BREAKING NEWS: CMS-0062 Proposals in the FY2027 CMS IPPS Final Rule

The CMS FY 2027 Hospital Inpatient Prospective Payment System (IPPS) Final Rule, published in the Federal Register on August 4, 2026, finalized updated versions of data exchange standards that were proposed in CMS-0062.  The adopted standards support the interoperability of FHIR APIs for the ePA API; Patient, Provider, and Payer-to-Payer APIs; sharing payer drug formularies; and sharing information about payer provider directories. The standard implementation guides (IGs) are:

• HL7 FHIR® Da Vinci—Coverage Requirements Discovery (CRD) IG, Version 2.2.1 – STU 2.2
• HL7 FHIR® Da Vinci—Documentation Templates and Rules (DTR) IG, Version 2.2.0 – STU 2.2
• HL7 FHIR® Da Vinci—Prior Authorization Support (PAS) IG, Version 2.2.1 – STU 2.2
• HL7 FHIR® CARIN Consumer Directed Payer Data Exchange (CARIN IG for Blue Button®), Version 2.2.0 – STU 2.2
• HL7 FHIR® Da Vinci Payer Data Exchange (PDex) US Drug Formulary IG, Version 2.1.0 – STU 2.1
• HL7 FHIR® Da Vinci PDex Plan Net IG, Version 1.2.0 – STU 1.2
• HL7 FHIR® Da Vinci Clinical Data Exchange (CDex) IG, Version 2.1.0 – STU 2.1

The versions of these IGs replace the previously adopted versions. The effective date of these standards is October 1, 2026.

CMS-0062 Overview

Interoperability and Drug Prior Authorization (CMS-0062) Proposed Rule

• Published: Apr. 14, 2026
• Comment deadline: Jun. 15, 2026

The Centers for Medicare & Medicaid Services (CMS) Interoperability Standards and Prior Authorization for Drugs Proposed Rule (CMS-0062) builds on CMS' previous interoperability initiatives by expanding electronic prior authorization (ePA) requirements to include drugs and further advancing the use of standardized health information exchange across the health care ecosystem. The proposal extends many of the requirements established in the CMS Interoperability and Prior Authorization Final Rule (CMS-0057), which focused on medical items and services. Other components of CMS-0062 advance the Office of the National Coordinator for Health Information Technology’s (ONC’s) work on the interoperability and access to health information through Patient, Provider, and Payer-to-Payer application programming interfaces (APIs).

A central component of CMS-0062 is the proposal to require impacted payers to support ePA for drugs using standardized, Fast Healthcare Interoperability Resources® (FHIR®)-based APIs. The rule also proposes shorter and more consistent prior authorization decision timeframes across CMS programs, greater transparency into prior authorization decisions and denial rates, updated health information technology (IT) standards, and reporting of interoperability endpoints and API usage metrics to CMS. Collectively, these provisions are intended to reduce administrative burden, improve care coordination, and accelerate patient access to medically necessary therapies.

In addition to expanding API requirements, the proposed rule includes updates under the HIPAA Administrative Simplification provisions by proposing the adoption of new HL7 FHIR standards and implementation specifications for prior authorization transactions. These proposals would apply broadly to HIPAA-covered entities that electronically exchange prior authorization requests and responses. By aligning technical standards and encouraging automated data exchange, CMS seeks to replace manual, fragmented processes with more efficient, standardized workflows.