CMS Proposes to Update Interoperability Standards

An April 14 proposed rule adds interoperability standards for the prior authorization of drugs that align with existing standards for non-drug items and services. The rule, issued by the Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and Department of Health and Human Services (HHS), extends the interoperability requirements that CMS finalized in 2024.

The rule requires that impacted payers make electronic prior authorization available for drugs, apply prior authorization decision timeframes to the subset of drugs without already established timeframes, and report application programming interface endpoints and related information to CMS.

The proposed rule also requires usage of certain Health Level Seven (HL7®) Fast Healthcare Interoperability Resources (FHIR®) implementation guides that are currently recommended for transactions related to prior authorizations.

ONC would adopt updated versions of certain health information technology standards and specifications for HHS use, including CMS' interoperability requirements, which are described in CMS' proposed Inpatient Prospective Payment System rule.

Comments are due June 15.

Contact Director of Policy Rob Nelb, MPH, at [email protected] or 202.585.0127 with questions.