Regulatory Sprint: HHS Proposes Expansion of Protections for EHR and Cybersecurity Donations

Baker Ober Health Law

Baker Ober Health Law

In furtherance of its goals of expanding the adoption of electronic health records (EHR) and improving security through the use of cybersecurity technology, the Department of Health and Human Services (HHS) has proposed expanding protections for EHR and cybersecurity donations. HHS recognizes that barriers (whether real or perceived) to the adoption of EHR and cybersecurity technology will hinder the growth of care coordination which is at the heart of the health care system's move from a volume-based to a value-based system.

The HHS Office of Inspector General (OIG) and the Centers for Medicare & Medicaid Services (CMS) each included two proposals toward that end in their respective proposed coordination of care regulations issued October 2019. First, the OIG and CMS proposed expanding and extending the existing Anti-Kickback Statute (AKS) safe harbor and Physician Self-Referral (Stark) Law exception for EHR donations. Second, the OIG and CMS proposed a new AKS safe harbor and Stark exception for donations of cybersecurity technology and related services. The EHR and cybersecurity proposals are discussed below as part of the Baker Ober Health Law Team's ongoing effort to delve into the details of the Administration's "Regulatory Sprint to Coordinated Care."

EHR Donations Clarifications and Amendments

The OIG and CMS finalized the AKS safe harbor and Stark exception for donations of interoperable EHR software and related training services in 2006, then amended both in 2013. The newly proposed regulations attempt to inject some standardization around the concepts of interoperability, information blocking, and data lock-in. The new regulations also propose the removal of the sunset provisions, offer options with respect to cost-sharing, and clarify protections for cybersecurity technology and software as part of an EHR donation.

Interoperability (deeming provisions, information blocking and data lock-in)

The OIG and CMS propose significant updates to the deeming provisions around the interoperability of EHR software. Currently, the exception and safe harbor deem EHR software as interoperable if the software has been certified before the date of donation. Under the new proposed rules, the donated EHR software must have current certification as of the date of donation. The mere certification of the EHR software at some previous date would no longer qualify under the deeming provision.

The agencies also propose aligning the EHR prohibition against donors who take actions to limit or restrict the use, compatibility, or interoperability of the items or services with other electronic prescribing or EHR systems (now known as information blocking) with the 21st Century Cures Act (Cures Act) definition of information blocking. Under the Cures Act, a provider engages in information blocking when the provider "knows that [the] practice is unreasonable and is likely to interfere with, prevent, or materially discourage access, exchange, or use of [EHR]." Although health plans are not subject to the information blocking provisions under the Cures Act, the OIG specifically proposes to apply this knowledge standard to both health plans and health care providers.


The OIG and CMS also clarify that the EHR safe harbor and exception have always protected certain cybersecurity software and services. The agencies state that an entity donating EHR software and providing training and other related services may also donate the related cybersecurity software and services needed to protect the donated EHR. Individuals seeking protection for cybersecurity software and service donations only need to meet the EHR exception and safe harbor or the newly proposed cybersecurity exception and safe harbor, as discussed below.

Definitions of Interoperability and Electronic Health Records

The OIG and CMS also propose to modify the definitions of Electronic Health Records and Interoperability based on the definitions used in the Cures Act and the Office of the National Coordinator for Health Information Technology's proposed regulations.

Cost-sharing/Contribution Requirements

The proposed regulations also seek comments on changing the cost-sharing/contributions requirements. The EHR exception and safe harbor currently require a 15-percent cost-sharing contribution. The OIG and CMS propose three potential alternatives:

  • eliminate or reduce the percentage contribution required for small or rural practices;
  • eliminate or reduce the 15-percent contribution requirement for all recipients; or
  • modify or eliminate the contribution requirement for updates to previously donated EHR software or technology.

Stakeholders are encouraged to submit their comments on the proposed alternatives or other similar alternatives.

Replacement Technology

Both agencies also propose deleting the prohibition against donating equivalent technology, and instead would allow donations of replacement electronic health records technology. The agencies seek comments on this proposal.

OIG's Expanded Scope of Protected Donors

In addition, the OIG proposes expanding the scope of protected donors under the EHR safe harbor to include those who "submit[ ] claims or requests for payment, either directly or through reassignment, to the Federal health care program." In light of its goals to advance the adoption of electronic health records technology, the OIG proposes eliminating or revising the restrictions on who may qualify as a protected donor. If the OIG revises rather than eliminates the provision, it would likely expand the safe harbor protection to entities with indirect responsibility for patient care. This would protect donor entities such as health systems or accountable care organizations that neither are health plans nor submit claims for payment. Notably, CMS made no similar proposal, although it is also not clear that such a change is necessary given the scope of the Stark Law.

