The Centers for Medicare and Medicaid Services is delaying enforcement of an interoperability provision that governs how payers are expected to exchange data with one another, the agency announced Wednesday.
"CMS' decision to exercise enforcement discretion for the payer-to-payer policy until future rulemaking occurs does not affect any other existing regulatory requirements and implementation timelines outlined in the final rule," the agency posted to a frequently asked questions webpage late Wednesday. CMS has other regulations it must promulgate before it commences enforcing the rule, the agency said in the notice.
The payer-to-payer data exchange provision of the agency's interoperability rule had been slated to go into effect Jan. 1, 2022.
When it takes effect at a later date, the payer-to-payer provision will require insurance companies that do business with CMS, including Medicare Advantage carriers and Medicaid managed care organizations, to exchange data at patients' request. Insurers would also be required to incorporate data they receive from other payers into members' health records.
But the interoperability rule didn't establish a mechanism or technical specifications for exchanging data, leading multiple payers to raise complaints to CMS. The rule required payers to accept data in whatever format they are sent, which payers told CMS would be complicated to implement.
"Looking at the potential for negative outcomes that impede, rather than support, interoperable payer-to-payer data exchange, CMS is exercising enforcement discretion to delay the payer-to-payer data exchange requirement until future rulemaking is finalized," a spokesperson wrote in an email
The lack of a data-exchange standard would create challenges during implementation that could lead to poor data quality and increased administrative burden, the CMS said, citing concerns expressed by insurance companies.
Additional rulemaking that outlines "concrete details" and requirements for payer-to-payer data exchange will help to make sure health plans implement changes that allow them to more easily share data, a spokesperson for the insurer Priority Healthwrote in an email.
"While the speed at which the federal government has moved to implement this ruling should be applauded, the lack of clarity around certain requirements made it challenging to operationalize in a short amount of time," the spokesperson wrote.
America's Health Insurance Plans supports the delay, a spokesperson wrote in an email.
"Despite the continuing pandemic, health insurance providers are diligently implementing the many provisions of the interoperability rule, and we appreciate CMS recognizing the difficulty of standing up this new technology," the spokesperson wrote.
The Alliance of Community Health Plans also applauded the agency's decision, said Michael Bagel, director of public policy. Compliance "wasn't feasible" without more guidance, he said.
CMS, the Office of the National Coordinator for Health Information Technology and other Health and Human Services Department agencies should align data standards, Bagel said.
"There are a whole slew of health data regulations that are out there," Bagel said. "How is it that we can create common standards that work across all of the different areas that health data is being pursued?"
CMS and ONC released companion interoperability regulations last year, but subsequently postponed applying the regulation amid the COVID-19 pandemic. CMS began enforcing provisions of its rule in June. A first phase of ONC's rule went into effect in early April.
CMS continues to encourage payers that already have deployed application programming interfaces—protocols that connect various types of software to one another—that use the Fast Healthcare Interoperability Resources, or FHIR, standard to support payer-to-payer data exchange to move forward.
