Rule History

2027

CMS-1849 and
CMS-0062

Volume 91

50028

·       Removal of the previously required ONC Direct Review Attestation beginning with the EHR reporting period in CY 2026

·       Removal of the previously optional ONC-ACB Surveillance Attestation beginning with the EHR reporting period in CY 2026

·       Removal of the Support Electronic Referral Loops by Sending Health Information and Support Electronic Referral Loops by Receiving and Reconciling Health Information measures under the HIE objective, beginning with the EHR reporting period in CY 2029

·       Modified the ePA measure under the HIE objective, beginning with the EHR reporting period in CY 2027. The measure is optional and worth 10 points for the EHR reporting period in CY 2027. The measure is mandatory beginning with the EHR reporting period in CY 2028

·       Adopted the UDIs for Implantable Medical Devices measure under the PHCDE objective, beginning with the EHR reporting period in CY 2027. “Yes” and “No” attestation responses are allowed for the first year

·       Adopted 2 new eCQMs (Advance Care Planning and HH-Postoperative VTE) beginning with CY 2028

·       Removed 3 eCQMs (VTE-1, VTE-2, and STK-2) beginning with CY 2028.

·       Mandatory reporting of the MCS eCQM beginning with CY 2028

·       Mandatory reporting of the Hospital Harm eCQMs after two years as “self-selected” measures, beginning with CY 2028

·       Public reporting of the Hospital Harm eCQMs with modification: For the first year of mandatory reporting, data will display on the PDC only. For the second year of mandatory reporting, data will be moved to Care Compare and be included in Star Ratings

·       Adopted updated versions of ONC’s Certified Health Information Technology Standards and Specifications. (These provisions were originally proposed in the 2026 CMS Interoperability Standards and Prior Authorization for Drugs rule.)

·       Finalized updates to the CEHRT definition effective January 1, 2027; removed references to certification criteria proposed for removal in ONC’s HTI-5 rule proposed rule (family health history, patient health information capture, automated numerator recording, and automated measure calculation)

2026

CMS-1833 and CMS-1808

Volume 90

37043

·       Finalized the definition of the “EHR reporting period for a payment adjustment year” in CY 2026 and subsequent years as a minimum of any continuous 180-day period within that calendar year; Updated corresponding revisions at 42 CFR 495.4

·       Modified the Security Risk Analysis Measure beginning with the EHR reporting period in CY 2026, to require eligible hospitals and CAHs to attest “Yes” to having conducted security risk management, in addition to the existing requirement to attest “Yes” to having conducted a security risk analysis

·       Modified the SAFER Guides Measure beginning with the EHR reporting period in CY 2026 and in subsequent years, to require eligible hospitals and CAHs to conduct an annual self-assessment using all 8 of the 2025 SAFER Guides at any point during the calendar year in which the EHR reporting period occurs

·       Adoption of an Optional Bonus Measure for Public Health Reporting Using TEFCA® under the PHCDE objective, beginning with the EHR reporting period in CY 2026; Eligible hospitals and CAHs may earn a maximum of 5 bonus points for reporting on any or all of the 3 optional bonus measures

·       Suppression of the Electronic Case Reporting measure from scoring for the EHR reporting period in CY 2025 (CY 2026 PFS final rule)

·       Adoption of a Measure Scoring Suppression Policy beginning with the EHR reporting period in CY 2026 (CY 2026 PFS final rule)

·       Finalized new and revised standards and certification criteria to the ONC Health IT Certification Program (pages 37131–37184) (The HTI-4 final rule was published as part of the FY 2026 IPPS/LTCH PPS final rule.)

2025

CMS-1808

Volume 89

69600

·       Separated the AUR Surveillance measure into 2 measures, AU Surveillance and AR Surveillance, beginning with the EHR reporting period in CY 2025

·       Adopted 3 exclusions each, for AU Surveillance and AR Surveillance measures

·       Will treat the AU Surveillance and AR Surveillance measures as new measures with respect to level of active engagement, beginning with the EHR reporting period in CY 2025 and subsequent years

·       Maintaining the approach to scoring for the PHCDE objective.

