ADA Seeks Input on Proposed CMS Rule on Interoperability and Prior Authorization
ADA seeks input on proposed CMS rule on interoperability, prior authorization
Summary
The American Dental Association (ADA) is soliciting input from dental stakeholders regarding a proposed Centers for Medicare & Medicaid Services (CMS) rule concerning interoperability standards and prior authorization for drugs. The rule aims to mandate standardization using FHIR and NCPDP, improving process transparency, which significantly impacts the industry.
Details
The American Dental Association (ADA) is hosting a call to gather feedback on a proposed CMS rule regarding interoperability standards and prior authorization for prescription drugs. This rule intends to streamline the prior authorization process and mandates specific adherence to Health Level Seven International Fast Healthcare Interoperability Resources (HL7 FHIR) and National Council for Prescription Drug Programs (NCPDP) standards by October 1, 2027, while also introducing increased transparency reporting. Key areas of concern for ADA stakeholders include: 1. **FHIR Transition:** Replacing the current electronic prior authorization standard with a new FHIR-based system, affecting all dental offices submitting authorizations electronically. Feedback is sought on software compatibility and timeline feasibility. 2. **Direct Data Entry Portal Exception:** CMS considers eliminating the exception allowing data submission (including prior authorizations) through payer web portals. ADA seeks input on the risks this poses for small and rural practices. 3. **Cybersecurity:** Addressing healthcare cybersecurity, where dental offices face distinct vulnerabilities. Stakeholders are asked to help frame the industry's needs in this section of the rule. The public comment period for the proposed rule closes on June 15.
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