CHIME Comments on Proposed Information Blocking Penalties for Healthcare Providers

December 18, 2023

The Honorable Xavier Becerra, Secretary

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC, 20201

Dear Secretary Becerra:

The College of Healthcare Information Management Executives (CHIME) is grateful for the opportunity to submit comments on the “21st Century Cures Act: Establishment of Disincentives for Health Care Providers That Have Committed Information Blocking” proposed rule published November 1, 2023, in the Federal Register.

I. Background

CHIME is an executive organization dedicated to serving chief information officers (CIOs), chief medical information officers (CMIOs), chief nursing information officers (CNIOs) and other senior healthcare IT leaders. With over 5,000 members, CHIME provides a highly interactive, trusted environment enabling digital health leaders to collaborate; exchange best practices; address professional development needs; and advocate for the effective use of information management to improve the health and healthcare in the communities they serve.

CHIME appreciates and strongly supports the need to continue fostering and constantly improving secure meaningful data exchange to foster better patient access to their records and to continue improving clinical decision making. We furthermore recognize that improving this process is a shared journey and not a destination. We are constantly improving even in the face of an everchanging technological landscape. Our members are committed to sharing data to the best of their abilities and fostering an environment that is a learning healthcare system.

II. Key Recommendations

Our members have unbridled optimism as we enter a new era punctuated by emerging technologies and more solutions than ever to improve data sharing. As providers navigate this rapidly changing landscape, they are also confronting numerous headwinds. The provider workforce is the backbone of our healthcare system, but it is being severely strained as more providers retire or face burnout post-pandemic. Our members are operating on razor thin margins. Hospitals and other providers are further consolidating and merging, creating efficiencies but also exacerbating access to care challenges. Opportunities abound with the use of artificial intelligence (AI) and generative AI to improve care efficiencies and workflow, but they come with a substantial financial cost. This is placing hospitals, healthcare systems, and clinicians at great risk of inadvertently creating an even greater digital divide (i.e., the “haves” and “have nots” in terms of health IT such as generative AI) if not addressed. Finally, we are besieged daily by cybersecurity attacks, risking patient lives and creating national security issues. Any new health IT and digital health compliance mandates must be balanced against the environment in which healthcare providers currently operate and exist.

We respectfully request that the U.S. Department of Health and Human Services (HHS) recognize the myriad of issues facing healthcare providers and take a holistic approach to compliance for not only this rule but also existing and other forthcoming mandates. We must work together to ensure all of the key ingredients needed for a high-functioning health system are in place. As HHS considers how best to enforce information blocking disincentives for healthcare providers, our primary and foremost recommendation for a fair and balanced set of policies is to implement them in the least burdensome and least punitive manner possible. Specifically, our granular recommendations include:

1. Providing at least one year of education and outreach predicated on learning from those found to be in violation of information blocking penalties to inform compliance in a non-punitive manner;

1. Focusing on the most egregious alleged violations of information blocking;

1. Establishing a uniform appeals process;

1. Precluding providers from being penalized more than once for the same violation; and

1. Exempting those providers who were ineligible for HITECH funding from being penalized now and in the foreseeable future.

III. Detailed Comments

Section 3022 of the PHSA as added by section 4004 of the Cures Act authorizes the Office of the National Coordinator (ONC), the HHS Office for Civil Rights (OCR), and the Office of the Inspector General (OIG) to consult, refer, and coordinate to resolve claims of information blocking.

The purpose of this proposed rule is to implement the provision contained in the 21st Century Cures Act (Cures Act) concerning referrals of healthcare providers, when determined by the Office of Inspector General (OIG) to have committed information blocking, to the appropriate agency to determine the “disincentives.” ONC states that, “this set of disincentives would directly advance HHS priorities for deterring information blocking, while also advancing appropriate sharing of electronic health information (EHI) by health care providers to support safer, more coordinated care for all patients.”

HHS has said they believe it is important to establish disincentives for all providers that are covered in the definition of “health care provider” under information blocking. The administration furthermore says that fewer patients will benefit unless disincentives are established for all providers under this definition. HHS is seeking feedback on how they can expand the disincentives to all actors who are providers under the information blocking policies since this proposed rule only applies to a subset of providers.

Information blocking disincentives vary depending on the type of actor you are. Actors who are considered a health information technology developer, exchange, or network, may be subjected to fines up to $1 million per information blocking violation. The threshold for holding one of these three actors accountable varies from how actors who are considered health care providers are held accountable. Specifically, the threshold for a health information technology developer, exchange, or network, is whether such developer, exchange, or network knows, or should know , that such a practice is likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information. For healthcare providers, however, the threshold centers around “intent.” We have concerns with this approach which are detailed below.

