CMS Announces Interoperability & Prior Authorization Final Rule Rollout

The Centers for Medicare & Medicaid Services (CMS) will issue a final rule that places new requirements on Medicare Advantage (MA) organizations, Medicaid managed care plans, Children’s Health Insurance Program (CHIP) managed care entities, state Medicaid and CHIP Fee-for-Service (FFS) programs, and Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs) to improve the electronic exchange of healthcare data and streamline processes related to prior authorization. This final rule will also add a new measure for eligible hospitals and critical access hospitals (CAHs) under the Medicare Promoting Interoperability Program and for Merit-based Incentive Payment System (MIPS) eligible clinicians under the Promoting Interoperability performance category of MIPS.

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