CMS Advancing Interoperability and Improving Prior Authorization Proposed Rule (CMS-0057-P) - feature" width="1280" height="1280" />CMS Advancing Interoperability and Improving Prior Authorization Proposed Rule (CMS-0057-P) - feature" width="1280" height="1280" />
CMS Advancing Interoperability and Improving Prior Authorization Proposed Rule (CMS-0057-P) - feature" width="1280" height="1280" />
The Centers for Medicare & Medicaid Services (CMS) published the Interoperability and Patient Access Final Rule on May 1, 2020, putting patients first, giving them access to their health information when they need it most and in a way, they can best use it. This final rule focused on driving interoperability and patient access to health information by liberating patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, Children's Health Insurance Program (CHIP), and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs).
This regulation includes policies which require or encourage payers to implement Application Programming Interfaces (APIs) to improve the electronic exchange of healthcare data—sharing information with patients or exchanging information between a payer and provider or between two payers. Through this rule, CMS adopted the content and vocabulary standards that were finalized by the Department of Health and Human Services (HHS) in the ONC 21st Century Cures Act final rule, to support these API policies. 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.
You can find links to resources that are useful for implementing the APIs to support the policies of these rules in the Implementation Guides and Standards section of this website. 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.
