Meaningful Use Stage 2: CMS and ONC Release Final Rule for Meaningful Use and Certification
Excerpted from HealthIT.gov and CMS.gov on August 26, 2012

On August 23, 2013, the Centers for Medicare & Medicaid Services (CMS) released the final rule which establishes Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs, updates Stage 1, and includes other program modifications. At the same time the Office of National Coordinator for Health IT (ONC) released the 2014 Edition Standards and Certification Criteria (S&CC) final rule which completes ONC’s second full rulemaking cycle to adopt standards, implementation specifications, and certification criteria for EHR technology.

The CMS  final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to continue to participate in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. All providers must achieve meaningful use under the Stage 1 criteria before moving to Stage 2.

The 2014 Edition S&CC final rule reflects ONC’s commitment to reduce regulatory burden; promote patient safety and patient engagement; enhance EHR technology’s interoperability, electronic health information exchange capacity, public health reporting, and security; enable clinical quality measure data capture, calculation, and electronic submission to CMS or states; and introduce greater transparency and efficiency to the certification process.

CMS Final Rule

• Read the CMS Final Rule [PDF - 1.8 MB]
• CMS Fact Sheet
• CMS Press Release
• Bookmarked version released by The Advisory Board Company

CMS Resources

• Stage 2 Overview Tipsheet [PDF - 680 KB]
• Stage 1 vs. Stage 2 Comparison Table for Eligible Professionals [PDF - 250 KB]
• Stage 1 vs. Stage 2 Comparison Table for Eligible Hospitals and CAHs [PDF - 248 KB]
• Stage 1 Changes Tipsheet [PDF - 197 KB]
• 2014 Clinical Quality Measures Tipsheet [PDF - 587 KB]
• Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Hospitals and CAHs [PDF - 175 KB]
• Payment Adjustments & Hardship Exceptions Tipsheet for Eligible Professionals [PDF - 318 KB]
• FAQs related to Changes in Medicaid Patient Volume Calculation
  • Medicaid changes to patient volume calculations
  • CHIP patients eligible to be included in Medicaid patient volume totals
  • Base year changes for Medicaid hospital incentive payment calculation

ONC Final Rule

• Read the ONC Final Rule [PDF - 1.3 MB]
• ONC Fact Sheet: 2014 Edition Standards & Certification Criteria (S&CC) Final Rule [PDF - 1 MB]
• HHS Press Release
• Bookmarked version released by The Advisory Board Company

ONC Resources

• 2014 Edition EHR Certification Criteria Required to Satisfy the Base EHR Definition [PDF - 1 MB]
• Equivalency Table [PDF - 1 MB]
• Do you have EHR Technology that meets the new Certified EHR Technology definition for Meaningful Use Stage 1? [PPTX - 267 KB]
• Do you have EHR Technology that meets the new Certified EHR Technology definition for Meaningful Use Stage 2? [PPTX - 266 KB]
• 2014 Edition EHR Certification Criteria Mapped to the 2014 CEHRT Definition for EPs Seeking to Achieve MU Stage 1 in and after CY 2014 [PPTX - 65 KB]
• 2014 Edition EHR Certification Criteria Required to Satisfy the Complete EHR Definition [PDF - 1 MB]

Other Resources

• How to Play by the (Final) Rules: An Overview of Meaningful Use Stage 2 and the Standards and Certification Criteria Final Rules: Webinar recording and presentation materials

Stage 2 Timeline
The earliest that the Stage 2 criteria will be effective is in fiscal year 2014 for eligible hospitals and CAHs or calendar year 2014 for EPs. The table below illustrates the progression of meaningful use stages from when a Medicare provider begins participation in the program.

Note that providers who were early demonstrators of meaningful use in 2011 will meet three consecutive years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in 2014. All other providers would meet two years of meaningful use under the Stage 1 criteria before advancing to the Stage 2 criteria in their third year.

In the first year of participation, providers must demonstrate meaningful use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use for a full year EHR reporting period (an entire fiscal year for hospitals or an entire calendar year for EPs) except in 2014, which is described below. Providers who participate in the Medicaid EHR Incentive Programs are not required to demonstrate meaningful use in consecutive years as described by the table above, but their progression through the stages of meaningful use would follow the same overall structure of two years meeting the criteria of each stage, with the first year of meaningful use participation consisting of a 90-day EHR reporting period.

For 2014 only, all providers regardless of their stage of meaningful use are only required to demonstrate meaningful use for a 3-month EHR reporting period. For Medicare providers, this 3-month reporting period is fixed to the quarter of either the fiscal (for eligible hospitals and CAHs) or calendar (for EPs) year in order to align with existing CMS quality measurement programs, such as the Physician Quality Reporting System (PQRS) and Hospital Inpatient Quality Reporting (IQR). The 3-month reporting period is not fixed for Medicaid EPs and hospitals that are only eligible to receive Medicaid EHR incentives, where providers do not have the same alignment needs. CMS is permitting this one-time 3-month reporting period in 2014 only so that all providers who must upgrade to 2014 Certified EHR Technology will have adequate time to implement their new Certified EHR systems.

Core and Menu Objectives
Stage 2 uses a core and menu structure for objectives that providers must to achieve in order to demonstrate meaningful use. Core objectives are objectives that all providers must meet. There is also a predetermined number of menu objectives that providers must select from a list and meet in order to demonstrate meaningful use.
To demonstrate meaningful use under Stage 2 criteria—

• EPs must meet 17 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 20 core objectives.
• Eligible hospitals and CAHs must meet 16 core objectives and 3 menu objectives that they select from a total list of 6, or a total of 19 core objectives.

Download the Stage 2 Overview Tipsheet for a complete list of the Stage 2 core and menu objectives for both EPs and eligible hospitals and CAHs. Providers can also download a table of the Stage 2 core and menu objectives and measures by clicking on the links below:

• Stage 1 vs. Stage 2 Core and Menu Objectives for EPs
• Stage 1 vs. Stage 2 Core and Menu Objectives for Eligible Hospitals and CAHs

Clinical Quality Measures for 2014 and Beyond
All providers are required to report on CQMs in order to demonstrate meaningful use. Beginning in 2014, all providers regardless of their stage of meaningful use will report on CQMs in the same way.

• EPs must report on 9 out of 64 total CQMs.
• Eligible hospitals and CAHs must report on 16 out of 29 total CQMs.

In addition, all providers must select CQMs from at least 3 of the 6 key health care policy domains recommended by the Department of Health and Human Sevices’ National Quality Strategy:

• Patient and Family Engagement
• Patient Safety
• Care Coordination
• Population and Public Health
• Efficient Use of Healthcare Resources
• Clinical Processes/Effectiveness

A complete list of 2014 CQMs and their associated National Quality Strategy domains will be posted on the Clinical Quality Measures tab in the future. CMS will also post a recommended core set of CQMs for EPs that focus on high-priority clinical conditions.
For more detailed information on 2014 CQMs and electronic reporting options, click to download our 2014 Clinical Quality Measures Tipsheet.