·       Maintaining the existing exclusion redistribution policy for the PHCDE objective but modified it to indicate there are 6 measures rather than 5 measures

·       Changed references to “2015 Edition health IG certification criteria” to “ONC health IT certification criteria”

·       Finalized an increase to the minimum performance-based scoring threshold from 60 points to 70 points for the EHR reporting period in CY 2025, and from 70 points to 80 points beginning with the EHR reporting period in CY 2026 and continuing in subsequent years

·       Adopted 2 new eCQMs (HH-FI and HH-RF)

·       Adopted the modification to the GMCS eCQM

·       Adopted the increase in eCQM reporting (total of 8 for CY 2026, total of 9 for CY 2027, and a total of 11 for CY 2028).

2024

CMS-1785

Volume 88

59144

·       Finalized that the EHR reporting period in CY 2025 will be a minimum of any continuous 180-day period within CY 2025

·       Finalized that beginning with the EHR reporting period in CY 2025 for all eligible hospitals (new and returning participants), the EHR reporting period in CY 2025 will apply for purposes of the FY 2027 payment adjustment year

·       Modified the requirement for the SAFER Guides measure beginning with the EHR reporting period in CY 2024 and continuing in subsequent years, to require eligible hospitals and CAHs to attest ‘‘Yes’’ to having conducted an annual self-assessment using all 9 SAFER Guides, at any point during the calendar year in which the EHR reporting period occurs

·       Beginning with the EHR reporting period in CY 2024, will refer to calculation considerations related to unique patients or actions for measures for which there is no numerator and denominator, and for which unique patients or actions are not counted, to read ‘‘N/A (measure is Yes/No)’’

·       Adopted 3 new eCQMs (HH-PI, HH-AKI, Excessive Radiation)

2023

CMS-1771

Volume 87

49319

·       Finalized changes to the Query of PDMP measure

·       Added the TEFCA Measure as an optional alternative to fulfill the HIE objective beginning with the EHR reporting period in CY 2023.

·       Modified the PHCDE objective by adding the AUR Surveillance Measure beginning with the EHR reporting period in CY 2024.

·       Consolidated the current options from three to two levels of active engagement for the PHCDE objective.

·       Finalized changes to the scoring methodology

·       Finalized the public reporting of data submitted by eligible hospitals and CAHs

·       Adopted 2 new eCQMs (ePC-07/SMM and ePC-02)

2022

CMS-1752

Volume 86

45460

·       Finalized that for CY 2023, the EHR reporting period is a minimum of any continuous 90-day period in CY 2023 for new and returning participants and that for CY 2024 the EHR reporting period is a minimum of any continuous 180-day period in CY 2024 for new and returning participants

·       Finalized to maintain the Query of PDMP measure as optional while increasing its associated bonus points from 5 points to 10 points

·       Added HIE Bi-Directional Exchange Measure as optional and worth 40 points

·       Made 4 measures required under the PHCDE objective (Syndromic Surveillance Reporting, Immunization Registry Reporting, Electronic Case Reporting, and Electronic Reportable Laboratory Result Reporting)

·       Modified the scoring of the PHCDE objective

·       Added the new SAFER Guides measure to the Protect Patient Health Information objective

·       Finalized modifications to the Attestation Statements

·       Increased the minimum scoring threshold from 50 points to 60 points.

