Association Comments on Interoperability Standards and Prior Authorization for Drugs

America's Essential Hospitals on June 8 submitted comments to the Centers for Medicare & Medicaid Services (CMS), Office of the National Coordinator for Health Information Technology (ONC), and Department of Health and Human Services regarding the proposed Interoperability Standards and Prior Authorization for Drugs rule. The proposal would expand prior authorization requirements to prescription drugs and strengthen health information sharing and interoperability.

Among its key provisions, the proposed rule would:

• Establish a 24-hour turnaround time for expedited drug prior authorization requests and a 72-hour turnaround time for standard requests
• Replace legacy HIPAA transaction standards with HL7 Fast Healthcare Interoperability Resources (FHIR) standards for data exchange

In the comments, the association urged CMS to require real-time, 24/7 prior authorization determinations for all services; modernize requirements for non-drug prior authorization requests; and provide implementation grants or technical assistance to help essential hospitals adopt HL7 FHIR standards. The association also urged ONC to establish rigorous certification criteria for electronic health record vendors.

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