Sunset Provision

The current EHR safe harbor and exception are scheduled to end on December 31, 2021. The agencies propose eliminating this sunset provision, although they are also seeking comments on whether a later sunset date should be chosen instead.

Cybersecurity Exception and Safe Harbor

In addition to clarifying that cybersecurity technology and services may be included under the EHR donation exception and safe harbor, the OIG and CMS propose a new, separate cybersecurity technology and services donation exception and safe harbor. The agencies stress the growing threats posed by cyberattacks. Without adequate cybersecurity, these attacks can prevent access to and lead to corruption of health records and other health-related information.

The proposed AKS safe harbor and Stark exception are substantially similar, although there are a few differences which are noted below. For a donation to qualify for the cybersecurity safe harbor or exception, the proposed arrangement must meet the following conditions:

  1. The donated technology and/or services must be necessary and must be predominantly used to implement, maintain, or reestablish cybersecurity.
  2. Under the Stark exception, the donor cannot condition the donation, the amount or nature of the donation, or the eligibility for donation on referrals or the business generated.
  3. Under the AKS safe harbor:
    1. The donor cannot directly take into account the volume or value of referrals or other business between the parties when determining a potential recipient's eligibility for donation, "or the amount or nature of the technology or services to be donated."
    2. The donor cannot condition the donation, the amount or the nature of the donation on future referrals.
  4. The potential recipient and/or the potential recipient's practice (including employees or staff members) cannot make the donation of cybersecurity technology and services a condition of doing business or continuing to do business with the donor.
  5. The arrangement must be documented in writing, identify the parties to the arrangement, and include a general description of the cybersecurity technology and related service to be donated during the term of the arrangement, the estimated value of the donation, and any shared financial responsibility for the cost of the technology and related services. In addition, under the AKS safe harbor, the written arrangement must be signed by the parties to the arrangement.
  6. Under the AKS safe harbor, the donor may not shift the donation costs to federal health care programs.

Newly Defined Terms Under the Cybersecurity Safe Harbor and Exception

The proposed cybersecurity exception and safe harbor include broad definitions for the terms cybersecurity and technology. The OIG and CMS define cybersecurity as "the process of protecting information by preventing, detecting, and responding to cyberattacks." The term technology is defined as "any software or other types of information technology other than hardware." It includes:

  • cybersecurity software that provides malware prevention; software security measures to protect endpoints that allow for network access control; business continuity software; data protection and encryption; email traffic filtering; and
  • cybersecurity services that are associated with developing, installing, and updating cybersecurity software; cybersecurity training services; cybersecurity services for business continuity and data recovery services; "cybersecurity as a service"; cybersecurity risk assessment or analysis; sharing information about known cyber threats; and assisting recipients responding to threats or attacks on their systems.

Although the proposed definition of technology excludes hardware, the agencies seek comments on whether to provide limited protection for specific types of hardware. For example, the OIG and CMS raise the possibility of protecting cybersecurity hardware that has been determined reasonably necessary to address identified cybersecurity risks based on the donor's and the potential recipient's cybersecurity risk assessments. The agencies also seek comments on whether to deem certain arrangements as satisfying the requirement that the technology or service is necessary to implement, maintain, or reestablish cybersecurity.

Other Notable Requirements

  • The current proposals do not include contribution requirements for donations of cybersecurity technology and services.
  • The AKS safe harbor and Stark exception do not protect donations of cybersecurity technology and services that are used in the normal course of the recipient's business (for example, general help desk services).
  • All donations must be nonmonetary.


If adopted, the EHR and cybersecurity proposals would open the door to greater use of EHR and cybersecurity technology in the health care industry. Such expansion would also facilitate coordination of care as the health care industry moves from a volume-based to a value-based system. To this end, the proposed regulations appear to have been strategically designed to work congruently with other federal laws and regulations related to health information technology protections.

The OIG and CMS have invited feedback from health care industry stakeholders about a number of important aspects of the EHR and cybersecurity proposals. They seem to genuinely want to make sure these regulations are workable and reflect existing (and, to the extent possible, future) realities of health care IT. Public comments are due by December 31, 2019. 

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Baker Ober Health Law | Attorney Advertising

Written by:

Baker Ober Health Law

Baker Ober Health Law on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
- hide

JD Supra Privacy Policy

Updated: May 25, 2018:

JD Supra is a legal publishing service that connects experts and their content with broader audiences of professionals, journalists and associations.

