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.
 

Sign In and View the Special Bulletin

Related Resources

Special Bulletin
Member
At a Glance  The Centers for Medicare & Medicaid Services (CMS), in coordination with the Office of the National Coordinator for Health Information…
Letter/Comment
Public
AHA comments on CMS’ proposed rule on prior authorization.
Letter/Comment
Sens. Sherrod Brown, D-Ohio, and John Thune, R-S.D., introduced the Improving Seniors' Tmely Access to Care Act (S. 5044), bipartisan legislation that would…
AHA Center for Health Innovation Market Scan
Using technology like artificial intelligence and data to target at-risk and vulnerable populations is still at a nascent stage, but progress is being made.…
Action Alert
Member Non-Fed
As Congress continues to negotiate a year-end spending package and more COVID-19 relief, we’re continuing to keep you updated on the latest issues. This is our…
Special Bulletin
Member
The Centers for Medicare & Medicaid Services (CMS) Nov. 25 released a proposed rule that would implement the standards governing health insurance…