appointment.
In theory, the regulations could also make it easier for agents to move clients from one Medicare plan to another, by making Medicare Advantage plan records, and records at some private health insurance plans, less sticky.
Many executives from U.S. information technology companies, including health IT companies, have talked in recent years about how problems with health record access have hurt them or their loved ones.
Neal Patterson, the late founder and chief executive officer of Cerner Corp., a giant, North Kansas City, Missouri-based health IT company, testified at a 2015 Senate hearing about how his own wife, Jeanne Lillig-Patterson, had to carry shopping bags full of medical records to the doctors who were trying to help her fight her breast cancer. Neal Patterson died of cancer in July 2017. Lillig-Patterson died of cancer in 2017.
Seema Verma, the CMS administrator, said last April, at a health data conference, that she had trouble getting complete records for her own husband, who suffered a heart attack in the summer of 2017, even though she was the CMS administrator.
All she could get was a five-page written summary and a CD-ROM that left out many key records, such as the results from an MRI.
The New Draft Regulations
In the preamble, or introduction, to the new draft regulations, HHS officials say they want to overcome at least some of the barriers that have blocked past “interoperability” efforts.
” We are committed to solving the issue of interoperability and achieving complete access to health information for patients in the United States (U.S.) health care system, and are taking an active approach to move participants in the health care market toward interoperability and the secure and timely exchange of health information,” officials say in the preamble.
Here are seven more things for agents and brokers to know about the new draft regulations.
1. The Nuts and Bolts
CMS and the HHS Office of the Secretary developed the draft to implement the 21st Century Cures Act of 2019 and Executive Order 13813.
President Donald Trump issued Executive Order 13813 in October 2017. The order calls for the administration to “improve access to, and the quality of, information that Americans need to make informed health care decisions, including information about health care prices and outcomes, while minimizing reporting burdens on affected plans, providers, and payers.”
The draft regulations are set to appear in the Federal Register — an official government publication — March 4.
Comments on the draft regulations will be due 60 days after the official Federal Register publication date.
The regulation lists Natalie Albright as the contact for issues related to Medicare Advantage; Emily Pedneau as the contact for issues related to “qualified health plans,” or plans sold through the Affordable Care Act public exchange system; and Melissa Singer as the contact for issues related to provider directories.
2. The ‘Payers’ That Would, and Would Not, Be Directly Affected
For health IT purposes, HHS has direct jurisdiction only over federal, and federal-state, health care delivery and health insurance programs, such as Medicare, Medicaid, and HealthCare.gov, and health care providers’ relationships with those programs.
State governments have jurisdiction over other “payers,” and over providers overall operations.
Because of those restrictions, the payer rules proposed in the new draft regulations would have a direct effect only on:
- Medicare Advantage plans.
- Medicaid managed care plans.
- State Medicaid agencies.
- The Children’s Health Insurance Program (CHIP).
- Insurers that issue “qualified health plans,” or Affordable Care Act public exchange plans, through HealthCare.gov.
The traditional Medicare program already comes a separate, similar set of “Blue Button” patient record access program requirements.