·       Removed 3 eCQMs (STK-06, PC-05, ED-2)

·       Adopted 2 new eCQMs (HH-01 and HH-02)

·       Require eligible hospitals and CAHs to use only certified technology updated consistent with the 2015 Edition Cures Update

2021

CMS-1735

Volume 85

58966

·       Removed Medicaid from the program

·       Finalizing that for CY 2022, the EHR reporting period is a minimum of any continuous 90-day period in CY 2022 for new and returning participants

·       Maintained the Electronic Prescribing Objective’s Query of PDMP measure as optional and worth 5 bonus points

·       Modified the name of the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure to Support Electronic Referral Loops by Receiving and Reconciling Health Information

·       Finalized to progressively increase, over a 3-year period, the number of quarters that eligible hospitals and CAHs are required to report eCQM data

·       Finalized to begin publicly reporting eCQM data

2020

CMS-1716

Volume 84

42591

·       Finalized conversion of the Query of PDMP measure to a Yes/No attestation

·       Finalized the EHR reporting period as a minimum of any continuous 90-day period in CY 2021 for new and returning participants

·       Clarified that actions must occur within the EHR Reporting Period

·       Made the Query of PDMP measure optional and eligible for 5 bonus points and remove the numerator and denominator and will require a “Yes/No” response and removed the exclusions

·       Removed the Verify Opioid Treatment Agreement measure

·       Revised the regulations for the Support Electronic Referral Loops by Receiving and Incorporate Health Information measure and that the electronic summary of care record must be received using CEHRT and that clinical information reconciliation for medication, medication allergy, and current problem list must be conducted using CEHRT

·       Adopted the Safe Use of Opioids—Concurrent Prescribing CQM

·       Finalized reporting periods, reporting criteria, and submission periods for
CY 2020, 2021, and 2022

·       Eliminated attestation as a method for reporting CQMs and instead requires all eligible hospitals and CAHs to submit their CQM data electronically

2019

CMS-1694

Volume 83

41634

·       Changed the program from the Medicare and Medicaid EHR Incentive Programs to the Medicare and Medicaid Promoting Interoperability Program

·       Finalized an EHR reporting period of a minimum of any continuous 90-day period in CY 2019 and 2020 for new and returning participants attesting to CMS or their State Medicaid agency

·       Finalized the proposed performance-based scoring methodology

·       Finalized the Verify Opioid Treatment Agreement measure as optional in
CY 2019 and CY 2020, with the ability to earn 5 bonus points per year

·       Must earn a minimum total score of 50 points in order to satisfy the requirement to report on the objectives and measures of meaningful use

·       Adopted 3 new measures (Query of PDMP, Verify Opioid Treatment Agreement, and Support Electronic Referral Loops by Receiving and Incorporating Health Information)

·       Removed the Coordination of Care Through Patient Engagement objective and its associated measures

·       Renamed Patient Electronic Access to Health Information objective to Provider to Patient Exchange objective, and renamed the remaining measure, Provide Patient Access to Provide Patients Electronic Access to Their Health Information

·       Removed 8 CQMs (AMI-8a, CAC-3, ED-1, EHDI–1a, PC-01, STK-08, STK-10, and ED-3)

·       Codified that eligible hospitals would include subsection (d) Puerto Rico hospitals unless otherwise indicated

2018

CMS-1677

Volume 82

38474

·       Decreased the number of calendar quarters hospitals are required to submit data; and decreased the number of CQMs hospitals must submit

·       Finalized the CQM requirements and submissions for CY 2017 and 2018

·       Added new exception for not being able to comply with being a meaningful user due to their EHR technology being decertified under ONC’s Health IT Certification Program

·       Finalized the use of either 2014 Edition or 2015 Edition CEHRT, or a combination of 2014 Edition and 2015 Edition CEHRT, for an EHR reporting period in CY 2018

·       Finalized changes to the Medicare and Medicaid EHR Incentive Programs:

o   Finalized an EHR reporting period of a minimum of any continuous 90-day period in CY 2018 for new and returning participants attesting to CMS or their State Medicaid agency

o   Finalized the definition of an ASC-based EP

2017

CMS-1655

Volume 81

57249

·       Finalized the reporting of only 8 CQMs for eligible hospitals and CAHs that choose to report electronically

·       Removal of 13 CQMs

·       Finalized the submission periods for eligible hospitals and CAHs reporting CQMs by attestation and those that are electronically reporting CQMs

