February 27, 2026
Thomas Keane
Assistant Secretary for Technology Policy
U.S. Department of Health and Human Services
330 C Street SW, 7th Floor
Washington, DC 20201
Attention: 0955AA09
Dear Dr. Keane:
The National Committee for Quality Assurance (NCQA) appreciates the opportunity to provide feedback on ASTP/ONC’s proposed rule for Health Data, Technology, and Interoperability (HTI-5).
NCQA is a private, 501(c)(3) not for profit, independent organization dedicated to improving health care quality through our accreditation and measurement programs. As a national leader in quality oversight and a pioneer in quality measurement, NCQA is committed to supporting the transition to a more digital, interoperable health care system in service of better outcomes for all Americans.
NCQA applauds regulatory approaches that reduce burden, promote interoperability, and strengthen the digital foundation needed for reliable, scalable quality measurement. We commend ASTP/ONC for advancing a FHIR®-forward framework that modernizes the Health IT Certification Program while preserving patient access. These initiatives align with NCQA’s dedication to improving healthcare quality by leveraging configurable, FHIR®-based digital measures that streamline quality measurement, reduce administrative burden, and provide actionable patient-level insights.
Enhancements to Information Blocking Provisions
NCQA supports the proposed removal of the TEFCA Manner Exception (§ 171.403). While we acknowledge TEFCA’s potential to promote national interoperability, this exception has inadvertently enabled actors to limit data access and impede innovation. Its elimination will help ensure TEFCA does not serve as an artificial cap on interoperability or foster exclusive data networks that hinder third-party innovators and quality measurement organizations.
NCQA commends ASTP/ONC’s proposal to remove the third-party seeking modification use condition from the Infeasibility Exception. This provision has frequently been used to deny appropriate access requests from quality measurement organizations, health information exchanges, and other stakeholders. Its vague interpretation of “modification” has enabled actors to invoke information blocking protections when refusing to supply data in formats essential for quality measurement, population health, and care coordination. Eliminating this condition is necessary to remove a longstanding obstacle and facilitate the timely exchange of information critical to improving healthcare quality.
NCQA appreciates the proposed steps to refine the Manner Exception Exhausted Condition but urges ASTP/ONC to remove § 171.204(a)(4) altogether rather than revise it. The provision, as proposed, remains open to potential misuse, allowing actors to fragment services and deny appropriate data access under the guise of infeasibility. Eliminating this condition and relying on more focused exceptions would better safeguard against unnecessary barriers and ensure that valid requests for data access, which are vital for quality measurement and innovation, are not obstructed.
Ensuring FHIR-Enabled Quality Measurement through Certification Provisions
NCQA strongly supports retaining § 170.315(c)(3) for clinical quality measure reporting. However, as proposed, ASTP/ONC’s approach reflects a fundamental inconsistency with its stated “FHIR-Forward Future” policy. ASTP/ONC proposes removing C-CDA creation requirements from § 170.315(b)(1) and § 170.315(g)(6) on the grounds that continued support for C-CDA criteria “can detract from industry efforts to move toward FHIR-based solutions.” Yet the proposal simultaneously retains mandatory QRDA creation requirements in § 170.315(c)(3), even though QRDA shares the same core limitations ASTP/ONC identifies for C-CDA: an inability to support data element–level retrieval, lack of real-time exchange, and misalignment with contemporary, web-based architectures.
This approach creates architectural fragmentation. Developers cannot fully redirect resources toward FHIR-based solutions if they are required to maintain parallel, document centric QRDA infrastructure indefinitely. As a result, clinical data exchange advances through modern, API-based FHIR standards, while quality measurement remains anchored in legacy document architectures.
NCQA therefore recommends revising § 170.315(c)(3) to allow satisfaction through either QRDA or FHIR-based quality reporting implementation guides, mirroring the regulatory structure in § 170.315(f)(5) for electronic case reporting.
This approach would preserve QRDA as an acceptable option for existing programs, while establishing a clear, voluntary pathway for FHIR-based alternatives as standards mature. It would align quality reporting with ASTP/ONC’s FHIR-forward policy, reduce long term vendor burden, promote technology neutrality consistent with electronic case reporting, and support a more cohesive modernization strategy across clinical exchange and quality measurement. Absent this change, HTI5 would modernize clinical data exchange while effectively locking quality reporting into the same legacy architecture ASTP/ONC explicitly seeks to phase out.
NCQA applauds ASTP/ONC’s leadership in advancing a FHIR-forward vision for interoperability through HTI5. Aligning quality reporting requirements with this vision is essential to ensuring that quality measurement evolves alongside clinical interoperability. We look forward to continued collaboration to modernize the nation’s quality infrastructure in a manner that reduces burden, encourages innovation, and improves health outcomes.
Sincerely,
Eric Musser
Vice President, Federal Affairs
National Committee for Quality Assurance