Enforcement for CMS' interoperability rule, a companion to information-blocking and data-sharing regulations from HHS' Office of the National Coordinator for Health Information Technology, begins Thursday.
Here are five things to keep in mind as CMS begins enforcement:
1. The CMS rule, a provision of the 21st Century Cures Act, was released last year with the ONC's rule, but implementation was pushed back due to the COVID-19 pandemic. While requirements under CMS' rule started going into effect in January, CMS said it would not enforce the regulations until July.
2. CMS will begin enforcing requirements that payers it regulates—including those participating in Medicare Advantage, Medicaid, Children's Health Insurance Program and Qualified Health Plans—implement application programming interfaces for patient access and provider directories on Thursday. APIs are protocols that allow different applications to communicate and share data with one another.
3. For the patient access requirements, payers must be able to make adjudicated claims, encounters with capitation providers and clinical data available within one business day of a claim being adjudicated or receiving encounter data . Provider directories must make provider names, addresses, phone numbers and specialties public within 30 days of a payer receiving the information.
New requirements that force CMS-regulated payers to exchange a subset of patient data elements—called the U.S. Core Data for Interoperability—with one another when patients request it will take effect on January 1, 2022.
4. The rule fits into a broader interoperability push that CMS has been pursuing since it rebranded the meaningful use program in 2018 as "Promoting Interoperability." The agency previously has rolled out programs to encourage clinicians to exchange claims data via APIs and proposed using the same technology to ease prior authorization.
5. The first phase of ONC's companion rule, which bars healthcare providers from blocking patients and other providers from accessing health data, went into effect in April. In December 2022, a second component of the rule will go into effect, forcing some developers of health IT software to make standard APIs available to customers.
