CMS’s Advancing Interoperability and Improving Prior Authorization Processes proposed rule, published on December 13th, builds on its 2020 Patient Access and Interoperability rule with new requirements for health care payers regulated by CMS (such as Medicare Advantage plans, Medicaid, Children’s Health Insurance Plans, and Qualified Health Plans on the Federally-facilitated Exchanges). Under the proposed rule, these payers would be required to:
- establish application programming interfaces (APIs) to share information with health care providers about their patients covered under the plan;
- share information with other payers when patients change plans;
- enable providers to easily obtain coverage requirements for items and services that require prior authorization; and
- submit information needed to request the authorization. Read the full article here.