Regulatory History

The final rule identified eight reasonable and necessary activities that do not constitute information blocking pursuant to PHSA section 3022(a)(3). [1] The term ‘‘health care provider’’ is defined in Section 4004 of the Cures Act; ONC adopted the definition of healthcare provider in section 3000(3) of the PHSA for purposes of the information blocking regulations which is quite expansive. The proposal outlined by HHS applies disincentives only to a subset of the providers, as discussed in greater detail below.

ONC has reminded stakeholders in this rule that providers can meet both the definition of a healthcare provider, as well as being considered a health IT developer of certified health IT (85 FR 25798 through 25799). Providers could meet both the definition of a health care provider and a health information exchange or network. ONC states: “We mention these potential scenarios so that health care providers are aware that they would not necessarily only be subject to the disincentives proposed in this rule (should they be finalized), but depending on the specific facts and circumstances, they could meet the definition of a health information network or exchange, and therefore be subject to civil money penalties (CMPs), if found by OIG to have committed information blocking.”

OIG has stated that as part of its assessment of whether a healthcare provider is a health information network or exchange that could be subject to CMPs for information blocking, OIG anticipates engaging with the healthcare provider to better understand their functions and to offer the provider an opportunity to explain why it is not a health information network or exchange. While CHIME appreciates this, we continue to remain extremely concerned with this policy and have raised this numerous times with ONC. First, it could deter well-intended providers from offering data exchange services, which is contrary to the intent of the Cures Act. Second, it is unduly punitive and could subject providers to two or more sets of penalties. Third, we are deeply concerned that it is overly burdensome and urge HHS and the other agencies that have promulgated this rulemaking to take this into consideration.

Relevant Statutory Terms and Provisions

Healthcare providers that OIG has determined to have committed information blocking ‘‘shall be referred to the appropriate agency to be subject to appropriate disincentives using authorities under applicable Federal law.” ONC has proposed to define ‘‘appropriate agency’ ’ to mean a government agency that has established disincentives for healthcare providers that OIG determines have committed information blocking.

The Cures Act does not specify what types of disincentives should be established for healthcare providers. ONC has proposed to define the term ‘‘disincentive’’ to mean “a condition that may be imposed by an appropriate agency on a health care provider that OIG determines has committed information blocking.” The law also does not define the term ‘‘appropriate’’ for the purposes of disincentives. ONC has proposed that a disincentive for a healthcare provider that OIG has determined to have committed information blocking may be “ any condition , (emphasis added) established through notice and comment rulemaking, that would.... deter information blocking practices among health care providers subject to the information blocking regulations.”

First, CHIME is concerned that this definition is unclear, excessively broad and could potentially be interpreted to include scenarios outside the control of the provider – such as a cyber-attack.

Second, ____ we believe ample time is needed to learn from alleged cases identified as information blocking. We understand that there have been 856 “possible” claims of information blocking, and that the majority of claims are said to be with healthcare providers, according to ONC’s data. [2] There are no details, however, regarding the fact pattern in these cases, and it is thus very hard to learn from them. Providers need time to understand how HHS plans to apply policies before being penalized. This is an entirely new regulatory regime, and providers want to follow the rules, but they first need to understand the rules in order to do so.

Third, there are numerous situations that are difficult, if not impossible, for providers to control. For example, cyber-attacks are a now daily reality for providers, which compromises patient safety and care. We are also concerned about periods of transition whereby an actor may be undergoing a merger and acquisition (M&A), and data sharing may be temporarily interrupted. During an M&A when data sources are being combined, every effort will be made to share information but a grace period of one year should be allowed. With natural disasters on the rise this too should be considered.

Finally, we also remain concerned that there will be significant challenges to ascertaining where the fault lies – will it be determined to be the fault of the provider, the vendor, or both? ____ If a provider misconfigures their software based on advice from their vendor, we are concerned that this could inadvertently lead to information blocking accusations for providers. A clear “chain of custody” and documentation must be established so that providers understand what is expected of them. For example, if a physician fails to include information that is requested by the patient, the healthcare organization (HCO) cannot provide the same information. If the physician provides the information and the HCO withholds that information and does not meet an exception, then the blocking is the responsibility of the organization.

For these reasons, we firmly believe that at least one year is needed to help educate both the federal government, providers, and other actors around compliance.