This Privacy Policy describes how JD Supra, LLC ("JD Supra" or "we," "us," or "our") collects, uses and shares personal data collected from visitors to our website (located at (our "Website") who view only publicly-available content as well as subscribers to our services (such as our email digests or author tools)(our "Services"). By using our Website and registering for one of our Services, you are agreeing to the terms of this Privacy Policy.

Please note that if you subscribe to one of our Services, you can make choices about how we collect, use and share your information through our Privacy Center under the "My Account" dashboard (available if you are logged into your JD Supra account).

Collection of Information

Registration Information. When you register with JD Supra for our Website and Services, either as an author or as a subscriber, you will be asked to provide identifying information to create your JD Supra account ("Registration Data"), such as your:

  • Email
  • First Name
  • Last Name
  • Company Name
  • Company Industry
  • Title
  • Country

Other Information: We also collect other information you may voluntarily provide. This may include content you provide for publication. We may also receive your communications with others through our Website and Services (such as contacting an author through our Website) or communications directly with us (such as through email, feedback or other forms or social media). If you are a subscribed user, we will also collect your user preferences, such as the types of articles you would like to read.

Information from third parties (such as, from your employer or LinkedIn): We may also receive information about you from third party sources. For example, your employer may provide your information to us, such as in connection with an article submitted by your employer for publication. If you choose to use LinkedIn to subscribe to our Website and Services, we also collect information related to your LinkedIn account and profile.

Your interactions with our Website and Services: As is true of most websites, we gather certain information automatically. This information includes IP addresses, browser type, Internet service provider (ISP), referring/exit pages, operating system, date/time stamp and clickstream data. We use this information to analyze trends, to administer the Website and our Services, to improve the content and performance of our Website and Services, and to track users' movements around the site. We may also link this automatically-collected data to personal information, for example, to inform authors about who has read their articles. Some of this data is collected through information sent by your web browser. We also use cookies and other tracking technologies to collect this information. To learn more about cookies and other tracking technologies that JD Supra may use on our Website and Services please see our "Cookies Guide" page.

How do we use this information?

We use the information and data we collect principally in order to provide our Website and Services. More specifically, we may use your personal information to:

  • Operate our Website and Services and publish content;
  • Distribute content to you in accordance with your preferences as well as to provide other notifications to you (for example, updates about our policies and terms);
  • Measure readership and usage of the Website and Services;
  • Communicate with you regarding your questions and requests;
  • Authenticate users and to provide for the safety and security of our Website and Services;
  • Conduct research and similar activities to improve our Website and Services; and
  • Comply with our legal and regulatory responsibilities and to enforce our rights.

How is your information shared?

  • Content and other public information (such as an author profile) is shared on our Website and Services, including via email digests and social media feeds, and is accessible to the general public.
  • If you choose to use our Website and Services to communicate directly with a company or individual, such communication may be shared accordingly.
  • Readership information is provided to publishing law firms and authors of content to give them insight into their readership and to help them to improve their content.
  • Our Website may offer you the opportunity to share information through our Website, such as through Facebook's "Like" or Twitter's "Tweet" button. We offer this functionality to help generate interest in our Website and content and to permit you to recommend content to your contacts. You should be aware that sharing through such functionality may result in information being collected by the applicable social media network and possibly being made publicly available (for example, through a search engine). Any such information collection would be subject to such third party social media network's privacy policy.
  • Your information may also be shared to parties who support our business, such as professional advisors as well as web-hosting providers, analytics providers and other information technology providers.
  • Any court, governmental authority, law enforcement agency or other third party where we believe disclosure is necessary to comply with a legal or regulatory obligation, or otherwise to protect our rights, the rights of any third party or individuals' personal safety, or to detect, prevent, or otherwise address fraud, security or safety issues.
  • To our affiliated entities and in connection with the sale, assignment or other transfer of our company or our business.

How We Protect Your Information

JD Supra takes reasonable and appropriate precautions to insure that user information is protected from loss, misuse and unauthorized access, disclosure, alteration and destruction. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. You should keep in mind that no Internet transmission is ever 100% secure or error-free. Where you use log-in credentials (usernames, passwords) on our Website, please remember that it is your responsibility to safeguard them. If you believe that your log-in credentials have been compromised, please contact us at

Children's Information

Our Website and Services are not directed at children under the age of 16 and we do not knowingly collect personal information from children under the age of 16 through our Website and/or Services. If you have reason to believe that a child under the age of 16 has provided personal information to us, please contact us, and we will endeavor to delete that information from our databases.

