����������

June 16, 2024

The Honorable Thomas Keane, M.D.
Assistant Secretary for Technology Policy
National Coordinator for Health Information Technology
Department of Health and Human Services
Attention: CMS-0042-NC
P.O. Box 8013
Baltimore, MD 21244-8013

The Honorable Stephanie Carlton
Deputy Administrator and Chief of Staff
Centers for Medicare & Medicaid Services
Department of Health and Human Services
Attention: CMS-0042-NC
P.O. Box 8013
Baltimore, MD 21244-8013

Submitted Electronically

RE: CMS-0042-NC Request for Information; Health Technology Ecosystem

Dear Assistant Secretary Keane and Deputy Administrator Carlton,

On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the ���������� Association (AHA) appreciates the opportunity to provide comment on the Centers for Medicare & Medicaid Services (CMS) and Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC) Request for Information (RFI) regarding the Health Technology Ecosystem.

We support the agencies’ goals of reducing barriers for data interoperability and fostering innovation to support better health outcomes. The AHA recognizes the pivotal role that health technology plays in care delivery today and its potential to transform the patient and provider experience in the future. From artificial intelligence (AI) to mobile apps, medical devices to electronic health records (EHRs) — technology supports improvements in quality and efficiency for patients, caregivers and providers. Moreover, we believe that technology and data interoperability have the potential to address some of the prevalent challenges confronting the health care ecosystem today, including provider burnout and staffing shortages driven by administrative burdens. We also recognize that the innovative applications of health information technology (IT) must be balanced with reasonable guardrails to protect sensitive patient data and ensure security and privacy. In addition, while health technology can make care more efficient, implementing new tools and standards often requires significant financial investment and workflow changes for health care providers. This makes it critical for policymakers to ensure that policy changes intended to spur adoption are scoped and paced sustainably.

The AHA has several recommendations to improve health IT standards and infrastructure, increase beneficiary access to effective digital health tools, and advance data availability to improve health outcomes. Specifically, we recommend that CMS and ASTP/ONC:

• Foster a sustainable pace of standards implementation by continuing to develop ASTP/ONC’s United States Core Data for Interoperability vocabulary standards (USCDI), and extending the timeline to transition from USCDI version 3 to USCDI version 4 by an additional year (through calendar year (CY) 2028).
• Collaborate across agencies to address broader infrastructure challenges associated with health IT adoption, such as lack of broadband, digital literacy training and reliable Wi-Fi access for rural and underserved communities.
• Support reimbursement for the use of health technology by clarifying guidance on digital health and interprofessional consultation billing codes, and develop pathways to provide provisional payment for new technologies.
• Promote accountability and engagement from payers on interoperability by requiring that impacted payers adopt and use certified payer application programming interfaces (APIs) and developing safety and security requirements for the Provider Directory APIs.
• Repeal provider disincentives in the June 2024 final rule “21st Century Cures Act: Establishment of Disincentives for Healthcare Providers That Have Committed Information Blocking.” Under the final rule, hospitals and providers found to engage in information blocking may face excessive reductions in payment, which threatens access to services (particularly in rural and underserved areas).
• Build additional infrastructure to provide oversight for Trusted Exchange Framework and Common Agreement (TEFCA), including establishing an attestation schedule for all qualified health information networks (QHINs)
• Provide protections to ensure hospitals or health systems that have a QHIN that is suspended or terminated are not held liable for information blocking claims.
• Advance administrative simplification efforts by establishing a standard transaction for clinical attachments to support claims.
• Streamline current price transparency policies to remove complexity from the patient experience by focusing on options for patient estimates and other pricing information. Rely on No Surprises Act good faith estimates (GFEs) and advanced explanation of benefits (AEOBs) to provide patients with the most accurate estimates for their courses of care.
• Provide incentives for technology investment to enable providers to transition to value-based arrangements.
• Revert to previous thresholds (i.e., percentage threshold for the number of clinicians meeting certified electronic health record requirements) for the Medicare Shared Savings Program promoting interoperability measures.

There are other areas relevant to the health technology ecosystem that were not directly addressed in the RFI, including cybersecurity. We included several health IT and cybersecurity-focused recommendations in our recent response to the Office of Management and Budget's RFI on deregulation, including modifying the HIPAA cybersecurity rule of December 2024 to make the requirements voluntary.¹

Our detailed comments are attached. We look forward to the opportunity to work with CMS, ASTP/ONC and the Department of Health and Human Services (HHS) to help realize technology’s full potential for improving health outcomes, fully engaging patients in managing their health and reducing administrative burden. Please contact me if you have questions, or feel free to have a member of your team contact Jennifer Holloman, AHA director of health IT policy, at jholloman@aha.org.

Sincerely,

/s/

Ashley Thompson
Senior Vice President
Public Policy Analysis and Development

__________

¹ /system/files/media/file/2025/05/aha-response-to-omb-deregulation-rfi-letter-5-12-2025.pdf