On December 10th, the Centers for Medicare & Medicaid Services and the Office of the National Coordinator proposed a rule that, if finalized, would place new requirements on state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities, and Qualified Health Plan issuers on the Federally-facilitated Exchanges. The rule seeks to facilitate the exchange of health information among payers, providers, and patients by increasing access to patient-specific payer data and by streamlining the prior authorization process to reduce provider burden, among other proposals.
This rule builds on the Interoperability and Patient Access final rule released in March, and a summary of the new rule in the context of the previous rule is attached. The full proposed rule is available here. Comments must be received by January 4th, 2021.