CMS Webinar on New Interoperability and Prior Authorization Rule: Slides and Recording Now Available

On March 26, 2024, the Centers for Medicare and Medicaid Services (CMS) hosted a webinar on the new Interoperability and Prior Authorization Final Rule. As previously reported, the new Rule is intended to improve health information exchange to facilitate access to health records for patients, health care providers, and payers. The Rule also seeks to improve prior authorization processes through policies and technology. The Rule applies to Medicare Advantage, Medicaid fee-for-service (FFS) and managed care, Child Health Plus, and other government-sponsored programs. It does not apply to Medicare FFS (i.e., Original Medicare).

The Rule includes requirements related to the development and implementation of various Application Programming Interfaces (APIs), including the addition of prior authorization information to patient access APIs, the development of provider access APIs to support value-based payment and care coordination, the implementation of payer-to-payer APIs, and the implementation of prior authorization APIs.

In addition to the technology-related provisions, the Rule imposes new prior authorization standards and time frames for all covered payers.

More information is available here and here. The slides and recording are available here (scroll down for the links).

Contact: Karen Lipson, klipson@leadingageny.org