Approach To Determination of Information Blocking and Application of Disincentives

HHS states that the OIG has discretion to choose which information blocking complaints to investigate. They also note that OIG typically focuses on investigating cases that are consistent with their “enforcement priorities” and ONC says they intend to apply this rationale to their approach for selecting information blocking complaints for investigation. OIG also says that they expect their CMP enforcement priorities to evolve over time as they gain more experience investigating information blocking allegations. They plan to begin with practices that:

1. Resulted in, are causing, or have the potential to cause patient harm;

1. Significantly impacted a provider’s ability to care for patients;

1. Were of long duration;

1. Caused financial loss to Federal healthcare programs, or other government or private entities; or

1. Were performed with actual knowledge.

OIG has said, however, that they expect to focus on the first four priorities for the purposes of healthcare provider enforcement for three reasons. The first reason centers around the concept of “intent” as further addressed below. The second reason is because OIG believes they can better use their limited resources to address the first four categories. And the third reason centers around their argument that they have “significant experience” with intent-based laws (e.g., anti-kickback statute).

Concept of Intent

Concerning the manner of intent, OIG says they plan on approaching alleged instances of information blocking by providers differently than other actors, citing the following applicable statute.

Providers Non-Provider Actors

(vendors, HIEs, HINs)

PHSA section 3022(a)(1)(B)(ii): PHSA section 3022(a)(1)(B)(i):

if conducted by a health care provider, such provider knows that such practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information. (emphasis added) if conducted by a health information technology developer, exchange, or network, such developer, exchange, or network knows, or should know , that such practice is likely to interfere with, prevent, or materially discourage the access, exchange, or use of electronic health information. (emphasis added)

OIG states that since the information blocking statute includes an element of intent, they do not plan on using the final category involving ‘‘actual knowledge’’ as an enforcement priority. It is for these reasons, OIG explains, that they plan on using a different standard for healthcare providers than for other actors. OIG has also said that if there is no knowledge, they will not review. CHIME finds this entire proposed policy very confusing. After consulting with other provider stakeholders, interpretation around these provisions varied. CHIME’s interpretation is that the Department’s approach will require a lower bar for OIG to investigate providers than may occur with non-provider actors; if this interpretation is correct, this is worrisome.

OIG states in the proposed rule that, “As with other conduct that OIG has authority to investigate, OIG has discretion to choose which information blocking complaints to investigate.” CHIME strongly urges the OIG to focus on what they believe to be known instances of wrongdoing rather than going after cases that simply indicate that may cause harm. We seek clarification on this point in particular.

Need for Education from Real Life Examples of Information Blocking

As noted earlier, we are also concerned that there is insufficient emphasis placed on educating providers before enacting any penalty. While ONC has many materials on their website to help educate providers and others on compliance responsibilities, the fact remains that there are numerous unanswered questions pertaining to the applicability of the eight exceptions. [3] We, as an industry, have just over a full year of experience and familiarity navigating compliance with the rule which ultimately set October 6 th , 2022 as the compliance date. Our members have also found that even where there is an available explanation, confusion persists; this in itself is a strong indicator of the need for more outreach and education. We continue to receive numerous questions particularly those centered around:

* What specifically is included in EHI [4] including the fact that while the term has the word “electronic” in it the definition still includes some paper records.

* When hardships exceptions may be claimed. Specifically, the hardships related to the infeasibility exception and the content and manner exception. [5]

CHIME believes that the best course of action to address claims or allegations of __ information blocking against providers is to first use education to help remedy noncompliance, and to focus on the most egregious cases of alleged information blocking. HHS should first start by fostering compliance through a period of learning spanning at least one year and which is informed by more granular education based off real world examples to help ensure provider understanding. We also recommend that ONC publish answers to long-sought questions asked by providers and others to establish greater clarity around compliance – specifically, when the exceptions are applicable and appropriate to use and when they are not. __

Further, as we outline in greater detail below, we believe there must be a clear-cut appeals process. These policies are seismic in nature and providers will strive to be in complete compliance. As a contrast, the EHR Meaningful Use Incentive Program included four years of incentives prior to moving to a penalty phase. [6] Taking into account the aforementioned need for education, an adequate learning period, the strains already being placed on providers as a result of workforce shortages, the downturn in the economy, and other forthcoming HHS mandates (e.g., HTI-1, CIRCIA, and other cyber mandates), we believe this represents a fair and balanced approach.

