United States Government Publishing Office publisher pbl distributor dst United States National Archives and Records Administration Office of the Federal Register author aut Government Organization text government publication eng FR Regulatory Information 2022_register executive 2022-12-13 article Part II Proposed Rules D09002ee1c7a06f1b D09002ee1c7a06fee United States Department of Health and Human Services originator org United States Government Agency or Subagency United States Centers for Medicare & Medicaid Services originator org United States Government Agency or Subagency United States Office of the Secretary originator org United States Government Agency or Subagency This proposed rule would place new requirements on Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, 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, while continuing CMS' drive toward interoperability in the healthcare market. This proposed rule would 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. These policies taken together would play a key role in reducing overall payer and provider burden and improving patient access to health information. 87 FR 76238 https://www.govinfo.gov/app/details/FR-2022-12-13/2022-26479 2022-26479 fr13de22-20 RIN 0938-AU87 4120-01-P CMS-0057-P https://www.govinfo.gov/app/details/FR-2022-12-13/2022-26479 https://www.govinfo.gov/content/pkg/FR-2022-12-13/html/2022-26479.htm https://www.govinfo.gov/content/pkg/FR-2022-12-13/pdf/2022-26479.pdf Administrative Practice and Procedure Health Facilities Health Maintenance Organizations (Hmo) Medicare Penalties Privacy Reporting and Recordkeeping Requirements Grant Programs-Health Medicaid State Fair Hearings Aid to Families with Dependent Children Notices Supplemental Security Income (Ssi) Wages Health Insurance Advertising Brokers Conflict of Interests Consumer Protection Grants Administration Health Care Health Records Hospitals Indians Individuals with Disabilities Intergovernmental Relations Loan Programs-Health Organization and Functions (Government Agencies) Prescription Drugs Public Assistance Programs Technical Assistance Women Youth 134 p. 76238 76371 87 FR 76238 Title 42 Part 422 42 CFR Part 422 Title 42 Part 431 42 CFR Part 431 Title 42 Part 435 42 CFR Part 435 Title 42 Part 438 42 CFR Part 438 Title 42 Part 440 42 CFR Part 440 Title 42 Part 457 42 CFR Part 457 Title 45 Part 156 45 CFR Part 156 RIN 0938-AU87 Medicare and Medicaid Programs; Patient Protection and Affordable Care Act; Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, Children's Health Insurance Program (CHIP) Agencies and CHIP Managed Care Entities, Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges, Merit-Based Incentive Payment System (MIPS) Eligible Clinicians, and Eligible Hospitals and Critical Access Hospitals in the Medicare Promoting Interoperability Program; Federal Register Vol. 87, Issue PRORULE 2022-26479 II DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Office of the Secretary 2023-03-13 CMS-0057-P 4120-01-P 2022-26479 Proposed rule.

This proposed rule would place new requirements on Medicare Advantage (MA) organizations, state Medicaid fee-for-service (FFS) programs, state Children's Health Insurance Program (CHIP) FFS programs, Medicaid managed care plans, CHIP managed care entities, 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, while continuing CMS' drive toward interoperability in the healthcare market. This proposed rule would 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. These policies taken together would play a key role in reducing overall payer and provider burden and improving patient access to health information.

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on March 13, 2023. Alexandra Mugge, (410) 786-4457, for general questions related to any of the policies in this proposed rule, or questions related to CMS interoperability initiatives. Administrative Practice and Procedure Health Facilities Health Maintenance Organizations (Hmo) Medicare Penalties Privacy Reporting and Recordkeeping Requirements Grant Programs-Health Medicaid State Fair Hearings Aid to Families with Dependent Children Notices Supplemental Security Income (Ssi) Wages Health Insurance Advertising Brokers Conflict of Interests Consumer Protection Grants Administration Health Care Health Records Hospitals Indians Individuals with Disabilities Intergovernmental Relations Loan Programs-Health Organization and Functions (Government Agencies) Prescription Drugs Public Assistance Programs Technical Assistance Women Youth Medicare and Medicaid Programs: Advancing Interoperability and Improving Prior Authorization Processes for Medicare Advantage Organizations, Medicaid Managed Care Plans, State Medicaid Agencies, etc., Census.gov HealthCare.gov HealthIT.gov http://hl7.org/fhir/us/davinci-atr/ http://hl7.org/fhir/us/davinci-pdex/STU1/ http://www.health.state.pa.us/pdf/act63.pdf http://www.hl7.org/about/fhir-accelerator/index.cfm http://www.hl7.org/Fhir/security.html