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referral. A provider who limits the results in a summary of care document must send the full results upon the

request of the receiving provider or upon the request of the patient.

The Consolidated Clinical Document Architecture (C-CDA) is the standard adopted for EHR technology

certification for summary of care documents. In this final rule, all the required data elements for the C-CDA

remain as previously finalized.

Transitions of Care and Referrals

A transition of care is defined as the movement of a patient from one setting of care (hospital, ambulatory

primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to

another. At a minimum, this includes all discharges from the inpatient department and after admissions to the

emergency department when follow-up care is ordered by an authorized provider of the hospital.

Referrals are cases where one provider refers a patient to another, but the referring provider maintains their

care of the patient as well. In addition:



Transition of care for electronic exchange has been further defined as one where the referring provider

is under a different billing identity within the Medicare and Medicaid EHR Incentive Programs (such as a

different National Provider Identifier [NPI] or hospital CMS Certification Number [CCN]) than the

receiving provider and where the providers do not share access to the EHR.



In cases where the providers do share access to the EHR, a transition or referral may still count toward

the measure if the referring providers creates the summary of care document using CEHRT and sends

the summary of care document electronically. If a provider chooses to include such transitions to

providers where access to the EHR is shared, they must do so universally for all patients and all

transitions or referrals.



In cases where a provider has a patient who seeks out and receives care from another provider without

a prior referral, the first provider may include that transition as a referral if the patient subsequently

identifies the other provider of care.

Electronic Transmission of Summary of Care Documents

For the EHR Incentive Programs in 2017, the HIE measure simply states that a provider is required to create the

summary of care records using CEHRT and to transmit the summary of care record electronically. The intent is to

promote and facilitate a wide range of options for the transmission of an electronic summary of care document.

The initiating provider must send a C–CDA document that the receiving provider would be capable of

electronically incorporating as a C–CDA on the receiving end. In other words, if a provider sends a C–CDA and

the receiving provider converts the C–CDA into a pdf or a fax or some other format, the sending provider may

still count the transition or referral in the numerator. If the sending provider converts the file to a format the

receiving provider could not electronically receive and incorporate as a C–CDA, the initiating provider may not

count the transition in their numerator. The provider may use a third party to send the summary of care record,

but it is not required.

Medicaid Ehr Incentive Program Health Information Exchange - Objective Stage 3 - Centers For Medicare And Medicaid Services Page 4