CMS Finalizes Rule to Expand Access to Health Information and Improve the Prior Authorization Process

Biden-Harris Admin’s CMS Interoperability and Prior Authorization Rule finalization targets $15B in savings. The rule streamlines processes for Medicare Advantage, Medicaid, CHIP, and others, enhancing electronic health data exchange. It introduces shorter timeframes for prior authorization decisions, mandates specific denial reasons, and requires public reporting. Implementation of HL7® FHIR® Prior Authorization API automates processes, and there’s enforcement discretion for HIPAA X12 278 standard. API compliance dates shifted to Jan 1, 2027, with added APIs for patient and provider access. A new Electronic Prior Authorization measure benefits MIPS and eligible hospitals.

• Reference CMS’s fact sheet here: https://www.cms.gov/newsroom/fact-sheets/cms-interoperability-and-prior-authorization-final-rule-cms-0057-f
• Review the final rule here: https://www.cms.gov/files/document/cms-0057-f.pdf

 

Source: https://www.cms.gov/newsroom/press-releases/cms-finalizes-rule-expand-access-health-information-and-improve-prior-authorization-process