"CMS Finalizes Rule to Streamline Prior Authorization and Expand Health Information Access"

The Centers for Medicare & Medicaid Services (CMS) has issued the CMS Interoperability and Prior Authorization final rule (CMS-0057-F), requiring impacted payers to implement Health Level 7® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) application programming interfaces (APIs) to enhance electronic health data exchange and streamline prior authorization processes. The rule also includes provisions for patient and provider access APIs, payer-to-payer APIs, and prior authorization APIs, with compliance dates starting January 1, 2027. Additionally, impacted payers are required to report annual metrics on Patient Access API usage and publicly report certain prior authorization metrics. The rule aims to improve patient, provider, and payer access to interoperable patient data and reduce the burden of prior authorization processes.