The heavy exception and the SAFE AKS port, introduced in 2006, were due to expire on 31 December 2013. A proposal for an extension was announced in April 2013 and the final rules of CMS and OIG, including an extension until 2021, were made available on 23 December 2013. If the exception and safe port had not been renewed, hospitals would have had to change their pricing strategies with active donation agreements, most likely by applying a Fair Market Value Agreement (VMF) – which requires the VMF to be determined both by taking into account the actual costs of the hospital and on the basis of market benchmarks. Elana Zana, lawyer for Ogden, Murphy, Wallace, PLLC: “The change in interoperability determination, which considers EHR-certified technology to be interoperable, encourages hospitals and physician groups to work together to respond to good use. Now, the exemption for the donation agreement is not only a way to purchase electronic medical records, but aligning certification with sound usage standards allows physician groups to avoid payment adjustments and be potentially eligible for incentive dollars. While the various alternative proposals make it difficult to predict what agencies will conclude, the final rules could make the MM exception and the Safe Harbour less restrictive if they adopt the more lenient proposals – particularly with regard to the removal of the 15% contribution requirement – the EHR exception and the Safe Harbor could be less restrictive by removing unnecessary administrative requirements related to protected donations. Given the diversity of options on the table, it will be important for the health sector to provide solid feedback on proposals to contribute to information on the final rules of agencies. The market landscape is very different from that of 2006, making some details integrated into the exception and safe port more relevant today than in the past. For example, there are limits for donations to organizations that already have comparable technologies. The introduction of honour by office providers increased from 17% in 2008 to 40% in 2012, according to the Office of the National Health Informatics Coordinator.