Links to Other Websites

Our Website and Services may contain links to other websites. The operators of such other websites may collect information about you, including through cookies or other technologies. If you are using our Website or Services and click a link to another site, you will leave our Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We are not responsible for the data collection and use practices of such other sites. This Policy applies solely to the information collected in connection with your use of our Website and Services and does not apply to any practices conducted offline or in connection with any other websites.

Information for EU and Swiss Residents

JD Supra's principal place of business is in the United States. By subscribing to our website, you expressly consent to your information being processed in the United States.

  • Our Legal Basis for Processing: Generally, we rely on our legitimate interests in order to process your personal information. For example, we rely on this legal ground if we use your personal information to manage your Registration Data and administer our relationship with you; to deliver our Website and Services; understand and improve our Website and Services; report reader analytics to our authors; to personalize your experience on our Website and Services; and where necessary to protect or defend our or another's rights or property, or to detect, prevent, or otherwise address fraud, security, safety or privacy issues. Please see Article 6(1)(f) of the E.U. General Data Protection Regulation ("GDPR") In addition, there may be other situations where other grounds for processing may exist, such as where processing is a result of legal requirements (GDPR Article 6(1)(c)) or for reasons of public interest (GDPR Article 6(1)(e)). Please see the "Your Rights" section of this Privacy Policy immediately below for more information about how you may request that we limit or refrain from processing your personal information.
  • Your Rights
    • Right of Access/Portability: You can ask to review details about the information we hold about you and how that information has been used and disclosed. Note that we may request to verify your identification before fulfilling your request. You can also request that your personal information is provided to you in a commonly used electronic format so that you can share it with other organizations.
    • Right to Correct Information: You may ask that we make corrections to any information we hold, if you believe such correction to be necessary.
    • Right to Restrict Our Processing or Erasure of Information: You also have the right in certain circumstances to ask us to restrict processing of your personal information or to erase your personal information. Where you have consented to our use of your personal information, you can withdraw your consent at any time.

You can make a request to exercise any of these rights by emailing us at or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

You can also manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard.

We will make all practical efforts to respect your wishes. There may be times, however, where we are not able to fulfill your request, for example, if applicable law prohibits our compliance. Please note that JD Supra does not use "automatic decision making" or "profiling" as those terms are defined in the GDPR.

  • Timeframe for retaining your personal information: We will retain your personal information in a form that identifies you only for as long as it serves the purpose(s) for which it was initially collected as stated in this Privacy Policy, or subsequently authorized. We may continue processing your personal information for longer periods, but only for the time and to the extent such processing reasonably serves the purposes of archiving in the public interest, journalism, literature and art, scientific or historical research and statistical analysis, and subject to the protection of this Privacy Policy. For example, if you are an author, your personal information may continue to be published in connection with your article indefinitely. When we have no ongoing legitimate business need to process your personal information, we will either delete or anonymize it, or, if this is not possible (for example, because your personal information has been stored in backup archives), then we will securely store your personal information and isolate it from any further processing until deletion is possible.
  • Onward Transfer to Third Parties: As noted in the "How We Share Your Data" Section above, JD Supra may share your information with third parties. When JD Supra discloses your personal information to third parties, we have ensured that such third parties have either certified under the EU-U.S. or Swiss Privacy Shield Framework and will process all personal data received from EU member states/Switzerland in reliance on the applicable Privacy Shield Framework or that they have been subjected to strict contractual provisions in their contract with us to guarantee an adequate level of data protection for your data.

California Privacy Rights

Pursuant to Section 1798.83 of the California Civil Code, our customers who are California residents have the right to request certain information regarding our disclosure of personal information to third parties for their direct marketing purposes.

You can make a request for this information by emailing us at or by writing to us at:

Privacy Officer
JD Supra, LLC
10 Liberty Ship Way, Suite 300
Sausalito, California 94965

Some browsers have incorporated a Do Not Track (DNT) feature. These features, when turned on, send a signal that you prefer that the website you are visiting not collect and use data regarding your online searching and browsing activities. As there is not yet a common understanding on how to interpret the DNT signal, we currently do not respond to DNT signals on our site.

Access/Correct/Update/Delete Personal Information

For non-EU/Swiss residents, if you would like to know what personal information we have about you, you can send an e-mail to We will be in contact with you (by mail or otherwise) to verify your identity and provide you the information you request. We will respond within 30 days to your request for access to your personal information. In some cases, we may not be able to remove your personal information, in which case we will let you know if we are unable to do so and why. If you would like to correct or update your personal information, you can manage your profile and subscriptions through our Privacy Center under the "My Account" dashboard. If you would like to delete your account or remove your information from our Website and Services, send an e-mail to

Changes in Our Privacy Policy

We reserve the right to change this Privacy Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our Privacy Policy will become effective upon posting of the revised policy on the Website. By continuing to use our Website and Services following such changes, you will be deemed to have agreed to such changes.

