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HHS/CMS | RIN: 0938-AU87 | Publication ID: Spring 2023 |
Title: 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) | |
Abstract:
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. |
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Agency: Department of Health and Human Services(HHS) | Priority: Economically Significant |
RIN Status: Previously published in the Unified Agenda | Agenda Stage of Rulemaking: Long-Term Actions |
Major: Yes | Unfunded Mandates: No |
CFR Citation: 42 CFR 422 42 CFR 431 42 CFR 435 42 CFR 438 ... (To search for a specific CFR, visit the Code of Federal Regulations.) | |
Legal Authority: 42 U.S.C. 1395hh |
Legal Deadline:
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Overall Description of Deadline: 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. |
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Timetable:
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Regulatory Flexibility Analysis Required: Undetermined | Government Levels Affected: Federal, State |
Federalism: No | |
Included in the Regulatory Plan: Yes | |
RIN Data Printed in the FR: No | |
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 Burden Reduction and Health Informatics, MS: C5-02-00, 7500 Security Boulevard, Baltimore, MD 21244 Phone:410 786-4457 Email: alexandra.mugge@cms.hhs.gov |