CMS Releases Rule for Interoperability and Prior Authorization Improvement
CMS Releases the rule many have been waiting for | Onyx Health Insights
Summary
The Centers for Medicare & Medicaid Services (CMS) released a proposed rule titled 'Advancing Interoperability and Improving Prior Authorization Processes.' This extensive regulation mandates several key components, including Patient Access API and FHIR-based data exchange, requiring payers to begin preparation.
Details
On December 7, 2022, the Centers for Medicare & Medicaid Services (CMS) dropped a comprehensive proposed rule: 'Advancing Interoperability and Prior Authorization Proposed Rule.' This regulation covers several critical areas designed to transform healthcare data access and processes. Key components include: A. Patient Access API B. Provider Access API (Bulk FHIR) C. Payer to Payer Data Exchange on FHIR D. Improving Prior Authorization Processes E. Electronic Prior Authorization for the Merit-based Incentive Payment System (MIPS) The rule's implementation deadline is set for January 1, 2026, but payers must implement certain parts of the regulation by January 1, 2025, specifically to generate required metrics. This represents a significant regulatory push toward mandatory data interoperability using modern standards like FHIR. The requirement for structured API access and standardized data exchange between payers is expected to drastically improve care coordination and reduce administrative friction in US healthcare. For global health-IT practitioners, this emphasizes the critical need for adopting robust, standard-based APIs (like FHIR) to facilitate secure and timely data sharing across different organizational silos.
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