On May 26, CMS issued a proposed rule (published in the June 1, 2011 Federal Register) intended to align the Medicare Electronic Prescribing (eRX) Incentive Program with the Medicare and Medicaid electronic health record (EHR) Incentive Programs. Under the eRX Incentive Program, established by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), eligible professionals who are successful electronic prescribers can receive a 1 percent incentive payment for program years 2011 and  2012, and 0.5 percent for 2013. In addition to incentive payments, MIPPA requires a Medicare Physician Fee Schedule (MPFS) downward payment adjustment, beginning in 2012, for eligible professionals who are NOT successful electronic providers.  The calendar year (CY) MPFS final rule, published in the November 29, 2010 Federal Register, established the program requirements for reporting the electronic prescribing quality measure for the 2012 eRX payment adjustment.

The proposed rule would modify the description statement of the existing 2011 electronic prescribing measure “to also recognize as certified electronic health record (EHR) technology as defined at 45 CFR 170.102 as a ‘qualified’ eRX prescribing system”. As stated in the Preamble of the proposed rule, “ Among other requirements, certified EHR technology must be able to electronically generate and transmit prescriptions and prescription-related information in accordance with certain standards, some of which have been adopted for purposes of electronic prescribing under Part D”. 

This change “provides eligible professionals and groups participating in the eRX Incentive Program with the option of adopting either a qualified eRX system or certified EHR technology”. 

The proposed rule also adds the following new significant hardship exemption categories for the 2012 eRX payment adjustment:      

• Eligible professionals who register to participate in the Medicare EHR Incentive Program  or the Medicaid EHR Incentive Program and adopt certified EHR technology;
• Inability to electronically prescribe due to local, state, or federal law;
• Limited prescribing activity; or
• Insufficient opportunities to report the electronic prescribing measure due to limitations of the measure’s denominator.
• Existing hardship exemption categories are: the eligible professional practices in a rural area without sufficient high speed internet access; and, the eligible professional practices in an area without sufficient available pharmacies for electronic prescribing.

The proposed rule also extends the deadline to request a significant hardship exemption to October 1, 2011.

Under the EHR Incentive Programs, which were established by the American Recovery and Reinvestment Act of 2009, eligible providers can receive incentive payments in their first year of participation by successfully registering through CMS’ Web-based registration system and then demonstrating to their state that they are eligible and have adopted, implemented, or upgraded certified EHR technology.