On September 15, 2021, CMS published three FAQs which explain that CMS will not take enforcement action against certain payers for the payer-to-payer data exchange provision of the May 2020 Interoperability and Patient Access final rule until future rulemaking is finalized. CMS’ decision to exercise enforcement discretion for the payer-to-payer policy until future rulemaking occurs does not affect any other existing regulatory requirements and implementation timelines outlined in the final rule. Please review the relevant FAQs for details.
As of July 1, 2021, two of the policies from the May 2020 Interoperability and Patient Access final rule are now in effect. On April 30, 2021, the requirements for hospitals with certain EHR capabilities to send admission, discharge and transfer notifications to other providers went into effect. On July 1, 2021, CMS began to enforce requirements for certain payers to support Patient Access and Provider Directory APIs. Additional information is available on the FAQ page and in the other information available below.
CMS continues to build on its roadmap to improve interoperability and health information access for patients, providers, and payers. When implemented effectively, health information exchange (interoperability) can also reduce the burden of certain administrative processes, such as prior authorization. Our regulations will drive change in how clinical and administrative information is exchanged between payers, providers and patients, and will support more efficient care coordination.
The CMS regulations include policies which require or encourage payers to implement Application Programming Interfaces (APIs) to improve the electronic exchange of health care data – sharing information with patients or exchanging information between a payer and provider or between two payers. APIs can connect to mobile apps or to a provider electronic health record (EHR) or practice management system to enable a more seamless method of exchanging information. The regulations also include policies which may reduce burdens of the prior authorization process by increasing automation and encouraging improvements in policies and procedures to streamline decision making and communications.
On this page you can find links to resources that will be useful for implementing the APIs to support the policies of these rules. In particular we encourage stakeholders to use the general information for the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) Implementation Guides (IGs) referenced in the CMS regulations.
LINK TO CMS: https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index
