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Payer and Provider Compliance for CMS Final Rule
CMS Interoperability and Patient Access final rule
CMS Interoperability and Patient Access final rule
The Interoperability and Patient Access final rule (CMS-9115-F) delivers on the promise to put patients first, giving them access to their health information when they need it most and in a way they can best use it. As part of the MyHealthEData initiative, this final rule is focused on driving interoperability and patient access to health information by liberating patient data using CMS authority to regulate Medicare Advantage (MA), Medicaid, CHIP, and Qualified Health Plan (QHP) issuers on the Federally-facilitated Exchanges (FFEs).
Overview
This rule finalizes new policies that give patients access to their health information and moves the healthcare system toward greater interoperability. These new policies include:
- Patient Access API (January 1, 2021) Enforcement Date 7/1/2021
- Provider Directory API (January 1, 2021) Enforcement Date 7/1/2021
- Payer-to-Payer Data Exchange (January 1, 2022)
- Improving the Dually Eligible Experience by Increasing the Frequency of Federal-State Data Exchanges (April 1, 2022)
- Public Reporting and Information Blocking (April 5 2021)
- Digital Contact Information (April 30, 2021)
- Admission, Discharge, and Transfer Event Notifications (May 1, 2021)
COVID 19 | Enforcement Date Changes
The Interoperability and Patient Access final rule includes policies that impact a variety of stakeholders. Recognizing that hospitals, including psychiatric hospitals, and critical access hospitals, are on the front lines of the COVID-19 public health emergency, CMS is extending the implementation timeline for the admission, discharge, and transfer (ADT) notification Conditions of Participation (CoPs) by an additional six months. In the version of the rule displayed on March 9, 2020 on the CMS website, it stated these CoPs would be effective 6 months after the publication of the final rule in the Federal Register. We have changed this in the final rule now displayed on the Federal Register to state that the new CoPs at 42 CFR Parts 482 and 485 will now be effective 12 months after the final rule is published in the Federal Register.
CMS also finalized the Patient Access API and Provider Directory API policies for Medicare Advantage (MA), Medicaid, and the Children’s Health Insurance Program (CHIP) effective January 1, 2021. CMS will exercise enforcement discretion for a period of six months in connection with these two API provisions. Therefore, as a result of COVID-19, and to provide additional flexibility to payers, CMS will not enforce the new requirements under 42 CFR Parts 422, 431, 438, and 457 until July 1, 2021.
Finally, CMS finalized the Patient Access API for Qualified Health Plan (QHP) issuers on the individual market Federally-Facilitated Exchanges (FFEs) beginning with plan years beginning on or after January 1, 2021. CMS will not enforce the new requirements under 45 CFR Part 156 until July 1, 2021.
Other policies contained in the final rule will be implemented and enforced on schedule.