CMS and ONC proposed rule on electronic data exchange

On December 10, 2020, CMS and the Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) released a public display version of a proposed rule to further “improve the electronic exchange of health care data between payers and providers and streamline processes related to prior authorization.” The proposed rule builds upon the CMS Interoperability and Patient Access final rule issued in March 2020 and places new requirements on a number of CMS-regulated “impacted” plan payers. The proposed requirements outlined below would generally become effective in January 2023, although CMS proposes to provide state fee-for-service (FFS) programs the opportunity to request a one-time extension of up to one year for the implementation of one requirement, and an exceptions process for Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchanges (FFEs). Comments on the proposed rule are due January 4, 2021.