The Centers for Medicare & Medicaid Services (CMS) released its ­­­­­­notice of proposed rulemaking (NPRM) regarding Stage 2 meaningful use (MU) on the Office of the Federal Register’s public inspection desk on Feb. 23. Although the Office of the National Coordinator for Health IT (ONC) has not released its NPRM on Stage 2 standards, specifications and certification criteria, key players have indicated that the agencies have taken into account many of the requests made by the American College of Radiology (ACR) and other imaging stakeholders.

Both NPRMs will be published in the Federal Register on March 7 with 60-day public comment periods. In an unusual move, the NPRMs were discussed in general terms prior to actual public release during the Healthcare Information and Management Systems Society (HIMSS) 2012 annual conference.

In the preview presentations, CMS and ONC staff indicated that several of ACR’s MU recommendations have been incorporated in some form into the NPRMs, according to an ACR statement. These include:

• A menu set (discretionary) measure focused on diagnostic image accessibility via certified EHR technology;
• Massively increased flexibility in the definition of “certified EHR technology” so that eligible professionals (EPs) no longer have to implement technology certified for criteria that correspond with measures from which they have been excluded (with certain exceptions due to statutory requirements);
• Menu set measures to promote cancer registry and specialty society registry participation;
• Exclusions from individual measures appear to be more flexible and useful;
• More information specific to the future penalties, including a question posed by the CMS regarding significant hardship exemptions for EPs in certain situations;
• Clinical quality measures of relevance to radiology;
• More flexibility/direction in the definition of an encounter; and
• Consolidation of the patient information provision related measures.

“We are encouraged by early indications from the agencies that many of ACR's various 'asks' have apparently been included to a certain degree,” said Keith Dreyer, MD, chair of the ACR IT and Informatics Committee-Government Relations Subcommittee. “We will review both proposed rules over the next several days and provide additional information, including an in-depth regulatory summary, as soon as possible,” he said.

Following the public comment period, the agencies will review the stakeholder feedback received and begin the process of developing the final rules.

The ACR IT and Informatics Committee invites interested members to provide input for potential inclusion in future ACR comments.

“It is important to remember that these proposed rules have a very long way to go in the rulemaking process. Many things can, and will, change before the final rules are promulgated by the CMS and ONC later this year,” said Dreyer.