http://www.hl7.org/legal/trademarks.cfm?ref=nav https://-www.federalregister.gov/d/2022-14562 https://academic.oup.com/jamia/article/25/6/635/4587931 https://aspe.hhs.gov/reports/medicaid-churning-continuity-care https://aspe.hhs.gov/sites/default/files/documents/84a701e0878bc26b2812a074aa22a3e2/roadmap-behavioral-health-integration.pdf https://confluence.hl7.org/display/DVP/Da+Vinci+2022+-+Calendar https://confluence.hl7.org/display/DVP/Da+Vinci+HIPAA+Exception https://doi.org/10.37765/ajmc.2020.42148 https://dpc.cms.gov/docsV1#attestation--attribution https://dpc.cms.gov/docsV2#groups https://dpc.cms.gov/terms-of-service https://fhir.org/guides/argonaut/scheduling/ https://getreferralmd.com/2018/04/prior-authorization-problems-healthcare/ https://health.gov/healthypeople https://health.gov/healthypeople/priority-areas/health-literacy-healthy-people-2030/history-health-literacy-definitions https://health.gov/sites/default/files/2019-09/Health_Literacy_Action_Plan.pdf https://ncvhs.hhs.gov/about/charter/ https://ncvhs.hhs.gov/wp-content/uploads/2019/12/Transcript-Full-Committee-Meeting-November-13-2019.pdf https://pubmed.ncbi.nlm.nih.gov/31532515/ https://rce.sequoiaproject.org/wp-content/uploads/2022/01/FHIR-Roadmap-v1.0_updated.pdf https://rce.sequoiaproject.org/wp-content/uploads/2022/01/QTF_0122.pdf https://rce.sequoiaproject.org/wp-content/uploads/2022/06/SOP-IAS-Privacy-and-Security-Notice-1.pdf https://rce.sequoiaproject.org/wp-content/uploads/2022/06/SOP_IAS_Exchange_Purpose_Implementation.pdf https://saferbirth.org/patient-safety-bundles/ https://sequoiaproject.org/onc-awards-the-sequoia-project-a-cooperative-agreement-for-the-trusted-exchange-framework-and-common-agreement-to-support-advancing-nationwide-interoperability-of-electronic-health-information/ https://www.aha.org/system/files/media/file/2019/11/aha-to-cms-health-plan-prior-authorization-11-4-19.pdf https://www.ahajournals.org/doi/10.1161/circ.145.suppl_1.EP50 https://www.ahip.org/news/press-releases/new-fast-path-initiative-aims-to-improve-prior-authorization-for-patients-and-doctors https://www.ahip.org/wp-content/uploads/202103-AHIP_FastPATH-2pg-v03.pdf https://www.ama-assn.org/about/rvs-update-committee-ruc/composition-rvs-update-committee-ruc https://www.ama-assn.org/practice-management/prior-authorization/inside-cleveland-clinic-s-10-million-prior-authorization https://www.ama-assn.org/press-center/press-releases/ama-urges-multifaceted-approach-address-social-determinants-health https://www.ama-assn.org/sites/ama-assn.org/files/corp/media-browser/public/arc/prior-auth-2017.pdf https://www.ama-assn.org/system/files/2019-06/principles-with-signatory-page-for-slsc.pdf https://www.ama-assn.org/system/files/2021-04/prior-authorization-survey.pdf https://www.ama-assn.org/system/files/2021-05/prior-authorization-reform-progress-update.pdf https://www.ama-assn.org/system/files/prior-authorization-survey.pdf https://www.bls.gov/oes/current/oes_nat.htm https://www.caqh.org/sites/default/files/explorations/index/2021-caqh-index.pdf https://www.caqh.org/sites/default/files/explorations/index/report/2019-caqh-index.pdf?token=SP6YxT4u https://www.carinalliance.com/our-work/trust-framework-and-code-of-conduct/ https://www.census.gov/library/publications/2017/econ/2017-naics-manual.html https://www.cms.gov/files/document/cms-maternity-care-action-plan.pdf https://www.cms.gov/files/document/maternal-morbidity-structural-measure-specifications.pdf https://www.cms.gov/files/document/required-face-face-encounter-and-written-order-prior-delivery-list.pdf https://www.cms.gov/files/document/z-codes-data-highlight.pdf https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures https://www.cms.gov/newsroom/press-releases/biden-harris-administration-announces-more-half-all-states-have-expanded-access-12-months-medicaid https://www.cms.gov/Regulations-and-Guidance/Administrative-Simplification/Subregulatory-Guidance/Go-to-Guidance-Guidance-Letters https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-Health-Services.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFSCompliance-Programs/SimplifyingRequirements.html https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-160/subpart-A/section-160.103 https://www.federalregister.gov/d/2022-07642 https://www.federalregister.gov/d/2022-09375 https://www.federalregister.gov/d/2022-15372/p-2609 https://www.federalregister.gov/d/2022-16472/p-6888 https://www.federalregister.gov/documents/2021/01/25/2021-01753/advancing-racial-equity-and-support-for-underserved-communities-through-the-federal-government https://www.federalregister.gov/documents/2021/08/13/2021-16519/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the https://www.federalregister.gov/documents/2022/05/09/2022-09375/medicare-program-contract-year-2023-policy-and-technical-changes-to-the-medicare-advantage-and https://www.federalregister.gov/documents/2022/08/10/2022-16472/medicare-program-hospital-inpatient-prospective-payment-systems-for-acute-care-hospitals-and-the