We appreciate that OIG, in reviewing an alleged case of information blocking by a provider, plan to assess the unique facts and circumstances associated with that particular instance; however, we have further questions. The proposed rule states, “Although OIG’s anticipated priorities are framed around individual allegations, OIG may evaluate allegations and prioritize investigations based in part on the volume of claims relating to the same (or similar) practices by the same entity or individual (for example, a health care provider or health information).” We respectfully request additional clarification on what this means, and what are the real-world implications. For instance, will a provider be more heavily penalized if the allegation involved a higher number of claims or patients? If a provider believes that they are using an exemption in the correct manner, then it will be repeated. The provider needs to be informed and correct all future information releases.

Application of Disincentives

HHS has proposed to target an initial set of providers for enforcement, along with an initial set of associated certain disincentives. However, they indicate they have plans to establish additional disincentives in the future. The following providers will be subjected to disincentives from an appropriate agency based on a determination of an information blocking referred by OIG. CMS would levy the following penalties for non-compliance if this proposal is finalized as proposed:

Provider Type Ensuing Penalty

1 An eligible hospital or CAH Deemed to not be a successful meaningful EHR user

2 A MIPS eligible clinician who is also a health care provider under Information Blocking definition Is not a meaningful EHR user for MIPS

3 ACOs who are health care providers as defined under Information Blocking definition, ACO participants, and ACO providers/ supplies Will be removed from, or denied approval to participate, in the Medicare Shared Savings Program for at least 1 year

In addition to establishing a year of learning based upon real world instances of information blocking, we furthermore recommend that HHS balance the disincentives with incentives for those providers who are successfully sharing information. The Meaningful Use incentives ended in 2015 for Medicare providers, but the infrastructure costs and investments needed to support data sharing continue in perpetuity. Currently, hospitals must attest they are not information blocking already. For hospitals attesting that they are not data blocking, we recommend that hospitals receive an increase in their market basket. For clinicians, we recommend they receive additional points for their MIPS score.

We furthermore recommend against HHS finalizing their Accountable Care Organization (ACO) disincentive proposal. We believe that ACOs need time to foster improved data exchange policies and removing them from MSSP only hurts their journey to value and accountability. Health IT and data exchange are pivotal to the success of ACOs [7] and we are unclear what the genesis is for the proposal to deny participation in Medicare’s Shared Savings Program (MSSP) as an information blocking penalty. At face value, this proposal appears contrary to the administration’s goals of fostering a move to value and care transformation [8] – which includes a goal of moving all Medicare patients into an accountable care model by 2030 9 - and which could inadvertently penalize Medicare patients. Would these patients and beneficiaries simply return to the traditional, fee-for-service Medicare program? Additionally, it remains unclear what impact this will have on care coordination and data exchange overall. It is completely inappropriate and overly punitive if the policy intent is, in fact, that if l an individual clinician participating in an ACO is found guilty of information blocking, the entire ACO is penalized.

We also question the impact this will have on cost savings to the Medicare program. A recent Congressional Budget Office (CBO) report found payment models being tested under the Center for Medicare & Medicaid Innovation (CMMI) had mixed cost savings results. [9] It is difficult to understand what impact CMS’ proposal will have without further research, but given the significant investments that providers are making and have made to jumpstart efforts to join an ACO, we believe this proposal would deter participation in an ACO. One recent article found, “that although ACOs are encouraging hospitals to broaden their data-sharing networks, they do so unevenly, suggesting there is a “network effect” where greater ACO presence in a local market creates stronger incentives for investing in care coordination infrastructure such as HIE.” [10] We believe policies that support, rather than penalize, care coordination should be implemented. CHIME recommends that instead of removing an ACO from the MSSP, they be placed on a oneyear probation period, during which time they can make any required changes in order to come into compliance.

HHS also notes that providers identified as information blockers will be notified that they are receiving a penalty. HHS states: “We propose in 45 CFR 171.1002(a) through (d) that an appropriate agency that imposes a disincentive or disincentives in § 171.1001(a) would send a notice (using usual methods of communication for the program or payment system) to the health care provider subject to the disincentive or disincentives.” CHIME respectfully requests further clarification from HHS as to whether this means all providers who have been identified as alleged information blockers will indeed receive a penalty.

Providers Not Eligible for Meaningful Use Incentives

In addition to our above comments and recommendations concerning how disincentives are applied, we furthermore have two additional overarching recommendations . First, as a preliminary matter, providers who did not receive Meaningful Use EHR incentives should be exempt from any information blocking disincentives. We strongly urge HHS to exercise enforcement discretion and preclude these providers from penalties as this will only serve to set them back further in their efforts to adopt more robust data exchange capabilities and will hurt patients. HHS has acknowledged in multiple regulations as well as verbal remarks that they understand the challenges faced by these providers such as long-term and post-acute care (LTPAC) entities. CHIME urges HHS to take these providers off the table given they are still – after more than fifteen years – playing catch up with ambulatory and acute providers who received EHR funding under HITECH.