·       Finalized to continue the policy that electronic submission of CQMs will require the use of the most recent version of the CQM electronic specification for each CQM to which the EHR is certified

·       Finalized the use of EHR technology certified to the 2014 or 2015 Edition for CQM reporting in 2017

2016

CMS-1632

Volume 80

49756

·       Finalized that for CY 2016/FY 2018 hospitals can report using either the 2014 or 2015 edition of CEHRT

·       Finalized that hospitals must submit electronic data via a QRDA Category I file

·       Aligned the reporting periods and requirements for electronically submitted CQMs with the reporting periods and requirements for electronically submitted CQMs for the Hospital IQR Program

·       Finalized that hospitals that choose to report CQMs electronically in CY 2016 are required to submit a minimum of 4 electronically submitted CQMs in either Q3 or Q4 of CY 2016, with a submission deadline of February 28, 2017 This final policy does not change the reporting periods or requirements for the meaningful use objectives and associated measures or apply for CQMs that are reported by attestation via the Registration and Attestation System.

·       Allowed eligible hospitals and CAHs in any year of participation in the Medicare EHR Incentive Program in 2016 to report CQMs by attestation or electronically, and to continue our policy that electronic submission of CQMs will require the use of the most recent release of the CQM version.

·       Removed the QRDA III as an option for reporting and requiring QRDA I for CQM electronic submissions

2015

CMS-1607

Volume 79

50319

·       Referred to as the “EHR Incentive Program” and first inclusion of the program in the IPPS/LTCH PPS rule

·       Finalized the aligning of the reporting and submission timelines for clinical quality measures for eligible hospitals and CAHs with the reporting and submission timelines for the Hospital IQR Program

·       Finalized the annual submission of the eCQMs (did not finalize the proposal for quarterly submissions)

·       May report CQMs electronically using QRDA I (patient-level data) or via attestation (aggregate-level data)

·       Must use the most recent version of the electronic specifications for the CQMs

·       Provided guidance and clarification for reporting zero denominators and case threshold exemptions

Acronyms

ACB

Authorized Certification Body

HTI

Health Data, Technology, and Interoperability: Electronic Prescribing, Real-Time Prescription Benefit, and Electronic Prior Authorization

AKI

acute kidney injury

IG

Implementation Guide

AMI

acute myocardial infarction

IPPS

Inpatient Prospective Payment System

AR

antibiotic resistance

IQR

Inpatient Quality Reporting

ASC

ambulatory surgery center

IT

information technology

AU

antibiotic use

LTCH

long-term care hospital

AUR

Antimicrobial Use and Resistance 

MCS

Malnutrition Care Score

CAC

Children’s Asthma Care

N/A

not applicable

CAHs

critical access hospitals

ONC

Office of the National Coordinator for
Health Information Technology

CEHRT

Certified Electronic Health
Record Technology

PC

perinatal care

CFR

Code of Federal Regulations

PDC

Production Data Catalog

CMS

Centers for Medicare & Medicaid Services

PDMP

Prescription Drug Monitoring Program

CQM

clinical quality measure

PFS

Physician Fee Schedule

CY

calendar year

PHCDE

Public Health and Clinical Data Exchange

eCQMs

electronic clinical quality measures

PI

pressure injury

ED

emergency department

PPS

Prospective Payment System

EHDI

Early Hearing Detection and Intervention

Q

quarter

EHR

electronic health record

QRDA

Quality Reporting Document Architecture

EP

eligible provider

RF

respiratory failure

ePA

Electronic Prior Authorization

SAFER

Safety Assurance Factors for EHR Resilience

ePC

electronic perinatal care

SMM

severe maternal morbidity

FI

falls with injury

STK

stroke

FY

fiscal year

TEFCA®

Trusted Exchange Framework and Common Agreement^TM

GMCS

Global Malnutrition Composite Score

UDI

Unique Device Identifiers

HH

hospital harm

VTE

venous thromboembolism

HIE

Health Information Exchange