CMS finalized a rule Jan. 15 to simplify prior authorizations and create a better exchange of healthcare data between payers, providers and patients.
The rule requires payers in Medicaid, Children's Health Insurance Program and Qualified Health Plan to build application programming interfaces to ease data exchange and prior authorizations.
Application programming interfaces allow two entities to communicate and share healthcare data electronically. Under the rule, payers are required to maintain these interfaces using the Health Level 7 Fast Healthcare Interoperability Resources standard, a technology-based tool to help close data gaps between systems.
"Thanks to this rule, millions of patients will no longer have to wrangle with prior providers or locate ancient fax machines to take possession of their own data," CMS Administrator Seema Verma said in a news release. "Many providers, too, will be freed from the burden of piecing together patients’ health histories based on incomplete, half-forgotten snippets of information supplied by the patients themselves, as well as the most onerous elements of prior authorization."
After CMS proposed the rule Dec. 10, it drew criticism from some hospital organizations, including the American Hospital Association, for not including Medicare Advantage plans in the rule. The agency said that while Medicare Advantage plans are not included in the finalized rule, it "is considering whether to do so in future rulemaking."