CMS Releases Final Rule on Interoperability and Patient Access

On March 9, 2020, the Centers for Medicare & Medicaid Services (CMS) released the final rule (CMS-9115-F) regarding Interoperability and Patient Access. While CMS issued a fact sheet regarding this rule, this rule has not yet been published for public inspection or in the Federal Register. This rule implements most of the provisions CMS set forth in the proposed rule on the same subject issued last year and contains provisions that impact Medicare Advantage (MA), Medicaid, CHIP and Qualified Health Plans on the Federally Facilitated Exchange.

The required implementation dates for provisions of the rule affecting these plans range from January 1, 2021 to January 1, 2022.  Most immediately, MA Plans need to act swiftly to understand the implementation costs associated with the Patient Access and Provider Directory Application Programming Interfaces (APIs), which this rule requires MA Plans implement by January 1, 2021, in order to incorporate such costs into their 2021 bids (due June 1, 2020).

Please contact us if you would like to receive a copy of BluePeak’s summary of the final rule.