CMS Expands on Patient Access and Interoperability Requirements for Health Plans

CMS’s vision is a framework within which all API requirements on plans are consistent, leveraging the FHIR standard and exchanging the same categories of data—now including prior authorization. This vision is supported by an additional proposal within the rule by ONC, on behalf of HHS, to propose its API standards and implementation specifications (45 CFR 170.215) as the default for “a nationwide health information technology infrastructure” ostensibly across multiple health care industry stakeholders, including payers, providers, and developers of certified health IT.

Additionally, the NPRM will require the use of certain technical implementation guides (IGs) and standards, as opposed to suggesting their use as optional. Stakeholders may wish to comment on the pros and cons of this approach, such as balancing the benefits of mandated consistency against the difficulty of modifying or updating regulations to keep pace with quickly changing technical standards. CMS proposes that plans would be able to use an updated version of any required IGs, so long as such use does not impact an API user’s ability to access the data.