https://www.ftc.gov/business-guidance/resources/mobile-health-apps-interactive-tool https://www.ftc.gov/legal-library/browse/cases-proceedings/192-3133-flo-health-inc https://www.ftc.gov/system/files/documents/public_statements/1596364/statement_of_the_commission_on_breaches_by_health_apps_and_other_connected_devices.pdf https://www.ftc.gov/tips-advice/business-center/guidance/complying-ftcs-health-breach-notification-rule https://www.govinfo.gov/content/pkg/FR-2021-12-10/pdf/2021-26764.pdf https://www.govinfo.gov/content/pkg/FR-2022-07-26/pdf/2022-15372.pdf https://www.healthit.gov https://www.healthit.gov/api-education-module/story_html5.html https://www.healthit.gov/buzz-blog/health-it/thinking-outside-the-box-the-uscdi-initiative https://www.healthit.gov/buzz-blog/interoperability/321tefca-is-go-for-launch https://www.healthit.gov/buzz-blog/interoperability/advancing-interoperable-social-determinants-of-health-data https://www.healthit.gov/data/data-briefs/individuals-access-and-use-patient-portals-and-smartphone-health-apps-2020 https://www.healthit.gov/hitac/committees/intersection-clinical-and-administrative-data-task-force https://www.healthit.gov/isa/sites/isa/files/2021-07/USCDI-Version-2-July-2021-Final.pdf https://www.healthit.gov/isa/sites/isa/files/2022-07/USCDI-Version-3-July-2022-Final.pdf https://www.healthit.gov/isa/standards-version-advancement-process https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi https://www.healthit.gov/sites/default/files/page/2019-05/2015to2017PhysicianInteroperabilityDataBrief_0.pdf https://www.healthit.gov/sites/default/files/page/2020-02/BurdenReport_0.pdf https://www.healthit.gov/sites/default/files/page/2020-06/Pediatric-Health-IT-Developer-IR-06102020.pdf https://www.healthit.gov/sites/default/files/page/2020-11/2020-11-17_ICAD_TF_FINAL_Report_HITAC.pdf https://www.healthit.gov/sites/default/files/page/2022- https://www.healthit.gov/sites/default/files/page/2022-01/Common_Agreement_for_Nationwide_Health_Information_Interoperability_Version_1.pdf https://www.healthit.gov/sites/default/files/page/2022-01/Trusted_Exchange_Framework_0122.pdf https://www.healthit.gov/sites/default/files/reports/finalsummativereportmarch_2016.pdf https://www.healthit.gov/topic/behavioral-health https://www.healthit.gov/topic/federal-advisory-committees/health-information-technology-advisory-committee-hitac-history https://www.healthit.gov/topic/health-it-basics/improved-diagnostics-patient-outcomes https://www.healthit.gov/topic/privacy-security-and-hipaa/model-privacy-notice-mpn https://www.healthit.gov/topic/standards-version-advancement-process-svap https://www.healthit.gov/topic/usability-and-provider-burden/strategy-reducing-burden-relating-use-health-it-and-ehrs https://www.hhs.gov/hipaa/for-professionals/faq/2039/what-is-the-liability-of-a-covered-entity-in-responding/index.html https://www.hhs.gov/hipaa/for-professionals/faq/2069/under-hipaa-when-can-a-family-member/index.html https://www.hhs.gov/hipaa/for-professionals/faq/3012/can-a-covered-entity-refuse-to-disclose-ephi.html https://www.hhs.gov/hipaa/for-professionals/faq/personal-representatives-and-minors/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access-right-health-apps-apis/index.html https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html https://www.hhs.gov/hipaa/for-professionals/security/guidance/index.html?language=es https://www.HL7.org https://www.hl7.org/about/davinci/ https://www.hl7.org/carin/ https://www.hl7.org/gravity/ https://www.medicaid.gov/federal-policy-guidance/downloads/sho20003.pdf https://www.medicaid.gov/medicaid/quality-of-care/downloads/2022-maternity-core-set.pdf https://www.medicare.gov/manage-your-health/share-your-medicare-claims-medicares-blue-button https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6371252/ https://www.nihcr.org/wp-content/uploads/Altarum-Prior-Authorization-Review-November-2019.pdf https://www.opm.gov/news/releases/2020/02/opm-issues-updated-time-to-hire-guidance/ https://www.regulations.gov https://www.sciencedirect.com/science/article/pii/S0002937820300260?via%3Dihub#bib5 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5322 https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5425 https://www.whitehouse.gov/briefing-room/presidential-actions/2022/04/08/a-proclamation-on-black-maternal-health-week-2022/ https://www.whitehouse.gov/briefing-room/statements-releases/2021/12/07/fact-sheet-vice-president-kamala-harris-announces-call-to-action-to-reduce-maternal-mortality-and-morbidity/ https://www.whitehouse.gov/ostp/ai-bill-of-rights/ https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/circulars/A4/a-4.pdf https://www.whitehouse.gov/wp-content/uploads/2022/06/Maternal-Health-Blueprint.pdf Regulations.gov SequoiaProject.org www.HL7.org Vol. 87, no. 238 Office of the Federal Register, National Archives and Records Administration 2022-12-13 continuing daily deposited born digital 305 p. 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