On February 8, 2024, CMS released the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F). This final rule emphasizes the need to improve health information exchange to achieve appropriate and necessary access to health records for patients, providers, and payers. It also addresses the need to improve prior authorization processes through policies and technology, to help ensure that patients remain at the center of their own care.

The final rule enhances certain policies from the CMS Interoperability and Patient Access Final Rule (CMS-9115-F) and advances CMS’ continued work to leverage Health Level 7® (HL7®) Fast Healthcare Interoperability Resources® (FHIR®) standards to increase efficiency and access readily available health information.

Impacted payers are required to implement certain provisions by January 1, 2026. As of January 1, 2027, impacted payers will need meet the application programming interface (API) development and enhancement requirements.