Overlapping Penalties

Another overarching issue we wish to convey relates to how HHS plans to address the possibility of multiple sets of penalties. HHS writes, “where a health care provider that has been determined to have committed information blocking is subject to multiple disincentives (emphasis added) established by an appropriate agency, nothing in this proposal would prevent the appropriate agency from combining these notices into a single communication.” While we appreciate the efficiency of a single letter, this statement raises another question. We are unclear if it is HHS’ plan to allow for multiple, different penalties from various agencies under various authorities? This language points to the strong possibility that providers will be penalized under various authorities.

In the proposal, HHS states, “OIG stated that it anticipates coordinating with other HHS agencies to avoid duplicate penalties (emphasis added) as identified in section 3022(d)(4) of the PHSA. Depending on the facts and circumstances, OIG stated that it might also consult or coordinate with a range of other government agencies, including CMS, FTC, or others.” Furthermore, elsewhere in the rule HHS writes, “PHSA section 3022(d)(4) requires the Secretary, in carrying out section 3022 and to the extent possible, to ensure that information blocking penalties do not duplicate penalty structures (emphasis added) that would otherwise apply with respect to information blocking and the type of individual or entity involved as of the day before the date of enactment of the Cures Act.”

Our members are also concerned that the Joint Commission, during a survey, may identify what they believe is an information blocking violation and we are concerned this too could add a duplicate penalty structure. CHIME is therefore worried about the prospect of a provider being penalized under multiple authorities and urges HHS to do everything under their control to avoid this. The penalties – as discussed in more detail below – are very steep, and it would be unduly punitive to subject providers to more than one set of disincentives.

Appeals

CHIME is extremely concerned by the notion that there may – or may not – be an option to appeal. HHS writes, “a health care provider…may have the right to appeal administratively a disincentive if the authority used to establish the disincentive provides for such an appeal.” Once again, there seems to be a disparity in the way HHS plans to treat provider actors as contrasted with nonprovider actors. HHS states: “We note that PHSA section 3022(b)(2)(C) requires that the imposition of CMPs that apply to health IT developers of certified health IT, and health information networks or health information exchanges, which have committed information blocking, follow the procedures of SSA section 1128A, which includes procedures for appeals.” HHS further notes that, “the Cures Act did not provide similar instruction regarding appeals of disincentives for health care providers established under PHSA section 3022(b)(2)(B). Therefore, any right to appeal administratively a disincentive, if available, would be provided under the authorities used by the Secretary to establish the disincentive through notice and comment rulemaking.”

CHIME strongly supports the need for an appeals process, but we have two significant concerns with this approach. First, we believe HHS should establish a uniform appeals process for providers for the purposes of allegations of information blocking. If this is not feasible, we recommend that HHS not impose penalties under programs which do not have an appeals mechanism. Second, we are very concerned that the agency levying the fine should not be the same agency handling the appeals process. We believe that there needs to be an independent arbitrator. Thus, CHIME recommends that ONC establish a uniform and independent appeals process outside of the agency issuing the disincentive.

Posting Information about Information Blocking Violators

HHS discusses the importance of promoting transparency concerning how and where information blocking is impacting the nationwide health information technology infrastructure. HHS has said they plan to publicly release information, including applicable public settlements, penalties, and disincentives, about actors that have been determined by OIG to have committed information blocking because it can “inform the public about how and where information blocking is occurring within the broader health information technology infrastructure.”

PHSA section 3001(c)(4) requires that the National Coordinator maintain an internet website ‘‘to ensure transparency in promotion of a nationwide health information technology infrastructure.’’ While we appreciate the need for transparency, we harken back to our earlier comments which focus on the need for education prior to taking punitive actions against providers. We recognize the Cures Act requires ONC to maintain a website to “to ensure transparency in promotion of a nationwide health information technology infrastructure.’’ Our main three recommendations are: 1) to list all of the providers who are successfully exchanging information rather than focus on the few entities who have been found guilty; 2) should HHS proceed with their plans to post violators, we believe they should only be posted after at least one year in order to give providers time to come into compliance; and 3) information should only be posted after an appeals process has been exhausted.

