0938-AU87 202304 Unified Agenda of Federal Regulatory and Deregulatory Actions 0938 Centers for Medicare & Medicaid Services CMS 0900 Department of Health and Human Services HHS Interoperability and Prior Authorization for MA Organizations, Medicaid and CHIP Managed Care and State Agencies, FFE QHP Issuers, MIPS Eligible Clinicians, Eligible Hospitals and CAHs (CMS-0057)

This final rule places new requirements on Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, state Medicaid and CHIP fee-for-service (FFS) programs, 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. This rule also adds a new measure for eligible hospitals and critical access hospitals under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System (MIPS) eligible clinicians under the Promoting Interoperability performance category of MIPS. These policies taken together play a key role in reducing overall payer and provider burden and improving patient access to health information.

]]> Economically Significant Previously Published in The Unified Agenda Long-Term Actions Yes No 42 CFR 422 42 CFR 431 42 CFR 435 42 CFR 438 ... 42 U.S.C. 1395hh Statutory Final 12/13/2025 MMA sec. 902 requires Medicare final rules publish within 3 years of a proposed or interim final rule. Per the CMS notice published December 30, 2004 (69 FR 78442), except for certain Medicare payment regulations and certain other statutorily-mandated regulations, we schedule all Medicare final regulations for publication within the 3-year standardized time limit in the current Unified Agenda. We do not intend to delay publishing a Medicare final regulation for 3 years if we are able to publish it sooner. Yes NPRM 12/13/2022 87 FR 76238 NPRM Comment Period End 03/13/2023 Final Action 12/00/2025 Undetermined Federal State No No No Alexandra Mugge Director & Chief Health Informatics Officer, Health Informatics and Interoperability Group 0938 Centers for Medicare & Medicaid Services CMS 410 786-4457 alexandra.mugge@cms.hhs.gov Office of Healthcare Experience and Interoperability, MS: C5-02-00, 7500 Security Boulevard, Baltimore MD 21244