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HHS/CMS RIN: 0938-AT99 Publication ID: Spring 2021 
Title: Medicaid; Reducing Provider and Patient Burden by Improving Prior Authorization Processes and Promoting Patients' Electronic Access to Health Information (CMS-9123) 
Abstract:

This final rule places new requirements on state Medicaid and CHIP fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs) to improve the electronic exchange of health care data, and streamline processes related to prior authorization, while continuing CMS' drive toward interoperability, and reducing burden in the health care market. In addition, on behalf of the Department of Health and Human Service (HHS), the Office of the National Coordinator for Health Information Technology (ONC) is adopting certain specified implementation guides (IGs) needed to support the Application Programming Interface (API) policies included in this rule. Each of these elements plays a key role in reducing overall payer and provider burden and improving patient access to health information.

 
Agency: Department of Health and Human Services(HHS)  Priority: Economically Significant 
RIN Status: Previously published in the Unified Agenda Agenda Stage of Rulemaking: Completed Actions 
Major: Yes  Unfunded Mandates: No 
CFR Citation: 42 CFR 431    42 CFR 435    42 CFR 438    42 CFR 440    ...     (To search for a specific CFR, visit the Code of Federal Regulations.)
Legal Authority: 42 U.S.C. 1302   
Legal Deadline:  None
Timetable:
Action Date FR Cite
NPRM  12/18/2020  85 FR 82586   
NPRM Comment Period End  01/04/2021 
Withdrawn  03/17/2021 
Regulatory Flexibility Analysis Required: Yes  Government Levels Affected: Local, State 
Small Entities Affected: Businesses  Federalism: Yes 
Included in the Regulatory Plan: No 
RIN Data Printed in the FR: Yes 
Agency Contact:
Alexandra Mugge
Director & Chief Health Informatics Officer, Health Informatics and Interoperability Group
Department of Health and Human Services
Centers for Medicare & Medicaid Services
Office of Healthcare Experience and Interoperability, MS: C5-02-00, 7500 Security Boulevard,
Baltimore, MD 21244
Phone:410 786-4457
Email: alexandra.mugge@cms.hhs.gov