Appropriate Disincentives for Health Care Providers

HHS has proposed to levy fines on providers in the form of cuts to their Medicare reimbursement. HHS writes, “we propose to establish a set of disincentives for health care providers that have committed information blocking. These disincentives would be imposed following a referral of a determination of information blocking by OIG.”

As described earlier, the penalties being proposed would be levied against providers participating in certain Federal programs which include the Medicare Promoting Interoperability Program (hospitals) and the MIPS Promoting Interoperability performance category (clinicians), and the MSSP. Below are the proposed penalty structure and estimated dollar figures.

Provider Type Penalty Structure Penalty Length Estimated Penalty

1 An eligible hospital 75 percent of the annual market basket increase; The calendar year in which the EHR reporting period falls. Median penalty amount = $394,353 with a range of $30,406 to $2,430,766

CAH 100 percent of reasonable costs instead of the 101 percent of reasonable costs that a CAH earned During the applicable EHR reporting period

2 A MIPS eligible clinician who is also a health care provider under Information Blocking definition Zero score for the Promoting Interop performance category [11] with maximum final score of 75 points for remaining performance categories. During the calendar year of the performance period. Median individual penalty = $686 with of $38 to $7,184.

Median 6 person group practice penalty = $4,116 with range of $1,372 to $165,326 for group ranging from two to 241 clinicians

3 ACOs who are health care providers as defined under Information Blocking definition, ACO participants, and ACO providers/ supplies Deny addition of any provider from participation. For existing ACO participants, application for participation in next year denied. One year, possibly longer Not receiving revenue that they might otherwise have earned if they had participated in the MSSP.

CHIME is concerned with the harsh nature of these penalties and strongly disagrees with the following sentiment: “CMS also believes the proposed disincentive under the Medicare Promoting Interoperability Program would be an appropriate disincentive that would similarly deter information blocking by other eligible hospitals and CAHs, consistent with the discussion in section III.A.3. of this proposed rule.” Based upon conversations with other provider organizations, we are concerned that the estimated losses as outlined above are underestimated. As noted earlier, we believe this is unduly punitive and the ultimate loss will be for patients. Instead of levying heavy financial penalties on already strained providers, our recommendation continues to be a path of education focusing on bringing providers into compliance. Additionally, we believe that should fines be levied, they should be redirected back into education efforts.

Last, we disagree that an alternate approach to establishing fines based on the severity of conduct cannot be used for information blocking. CHIME believes a better approach is to follow one similar to the Health Insurance Portability and Accountability Act (HIPAA), which uses a tiered approach depending on the severity of the violation. [12] OCR works with providers where violations have been found to help bring them into compliance with technical assistance.

IV. Conclusion

CHIME appreciates the opportunity to comment and looks forward to working with HHS to ensure that providers follow all information blocking policies. We again urge that as the administration looks to establish several new mandates on providers that they are done in the least burdensome manner while also supporting patient care, patient safety and prioritizing the security and privacy of

patient information. Should you have any questions concerning our comments and recommendations please do not hesitate to reach out to Mari Savickis, VP, Public Policy at [email protected] .

Sincerely,

Russ P. Branzell, CHCIO, LCHIME

President and CEO, CHIME

[1]Cures Act Final Rule: Information Blocking Exceptions (healthit.gov)[2]Information Blocking Claims: By the Numbers | HealthIT.gov[3]Cures Act Final Rule: Information Blocking Exceptions (healthit.gov)[4]Understanding Electronic Health Information (EHI) | HealthIT.gov[5] Defined as “It will not be information blocking for an actor to limit the content of its response to a request to access, exchange, or use EHI or the manner in which it fulfills a request to access, exchange, or use EHI, provided certain conditions are met.” [6]EHRIncentProgtimeline508_V1 (cms.gov)[7]Leveraging Health Information Technology for ACO Success (ajmc.com)[8]The Medicare Value-Based Care Strategy: Alignment, Growth, And Equity | Health Affairs9INNOVATION CENTER STRATEGY REFRESH (cms.gov)[9]Federal Budgetary Effects of the Activities of the Center for Medicare & Medicaid Innovation (cbo.gov)[10]Growth in Health Information Exchange With ACO Market Penetration (ajmc.com)[11] For CY 2024 performance period/2026 MIPS payment year, the scoring weights are: 30 percent for the quality performance category; 30 percent for the cost performance category; 15 percent for the improvement activities performance category; and 25 percent for the Promoting Interoperability performance category. [12]Summary of the HIPAA Privacy Rule | HHS.gov