CMS Proposes Rules to Accelerate Electronic Exchange of Health Care Data, Including for Prior Authorization Requests

AHA Special Bulletin
December 11, 2020

At a Glance

The Centers for Medicare & Medicaid Services (CMS), in coordination with the Office of the National Coordinator for Health Information Technology (ONC), Dec. 10 proposed new regulations that would build on efforts to improve the electronic exchange of health care information, including to streamline and reduce the burden associated with health plan prior authorization processes. The proposed requirements in most instances would apply to state Medicaid fee-for-service (FFS) programs, Medicaid managed care plans, state Children’s Health Insurance Program (CHIP) FFS programs, CHIP managed care entities, and qualified health plan issuers on the federally facilitated exchange (FFE or Health Insurance Marketplace). However, some requirements only apply to a subset of these coverage programs. The agency declined to include FFS Medicare or issuers offering health plans through the Medicare Advantage program.

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