2020-27593: Medicaid Program; Patient Protection and Affordable Care Act; Reducing Provider and Patient Burden by Improving Prior Authorization Processes, and Promoting Patients' Electronic Access to Health Information for Medicaid Managed Care Plans, State Medicaid Agencies, CHIP Agencies and CHIP Managed Care Entities, and Issuers of Qualified Health Plans on the Federally-Facilitated Exchanges; Health Information Technology Standards and Implementation Specifications
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This proposed rule would place new requirements on state Medicaid and CHIP fee-for-service (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 health care data, and streamline processes related to prior authorization, while continuing CMS' drive toward interoperability, and reducing burden in the health care market. In addition, on behalf of the Department of Health and Human Service (HHS), the Office of the National Coordinator for Health Information Technology (ONC) is proposing the adoption of certain specified implementation guides (IGs) needed to support the proposed Application Programming Interface (API) policies included in this rule. Each of these elements plays a key role in reducing overall payer and provider burden and improving patient access to health information.
The agency’s own summary, as published.
What this changes
Amends 7 parts of the Code of Federal Regulations — the standing rules this notice rewrites.
- 42 CFR 431 State Organization and General Administration
- 42 CFR 435 Eligibility in the States, District of Columbia, the Northern Mariana Islands, and American Samoa
- 42 CFR 438 Managed Care
- 42 CFR 440 Services: General Provisions
- 42 CFR 457 Allotments and Grants to States
- 45 CFR 156 Health Insurance Issuer Standards Under the Affordable Care Act, Including Standards Related to Exchanges
- 45 CFR 170 Health Information Technology Standards, Implementation Specifications, and Certification Criteria and Certification Programs for Health Information Technology
Rulemaking docket
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