Contacting JD Supra

If you have any questions about this Privacy Policy, the practices of this site, your dealings with our Website or Services, or if you would like to change any of the information you have provided to us, please contact us at:

JD Supra Cookie Guide

As with many websites, JD Supra's website (located at (our "Website") and our services (such as our email article digests)(our "Services") use a standard technology called a "cookie" and other similar technologies (such as, pixels and web beacons), which are small data files that are transferred to your computer when you use our Website and Services. These technologies automatically identify your browser whenever you interact with our Website and Services.

How We Use Cookies and Other Tracking Technologies

We use cookies and other tracking technologies to:

  1. Improve the user experience on our Website and Services;
  2. Store the authorization token that users receive when they login to the private areas of our Website. This token is specific to a user's login session and requires a valid username and password to obtain. It is required to access the user's profile information, subscriptions, and analytics;
  3. Track anonymous site usage; and
  4. Permit connectivity with social media networks to permit content sharing.

There are different types of cookies and other technologies used our Website, notably:

  • "Session cookies" - These cookies only last as long as your online session, and disappear from your computer or device when you close your browser (like Internet Explorer, Google Chrome or Safari).
  • "Persistent cookies" - These cookies stay on your computer or device after your browser has been closed and last for a time specified in the cookie. We use persistent cookies when we need to know who you are for more than one browsing session. For example, we use them to remember your preferences for the next time you visit.
  • "Web Beacons/Pixels" - Some of our web pages and emails may also contain small electronic images known as web beacons, clear GIFs or single-pixel GIFs. These images are placed on a web page or email and typically work in conjunction with cookies to collect data. We use these images to identify our users and user behavior, such as counting the number of users who have visited a web page or acted upon one of our email digests.

JD Supra Cookies. We place our own cookies on your computer to track certain information about you while you are using our Website and Services. For example, we place a session cookie on your computer each time you visit our Website. We use these cookies to allow you to log-in to your subscriber account. In addition, through these cookies we are able to collect information about how you use the Website, including what browser you may be using, your IP address, and the URL address you came from upon visiting our Website and the URL you next visit (even if those URLs are not on our Website). We also utilize email web beacons to monitor whether our emails are being delivered and read. We also use these tools to help deliver reader analytics to our authors to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

Analytics/Performance Cookies. JD Supra also uses the following analytic tools to help us analyze the performance of our Website and Services as well as how visitors use our Website and Services:

  • HubSpot - For more information about HubSpot cookies, please visit
  • New Relic - For more information on New Relic cookies, please visit
  • Google Analytics - For more information on Google Analytics cookies, visit To opt-out of being tracked by Google Analytics across all websites visit This will allow you to download and install a Google Analytics cookie-free web browser.

Facebook, Twitter and other Social Network Cookies. Our content pages allow you to share content appearing on our Website and Services to your social media accounts through the "Like," "Tweet," or similar buttons displayed on such pages. To accomplish this Service, we embed code that such third party social networks provide and that we do not control. These buttons know that you are logged in to your social network account and therefore such social networks could also know that you are viewing the JD Supra Website.

Controlling and Deleting Cookies

If you would like to change how a browser uses cookies, including blocking or deleting cookies from the JD Supra Website and Services you can do so by changing the settings in your web browser. To control cookies, most browsers allow you to either accept or reject all cookies, only accept certain types of cookies, or prompt you every time a site wishes to save a cookie. It's also easy to delete cookies that are already saved on your device by a browser.

The processes for controlling and deleting cookies vary depending on which browser you use. To find out how to do so with a particular browser, you can use your browser's "Help" function or alternatively, you can visit which explains, step-by-step, how to control and delete cookies in most browsers.

Updates to This Policy

We may update this cookie policy and our Privacy Policy from time-to-time, particularly as technology changes. You can always check this page for the latest version. We may also notify you of changes to our privacy policy by email.

Contacting JD Supra

If you have any questions about how we use cookies and other tracking technologies, please contact us at:

- hide

This website uses cookies to improve user experience, track anonymous site usage, store authorization tokens and permit sharing on social media networks. By continuing to browse this website you accept the use of cookies. Click here to read more about how we use cookies.