WEDI Virtual Spotlight: The Road to Interoperability Series: The CMS Interoperability and PA Rule, A Primer

We welcome Alexandra Mugge, Chief Health Informatics Officer and Director at Centers for Medicare & Medicaid Services for a walk thru of the recently finalized CMS Interoperability and Prior Authorization Final Rule (CMS-0057)

The rule sets requirements for Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on the Federally-Facilitated Exchanges (FFEs), (collectively “impacted payers”), to improve the electronic exchange of health information and prior authorization processes for medical items and services. Together, these policies will improve prior authorization processes and reduce burden on patients, providers, and payers, resulting in approximately $15 billion of estimated savings over ten years.